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90_HB3445 New Act Creates the Managed Care Reform Act of 1998. Provides for the regulation of managed care plans by the Department of Insurance. Creates specific patient rights to disclosure, quality of care, and confidentiality. Prohibits restraints on communications between physicians and patients. Requires the establishment of grievance procedures. Requires utilization review programs to register with the Department of Insurance. Effective January 1, 1999. LRB9011012JSsbA LRB9011012JSsbA 1 AN ACT concerning managed care arrangements. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 1. Short title. This Act may be cited as the 5 Managed Care Reform Act of 1998. 6 Section 5. Purpose. This Act addresses changes in managed 7 care practice and operations in Illinois. This Act enhances 8 quality, affordable, and accessible health care coverage for 9 Illinois citizens, families, and businesses. Through the 10 provisions of this Act, health care plan members will be 11 provided: 12 (1) Detailed information about health care plans, the 13 scope of coverage available, and the physicians' professional 14 qualifications so that they can make informed choices about 15 their health care. 16 (2) Notification of termination or change in any 17 benefits, services, or service delivery. This includes a 18 provision allowing enrollees to continue with a nonnetwork 19 physician under certain specific circumstances. 20 (3) Detailed grievance procedures and medical necessity 21 appeals procedures, which include an expedited appeal 22 process. This Act also ensures health care plan 23 accountability for accessible hospital and physician services 24 and reimbursement for covered emergency services. 25 Section 10. Definitions. As used in this Act: 26 "Basic health care services" means emergency care, and 27 inpatient hospital and physician care, outpatient medical 28 services, mental health services and care for alcohol and 29 drug abuse, including any reasonable deductibles and 30 copayments, all of which are subject to such limitations as -2- LRB9011012JSsbA 1 are determined by the Director. 2 "Department" means the Department of Insurance. 3 "Director" means the Director of Insurance. 4 "Emergency services" means the provision of care for the 5 sudden and, at the time, unexpected onset of a health 6 condition which would lead a prudent lay person to believe 7 that failure to receive immediate medical attention would 8 result in serious impairment to bodily function, serious 9 dysfunction to any bodily organ or part, or would place the 10 person's health in serious jeopardy. 11 "Enrollee" means an individual enrolled in a health care 12 plan. 13 "Governing body" means the board of trustees, or 14 directors, or if otherwise designated in the basic 15 organizational document bylaws, those individuals vested with 16 the ultimate responsibility for the management of the health 17 care plan. 18 "Grievance" means any written complaint submitted to the 19 health care plan by or on behalf of an enrollee regarding any 20 aspect of the plan relative to the enrollee, but shall not 21 include a complaint by or on behalf of a provider. 22 "Grievance committee" means individuals who have been 23 appointed by the health care plan to respond to grievances 24 which have been filed on appeal from the plan's simplified 25 complaint process. At least 50% of the individuals on this 26 committee shall be composed of enrollees who are consumers. 27 A grievance may not be heard or voted upon unless at least 28 50% of the voting individuals at the committee hearing are 29 enrollees. 30 "Health care plan" means any arrangement whereby an 31 organization undertakes to provide or arrange for and pay for 32 or reimburse the cost of basic health care services from 33 providers selected by the plan and the arrangement consists 34 of arranging for or the provision of health care services, as -3- LRB9011012JSsbA 1 distinguished from mere indemnification against the cost of 2 those services, on a per capita prepaid basis, through 3 insurance or otherwise. 4 "Health care services" means any services included in the 5 furnishing to any individual of medical or dental care, or 6 the hospitalization or incident to the furnishing of such 7 care or hospitalization as well as the furnishing to any 8 person of any and all other services for the purpose of 9 preventing, alleviating, curing, or healing human illness or 10 injury. 11 "Insurance company" means companies in this State 12 authorized to transact the kind or kinds of business 13 enumerated in Class 1(a), Class 1(b) or Class 2(a) of Section 14 4 of the Illinois Insurance Code. 15 "Insured" means an individual entitled to coverage of 16 expenses of health care services under a policy issued or 17 administered by an insurance company. 18 "Life threatening condition" means any condition, illness 19 or injury which (i) may directly lead to a patient's death, 20 (ii) results in a period of unconsciousness which is 21 indeterminate at the present, or (iii) imposes severe pain or 22 an inhumane burden on the patient. 23 "Medical director" means a physician licensed to practice 24 medicine in all its branches in Illinois who is employed by 25 or contracted with a health care plan and who shall be 26 responsible for final review when questions of medical 27 practice arise in the health care plan in order to assure the 28 quality of health care services provided. 