Public Act 100-0063
 
HB2506 EnrolledLRB100 08314 MJP 18421 b


  
    AN ACT concerning health.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  
 
 
    Section 5. The Health Maintenance Organization Act is 
amended  by changing Section 2-2 as follows:
 



    (215 ILCS 125/2-2)  (from Ch. 111 1/2, par. 1404)



    Sec. 2-2. Determination by Director; Health Maintenance 
Advisory Board. 

    (a) Upon receipt of an application for issuance of a 
certificate of
authority, the Director shall transmit copies of 
such application and
accompanying documents to the Director of 
the Illinois Department of Public
Health. The Director of the 
Department of Public Health shall then
determine whether the 
applicant for certificate of authority, with respect
to health 
care services to be furnished: (1) has demonstrated the

willingness and potential ability to assure that such health 
care service
will be provided in a manner to insure both 
availability and accessibility
of adequate personnel and 
facilities and in a manner enhancing
availability, 
accessibility, and continuity of service; and (2) has

arrangements, established in accordance with regulations 
promulgated by the
Department of Public Health for an ongoing 
quality of health care assurance
program concerning health care 
processes and outcomes. Upon investigation,
the Director of the 
Department of Public Health shall certify to the
Director 
whether the proposed Health Maintenance Organization meets the

requirements of this subsection (a). If the Director of the 
Department of
Public Health certifies that the Health 
Maintenance Organization does not
meet such requirements, he 
shall specify in what respect it is deficient.

    There is created in the Department of Public Health a 
Health Maintenance
Advisory Board composed of 11 members.  Nine 
members shall have practiced in the health
field, 4 of which 
shall have been or are currently affiliated with a
Health 
Maintenance Organization. Two of the members shall be members 
of the
general public, one of whom is over 50 years of age.  
Each member shall be
appointed by the
Director of the 
Department of Public Health and serve at the pleasure of
that 
Director and shall receive no compensation for services 
rendered other
than reimbursement for expenses. Six members of 
the Board shall
constitute
a quorum. A vacancy in the 
membership of the Advisory Board shall not
impair the right of 
a quorum to exercise all rights and perform all duties
of the 
Board. The Health Maintenance Advisory Board has the power to 
review
and comment on proposed rules and regulations to be 
promulgated by the
Director of the Department of Public Health 
within 30 days after those
proposed rules and regulations have 
been submitted to the Advisory Board.

    (b) Issuance of a certificate of authority shall be granted 
if the
following conditions are met:


        (1) the requirements of subsection (c) of
Section 2-1 
    have been fulfilled;


        (2) the persons responsible for the conduct
of the 
    affairs of the applicant are competent, trustworthy, and 
    possess
good reputations, and have had appropriate 
    experience, training or
education;


        (3) the Director of the Department of Public Health

    certifies that the Health Maintenance Organization's 
    proposed plan of
operation meets the requirements of this 
    Act;


        (4) the Health Care Plan
furnishes basic health care 
    services on a prepaid basis, through insurance
or 
    otherwise, except to the extent of reasonable requirements 
    for
co-payments or deductibles as authorized by this Act;


        (5) the Health
Maintenance Organization is financially 
    responsible and may reasonably be
expected to meet its 
    obligations to enrollees and prospective enrollees; in

    making this determination, the Director shall consider:


            (A) the financial soundness of the applicant's 
        arrangements for health
services and the minimum 
        standard rates, co-payments and other patient
charges 
        used in connection therewith;


            (B) the adequacy of working capital, other sources 
        of funding, and
provisions for contingencies; and


            (C) that no certificate of authority shall be 
        issued if the initial
minimum net worth of the 
        applicant is less than $2,000,000. The initial net

        worth shall be provided in cash and securities in 
        combination and form
acceptable to the Director;


        (6) the agreements with providers for the provision of 
    health services
contain the provisions required by Section 
    2-8 of this Act; and


        (7) any deficiencies identified by the Director have 
    been corrected.

(Source: P.A. 91-617, eff. 1-1-00.)

 
 
    Section 99. Effective date. This Act takes effect upon 
becoming law.