REGULATION-TECH Senate SponsorsSen. Jacqueline Y. Collins-Emil Jones, Jr.-M. Maggie Crotty House Sponsors(Rep. Mary E. Flowers-Fred Crespo-Lisa M. Dugan-Karen May-Jack McGuire, Esther Golar, Careen M Gordon, Monique D. Davis, Naomi D. Jakobsson, Kathleen A. Ryg and Joseph M. Lyons) 1/13/2009SenateSession Sine Die 215 ILCS 125/1-1from Ch. 111 1/2, par. 1401Amends the Health Maintenance Organization Act. Makes a technical change in a Section concerning the short title.Senate Floor Amendment No. 2 Deletes reference to:215 ILCS 125/1-1Adds reference to:5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356f.1 new215 ILCS 130/4003from Ch. 73, par. 1504-3215 ILCS 165/10from Ch. 32, par. 604Deletes everything after the enacting clause. Amends the State Employees Group Insurance Act of 1971, Counties Code, Illinois Municipal Code, School Code, Limited Health Service Organization Act, Voluntary Health Services Plans Act, and the Illinois Insurance Code. Adds a provision concerning external review appeals processes. Provides that a policy of accident or health insurance or managed care plan shall maintain an external review appeals process for member or member representatives' requests to reverse or modify adverse determinations made by the insurer or managed care plan. Adds a definition for "adverse determination". Sets forth guidelines for compliance to the provisions concerning external review appeals processes. Provides that the Director of the Division of Insurance of the Department of Financial and Professional Regulation, in consultation with the Director of the Department of Public Health, may certify alternative external review standards of national accreditation organizations or entities. Provides that the Division of Insurance may issue a corrective action plan where an external review program is not in compliance with the provisions concerning external review appeals processes and a subsequent cease and desist order where an external review program does not come into compliance. Makes other changes.House Amendment No. 1 Adds reference to:215 ILCS 125/5-3from Ch. 111 1/2, par. 1411.2Deletes everything after the enacting clause. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act. Provides that a policy of accident or health insurance or managed care plan shall establish and maintain an appeals procedure related to the denial of health care benefits. Sets forth guidelines for maintaining an appeals procedure, including an expedited process for an enrollee with (1) an ongoing course of treatment ordered by a health care provider, the denial of which could significantly increase the risk to an enrollee's health, or (2) a treatment referral, service, procedure, or other health care service, the denial of which could significantly increase the risk to an enrollee's health. Provides that if an initial appeal is denied by the policy or plan, an enrollee is entitled to seek external independent review of the decision made by the policy or plan. Sets forth guidelines and requirements for the external independent review process. Provides that nothing in the provision shall be construed to require a policy or plan to pay for a health care service not covered under the enrollee's certificate of coverage or policy. Provides that a policy or plan shall provide each enrollee, prospective enrollee, and enrollee representative with written notification of the policy's or plan's appeal processes. Provides that rulemaking authority to implement this amendatory Act of the 95th General Assembly, if any, is conditioned on the rules being adopted in accordance with all provisions of the Illinois Administrative Procedure Act and all rules and procedures of the Joint Committee on Administrative Rules; any purported rule not so adopted, for whatever reason, is unauthorized. Makes other changes. 