Rep. Robyn Gabel
Filed: 3/16/2023
 
 


 




10300HB0579ham001LRB103 04164 BMS 58897 a



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.
 
 
10300HB0579ham001- 2 -LRB103 04164 BMS 58897 a


1 This Section is repealed 3 years after the effective date 
2of this amendatory Act of the 103rd General Assembly.

3 Section 10. The Illinois Health Benefits Exchange Law is 
4amended by changing Section 5-5 and by adding Sections 5-21, 
55-22, and 5-23 as follows:

6 (215 ILCS 122/5-5)

7 Sec. 5-5. State health benefits exchange.  It is declared 
8that this State, beginning October 1, 2013, in accordance with 
9Section 1311 of the federal Patient Protection and Affordable 
10Care Act, shall establish a State health benefits exchange to 
11be known as the Illinois Health Benefits Exchange in order to 
12help individuals and small employers with no more than 50 
13employees shop for, select, and enroll in qualified, 
14affordable private health plans that fit their needs at 
15competitive prices. The Exchange shall separate coverage pools 
16for individuals and small employers and shall supplement and 
17not supplant any existing private health insurance market for 
18individuals and small employers. The Department of Insurance 
19shall operate the Illinois Health Benefits Exchange as a 
20State-based exchange using the federal platform by plan year 
212025 and as a State-based exchange by plan year 2026. The 
22Director of Insurance may require that all plans in the 
23individual and small group markets, other than grandfathered 
24health plans, be made available for comparison on the Illinois 
 
 
10300HB0579ham001- 3 -LRB103 04164 BMS 58897 a


1Health Benefits Exchange, but may not require that all plans 
2in the individual and small group markets be purchased 
3exclusively on the Illinois Health Benefits Exchange. The 
4Director of Insurance may require that plans offered on the 
5exchange conform with standardized plan designs that provide 
6for standardized cost sharing for covered health services. 
7Except when it is inconsistent with State law, the Department 
8of Insurance may enforce the coverage requirements under the 
9federal Patient Protection and Affordable Care Act that apply 
10to the individual and small group markets. The Director of 
11Insurance may elect to add a small business health options 
12program to the Illinois Health Benefits Exchange to help small 
13employers enroll their employees in qualified health plans in 
14the small group market. The General Assembly shall appropriate 
15funds to establish the Illinois Health Benefits Exchange. 

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

17 (215 ILCS 122/5-21 new)
18 Sec. 5-21. Monthly assessments.
19 (a) The Director of Insurance may apply a monthly 
20assessment to each health benefits plan sold on the Illinois 
21Health Benefits Exchange. The assessment shall be paid by the 
22issuer and to the Department of Insurance and shall be used 
23only for the purpose of supporting the exchange through 
24exchange operations, outreach, enrollment, and other means of 
25supporting the exchange, including any efforts that may 
 
 
10300HB0579ham001- 4 -LRB103 04164 BMS 58897 a


1increase market stabilization and that may result in a net 
2benefit to policyholders. The assessment may be applied at a 
3rate of:
4  (1) 0.5% of the total monthly premium charged by an 
5 issuer for each health benefits plan during any period 
6 that the State is on a State-based exchange using the 
7 federal platform; or
8  (2) 2.75% of the total monthly premium charged by an 
9 issuer for each health benefits plan during any period 
10 that the State is on the State-based exchange. The 
11 Director of Insurance may adjust this rate to ensure that 
12 the Illinois Health Benefits Exchange is fully funded.
13 (b) The Director of Insurance shall notify an issuer of 
14its assessment rate for the subsequent year. Issuers must 
15remit the assessment due in monthly installments to the 
16Department of Insurance.
17 (c) The assessment described in this Section shall be 
18considered a special purpose obligation and may not be applied 
19by issuers to vary premium rates at the plan level. 
20 (d) There is created a revolving fund to be known as the 
21Illinois Health Benefits Exchange Fund, to be held by the 
22Department of Insurance. The Illinois Health Benefits Exchange 
23Fund shall be the repository for moneys collected pursuant to 
24fees or assessments on exchange issuers, federal financial 
25participation as appropriate, and other moneys received as 
26grants or otherwise appropriated for the purposes of 
 
 
10300HB0579ham001- 5 -LRB103 04164 BMS 58897 a


1supporting health insurance outreach, enrollment efforts, and 
2plan management operations through an exchange. All moneys in 
3the Fund shall be used only for the purpose of supporting the 
4exchange through exchange operations, outreach, enrollment, 
5and other means of supporting the exchange, including any 
6efforts that may increase market stabilization and that may 
7result in a net benefit to policyholders. 

8 (215 ILCS 122/5-22 new)
9 Sec. 5-22. State medical assistance program coordination.
10 (a) The Department of Insurance and the Department of 
11Healthcare and Family Services shall coordinate the operations 
12of the exchange with the operations of State medical 
13assistance programs. The Department of Healthcare and Family 
14Services shall oversee and operate the exchange eligibility 
15rules engine to ensure accurate assessments and determinations 
16of exchange and State medical assistance program eligibility.
17 (b) The exchange may determine eligibility for State 
18medical assistance programs that use the modified adjusted 
19gross income methodology.
20 (c) The exchange may be used for enrollment into State 
21medical assistance program health plans.
22 (d) The Department of Healthcare and Family Services may 
23request federal financial participation funds from the Centers 
24for Medicare and Medicaid Services for any integrated 
25eligibility and enrollment functions of the exchange. 

 
 
10300HB0579ham001- 6 -LRB103 04164 BMS 58897 a


1 (215 ILCS 122/5-23 new)
2 Sec. 5-23. Department of Insurance and Department of 
3Healthcare and Family Services authority.
4 (a) The Department of Insurance and the Department of 
5Healthcare and Family Services, in addition to the powers 
6granted under the Illinois Insurance Code and the Illinois 
7Public Aid Code, have the power necessary to establish and 
8operate the Illinois Health Benefits Exchange, including, but 
9not limited to, the authority to:
10  (1) adopt rules deemed necessary by the departments to 
11 implement this Law;
12  (2) employ or retain sufficient personnel to provide 
13 administration, staffing, and necessary related support 
14 required to adequately discharge the duties described in 
15 this Law from funds held in the Illinois Health Benefits 
16 Exchange Fund;
17  (3) procure services, including a call center, and 
18 goods for the purpose of establishing the Illinois Health 
19 Benefits Exchange as emergency purchases as set forth in 
20 Section 20-30 of the Illinois Procurement Code; and 
21  (4) require any exchange vendor to have experience 
22 operating a State-based exchange in another state. 
23 (b) The Department of Insurance has the authority to 
24employ a Chief Operating Officer of the Illinois Health 
25Benefits Exchange. The Chief Operating Officer shall be 
 
 
10300HB0579ham001- 7 -LRB103 04164 BMS 58897 a


1subject to confirmation by the Senate. 


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