(215 ILCS 125/4-18)
Retirement facility residents.
With respect to an
enrollee who is a resident of a retirement facility consisting of a long-term
care facility, as defined in the Nursing Home Care Act, and residential
apartments, a contract or evidence of coverage issued, amended, delivered, or
renewed after the effective date of this amendatory Act of 1997 shall provide
that the enrollee's primary care physician must refer the enrollee to the
retirement facility's long-term care facility for Medicare covered skilled
nursing services if the primary care physician finds that:
(1) it is in the best interests of the patient;
(2) the facility, if not a participating provider in
the specific health maintenance organization, agrees during the preauthorization period to a negotiated rate for skilled nursing services covered in that organization's health care plan; and
(3) the facility meets all the requirements of a
participating provider for skilled nursing services as defined and covered under the health maintenance organization's health care plan.
Both the facility and the health maintenance organization must fully disclose
all pertinent information to consumers to assure that their decisions are based
upon full knowledge of the implications of their decision making.
(Source: P.A. 90-408, eff. 1-1-98; 90-655, eff. 7-30-98.)