Rep. Robyn Gabel
Filed: 3/23/2023
 
 


 




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1
AMENDMENT TO HOUSE BILL 579 




2 AMENDMENT NO. ______. Amend House Bill 579 by replacing 
3everything after the enacting clause with the following:


4 "Section 5. The Illinois Administrative Procedure Act is 
5amended by adding Section 5-45.35 as follows:

6 (5 ILCS 100/5-45.35 new)
7 Sec. 5-45.35. Emergency rulemaking; Illinois Health 
8Benefits Exchange Law. To provide for the expeditious and 
9timely implementation of Section 5-23 of the Illinois Health 
10Benefits Exchange Law, emergency rules implementing Section 
115-23 of the Illinois Health Benefits Exchange Law may be 
12adopted in accordance with Section 5-45 of this Act by the 
13Department of Insurance and the Department of Healthcare and 
14Family Services. The adoption of emergency rules authorized by 
15Section 5-45 and this Section is deemed to be necessary for the 
16public interest, safety, and welfare.
 
 
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1 This Section is repealed January 1, 2025.

2 Section 10. The Illinois Health Benefits Exchange Law is 
3amended by changing Section 5-5 and by adding Sections 5-21, 
45-22, 5-23, and 5-24 as follows:

5 (215 ILCS 122/5-5)

6 Sec. 5-5. State health benefits exchange.  It is declared 
7that this State, beginning October 1, 2013, in accordance with 
8Section 1311 of the federal Patient Protection and Affordable 
9Care Act, shall establish a State health benefits exchange to 
10be known as the Illinois Health Benefits Exchange in order to 
11help individuals and small employers with no more than 50 
12employees shop for, select, and enroll in qualified, 
13affordable private health plans that fit their needs at 
14competitive prices. The Exchange shall separate coverage pools 
15for individuals and small employers and shall supplement and 
16not supplant any existing private health insurance market for 
17individuals and small employers. The Department of Insurance 
18shall operate the Illinois Health Benefits Exchange as a 
19State-based exchange using the federal platform by plan year 
202025 and as a State-based exchange by plan year 2026. The 
21Director of Insurance may require that all plans in the 
22individual and small group markets, other than grandfathered 
23health plans, be made available for comparison on the Illinois 
24Health Benefits Exchange, but may not require that all plans 
 
 
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1in the individual and small group markets be purchased 
2exclusively on the Illinois Health Benefits Exchange. The 
3Director of Insurance may require that plans offered on the 
4exchange conform with standardized plan designs that provide 
5for standardized cost sharing for covered health services. 
6Except when it is inconsistent with State law, the Department 
7of Insurance shall enforce the coverage requirements under the 
8federal Patient Protection and Affordable Care Act, including 
9the coverage of all United States Preventive Services Task 
10Force Grade A & B preventive services without cost sharing 
11notwithstanding any federal overturning or repeal of 42 U.S.C. 
12300gg-13(a)(1), that apply to the individual and small group 
13markets. The Director of Insurance may elect to add a small 
14business health options program to the Illinois Health 
15Benefits Exchange to help small employers enroll their 
16employees in qualified health plans in the small group market. 
17The General Assembly shall appropriate funds to establish the 
18Illinois Health Benefits Exchange. 

19(Source: P.A. 97-142, eff. 7-14-11.)

20 (215 ILCS 122/5-21 new)
21 Sec. 5-21. Monthly assessments.
22 (a) The Director of Insurance may apply a monthly 
23assessment to each health benefits plan sold on the Illinois 
24Health Benefits Exchange. The assessment shall be paid by the 
25issuer and to the Department of Insurance and shall be used 
 
 
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1only for the purpose of supporting the exchange through 
2exchange operations, outreach, enrollment, and other means of 
3supporting the exchange, including any efforts that may 
4increase market stabilization and that may result in a net 
5benefit to policyholders. The assessment may be applied at a 
6rate of:
7  (1) 0.5% of the total monthly premium charged by an 
8 issuer for each health benefits plan during any period 
9 that the State is on a State-based exchange using the 
10 federal platform; or
11  (2) 2.75% of the total monthly premium charged by an 
12 issuer for each health benefits plan during any period 
13 that the State is on the State-based exchange. The 
14 Director of Insurance shall adjust this rate to ensure 
15 that the Illinois Health Benefits Exchange is fully 
16 funded, but in no case shall the assessment be applied at a 
17 rate that exceeds 4% of the total monthly premium charged 
18 by a carrier. If the Director determines it is necessary 
19 to adjust the rate pursuant to this paragraph, the 
20 Director shall, in advance of the adjustment, post on the 
21 Department's website a report describing the reasons and 
22 justifications for the adjustment, which shall be 
23 consistent with the purposes of supporting the Illinois 
24 Health Benefits Exchange as provided in this Section.
25 (b) The Director of Insurance shall notify an issuer of 
26its assessment rate for the subsequent year. Issuers must 
 
 
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1remit the assessment due in monthly installments to the 
2Department of Insurance.
3 (c) The assessment described in this Section shall be 
4considered a special purpose obligation and may not be applied 
5by issuers to vary premium rates at the plan level. 
6 (d) There is created a revolving fund to be known as the 
7Illinois Health Benefits Exchange Fund, to be held by the 
8Department of Insurance. The Illinois Health Benefits Exchange 
9Fund shall be the repository for moneys collected pursuant to 
10fees or assessments on exchange issuers, federal financial 
11participation as appropriate, and other moneys received as 
12grants or otherwise appropriated for the purposes of 
13supporting health insurance outreach, enrollment efforts, and 
14plan management operations through an exchange. All moneys in 
15the Fund shall be used only for the purpose of supporting the 
16exchange through exchange operations, outreach, enrollment, 
17and other means of supporting the exchange, including any 
18efforts that may increase market stabilization and that may 
19result in a net benefit to policyholders. 

