MANAGED CARE REFORM ACT
Synopsis of Bill as introduced:
Creates the Managed Care Reform Act. Specifies information that
must be disclosed by a managed care plan. Establishes a multi-level
grievance procedure and also provides for an independent external
review. Requires a managed care plan to maintain a grievance
register. Requires managed care plans to be certified by the Director
of Public Health with respect to adequacy of provider networks.
Authorizes the Department of Public Health to impose civil penalties.
Establishes a process, including hearings, for termination of a health
care provider. Requires managed care plans to report to professional
disciplinary agencies. Provides for the registration of utilization
service agents. Establishes utilization review program standards.
Provides that health insurance carriers, health care plans, and other
managed care entities for health care plans have the duty to exercise
ordinary care when making health care treatment decisions and are
liable for damages for harm to an insured or enrollee proximately
caused by the failure to exercise ordinary care. Authorizes a private
right of action. Defines terms. Applies only to causes of action that
accrue on or after the effective date of the Act. Amends the Civil
Administrative Code of Illinois to establish the Office of Health Care
Consumer Assistance, Advocacy, and Information. Establishes a Managed
Care Ombudsman Program to be a part of the Office of Health Care
Consumer Assistance, Advocacy, and Information. Amends the State
Finance Act to create the Managed Care Reform Fund. Amends the State
Mandates Act to require implementation without reimbursement. Amends
the State Employees Group Insurance Act of 1971, the Counties Code,
the Illinois Municipal Code, and the School Code to impose the
requirements of the Managed Care Reform Act upon the provision of
health care under those Acts. Amends the Health Maintenance
Organization Act to provide for 2 public members to be appointed to
the Health Maintenance Organization Guaranty Association Board.
Effective January 1, 2000.
Last action on Bill: SESSION SINE DIE
Last action date: 01-01-09
Amendments to Bill: AMENDMENTS ADOPTED: HOUSE - 0 SENATE - 0
END OF INQUIRY
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