29 "Patient" means any person who has received or is 30 receiving medical care, treatment, or services from an 31 individual or institution licensed to provide medical care or 32 treatment in this State. 33 "Primary care physician" means a provider who has 34 contracted with a health care plan to provide primary care -4- LRB9011012JSsbA 1 services as defined by the contract and who is (1) a 2 physician licensed to practice medicine in all of its 3 branches who spends a majority of clinical time engaged in 4 general practice or in the practice of internal medicine, 5 pediatrics, gynecology, obstetrics, or family practice or (2) 6 a chiropractic physician licensed to treat human ailments 7 without the use of drugs or operative surgery. 8 "Provider" means any physician, hospital facility, or 9 other person which is licensed or otherwise authorized to 10 furnish health care services and also includes any other 11 entity that arranges for the delivery or furnishing of health 12 care services. 13 "Stabilization" means the provision of medical treatment 14 to assure within reasonable medical probability that no 15 material deterioration of the condition is likely to result 16 from the transfer of the individual from a facility. 17 "Utilization review" means the study of the 18 appropriateness of the use of particular services and the 19 appropriateness of the volume of services used. 20 "Utilization review program" means an entity performing 21 utilization review, except an agency of the federal 22 government or its agent, but only to the extent that agent is 23 providing services to the federal government. 24 Section 15. Patient rights. The following rights are 25 hereby established: 26 (1) The right of each patient to be provided with 27 information about the health care plan and the providers 28 rendering care. For health care plans this right calls for 29 compliance with Section 20 of this Act. 30 (2) The right of each patient to a full disclosure of 31 the patient costs, benefits, risks, and alternatives related 32 to the treatment options and care, including health care plan 33 requirements, coverage, exclusions, or limitations that could -5- LRB9011012JSsbA 1 affect the enrollee's access to coverage or treatment 2 options. For health care plans this right calls for 3 compliance with Section 25 of this Act. Insurance companies 4 and health care plans are prohibited from terminating or 5 suspending a provider from its network for advocating 6 appropriate health care services because the provider 7 advocated for what he or she considered to be appropriate 8 health care. 9 (3) The right of each patient to care, consistent with 10 nursing and medical practices, to be informed of the name of 11 the physician responsible for coordinating his or her care, 12 to receive information from his or her physician concerning 13 his or her condition and proposed treatment, to refuse any 14 treatment to the extent permitted by law, and to privacy and 15 confidentiality of records except as otherwise provided by 16 law. 17 (4) The right of each patient, regardless of source of 18 payment, to examine and receive a reasonable explanation of 19 his or her total bill for services where such a bill is 20 rendered by his or her physician or health care provider, 21 including the itemized charges for specific services 22 received. Each provider shall be responsible for a reasonable 23 explanation of those specific services provided by such 24 physician or health care provider. 25 (5) In the event an insurance company or health care 26 plan cancels or refuses to renew an individual policy or 27 plan, the insured or enrollee shall be entitled to timely, 28 prior notice of the termination of such policy or plan. 29 An insurance company or health care plan that requires 30 any insured, enrollee, or applicant for new or continued 31 insurance or coverage to be tested for infection with HIV or 32 any other identified causative agent of AIDS shall (i) give 33 the patient or applicant prior written notice of such 34 requirement, (ii) proceed with such testing only upon the -6- LRB9011012JSsbA 1 written authorization of the insured, enrollee, or applicant, 2 and (iii) keep the results of such testing confidential. 3 Notice of an adverse underwriting or coverage decision may be 4 given to any appropriately interested party, but the 5 insurance company or health care plan may only disclose the 6 test result itself to a physician designated by the insured, 7 enrollee or applicant, and any such disclosure shall be in a 8 manner that assures confidentiality. 9 (6) At the time of renewal, the right of each patient to 10 notification of termination or change in any benefits, 11 services, or service delivery location. 