91st General Assembly
Summary of SB0579
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Senate Sponsors:
WALSH,T-KLEMM-SULLIVAN-RADOGNO-NOLAND, MYERS,J, 
   LUECHTEFELD, BOMKE AND CRONIN.

House Sponsors:
SCHOENBERG-KRAUSE-KENNER-FEIGENHOLTZ-CROSS

Short description: 
MANAGED CARE PATIENT RGHTS ACT                                             

Synopsis of Bill as introduced:
        Creates the Managed Care Patient Rights Act.  Enumerates  certain      
   information  and  quality  of  care  standards  to  which a patient is      
   entitled.  Requires health care plans to  disclose  to  enrollees  and      
   prospective  enrollees  specific  information  concerning benefits and      
   coverages, emergency services,  out-of-area  coverages,  service  area      
   covered,  access to specialists, and grievance procedures.  Sets forth      
   requirements  for  continuity  of  care.   Prohibits   restraints   on      
   communications  between health care providers and enrollees and others      
   regarding care alternatives, quality, and utilization  review  issues.      
   Establishes  requirements for access to specialists and the mechanisms      
   for second opinions.  Requires health care plans to  have  a  consumer      
   advisory  committee  made  up  of enrollees and to establish a quality      
   assessment program.  Provides  for  the  registration  of  utilization      
   review  programs.   Amends  the  Health  Care  Purchasing Group Act to      
   provide that the purchasing group may be formed by 2 or more employers      
   having no more than 500 covered employees each rather than  having  an      
   aggregate   limit   of  2,500  covered  individuals.   Authorizes  the      
   sponsorship of health care purchasing groups with up to 100,000 rather      
   than 10,000 covered individuals.  Amends  the  State  Employees  Group      
   Insurance  Plan  of  1971,  the  Counties Code, the Illinois Municipal      
   Code,  the  Comprehensive  Health  Insurance  Plan  Act,  the   Health      
   Maintenance  Organization Act, the Limited Health Service Organization      
   Act, the Voluntary Health Services Plans Act, and the Illinois  Public      
   Aid  Code to require that health care coverage under those Acts comply      
   with Managed Care Patient Rights Act.  Amends the  Illinois  Insurance      
   Code to require compliance with provisions of the Managed Care Patient      
   Rights  Act  concerning  utilization  review and complaint procedures.      
   Amends the State Mandates Act to provide reimbursement by the State is      
   not required.  Effective January 1, 2000.                                   
        SENATE AMENDMENT NO. 2.                                                
        Provides that certain patient information may be shared for            
   quality assessment purposes. Provides that the term "physician" means       
   any physician licensed under the Medical Practice Act of 1987. Removes      
   provision prohibiting health care plans from imposing restrictions on       
   physicians or health care providers as to recommended health care           
   services. Provides that coverage for emergency services may not be          
   retrospectively denied. Provides that a health care plan may not dele-      
   gate the ultimate responsibility for coverage and payment decisions.        
   Excludes independent practice associations and physician-hospital           
   organizations from the scope of the bill. Delays the effective date         
   with respect to utilization review requirements to July 1, 2000.            
 
Last action on Bill: SESSION SINE DIE

   Last action date: 01-01-09

           Location: Senate

 Amendments to Bill: AMENDMENTS ADOPTED: HOUSE -   0     SENATE -   1


   END OF INQUIRY 



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