20 (215 ILCS 122/5-22 new)
21 Sec. 5-22. State medical assistance program coordination.
22 (a) The Department of Insurance and the Department of 
23Healthcare and Family Services shall coordinate the operations 
24of the exchange with the operations of State medical 
25assistance programs. The Department of Healthcare and Family 
 
 
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1Services shall oversee and operate the exchange eligibility 
2rules engine to ensure accurate assessments and determinations 
3of exchange and State medical assistance program eligibility.
4 (b) The exchange may determine eligibility for State 
5medical assistance programs that use the modified adjusted 
6gross income methodology.
7 (c) The exchange may be used for enrollment into State 
8medical assistance program health plans.
9 (d) The Department of Healthcare and Family Services shall 
10request federal financial participation funds from the Centers 
11for Medicare and Medicaid Services for any integrated 
12eligibility and enrollment functions of the exchange. 

13 (215 ILCS 122/5-23 new)
14 Sec. 5-23. Department of Insurance and Department of 
15Healthcare and Family Services authority.
16 (a) The Department of Insurance and the Department of 
17Healthcare and Family Services, in addition to the powers 
18granted under the Illinois Insurance Code and the Illinois 
19Public Aid Code, have the power necessary to establish and 
20operate the Illinois Health Benefits Exchange, including, but 
21not limited to, the authority to:
22  (1) adopt rules deemed necessary by the departments to 
23 implement this Law;
24  (2) employ or retain sufficient personnel to provide 
25 administration, staffing, and necessary related support 
 
 
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1 required to adequately discharge the duties described in 
2 this Law from funds held in the Illinois Health Benefits 
3 Exchange Fund;
4  (3) procure services, including a call center, and 
5 goods for the purpose of establishing the Illinois Health 
6 Benefits Exchange as emergency purchases as set forth in 
7 Section 20-30 of the Illinois Procurement Code; 
8  (4) require any exchange vendor to have experience 
9 operating a State-based exchange in another state; and
10  (5) implement programs that increase the affordability 
11 of or access to health insurance coverage, including for 
12 populations currently not eligible to enroll in the 
13 Illinois Health Benefits Exchange, through Section 1332 
14 waivers under the federal Patient Protection and 
15 Affordable Care Act or other available federal waivers and 
16 authorities. 
17 (b) The Department of Insurance has the authority to 
18employ a Chief Operating Officer of the Illinois Health 
19Benefits Exchange. The Chief Operating Officer shall be 
20subject to confirmation by the Senate.

21 (215 ILCS 122/5-24 new)
22 Sec. 5-24. Illinois Health Benefits Exchange Advisory 
23Committee.
24 (a) The Director of Insurance shall establish the Illinois 
25Health Benefits Exchange Advisory Committee no later than 
 
 
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1December 31, 2023. The Illinois Health Benefits Exchange 
2Advisory Committee shall be tasked with making recommendations 
3to the Chief Operating Officer of the Illinois Health Benefits 
4Exchange concerning the operation of the exchange, and the 
5Committee shall hold its first meeting no later than 90 days 
6following the establishment of the Committee and shall meet 
7quarterly thereafter. The Chief Operating Officer shall make a 
8quarterly report to the Committee.
9 (b) The Department of Insurance shall present regular and 
10timely reports to the Illinois Health Benefits Exchange 
11Advisory Committee regarding the progress in the development 
12of the Illinois Health Benefits Exchange before its 
13establishment by plan year 2026. The reports shall be posted 
14to the Department of Insurance's website and include 
15information on the Department of Insurance's progress toward 
16establishing and maintaining the Illinois Health Benefits 
17Exchange with the goal of ensuring an effective and efficient 
18transition from the federal platform to the State-based 
19exchange for individuals, employers, and health insurance 
20issuers while mitigating loss of health insurance coverage for 
21any potential consumer. The Department of Insurance's progress 
22reports shall include information regarding transparency, user 
23understandability, plan compliance, outreach and education, 
24and systems operations. The Department of Insurance shall 
25gather stakeholder input in developing operational plans and 
26preparing the reports for the Illinois Health Benefits 
 
 
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1Exchange Advisory Committee.
2 (c) The Illinois Health Benefits Exchange Advisory 
3Committee shall include 9 members, as follows:
4  (1) The Director of Insurance, or the Director's 
5 designee, who shall serve ex officio and as co-chair;
6  (2) The Director of Healthcare and Family Services, or 
7 the Director's designee, who shall serve ex officio and as 
8 co-chair;
9  (3) The Secretary of Human Services, or the 
10 Secretary's designee, who shall serve ex officio; and
11  (4) 6 public members, who shall be residents of the 
12 State, appointed by the Director of Insurance. The 
13 Director shall consider the diversity of this State in the 
14 selection of the committee members. Each public member 
15 shall have demonstrated experience in one or more of the 
16 following areas: health insurance consumer advocacy; 
17 enrollment and consumer assistance; individual health 
18 insurance coverage; providing health care services; or 
19 academic or professional research relating to health 
20 insurance.
21 (d) Members of the Illinois Health Benefits Exchange 
22Advisory Committee shall serve for a term of 2 years, shall 
23serve without compensation, and shall not be entitled to 
24reimbursement. The Department of Insurance shall provide 
25administrative support to the Illinois Health Benefits 
26Exchange Advisory Committee.
 
 
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1 (e) The Committee's quarterly meetings shall be open to 
2the public and subject to the Open Meetings Act.


3 Section 99. Effective date. This Act takes effect upon 
4becoming law.".