12 (7) The right of each patient to privacy and 13 confidentiality in health care. Each physician, health care 14 provider, health care plan and insurance company shall not 15 disclose the nature or details of services provided to 16 insureds and enrollees, except that such information may be 17 disclosed to the patient, the party making treatment 18 decisions if the patient is incapable of making decisions 19 regarding the health services provided, those parties 20 directly involved with providing treatment to the patient or 21 processing the payment for that treatment, those parties 22 responsible for peer review, utilization review and quality 23 assurance, and those parties required to be notified under 24 the Abused and Neglected Child Reporting Act, the Illinois 25 Sexually Transmissible Disease Control Act or where otherwise 26 authorized or required by law. This right may be waived in 27 writing by the patient or the patient's guardian, but a 28 physician or other health care provider may not condition the 29 provision of services on the patient's or guardian's 30 agreement to sign such a waiver. 31 Section 20. Provision of information. 32 (a) A health care plan shall provide to enrollees a list 33 of primary care physicians in the health care plan's service -7- LRB9011012JSsbA 1 area and an evidence of coverage that contains a description 2 of the following terms of coverage: 3 (1) The service area. 4 (2) Covered benefits, exclusions or limitations. 5 (3) Precertification and other utilization review 6 procedures and requirements. 7 (4) A description of the limitations on access to 8 specialists. 9 (5) Emergency coverage and benefits. 10 (6) Out-of-area coverages and benefits, if any. 11 (7) The enrollee's financial responsibility for 12 copayments, deductibles, and any other out-of-pocket 13 expenses. 14 (8) Provisions for continuity of treatment in the 15 event a provider's participation terminates during the 16 course of an insured's or enrollee's treatment by that 17 provider. 18 (9) The grievance process, including the telephone 19 number to call to receive information concerning 20 grievance procedures. 21 (b) Upon written request, a health care plan shall 22 provide to enrollees a description of the financial 23 relationships between the health care plan and any provider, 24 except that no health care plan shall be required to disclose 25 specific reimbursement to providers. 26 (c) A participating provider shall provide all of the 27 following to enrollees upon request: 28 (1) Information related to the health care 29 professional's educational background, experience, 30 training, specialty, and board certification, if 31 applicable. 32 (2) The names of licensed facilities on the 33 provider panel where the health professional presently 34 has privileges for the treatment, illness, or procedure -8- LRB9011012JSsbA 1 that is the subject of the request. 2 (3) Information regarding the health care 3 professional's participation in continuing education 4 programs and compliance with any licensure, 5 certification, or registration requirements, if 6 applicable. 7 Section 25. Prohibited restraints on communication. 8 Nothing in a physician's contract with a health care plan 9 shall be construed to impair the physician's ethical and 10 legal duty to provide full informed consent and medical 11 counsel to enrollees, including full discussion of the costs, 12 benefits, risks, and alternatives related to the enrollee's 13 treatment options and care and health care plan policies 14 related to those options, including health care plan 15 requirements, coverage, exclusions, or other policies or 16 practices that affect enrollees' access to coverage or 17 treatment options. 18 Section 30. Access to personnel and facilities. 19 (a) A health care plan shall include a sufficient number 20 and type of primary care physicians and specialists, 21 throughout the service area, to meet the needs of enrollees 22 and to provide meaningful choice. A health care plan shall 23 offer: 24 (1) accessible acute care hospital services, within 25 a reasonable distance or travel time; 26 (2) primary care physicians, within a reasonable 27 distance or travel time; and 28 (3) specialists within a reasonable distance or 29 travel time. 30 When the type of medical service needed for a specific 31 condition is not represented in the provider network, the 32 health care plan shall arrange for the enrollee to have -9- LRB9011012JSsbA 1 access to qualified nonparticipating health care 2 professionals as authorized by the primary care physician. 3 (b) A health care plan shall provide telephone access to 4 the health care plan for sufficient time during business 5 hours to assure enrollee access for routine care, and 24 hour 6 telephone access to the health care plan or, if so delegated 7 by the health care plan, a participating physician or group 8 for emergency care or authorization for care. 9 (c) A health care plan shall establish reasonable 10 standards for waiting times to obtain appointments, except as 11 provided below for emergency services. 12 Such standards shall include appointment scheduling 13 guidelines used for each type of health care service, 14 including prenatal care appointments, well-child visits and 15 immunizations, routine physicals, follow-up appointments for 16 chronic conditions, and urgent care. 17 (d) A health care plan shall provide for continuity of 18 care for its enrollees as follows: 19 (1) If an enrollee's physician leaves the health 20 care plan's network of providers for reasons other than 21 termination with cause and the physician remains within 22 the health care plan's service area, the health care plan 23 shall permit the enrollee to continue an ongoing course 24 of treatment with that physician during a transitional 25 period of: 26 (A) up to 60 days from the date of the notice 27 of physician's termination from the health care plan 28 network to the enrollee of the physician's 29 disaffiliation from the health care plan's network 30 if the enrollee has a life threatening disease or 31 condition; or 32 (B) if the enrollee has entered the third 33 trimester of pregnancy at the time of the 34 physician's disaffiliation, for a transitional -10- LRB9011012JSsbA 1 period that includes the provision of post-partum 2 care directly related to the delivery. 