(215 ILCS 125/5-4) (from Ch. 111 1/2, par. 1412)
Sec. 5-4.
Examination of affairs and quality of services by the
Director; books and records. The Director shall have with respect to health
maintenance organizations the powers of examination conferred upon him
relative to Sections 132 through 132.7 of the Illinois
Insurance Code. The Director of
Public Health shall make an examination concerning the quality of health
care services of any health maintenance organization and providers with
whom the organization has contracts, agreements, or other arrangements
pursuant to its health care plan as often as he deems it necessary for the
protection of the interest of the people of this State, but not less
frequently than once every 3 years. The cost of any examination
shall be paid by the health maintenance organization being examined.
The fee assessed against the organization being examined shall be
composed of a fixed annual fee plus an additional fee based on the
individual health maintenance organization's enrollment in Illinois. The
revenues generated shall not exceed the estimated actual costs of the program.
The methodology for computing the fee to be assessed shall be
established by rule, pursuant to the Illinois
Administrative Procedure Act.
Every health maintenance organization and provider shall submit its
books and records relating to the Health Care Plan to examination and
in every way facilitate them. For the purpose of examinations, the Director
and the Director of Public Health may administer oaths to
and examine the officers and agents of the health maintenance organization
and the principals of providers concerning their business.
(Source: P.A. 89-97, eff. 7-7-95.)
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