91st General Assembly
Summary of SB0626
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Senate Sponsors:

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. 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.                                                  
Last action on Bill: SESSION SINE DIE

   Last action date: 01-01-09

           Location: Senate

 Amendments to Bill: AMENDMENTS ADOPTED: HOUSE -   0     SENATE -   0


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