House Sponsors: FLOWERS-SAVIANO-SCHOENBERG-O'BRIEN-JOHNSON,TIM, MADIGAN,MJ, MCKEON, FEIGENHOLTZ, MCGUIRE, HAMOS, CURRY,JULIE, JONES,LOU, HOFFMAN, FOWLER, DAVIS,STEVE, RONEN, BOLAND, BRUNSVOLD, BUGIELSKI, BURKE, CAPPARELLI, CROTTY, DELGADO, FRANKS, FRITCHEY, GARRETT, GASH, GIGLIO, GRANBERG, HANNIG, HOLBROOK, HOWARD, JONES,SHIRLEY, KENNER, LOPEZ, MCCARTHY, MORROW, MURPHY, NOVAK, PUGH, REITZ, SILVA, SLONE, SMITH,MICHAEL, STROGER, TURNER,ART, WOOLARD, CURRIE, ACEVEDO, BRADLEY, DART, SHARP, HARTKE AND LANG. Senate Sponsors: BERMAN Short description: MANAGED CARE REFORM ACT Synopsis of Bill as introduced: Creates the Managed Care Reform Act. Specifies information that must be disclosed by a managed care plan. Establishes a multi-level grievance procedure and also provides for an independent external review. Requires a managed care plan to maintain a grievance register. Requires managed care plans to be certified by the Director of Public Health with respect to adequacy of provider networks. Authorizes the Department of Public Health to impose civil penalties. Establishes a process, including hearings, for termination of a health care provider. Requires managed care plans to report to professional disciplinary agencies. Provides for the registration of utilization service agents. Establishes utilization review program standards. Provides that health insurance carriers, health care plans, and other managed care entities for health care plans have the duty to exercise ordinary care when making health care treatment decisions and are liable for damages for harm to an insured or enrollee proximately caused by the failure to exercise ordinary care. Authorizes a private right of action. Defines terms. Applies only to causes of action that accrue on or after the effective date of the Act. Amends the Civil Administrative Code of Illinois to establish the Office of Health Care Consumer Assistance, Advocacy, and Information within the Department of Insurance. Establishes a Managed Care Ombudsman Program to be a part of the Office of Health Care Consumer Assistance, Advocacy, and Information. Amends the State Finance Act to create the Managed Care Reform Fund. Amends the State Mandates Act to require implementation without reimbursement. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code to impose the requirements of the Managed Care Reform Act upon the provision of health care under those Acts. Amends the Health Maintenance Organization Act to provide for 2 public members to be appointed to the Health Maintenance Organization Guaranty Association Board. Effective January 1, 2000. FISCAL NOTE (Department of Central Management Services) HB 626 will increase HMO costs to the State by 5% to 15%, a fiscal impact of between $13 million and $39 million. HOUSE AMENDMENT NO. 1. Deletes reference to: 20 ILCS 1405/56.5 new 20 ILCS 1405/56.6 new 20 ILCS 1405/56.7 new Adds reference to: 215 ILCS 123/15 215 ILCS 123/20 Exempts employee or employer self-insured plans subject to ERISA. Requires the Department of Insurance to maintain records concerning complaints. Prohibits retaliation by managed care plans against health care providers. Imposes requirements for access to specialists and for transition of services. Sets forth requirements for emergency services. Provides for an Office of Consumer Health Insurance within the Department of Insurance. Removes provisions relating to the Managed Care Ombudsman Program. Amends the Health Care Purchasing Group Act to provide that a purchasing group may be formed by 2 or more employers having no more than 500 covered employees each rather than having an aggregate limit of 2,500 individuals. Authorizes the sponsorship of health care purchasing groups of up to 100,000, rather than 10,000, individuals. Effective immediately. FISCAL NOTE, H-AM 1 (Department of Public Health) Fiscal impact would be approximately $1.5 million GRF annually, not including costs that would be incurred by other State agencies. STATE MANDATES NOTE, H-AM 1 (Department of Commerce and Community Affairs) Creates a personnel mandate for which reimbursement of the in- creased costs to local gov't. would normally be required; exempts the State from reimbursement liability. No estimate of local gov't. costs is available. HOME RULE NOTE, H-AM 1 (Department of Commerce and Community Affairs) Preempts home rule and declares compliance is an exclusive power of the State and a denial and limitation of home rule powers. Last action on Bill: SESSION SINE DIE Last action date: 01-01-09 Location: House Amendments to Bill: AMENDMENTS ADOPTED: HOUSE - 1 SENATE - 0 END OF INQUIRY Full Text Bill Status