State of Illinois
90th General Assembly
Legislation

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90_SB0376

      5 ILCS 375/6.9 new
      30 ILCS 805/8.21 new
      55 ILCS 5/5-1069.3 new
      65 ILCS 5/10-4-2.3 new
      105 ILCS 5/10-22.3f new
      215 ILCS 5/356t new
      215 ILCS 105/8.7 new
      215 ILCS 125/4-6.5 new
      215 ILCS 130/4002.2 new
      215 ILCS 165/10           from Ch. 32, par. 604
      305 ILCS 5/5-16.8 new
          Amends the State Employees Group Insurance Act  of  1971,
      Counties Code, Illinois Municipal Code, School Code, Illinois
      Insurance   Code,   Health   Maintenance   Organization  Act,
      Comprehensive  Health  Insurance  Plan  Act,  Limited  Health
      Service Organization Act,  Voluntary  Health  Services  Plans
      Act,  and  Illinois Public Aid Code.  Provides persons with a
      disability covered under a  group  or  individual  policy  of
      accident  and health insurance or a managed care plan must be
      permitted to designate a specialist to whom  the  person  has
      access   without   referral  or  prior  approval.   Effective
      immediately.
                                                     LRB9001952JSmg
                                               LRB9001952JSmg
 1        AN  ACT  concerning  access  to  health  care  providers,
 2    amending named Acts.
 3        Be it enacted by the People of  the  State  of  Illinois,
 4    represented in the General Assembly:
 5        Section  5.  The  State  Employees Group Insurance Act of
 6    1971 is amended by adding Section 6.9 as follows:
 7        (5 ILCS 375/6.9 new)
 8        Sec. 6.9.  Person with  a  disability;  specialist.   The
 9    program  of  health  benefits is subject to the provisions of
10    Section 356t of the Illinois Insurance Code.
11        Section 10.  The State Mandates Act is amended by  adding
12    Section 8.21 as follows:
13        (30 ILCS 805/8.21 new)
14        Sec.  8.21.   Exempt mandate.  Notwithstanding Sections 6
15    and 8 of this Act, no reimbursement by the State is  required
16    for  the  implementation  of  any  mandate  created  by  this
17    amendatory Act of 1997.
18        Section  15.  The  Counties  Code  is  amended  by adding
19    Section 5-1069.3 as follows:
20        (55 ILCS 5/5-1069.3 new)
21        Sec. 5-1069.3.  Person  with  a  disability;  specialist.
22    All  counties,  including  home rule counties, are subject to
23    the provisions of Section  356t  of  the  Illinois  Insurance
24    Code.   The  requirement  under this Section that health care
25    benefits provided by counties comply with Section 356t of the
26    Illinois Insurance Code is an exclusive power and function of
27    the State and is a denial and limitation of home rule  county
                            -2-                LRB9001952JSmg
 1    powers  under  Article  VII, Section 6, subsection (h) of the
 2    Illinois Constitution.
 3        Section 20.  The Illinois Municipal Code  is  amended  by
 4    adding 10-4-2.3 as follows:
 5        (65 ILCS 5/10-4-2.3 new)
 6        Sec.  10-4-2.3.   Person  with  a disability; specialist.
 7    The corporate authorities of all municipalities  are  subject
 8    to  the provisions of Section 356t of the  Illinois Insurance
 9    Code.  The requirement under this Section  that  health  care
10    benefits  provided by municipalities comply with Section 356t
11    of the Illinois Insurance Code  is  an  exclusive  power  and
12    function  of the State and is a denial and limitation of home
13    rule  municipality  powers  under  Article  VII,  Section  6,
14    subsection (h) of the Illinois Constitution.
15        Section 25.  The School Code is amended by adding Section
16    10-22.3f as follows:
17        (105 ILCS 5/10-22.3f new)
18        Sec. 10-22.3f.  Person  with  a  disability;  specialist.
19    Insurance  protection  and benefits for employees are subject
20    to the provisions of Section 356t of the  Illinois  Insurance
21    Code.
22        Section  30.  The  Illinois  Insurance Code is amended by
23    adding Section 356t as follows:
24        (215 ILCS 5/356t new)
25        Sec. 356t.  Person with a disability; specialist.
26        (a)  An individual or group policy of accident and health
