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
Amendments to Bill: AMENDMENTS ADOPTED: HOUSE - 1 SENATE - 1
END OF INQUIRY
Full Text Bill Status