96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
SB0682

 

Introduced 2/6/2009, by Sen. John J. Cullerton

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 125/4-5   from Ch. 111 1/2, par. 1408.5

    Amends the Health Maintenance Organization Act. Makes a technical change in a Section concerning organ transplants.


LRB096 06746 RPM 16830 b

 

 

A BILL FOR

 

SB0682 LRB096 06746 RPM 16830 b

1     AN ACT concerning regulation.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Health Maintenance Organization Act is
5 amended by changing Section 4-5 as follows:
 
6     (215 ILCS 125/4-5)  (from Ch. 111 1/2, par. 1408.5)
7     Sec. 4-5. Organ Transplants. No contract or evidence of
8 coverage issued by a health maintenance organization which
9 provides coverage for health care services shall deny
10 reimbursement for an otherwise covered expense incurred for any
11 organ transplantation procedure solely on the the basis that
12 such procedure is deemed experimental or investigational
13 unless supported by the determination of the Office of Health
14 Care Technology Assessment within the Agency for Health Care
15 Policy and Research within the federal Department of Health and
16 Human Services that such procedure is either experimental or
17 investigational or that there is insufficient data or
18 experience to determine whether an organ transplantation
19 procedure is clinically acceptable. If a health maintenance
20 organization has made written request, or had one made on its
21 behalf by a national organization, for determination by the
22 Office of Health Care Technology Assessment within the Agency
23 for Health Care Policy and Research within the federal

 

 

SB0682 - 2 - LRB096 06746 RPM 16830 b

1 Department of Health and Human Services as to whether a
2 specific organ transplantation procedure is clinically
3 acceptable and said organization fails to respond to such a
4 request within a period of 90 days, the failure to act may be
5 deemed a determination that the procedure is deemed to be
6 experimental or investigational.
7 (Source: P.A. 87-218.)