3 (2) Notwithstanding the provisions in item (1) of 4 this subsection, such care shall be authorized by the 5 health care plan during the transitional period only if 6 the physician agrees: 7 (A) to continue to accept reimbursement from 8 the health care plan at the rates applicable prior 9 to the start of the transitional period as payment 10 in full; 11 (B) to adhere to the health care plan's 12 quality assurance requirements and to provide to the 13 health care plan necessary medical information 14 related to such care; and 15 (C) to otherwise adhere to the organization's 16 policies and procedures, including but not limited 17 to procedures regarding referrals and obtaining 18 preauthorizations and a treatment plan approved by 19 the health care plan. 20 (e) A health care plan shall provide for continuity of 21 care for new enrollees as follows: 22 (1) If a new enrollee whose physician is not a 23 member of the health care plan's provider network, but is 24 within the health care plan's service area, enrolls in 25 the health care plan, the health care plan shall permit 26 the enrollee to continue an ongoing course of treatment 27 with the enrollee's current physician during a 28 transitional period of up to 60 days from the effective 29 date of enrollment, if: 30 (A) the enrollee has a life-threatening 31 disease or condition; or 32 (B) the enrollee has entered the third 33 trimester of pregnancy at the effective date of 34 enrollment, in which case the transitional period -11- LRB9011012JSsbA 1 shall include the provision of post-partum care 2 directly related to the delivery. 3 (2) If an enrollee elects to continue to receive 4 care from such physician pursuant to item (1) of this 5 subsection, such care shall be authorized by the health 6 care plan for the transitional period only if the 7 physician agrees: 8 (A) to accept reimbursement from the health 9 care plan at rates established by the health care 10 plan as payment in full, such rates shall be no more 11 than the level of reimbursement applicable to 12 similar physicians within the health care plan's 13 network for such services; 14 (B) to adhere to the health care plan's 15 quality assurance requirements and agrees to 16 provide to the health care plan necessary medical 17 information related to such care; and 18 (C) to otherwise adhere to the health care 19 plan's policies and procedures including, but not 20 limited to procedures regarding referrals and 21 obtaining preauthorization and a treatment plan 22 approved by the health care plan. In no event 23 shall this section be construed to require a health 24 care plan to provide coverage for benefits not 25 otherwise covered or to diminish or impair 26 preexisting condition limitations contained in the 27 subscriber's contract. 28 Section 35. Emergency services. 29 (a) Health care plans shall provide reimbursement for 30 covered emergency services provided at a participating or 31 nonparticipating emergency department up to the point of 32 stabilization of an enrollee. 33 (b) Once the enrollee is stabilized, the emergency -12- LRB9011012JSsbA 1 department shall contact the primary care physician or health 2 care plan as specified on the identification card to seek 3 prior authorization for any additional nonemergency services 4 beyond stabilization. 5 (c) With any claim for reimbursement, the emergency 6 department shall provide the health care plan with the 7 medical record documenting the presenting symptoms of the 8 enrollee at the time care was sought and the objective 9 findings of the medical examination. 10 (d) The health care plan's medical director's 11 determination of whether the enrollee meets the standard of 12 emergency shall take into account the presenting symptoms at 13 the time care was sought. 14 (e) Health care plans may require an enrollee to pay a 15 copayment for emergency services. 16 (f) Health care plans shall provide enrollees with 17 information on procedures for the coverage of emergency 18 services both inside and out of the plan service area. 19 Section 40. Grievance procedures. 20 (a) Every health care plan shall submit for the 21 Director's approval, and thereafter maintain, a system for 22 the resolution of grievances concerning the provision of 23 health care services or other matters concerning operation 24 of the health care plan as follows. A health care plan shall 25 do all of the following: 26 (1) Submit to the Director for prior approval any 27 proposed changes to the system by which grievances may be 28 filed and reviewed; 29 (2) Maintain records on each grievance filed with 30 the health care plan until the grievance is resolved and 31 for a period of at least 3 years to include: 32 (A) a copy of the grievance and the date of 33 its filing; -13- LRB9011012JSsbA 1 (B) the date and outcome of all consultations, 2 hearings and hearing findings; 3 (C) the date and decisions of any appeal 4 proceedings; and 5 (D) the date and proceeding of any litigation. 