27    insurance or a managed care plan amended, delivered,  issued,
28    or  renewed  in  this  State after the effective date of this
                            -3-                LRB9001952JSmg
 1    amendatory Act of 1997 that requires an insured  or  enrollee
 2    to  designate  an individual to coordinate care or to control
 3    access to health care services shall also permit  an  insured
 4    or  enrollee  with  a disability to designate a participating
 5    provider who is a specialist.
 6        (b)  If an insured or  enrollee  with  a  disability  has
 7    designated a specialist, then the insured or enrollee must be
 8    given direct access to the specialist for services covered by
 9    the  policy  or plan without the need for a referral or prior
10    approval.  Nothing shall prohibit the insurer or managed care
11    plan from requiring  prior  authorization  or  approval  from
12    either   a  primary  care  provider  or  the  specialist  for
13    referrals for additional care or services.
14        (c)  For the purposes of this Section the following terms
15    are defined:
16             (1)  "Disability"  means  a  permanent  physical  or
17        mental  impairment  resulting   from   disease,   injury,
18        functional disorder, or congenital condition.
19             (2  "Specialist"   means  a  physician  licensed  to
20        practice  medicine  in  all  of  its  branches  who   has
21        specialized training and meets professional standards for
22        diagnosing  and  treating  a  disabling  condition  of an
23        individual with a disability.
24             (3)  The terms "managed care entity", "managed  care
25        plan",  and  "participating  provider",  have the meaning
26        given to those terms in Section 356r of this Code.
27        Section 35. The Comprehensive Health Insurance  Plan  Act
28    is amended by adding Section 8.7 as follows:
29        (215 ILCS 105/8.7 new)
30        Sec.  8.7.  Person  with  a  disability; specialist.  The
31    plan shall be subject to the provisions of  Section  356t  of
32    the Illinois Insurance Code.
                            -4-                LRB9001952JSmg
 1        Section  40.  The  Health Maintenance Organization Act is
 2    amended by adding Section 4.6.5 as follows:
 3        (215 ILCS 125/4-6.5 new)
 4        Sec.  4-6.5.  Person  with  a   disability;   specialist.
 5    Health   maintenance   organizations   are   subject  to  the
 6    provisions of Section 356t of the Illinois Insurance Code.
 7        Section 45. The Limited Health Services Organization  Act
 8    is amended by adding Section 4002.2 as follows:
 9        (215 ILCS 130/4002.2 new)
10        Sec.   4002.2.  Person  with  a  disability;  specialist.
11    Limited health  service  organizations  are  subject  to  the
12    provisions of Section 356t of the Illinois Insurance Code.
13        Section  50.  The  Voluntary Health Services Plans Act is
14    amended by changing Section 10 as follows:
15        (215 ILCS 165/10) (from Ch. 32, par. 604)
16        Sec.  10.  Application  of  Insurance  Code   provisions.
17    Health  services plan corporations and all persons interested
18    therein  or  dealing  therewith  shall  be  subject  to   the
19    provisions  of  Article  XII  1/2 and Sections 3.1, 133, 140,
20    143, 143c, 149, 354, 355.2, 356r, 356t,  367.2,  401,  401.1,
21    402,  403,  403A, 408, 408.2, and 412, and paragraphs (7) and
22    (15) of Section 367 of the Illinois Insurance Code.
23    (Source: P.A. 89-514, eff. 7-17-96.)
24        Section 55. The Illinois Public Aid Code  is  amended  by
25    adding Section 5-16.8 as follows:
26        (305 ILCS 5/5-16.8 new)
27        Sec. 5-16.8.  Person with a disability; specialist.   The
                            -5-                LRB9001952JSmg
 1    medical  assistance  program  is subject to the provisions of
 2    Section 356t of the Illinois Insurance  Code.   The  Illinois
 3    Department shall adopt rules to implement the requirements of
 4    Section  356t  of  the Illinois Insurance Code in the medical
 5    assistance program including managed care components  defined
 6    in Section 5-16.3.
 7        Section  99.  Effective date.  This Act takes effect upon
 8    becoming law.

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