P.A. 103-0123 (HB 1384) (Rep. Cassidy, Sen. Loughran Cappel) – RECONSTRUCTIVE SERVICES
This new law provides that a managed care plan that is altered, presented, issued or renewed on or after January 1, 2025 may not refuse coverage for medically necessary services reconstructive services that are intended to restore physical appearance. Illinois Municipal League took no position on the legislation. Effective January 1, 2024; Compliance is required from companies for the plans on or after January 1,2025
P.A. 103-0420 (HB 1565) (Rep. Stuart, Sen. Loughran Cappel) – VAGINAL ESTROGEN COVERAGE
Starting from January 1, 2024, any accident and health insurance group or individual policy, as well as managed care plans, that are amended, delivered, issued, or renewed should include coverage for prescription drugs, specifically for vaginal estrogen. Importantly, this coverage for vaginal estrogen must not come with a deductible, coinsurance, copayment, or any other cost-sharing requirement.
Furthermore, if a particular vaginal estrogen product or its therapeutic equivalent version, approved by the United States Food and Drug Administration, is deemed medically necessary, the issuer is obligated to cover it. This coverage, however, would be subject to the cost-sharing requirement outlined in specified provisions starting from January 1, 2025
P.A. 103-0325 (HB 2799) (Rep. Hammond, Sen. Koehler) -PROTON BEAM THERAPY COVERAGE
Starting January 1, 2025, any group or individual accident and health insurance policy or managed care plan, when amended, delivered, issued, or renewed, must not impose a higher standard of clinical evidence for the coverage of proton beam therapy in the treatment of cancer compared to any other form of radiation therapy.
Additionally, from January 1, 2025 onwards, any group or individual accident and health insurance policy or managed care plan, when amended, delivered, issued, or renewed, that provides coverage or benefits for radiation oncology to residents of the state must include coverage or benefits for medically necessary proton beam therapy as recommended by the patient’s physician. This provision is effective from January 1, 2024.
P.A. 103-0535 (HB 2847) Rep. LaPointe, Sen. Fine) – MENTAL HEALTH AND WELLNESS ACT
In 2024, the Mental Health and Wellness Act will be established, replacing the Mental Health Equity Access and Prevention Act. In the section addressing coverage for no-cost mental health prevention and wellness visits, it is specified that these visits should be separate from an annual physical examination. The Department of Insurance is tasked with updating current procedural terminology codes through rule adoption if there are any changes to the codes mentioned in the provisions.
Moreover, a mental health prevention and wellness visit can be integrated into and reimbursed within any type of integrated primary care service delivery method. The Department is required to adopt any necessary rules for implementing these provisions by no later than October 31, 2024, as opposed to 2023. The legislation is effective from January 1, 2024.
P.A. 103-0445 (HB 3202) (Rep. Sanalitro, Sen. Lewis) – SALIVA CANCER TEST
Starting January 1, 2025, any individual or group accident and health insurance policy that is amended, delivered, issued, or renewed must include coverage for a medically necessary home saliva cancer screening every 24 months. This coverage applies if the patient is either asymptomatic and at high risk for the disease being tested or demonstrates symptoms of the disease during a physical examination. The legislation is effective from January 1, 2024, and the Illinois Municipal League did not take a position on it.
P.A. 103-0454 (HB 3639) (Rep. Mason, Sen. Halpin) – EPINEPHRINE COST LIMIT
This new 2024 legislation stipulates that insurers covering medically necessary epinephrine injectors must cap the total amount an insured is obligated to pay for a twin pack of these injectors at $60, irrespective of the specific type of epinephrine injector. It’s important to note that this provision does not prohibit insurers from reducing an insured individual’s cost-sharing by an amount exceeding the specified $60 limit. Furthermore, the Department of Insurance is granted the authority to adopt rules deemed necessary for the effective implementation and administration of these provisions. The legislation becomes effective on January 1, 2025, and the IML did not take a position on it.
P.A. 103-0458 (HB 3809) (Rep. DeLuca, Sen. Joyce) – COVERAGE FOR IMPAIRED CHILDREN
Starting January 1, 2025, any group or individual accident and health insurance policy that is amended, delivered, issued, or renewed is mandated to offer coverage for therapy, diagnostic testing, and necessary equipment designed to enhance the quality of life for children clinically or genetically diagnosed with any disease, syndrome, or disorder. This coverage specifically includes conditions involving low tone neuromuscular impairment, neurological impairment, or cognitive impairment. It’s crucial to note that the legislation becomes effective on January 1,2024, and the Illinois Municipal League did not take a position.
P.A. 102-0084 (SB 1282) (Sen. Simmons, Rep. Huynh) – LIVER DISEASE SCREEENINGS
Starting January 1, 2024, most health insurers are required to cover the expenses associated with preventive liver disease screenings for individuals between the ages of 35 and 65. The Illinois Municipal League did not take a position on this legislation.
P.A. 103-0091 (SB 1527) (Sen. Ellman, Rep. Gill) – COMPRESSION SLEEVE COVERAGE
From January 1, 2024, insurance coverage is mandated for medically necessary compression sleeves. The Illinois Municipal League did not express a stance on this legislation.
P.A. 103-0094 (SB 1568) (Sen. Morrison, Rep. Morgan) – HEALTH INSURANCE PARTY/ DISABILTY
Effective January 1, 2024, the legislation requires the Department of Insurance to gather specific data related to disability insurance plans and the restrictions on mental health and substance use disorder benefits. The Illinois Municipal League did not take a position on this legislation.
P.A. 103-0554 (SB 1670) (Sen. Feigenholtz, Rep. Evans Jr.) – FOIA – MEDICAL RECORDS
As of January 1, 2024, this legislation outlines that, for a public body classified as a HIPAA-covered entity, “private information” encompasses electronic medical records and all information, including demographic details, within or extracted from an electronic medical records system. This system must be operated or maintained by the public body in compliance with state and federal medical privacy laws and regulations, including, but not limited to, the Health Insurance Portability and Accountability Act (HIPAA) and its regulations. It’s important to note that the legislation exempts from disclosure under the Act any information classified as protected health information that may be present within or extracted from any record held by a public body that is a HIPAA-covered entity. The Illinois Municipal League did not take a position on this legislation.
P.A. 103-0512 (SB 2195) (Sen. Gillespie, Rep. Guzzardi) – PROSTHETIC DEVICE COVERAGE
Commencing January 1, 2025, the legislation specifies that, for an enrollee at any age, coverage for a prosthetic or custom orthotic device extends beyond the basic provision. Benefits are now required to include a prosthetic or custom orthotic device deemed by the enrollee’s provider as the most suitable model and medically necessary. This is essential to enable the enrollee to engage in various physical activities such as running, biking, swimming, and weightlifting. The goal is to enhance the enrollee’s overall body health and bolster both lower and upper limb function. The Illinois Municipal League did not take a position on this legislation.