INS-HLTH CARRIER EXTERNAL REV Senate SponsorsSen. Jacqueline Y. Collins House Sponsors(Rep. Frank J. Mautino-Greg Harris-Dan Brady-JoAnn D. Osmond) 1/12/2011SenateSession Sine Die New Act215 ILCS 5/155.36215 ILCS 134/40215 ILCS 134/45Creates the Health Carrier External Review Act. Sets forth standards for independent external review procedures for adverse determinations by a health carrier against a covered person. Provides that the Act applies to an entity subject to the insurance laws and regulations of this State or subject to the jurisdiction of the Director and that contracts or offers to contract concerning any costs of health care. Requires health carriers to notify covered persons and their health care providers in writing of the covered person's right to request an external review as provided by the Act. Sets forth notice requirements. Provides that a request for an external review shall not be made until the covered person has exhausted the health carrier's internal grievance process. Sets forth requirements for standard external reviews and expedited external reviews. Provides that an external review decision is binding on the health carrier and binding on the covered person except to the extent the covered person has other remedies available. Sets forth minimum qualifications for independent review organizations and provides that the Director shall approve independent review organizations eligible to be assigned to conduct external reviews. Provides that each health carrier shall maintain written records of external review requests for each calendar year and submit a report to the Director by March 1 of each year. Provides that the health carrier shall be solely responsible for paying the cost of external reviews. Sets forth disclosure requirements. Amends the Managed Care Reform and Patient Rights Act to provide that an enrollee may appeal adverse decisions in accordance with the Health Carrier External Review Act. Deletes a provision concerning external independent review. Makes other changes. Contains a severability clause. Effective January 1, 2010.Senate Committee Amendment No. 1 Deletes reference to:215 ILCS 5/155.36215 ILCS 134/40215 ILCS 134/45Adds reference to:215 ILCS 5/1from Ch. 73, par. 613Deletes everything after the enacting clause. Creates the Health Carrier External Review Act. Sets forth the purpose of the Act. Amends the Illinois Insurance Code. Makes technical changes in a Section concerning the short title.Senate Floor Amendment No. 2 Deletes reference to:215 ILCS 5/1Adds reference to:New ActReplaces everything after the enacting clause with the bill as introduced with the following changes. Deletes references to the Managed Care Reform and Patient Rights Act. Makes changes to the definitions of "authorized representative", "final adverse determination", "evidence-based standard", and "utilization review". Adds definitions for "best evidence", "case-series", "cohort study", "expert opinion", and "retrospective review". Provides that if the health carrier has not issued a written decision to the covered person or the covered person's authorized representative within 30 days following the date that the grievance is filed with the health carrier and the covered person or the covered person's authorized representative has not requested or agreed to a delay, the covered person or the covered person's authorized representative may file a request for external review. Deletes a provision requiring the insurer to send to the insured an authorization form that complies with the requirements of the federal Health Insurance Portability and Accountability Act. Makes changes in the provisions concerning when a covered person shall be considered to have exhausted the health carrier's internal grievance process. Makes changes in the provisions concerning standard external review. Adds factors for consideration for an independent review organization when there is an adverse determination or final adverse determination and when there is an adverse determination or final adverse determination that involves a denial of coverage based on a determination that the health care service or treatment recommended or requested is experimental or investigational. Makes changes to the provisions concerning the information that is required in the notice of the review organization's decision for reviews of experimental or investigational treatments. Makes changes in the provisions concerning expedited external review. Deletes the provisions amending the Illinois Insurance Code and Managed Care Reform and Patient Rights Act. Makes other changes. Effective January 1, 2010. 2/18/2009SenateFiled with Secretary by Sen. Jacqueline Y. Collins 2/18/2009SenateFirst Reading 2/18/2009SenateReferred to Assignments 2/25/2009SenateAssigned to Insurance 3/10/2009SenateSenate Committee Amendment No. 1 Filed with Secretary by Sen. Jacqueline Y. Collins 3/10/2009SenateSenate Committee Amendment No. 1 Referred to Assignments 3/11/2009SenateSenate Committee Amendment No. 1 Assignments Refers to Insurance 3/11/2009SenateSenate Committee Amendment No. 1 Adopted 3/12/2009SenateDo Pass as Amended Insurance; 007-005-000 3/12/2009SenatePlaced on Calendar Order of 2nd Reading March 17, 2009 3/25/2009SenateSenate Floor Amendment No. 2 Filed with Secretary by Sen. Jacqueline Y. Collins 3/25/2009SenateSenate Floor Amendment No. 2 Referred to Assignments 3/30/2009SenateSenate Floor Amendment No. 2 Assignments Refers to Insurance 3/31/2009SenateSenate Floor Amendment No. 2 Recommend Do Adopt Insurance; 010-000-000 3/31/2009SenateSecond Reading 3/31/2009SenateSenate Floor Amendment No. 2 Adopted; Collins 3/31/2009SenatePlaced on Calendar Order of 3rd Reading April 1, 2009 4/2/2009SenateThird Reading - Passed; 058-000-000 4/3/2009HouseArrived in House 4/3/2009HousePlaced on Calendar Order of First Reading 4/3/2009HouseChief House Sponsor Rep. Dan Brady 4/6/2009HouseFirst Reading 4/6/2009HouseReferred to Rules Committee 4/20/2009HouseAssigned to Insurance Committee 4/22/2009HouseAdded Alternate Chief Co-Sponsor Rep. Greg Harris 4/28/2009HouseRe-assigned to Health Care Availability and Accessibility Committee 4/30/2009HouseAlternate Chief Sponsor Changed to Rep. Frank J. Mautino 4/30/2009HouseAdded Alternate Chief Co-Sponsor Rep. Dan Brady 4/30/2009HouseAdded Alternate Chief Co-Sponsor Rep. JoAnn D. Osmond 5/8/2009HouseRule 19(a) / Re-referred to Rules Committee 1/12/2011SenateSession Sine Die