90th General Assembly
Summary of HB3431
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Short description: 
HMO-PUBLIC AID CD-COMM NTWORKS                                             

Synopsis of Bill as introduced:
        Amends the Medicaid Article of the  Public  Aid  Code.   Makes  a      
   stylistic  change  in  a  Section  concerning  purpose of the Medicaid      
          FISCAL NOTE, H-AM 1 (Dpt. Public Aid)                                
          No fiscal impact anticipated.                                        
        HOUSE AMENDMENT NO. 1.                                                 
          Deletes reference to:                                                
          305 ILCS 5/5-1                                                       
          Adds reference to:                                                   
          215 ILCS 125/2-1                from Ch. 111 1/2, par. 1403          
          305 ILCS 5/5-11                 from Ch. 23, par. 5-11               
          305 ILCS 5/15-2                 from Ch. 23, par. 15-2               
          305 ILCS 5/15-3                 from Ch. 23, par. 15-3               
          305 ILCS 5/15-5                 from Ch. 23, par. 15-5               
        Deletes everything.  Amends the HMO Act and the Public Aid  Code.      
   Provides  for  certification of managed care community networks (which      
   do not include HMOs) by the  Department  of  Public  Aid.   Authorizes      
   contracts  between  those  networks and the Department for health care      
   services  for  individuals  participating  in   Department   programs.      
   Authorizes  a  county  provider  to  contract  with  the Department to      
   provide services as  a  managed  care  community  network.   Effective      
        SENATE AMENDMENT NO. 1.                                                
        Deletes  authority  for  the  Department  of  Insurance  to   use      
   emergency  rulemaking  to implement provisions concerning exemption of      
   managed care community networks certified by the Department of  Public      
   Aid  from  application  of  the  Health  Maintenance Organization Act.      
   Imposes certain requirements on a managed care community network  that      
   contracts  with  the  Department  of Public Aid to furnish health care      
   services to or arrange those services for enrollees  participating  in      
   programs   administered  by  the  Department,  including:   (1)  allow      
   providers to provide services on a fee-for-service basis to Department      
   clients not enrolled in  the  entity;  (2)  provide  client  education      
   services;  (3) allow enrollees to choose the site for services and the      
   panel of health care providers; (4) not discriminate in enrollment  or      
   disenrollment  practices based on health status; (5) provide a quality      
   assurance and utilization review program;  (6)  issue  ID  cards;  (7)      
   ensure  that  primary  care  physicians  and pharmacies meet standards      
   established by the Department; (8) provide a  procedure  for  handling      
   complaints;  (9)  maintain records; and (10) provide that its pharmacy      
   formulary be no more restrictive than the Department's  pharmaceutical      
Last action on Bill: PUBLIC ACT.............................. 90-0618

   Last action date: 98-07-10

           Location: House

 Amendments to Bill: AMENDMENTS ADOPTED: HOUSE -   1     SENATE -   1


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