6 (3) Submit to the Director in a form prescribed by 7 the Director, a report by March 1 for the previous 8 calendar year which shall include at least the following: 9 (A) the total number of grievances handled; 10 (B) a compilation of causes underlying the 11 grievances; 12 (C) the outcomes of the grievances; 13 (D) the elapsed time from receipt of the 14 grievance by the health care plan until its 15 conclusion; and 16 (E) the number of malpractice claims filed and 17 if such claims have been completely adjudicated, a 18 compilation of causes, disposition, form, and amount 19 of any settlements. 20 (b) A health care plan shall have a grievance committee 21 which shall have the authority to hear and resolve by 22 majority vote grievances submitted to it as provided in 23 subsection (a). 24 Notwithstanding any other provisions of this Section, the 25 grievance committee may, but is not required to, hear any 26 grievance which alleges or indicates possible professional 27 liability, commonly known as "malpractice." 28 The committee is not empowered to resolve grievances in 29 any manner which, or prescribe any actions, that are in 30 conflict with written policies of the health care plan's 31 governing body, but the committee may hear such grievances 32 for the purpose of providing input to the governing body. 33 The grievance committee shall meet at the main office of 34 the health care plan, or such other office designated by the -14- LRB9011012JSsbA 1 health care plan where the main office is not within 50 miles 2 of the grievant's home address. Consideration shall be given 3 to the enrollee's request pertaining to the time and date of 4 such meeting. The enrollee shall have the right to attend 5 and participate in the formal grievance proceedings. The 6 enrollee shall have the right to be accompanied by a 7 designated representative of his or her choice. 8 The filing of a grievance shall not preclude the enrollee 9 from filing a complaint with the Department nor shall it 10 preclude the Department from investigating a complaint 11 pursuant to its authority under Section 4-6 of the Health 12 Maintenance Organization Act. 13 (c) The grievance procedures must be fully and clearly 14 communicated to all enrollees and information concerning such 15 procedures shall be readily available to the enrollee. 16 (d) A health care plan shall have simplified procedure 17 for resolving complaints. Such procedures do not require 18 review of the complaint by the grievance committee, but a 19 log, file, or other similar records must be maintained to 20 identify the general nature of such complaints. Resolution 21 of such complaints shall not preclude the enrollees' rightful 22 access to review by the grievance committee of a grievance. 23 (e) The health care plan shall institute procedures 24 which would require grievances to have a determination made 25 by the grievance committee within 60 days from the date the 26 grievance is received by the health care plan. A grievance 27 may not be heard or voted upon unless 50% of the voting 28 individuals of the committee present at the hearing are 29 enrollees. The determination by the grievance committee may 30 be extended for a period not to exceed 30 days in the event 31 of delay in obtaining documents or records necessary for the 32 resolution of the grievance. All requests for documents or 33 records necessary for the resolution of the grievance shall 34 be maintained in the health care plan's grievance file. -15- LRB9011012JSsbA 1 (f) The grievance procedure shall provide the enrollee 2 with a written acknowledgment of their grievance within 10 3 business days after receipt by the health care plan. 4 (g) The enrollee shall be notified at the time of the 5 hearing of the name and affiliation of those grievance 6 committee members who are representatives of the health care 7 plan. 8 (h) The health care plan shall institute procedures 9 whereby any document furnished to the members of the 10 grievance committee shall also be made available to the 11 enrollee not less than 5 business days prior to the hearing 12 of their grievance. The health care plan shall not present 13 any evidence without the enrollee having been given the 14 opportunity to be present. 15 (i) Notice in writing of the determination of the 16 grievance committee shall be mailed to the enrollee within 5 17 business days of such determination. Notice of the 18 determination made at the final appeal step of the health 19 care plan's grievance process shall include a notice of the 20 availability of the Department to receive complaints under 21 Section 4-6 of the Health Maintenance Organization Act. 22 (j) Prior to the resolution of a grievance filed by a 23 subscriber or enrollee, coverage shall not be terminated for 24 any reason which is the subject of the written grievance, 25 except where the health care plan has, in good faith, made a 26 reasonable effort to resolve the written grievance through 27 its grievance procedure and coverage is being terminated as a 28 result of good cause. 