{"data":{"id":"us-il/305-ilcs-5-5-16.8","jurisdiction":"us-il","citation":"305 ILCS 5/5-16.8","heading":"Required health benefits.","body":"(Text of Section from P.A. 104-73, 104-324, and 104-379)\nThe 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, 356z.35, 356z.46, 356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64, 356z.67, 356z.71, 356z.75, and 356z.80 of the Illinois Insurance Code, (ii) be subject to the provisions of Sections 356z.19, 356z.44, 356z.49, 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.\nThe Department, by rule, shall adopt a model similar to the requirements of Section 356z.39 of the Illinois Insurance Code.\nOn 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.\nTo 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.\n(Text of Section from P.A. 104-417)\nRequired 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, 356z.35, 356z.46, 356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64, 356z.67, 356z.71, and 356z.75 of the Illinois Insurance Code, (ii) be subject to the provisions of Sections 356z.19, 356z.44, 356z.49, 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.\nThe Department, by rule, shall adopt a model similar to the requirements of Section 356z.39 of the Illinois Insurance Code.\nOn 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.\nTo 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.","path":["CHAPTER 305 PUBLIC AID","Illinois Public Aid Code."],"source_url":"https://www.ilga.gov/legislation/ILCS/details?ActID=1413\u0026ChapterID=28\u0026ChapAct=FullText\u0026Print=True","current_through":"at least Public Act 104-790","vintage":"","retrieved_at":"2026-09-15T04:46:32Z","sha256":"12ad29c2a4fb4db539514cdc5330a26e57aea62ff826bcd0e42341ea163a33d0","source_id":"us-il","stale":false,"prev":"us-il/305-ilcs-5-5-16.7a","next":"us-il/305-ilcs-5-5-16.8a"},"notice":"GroundRules: Original legal text. Not legal advice."}