HB 4180

Abstract

Amends the Counties Code, the Illinois Municipal Code, the Illinois Insurance Code, the Health Maintenance Organization Act, and the Illinois Public Aid Code. In provisions concerning coverage for mammograms, provides that coverage for certain types of mammography shall be made available to patients of a specified age (rather than only women of a specified age). Makes changes to require coverage for molecular breast imaging and, in those cases where its not already covered, magnetic resonance imaging of breast tissue. Provides that the Department of Healthcare and Family Services shall convene an expert panel, including representatives of hospitals, free-standing breast cancer treatment centers, breast cancer quality organizations, and doctors, including radiologists that are trained in all forms of FDA approved breast imaging technologies, breast surgeons, reconstructive breast, surgeons, oncologists, and primary care providers to establish quality standards for breast cancer treatment. Makes technical changes. Effective immediately. House Committee Amendment No. 1 Deletes reference to: 55 ILCS 5/5-1069 65 ILCS 5/10-4-2 215 ILCS 125/4-6.1 Adds reference to: 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 Replaces everything after the enacting clause. Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for molecular breast imaging (MBI) of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue or when medically necessary as determined by a physician licensed to practice medicine in all of its branches. Amends the Health Maintenance Organization Act. Subjects health maintenance organizations to provisions of the Illinois Insurance Code that require coverage for mammograms, mastectomies and certain other breast cancer screenings. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall authorize the provision of and payment for molecular breast imaging (MBI) of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue or when medically necessary as determined by a physician licensed to practice medicine in all of its branches. Effective January 1, 2026. House Floor Amendment No. 2 Adds reference to: 55 ILCS 5/5-1069 from Ch. 34, par. 5-1069 65 ILCS 5/10-4-2 from Ch. 24, par. 10-4-2 215 ILCS 5/356g from Ch. 73, par. 968g 215 ILCS 125/4-6.1 from Ch. 111 1/2, par. 1408.7 Replaces everything after the enacting clause. Reinserts the provisions of the bill, as amended by House Amendment No. 1, with the following changes. In the Illinois Insurance Code and the Illinois Public Aid Code, requires coverage of molecular breast imaging (MBI) of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue or when medically necessary as determined by a physician licensed to practice medicine in all of its branches, physician assistant, or advanced practice registered nurse (rather than as determined by a physician licensed to practice medicine in all of its branches). Amends the Counties Code, the Illinois Municipal Code, and the Health Maintenance Organization Act. In provisions concerning coverage for mammograms, provides that coverage for certain types of mammography shall be made available to patients of a specified age (rather than only women of a specified age). Makes changes to require coverage for molecular breast imaging. Effective January 1, 2026. Senate Committee Amendment No. 1 In the Illinois Insurance Code and the Health Maintenance Organization Act, provides that, for an individual or group policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after the effective date of the amendatory Act, the policy or plan shall provide coverage for a comprehensive ultrasound screening and MRI of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue or when medically necessary as determined by a physician licensed to practice medicine in all of its branches, advanced practice registered nurse, or physician assistant. Makes a conforming change.