29 Section 45. Review of medical necessity. A health care 30 plan shall provide a mechanism for the timely review by a 31 physician holding the same class of license as the primary 32 care physician, who is unaffiliated with health care plan, 33 jointly selected by the patient (or the patient's next of kin -16- LRB9011012JSsbA 1 or legal representative if the patient is unable to act for 2 himself or herself), primary care physician and the health 3 care plan in the event of a dispute between the primary care 4 physician and the health care plan regarding the medical 5 necessity of a covered service proposed by the primary care 6 physician. In the event that the reviewing physician 7 determines the covered service to be medically necessary, the 8 health care plan shall provide the covered service. Future 9 contractual or employment action by the health care plan 10 regarding the primary care physician shall not be based 11 solely on the physician's participation in this procedure. 12 Section 50. Expedited review of medical necessity. 13 (a) A health care plan shall have an expedited review 14 procedure whereby an enrollee with a life-threatening 15 condition, or physician authorized in writing to act on 16 behalf of the enrollee with a life-threatening condition, may 17 appeal a health care plan's decision of medical necessity of 18 a covered service. 19 (b) The expedited review procedure shall provide that an 20 initial determination of the review will be made by the 21 health care plan not later than 3 business days after 22 receipt of all necessary information to complete the review 23 process. 24 (c) After the initial adverse determination by the 25 health care plan, the enrollee, or physician authorized in 26 writing to act on behalf of the enrollee, may request further 27 review by the health care plan. If further review is 28 requested, a final determination by the health care plan 29 shall be made not later than 30 days after receipt of all 30 necessary information to complete further review. Upon 31 notification to the enrollee of the health care plan's final 32 determination resulting from the expedited review process, 33 the plan shall provide the enrollee a notice of the -17- LRB9011012JSsbA 1 availability of the Department to receive complaints as 2 provided in Section 4-6 of the Health Maintenance 3 Organization Act. 4 (d) A request for an expedited review under this Section 5 must contain a statement submitted by the physician, orally 6 or in writing, substantiating that the enrollee has a 7 life-threatening condition. This subsection does not apply to 8 a provider's complaint concerning claims payment, handling, 9 or reimbursement for health care services. 10 (e) If the expedited review process is invoked it shall 11 be in place of and not in addition to the regular review 12 process. 13 Section 55. Registration of utilization review programs. 14 (a) All utilization review programs shall register 15 annually with the Department. 16 (b) The utilization review program will submit all of 17 the following: 18 (1) The name, address and telephone of the 19 registrant. 20 (2) The organization and governing structure of the 21 registrant. 22 (3) List of insurance companies and health care 23 plans for which the utilization review program performs 24 utilization review in this State and the number of lives 25 for which utilization review is conducted. 26 (4) Hours of operation. 27 (5) Description of the grievance process. 28 (6) Number of covered lives for which utilization 29 review was conducted for the previous calendar year. 30 (7) Written policies and procedures for protecting 31 confidential information according to applicable State 32 and federal laws. 33 (c) If the Director determines that an insurance company -18- LRB9011012JSsbA 1 or health care plan licensed by the Department meets the 2 provisions of the requirements of this Section under its 3 certification process, he or she may exempt the insurance 4 company or health care plan from providing duplicate 5 information. 6 Section 60. Managed care community networks. Managed 7 care community networks providing or arranging health care 8 services under contract with the State exclusively to persons 9 who are enrolled in the integrated health care program 10 established under Section 5-16.3 of the Illinois Public Aid 11 Code or a managed care community network owned, operated, or 12 governed by a county provider as defined in Section 15-1 of 13 that Code are required to comply with Sections 15, 20, and 25 14 of this Act and are exempt from all other Sections of this 15 Act. The Illinois Department of Public Aid shall adopt rules 16 to implement these provisions. 17 Section 65. Penalties. 18 (a) An organization that violates Section 20, 25, 30, 19 35, 40, 45, 50, or 55 of this Act is guilty of a Class B 20 misdemeanor. 21 (b) The Director may issue a cease and desist order, as 22 provided in Article XXIV, Section 401.1 of the Illinois 23 Insurance Code, to any organization subject to this Act. 24 Section 70. Severability. If any Section, term or 25 provision of this Act shall be adjudged invalid for any 26 reason, such judgment shall not affect, impair, or invalidate 27 any other Section, term, or provision of this Act, and the 28 remaining Sections, terms, and provisions shall be and remain 29 in full force and effect. 30 Section 75. Applicability of Act. A health care plan -19- LRB9011012JSsbA 1 amended, delivered, issued, or renewed in this State after 2 the effective date of this Act must comply with the terms of 3 this Act. 4 Section 99. Effective date. This Act takes effect 5 January 1, 1999.
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