2/8/2007SenateFiled with Secretary by Sen. William R. Haine 2/8/2007SenateChief Co-Sponsor Sen. Emil Jones, Jr. 2/8/2007SenateFirst Reading 2/8/2007SenateReferred to Rules 3/7/2007SenateAssigned to Executive 3/15/2007SenateDo Pass Executive; 007-005-000 3/15/2007SenatePlaced on Calendar Order of 2nd Reading March 20, 2007 3/22/2007SenateSecond Reading 3/22/2007SenatePlaced on Calendar Order of 3rd Reading March 27, 2007 3/30/2007SenateRule 2-10 Third Reading Deadline Established As May 31, 2007 5/31/2007SenateRule 2-10 Third Reading Deadline Established As December 31, 2007 12/3/2007SenatePursuant to Senate Rule 3-9(b) / Referred to Rules 5/21/2008SenateApproved for Consideration Rules 5/21/2008SenatePlaced on Calendar Order of 3rd Reading May 22, 2008 5/21/2008SenateSenate Floor Amendment No. 1 Filed with Secretary by Sen. Jacqueline Y. Collins 5/21/2008SenateSenate Floor Amendment No. 1 Referred to Rules 5/21/2008SenateSenate Floor Amendment No. 1 Rules Refers to Insurance 5/22/2008SenateSenate Floor Amendment No. 1 Held in Insurance 5/22/2008SenateChief Sponsor Changed to Sen. Jacqueline Y. Collins 5/22/2008SenateAdded as Chief Co-Sponsor Sen. M. Maggie Crotty 5/22/2008SenateRule 2-10 Third Reading Deadline Established As May 31, 2008 5/29/2008SenateSenate Floor Amendment No. 2 Filed with Secretary by Sen. Jacqueline Y. Collins 5/29/2008SenateSenate Floor Amendment No. 2 Referred to Rules 5/29/2008SenateSenate Floor Amendment No. 2 Rules Refers to Insurance 5/30/2008SenateSenate Floor Amendment No. 2 Recommend Do Adopt Insurance; 006-000-000 5/30/2008SenateFiscal Note Requested by Sen. Dale A. Righter 5/30/2008SenateRecalled to Second Reading 5/30/2008SenateSenate Floor Amendment No. 2 Adopted; Collins 5/30/2008SenatePlaced on Calendar Order of 3rd Reading 5/30/2008SenateThird Reading - Passed; 053-000-000 5/30/2008SenateSenate Floor Amendment No. 1 Tabled Pursuant to Rule 5-4(a) 5/30/2008HouseArrived in House 5/30/2008HousePlaced on Calendar Order of First Reading 5/30/2008HouseChief House Sponsor Rep. Mary E. Flowers 5/30/2008HouseFirst Reading 5/30/2008HouseReferred to Rules Committee 11/6/2008HouseFinal Action Deadline Extended-9(b) November 30, 2008 11/6/2008HouseAssigned to Health Care Availability and Access Committee 11/19/2008HouseHouse Amendment No. 1 Filed with Clerk by Health Care Availability and Access Committee 11/19/2008HouseHouse Amendment No. 1 Adopted in Health Care Availability and Access Committee; by Voice Vote 11/19/2008HouseDo Pass as Amended / Short Debate Health Care Availability and Access Committee; 010-000-000 11/19/2008HousePlaced on Calendar 2nd Reading - Short Debate 11/19/2008HouseSecond Reading - Short Debate 11/19/2008HousePlaced on Calendar Order of 3rd Reading - Short Debate 11/19/2008HouseAdded Alternate Chief Co-Sponsor Rep. Fred Crespo 11/19/2008HouseAdded Alternate Chief Co-Sponsor Rep. Lisa M. Dugan 11/19/2008HouseAdded Alternate Chief Co-Sponsor Rep. Karen May 11/19/2008HouseAdded Alternate Chief Co-Sponsor Rep. Esther Golar 11/19/2008HouseAlternate Chief Co-Sponsor Removed Rep. Esther Golar 11/19/2008HouseAdded Alternate Chief Co-Sponsor Rep. Jack McGuire 11/19/2008HouseAdded Alternate Co-Sponsor Rep. Esther Golar 11/20/2008HouseAdded Alternate Co-Sponsor Rep. Careen M Gordon 11/20/2008HouseAdded Alternate Co-Sponsor Rep. Monique D. Davis 11/20/2008HouseAdded Alternate Co-Sponsor Rep. Naomi D. Jakobsson 11/20/2008HouseAdded Alternate Co-Sponsor Rep. Kathleen A. Ryg 11/20/2008HouseThird Reading - Short Debate - Passed 088-021-000 11/20/2008SenateSecretary's Desk - Concurrence House Amendment(s) 01 11/20/2008SenatePlaced on Calendar Order of Concurrence House Amendment(s) December 15, 2008; 01 11/20/2008HouseAdded Alternate Co-Sponsor Rep. Joseph M. Lyons 1/12/2009SenateHouse Amendment No. 1 Motion to Concur Filed with Secretary Sen. Jacqueline Y. Collins 1/12/2009SenateHouse Amendment No. 1 Motion to Concur Referred to Rules 1/13/2009SenateSession Sine Die