93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB5389

 

Introduced 02/06/04, by Michael J. Madigan

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 134/80

    Amends the Managed Care Reform and Patient Rights Act. Makes technical changes in a Section concerning a quality assessment program.


LRB093 17066 DRJ 42730 b

 

 

A BILL FOR

 

HB5389 LRB093 17066 DRJ 42730 b

1     AN ACT concerning health care quality assurance.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Managed Care Reform and Patient Rights Act
5 is amended by changing Section 80 as follows:
 
6     (215 ILCS 134/80)
7     Sec. 80. Quality assessment program.
8     (a) A health care plan must shall develop and implement a
9 quality assessment and improvement strategy designed to
10 identify and evaluate accessibility, continuity, and quality
11 of care. The health care plan shall have:
12         (1) an ongoing, written, internal quality assessment
13     program;
14         (2) specific written guidelines for monitoring and
15     evaluating the quality and appropriateness of care and
16     services provided to enrollees requiring the health care
17     plan to assess:
18             (A) the accessibility to health care providers;
19             (B) appropriateness of utilization;
20             (C) concerns identified by the health care plan's
21         medical or administrative staff and enrollees; and
22             (D) other aspects of care and service directly
23         related to the improvement of quality of care;
24         (3) a procedure for remedial action to correct quality
25     problems that have been verified in accordance with the
26     written plan's methodology and criteria, including written
27     procedures for taking appropriate corrective action;
28         (4) follow-up measures implemented to evaluate the
29     effectiveness of the action plan.
30     (b) The health care plan shall establish a committee that
31 oversees the quality assessment and improvement strategy which
32 includes physician and enrollee participation.

 

 

HB5389 - 2 - LRB093 17066 DRJ 42730 b

1     (c) Reports on quality assessment and improvement
2 activities shall be made to the governing body of the health
3 care plan not less than quarterly.
4     (d) The health care plan shall make available its written
5 description of the quality assessment program to the Department
6 of Public Health.
7     (e) With the exception of subsection (d), the Department of
8 Public Health shall accept evidence of accreditation with
9 regard to the health care network quality management and
10 performance improvement standards of:
11         (1) the National Commission on Quality Assurance
12     (NCQA);
13         (2) the American Accreditation Healthcare Commission
14     (URAC);
15         (3) the Joint Commission on Accreditation of
16     Healthcare Organizations (JCAHO); or
17         (4) any other entity that the Director of Public Health
18     deems has substantially similar or more stringent
19     standards than provided for in this Section.
20     (f) If the Department of Public Health determines that a
21 health care plan is not in compliance with the terms of this
22 Section, it shall certify the finding to the Department of
23 Insurance. The Department of Insurance shall subject a health
24 care plan to penalties, as provided in this Act, for such
25 non-compliance.
26 (Source: P.A. 91-617, eff. 1-1-00.)