97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB3490

 

Introduced 2/8/2012, by Sen. M. Maggie Crotty

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 134/30

    Amends the Managed Care Reform and Patient Rights Act to provide that no health care plan or its subcontractors may, by contract, written policy, procedure, or any other means, mandate or require an optometrist or ophthalmologist to participate in and accept payment from a vision plan as a condition for participation in a health care plan. Effective immediately.


LRB097 17747 RPM 62962 b

 

 

A BILL FOR

 

SB3490LRB097 17747 RPM 62962 b

1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Managed Care Reform and Patient Rights Act
5is amended by changing Section 30 as follows:
 
6    (215 ILCS 134/30)
7    Sec. 30. Prohibitions.
8    (a) No health care plan or its subcontractors may prohibit
9or discourage health care providers by contract or policy from
10discussing any health care services and health care providers,
11utilization review and quality assurance policies, terms and
12conditions of plans and plan policy with enrollees, prospective
13enrollees, providers, or the public.
14    (b) No health care plan by contract, written policy, or
15procedure may permit or allow an individual or entity to
16dispense a different drug in place of the drug or brand of drug
17ordered or prescribed without the express permission of the
18person ordering or prescribing the drug, except as provided
19under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.
20    (c) No health care plan or its subcontractors may by
21contract, written policy, procedure, or otherwise mandate or
22require an enrollee to substitute his or her participating
23primary care physician under the plan during inpatient

 

 

SB3490- 2 -LRB097 17747 RPM 62962 b

1hospitalization, such as with a hospitalist physician licensed
2to practice medicine in all its branches, without the agreement
3of that enrollee's participating primary care physician.
4"Participating primary care physician" for health care plans
5and subcontractors that do not require coordination of care by
6a primary care physician means the participating physician
7treating the patient. All health care plans shall inform
8enrollees of any policies, recommendations, or guidelines
9concerning the substitution of the enrollee's primary care
10physician when hospitalization is necessary in the manner set
11forth in subsections (d) and (e) of Section 15.
12    (c-5) No health care plan or its subcontractors may, by
13contract, written policy, procedure, or any other means,
14mandate or require an optometrist or ophthalmologist to
15participate in and accept payment from a vision plan as a
16condition for participation in a health care plan.
17    (d) Any violation of this Section shall be subject to the
18penalties under this Act.
19(Source: P.A. 94-866, eff. 6-16-06.)
 
20    Section 99. Effective date. This Act takes effect upon
21becoming law.