305 ILCS 5/5-16.8
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article V - Medical Assistance

(Text of Section from P.A. 102-30)Sec. 5-16.8. Required health benefits. The medical assistance program  shall  (i) provide the post-mastectomy care benefits required to be covered by a policy of  accident and health insurance under Section 356t and the coverage required  under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 of the Illinois  Insurance Code and (ii) be subject to the provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of the Illinois  Insurance Code.The Department, by rule, shall adopt a model similar to the requirements of Section 356z.39 of the Illinois Insurance Code.On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e.To ensure full access to the benefits set forth in this Section, on and after January 1, 2016, the Department shall ensure that provider and hospital reimbursement  for post-mastectomy care benefits required under this Section are no lower than the Medicare reimbursement rate. (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22.)(Text of Section from P.A. 102-144)Sec. 5-16.8. Required health benefits. The medical assistance program  shall  (i) provide the post-mastectomy care benefits required to be covered by a policy of  accident and health insurance under Section 356t and the coverage required  under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 of the Illinois  Insurance Code, (ii) be subject to the provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of the Illinois  Insurance Code, and (iii) be subject to the provisions of subsection (d-5) of Section 10 of the Network Adequacy and Transparency Act.The Department, by rule, shall adopt a model similar to the requirements of Section 356z.39 of the Illinois Insurance Code.On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e.To ensure full access to the benefits set forth in this Section, on and after January 1, 2016, the Department shall ensure that provider and hospital reimbursement  for post-mastectomy care benefits required under this Section are no lower than the Medicare reimbursement rate. (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20; 102-144, eff. 1-1-22.)(Text of Section from P.A. 102-203, 102-306, 102-642)Sec. 5-16.8. Required health benefits. The medical assistance program  shall  (i) provide the post-mastectomy care benefits required to be covered by a policy of  accident and health insurance under Section 356t and the coverage required  under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, and 356z.43 of the Illinois  Insurance Code and (ii) be subject to the provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of the Illinois  Insurance Code.The Department, by rule, shall adopt a model similar to the requirements of Section 356z.39 of the Illinois Insurance Code.On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e.To ensure full access to the benefits set forth in this Section, on and after January 1, 2016, the Department shall ensure that provider and hospital reimbursement  for post-mastectomy care benefits required under this Section are no lower than the Medicare reimbursement rate. (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22.)(Text of Section from P.A. 102-530)Sec. 5-16.8. Required health benefits. The medical assistance program  shall  (i) provide the post-mastectomy care benefits required to be covered by a policy of  accident and health insurance under Section 356t and the coverage required  under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 of the Illinois  Insurance Code and (ii) be subject to the provisions of Sections 356z.19, 356z.43, 356z.44, 364.01, 370c, and 370c.1 of the Illinois  Insurance Code.The Department, by rule, shall adopt a model similar to the requirements of Section 356z.39 of the Illinois Insurance Code.On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e.To ensure full access to the benefits set forth in this Section, on and after January 1, 2016, the Department shall ensure that provider and hospital reimbursement  for post-mastectomy care benefits required under this Section are no lower than the Medicare reimbursement rate. (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20; 102-530, eff. 1-1-22.)