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215 ILCS 5/368e
(215 ILCS 5/368e)
Sec. 368e.
Administration and enforcement.
(a) Other than the duties specifically created in Sections 368b, 368c, and
368d,
nothing in those Sections is intended to preclude, prevent, or require the
adoption,
modification, or termination of any utilization management, quality management,
or
claims processing methodologies or other provisions of a contract applicable to
services provided under a
contract
between an insurer, health maintenance organization,
independent practice
association, or
physician hospital organization and a health care professional or health care
provider.
(b) Nothing in Sections 368b, 368c, and 368d precludes, prevents, or
requires
the
adoption, modification, or termination of any health plan term, benefit,
coverage or
eligibility provision, or payment methodology.
(c) The provisions of Sections 368b, 368c, and 368d are deemed incorporated
into health care professional and health care provider service contracts
entered into on or before the
effective date of
this amendatory Act of the 93rd General Assembly and do not require an insurer,
health
maintenance organization, independent practice
association, or physician
hospital
organization to renew or renegotiate the contracts with a health care
professional or health
care provider.
(d) The Department shall enforce the provisions of this Section and
Sections 368b, 368c, and 368d pursuant to the enforcement powers granted to it
by law.
(e) The Department is hereby granted specific authority to issue a cease and
desist order against, fine, or otherwise penalize independent practice
associations and
physician-hospital organizations for violations.
(f) The Department shall adopt reasonable rules to enforce compliance with
this Section and Sections 368b, 368c, and 368d.
(Source: P.A. 93-261, eff. 1-1-04.)
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