93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB5389


 
Introduced 02/06/04, by Michael J. Madigan
 
SYNOPSIS AS INTRODUCED:
 		














215 ILCS 134/80









    Amends the Managed Care Reform and Patient Rights Act.  Makes technical changes in a Section concerning a quality assessment program.
















LRB093 17066 DRJ 42730 b

















 


 


A BILL FOR









 











HB5389

LRB093 17066 DRJ 42730 b






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    AN ACT concerning health care quality assurance.

 
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    Be it enacted by the People of the State of Illinois,
 
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represented in the General Assembly:


 
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    Section 5. The Managed Care Reform and Patient Rights Act 
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is amended  by changing Section 80 as follows:
 



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    (215 ILCS 134/80)



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    Sec. 80. Quality assessment program. 

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    (a) A health care plan must
shall develop and implement a 
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quality assessment and
improvement strategy designed to 
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identify and evaluate accessibility,
continuity, and quality 
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of care.  The health care plan shall have:


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        (1) an ongoing, written, internal quality assessment 
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    program;


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        (2) specific written guidelines for monitoring and 
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    evaluating the quality
and appropriateness of care and 
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    services provided to enrollees requiring the
health care 
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    plan to assess:


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            (A) the accessibility to health care providers;


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            (B) appropriateness of utilization;


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            (C) concerns identified by the health care plan's 
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        medical or
administrative staff and enrollees; and


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            (D) other aspects of care and service directly 
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        related to the
improvement of quality of care;


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        (3) a procedure for remedial action to correct quality 
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    problems that have
been verified in accordance with the 
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    written plan's methodology and criteria,
including written 
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    procedures for taking appropriate corrective action;


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        (4) follow-up measures implemented to evaluate the 
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    effectiveness of the
action plan.

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    (b) The health care plan shall establish a committee that 
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oversees the
quality assessment and improvement strategy which 
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includes physician
and enrollee participation.

 


 






HB5389
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LRB093 17066 DRJ 42730 b




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    (c) Reports on quality assessment and improvement 
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activities shall be made
to the governing body of the health 
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care plan not less than quarterly.

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    (d) The health care plan shall make available its written 
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description of
the quality assessment program to the Department 
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of
Public Health.

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    (e) With the exception of subsection (d), the Department of 
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Public Health
shall accept evidence of accreditation with 
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regard to the health care network
quality management and 
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performance improvement standards of:


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        (1) the National Commission on Quality Assurance 
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    (NCQA);


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        (2) the American Accreditation Healthcare Commission 
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    (URAC);


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        (3) the Joint Commission on Accreditation of 
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    Healthcare Organizations
(JCAHO); or


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        (4) any other entity that the Director of Public Health 
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    deems has
substantially similar or
more stringent 
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    standards than provided for in this Section.

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    (f) If the Department of Public Health determines that a 
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health care plan
is not in compliance with the terms of this 
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Section, it shall certify the
finding to the Department of 
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Insurance. The Department of Insurance shall
subject a health 
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care plan to penalties, as provided in this Act, for such

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non-compliance.

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