Illinois General Assembly - Bill Status for HB 3923

Creates the Individual Market Fairness Reform Law. Provides that a managed care entity shall (1) fairly and affirmatively offer all of its managed care plans that are sold to all individuals in each service area in which the managed care entity provides or arranges for the provision of health care services and (2) may not reject an application for an individual managed care plan if certain requirements are met. Provides that the Division of Insurance of the Department of Financial and Professional Regulation shall develop a system to categorize all managed care plans offered and sold to individuals pursuant to this Law into 5 coverage choice categories. Creates the Minimum Medical Loss Ratio Law. Provides that any company selling a health benefit plan in the individual or small group market shall expend in the form of health care benefits no less than 85 percent of the aggregate dues, fees, and premiums received by the company. Creates the Health Sure Illinois Law to establish a program for the purpose of making managed care plans affordable and accessible to small employers and individuals. Provides that the program is limited to active managed care entities. Amends the Illinois Insurance Code. Creates new Articles in the Code establishing the Office of Patient Protection and the Illinois Health Carrier External Review Law. Amends the Small Employer Health Insurance Rating Act, Illinois Health Insurance Portability and Accountability Act, and Managed Care Reform and Patient Rights Act in provisions concerning small employers, individuals, review, and rates. Repeals a provision of the Small Employer Health Insurance Rating Act concerning establishment of a class of business. Makes other changes.

In the provisions of the Health Sure Illinois Law concerning Sure Standard managed care plans for eligible small employers and individuals, deletes a provision requiring that contracts issued pursuant to the Law by participating managed care entities and approved by the Department of Financial and Professional Regulation shall provide only in-plan benefits, except for emergency care or where services are not available through a plan provider. Makes changes to the list of covered services. Deletes provisions concerning the Department's determination of rates for providers and rate-setting procedures. Provides that certain mandated benefits shall not be applicable to the contracts issued pursuant to the Law with the exception of emergency room services prior to stabilization as provided in the Managed Care Reform and Patient Rights Act. In the provisions concerning stop loss funding for Sure Standard managed care plans issued to qualifying small employers and qualifying individuals, deletes a provision requiring active managed care entities to certify that provider reimbursement rates are consistent with certain other reimbursement rates. Makes other changes.

Deletes everything after the enacting clause. Amends the Illinois Insurance Code. Makes technical changes in a Section concerning the short title.

Replaces everything after the enacting clause with the contents of the bill as introduced with the following changes. Deletes provisions creating the Individual Market Fairness Reform Law and Health Sure Illinois Law. Creates the Minimum Medical Loss Ratio Law as a new Article in the Illinois Insurance Code. Provides that any company selling a health benefit plan shall expend in the form of health care benefits no less than 75% (instead of 85%) of the aggregate dues, fees, premiums, or other periodic payments received. Deletes Articles amending the Illinois Insurance Code creating (1) the Office of Patient Protection within the Division of Insurance of the Department of Financial and Professional Regulation and (2) the Illinois Health Carrier External Review Law. Deletes provisions amending the Small Employer Health Insurance Rating Act, Illinois Health Insurance Portability and Accountability Act, and Managed Care Reform and Patient Rights Act. Amends the Managed Care Reform and Patient Rights Act. Provides that the Director of Insurance shall ensure that persons covered by health insurance companies or health care plans are protected from health insurance company and health care plan actions or policy provisions that are unjust, unfair, inequitable, ambiguous, misleading, inconsistent, deceptive, or contrary to the law or to the public policy. Sets forth additional responsibilities of the Office of Consumer Health Insurance. Provides that the Director may issue a Notice of Hearing requiring a health insurance company or health care plan to appear at a hearing. Makes other changes. Effective January 1, 2010.

Provides that the Office of Consumer Health Insurance shall assist health insurance companies and health care plan consumers with respect to grievance and appeals rights established in the Illinois Insurance Code (instead of rights established in the Act). Makes a grammatical correction.

Deletes everything after the enacting clause. Creates the Health Carrier External Review Act. Sets forth provisions concerning notice of right to and requests for external review, exhaustion of internal grievance processes, standard and expedited external review, approval of and minimum qualifications for independent review organizations, and reporting and disclosure requirements. Amends the Illinois Insurance Code. In the provisions concerning the Managed Care Reform and Patient Rights Act, provides that insurance companies that issue accident and health insurance shall comply with the provisions concerning documents to be delivered to the Director by incorporators. Establishes a committee within the Department to create a uniform small employer group health status questionnaire and individual health statement. Provides that an insurer or managed care plan shall semi-annually prepare and provide to the Division of Insurance of the Department of Financial and Professional Regulation a statement of its aggregate administrative expenses. Amends the Managed Care Reform and Patient Rights Act to provide for external independent review processes as provided by the Illinois Health Carrier External Review Act. Deletes a provision concerning external independent review. Contains a nonacceleration clause. Contains a severability clause. Makes other changes. Effective January 1, 2010, except that (1) the changes to the provision of the Illinois Insurance Code concerning the Managed Care Reform and Patient Rights Act, (2) the changes to the provisions of the Managed Care Reform and Patient Rights Act, and (3) the Health Carrier External Review Act take effect July 1, 2010.

Restores language concerning contractual or employment actions by a health care plan regarding a patient's physician or other health care provider. Provides that such actions shall not be based solely on participation in health care services appeals, complaints, or external independent reviews. Makes a technical change.

Provides that the Director of Insurance may, in certain instances, overturn an external review decision and require a health carrier to pay for health care service or treatment (instead of assign a new independent review organization to reconsider the overturned decision). Provides that such decision shall be made solely on the legal or medical merits of the claim.

Date	Chamber	Action
1/5/2010	House	Public Act . . . . . . . . . 96-0857

Date	Chamber	Action
2/26/2009	House	Filed with the Clerk by Rep. Greg Harris
2/26/2009	House	Added Co-Sponsor Rep. Susana A. Mendoza
2/26/2009	House	Added Co-Sponsor Rep. LaShawn K. Ford
2/26/2009	House	First Reading
2/26/2009	House	Referred to Rules Committee
2/27/2009	House	Added Chief Co-Sponsor Rep. Mary E. Flowers
3/3/2009	House	Added Chief Co-Sponsor Rep. Karen May
3/3/2009	House	Added Co-Sponsor Rep. Lou Lang
3/3/2009	House	Added Chief Co-Sponsor Rep. Lou Lang
3/3/2009	House	Removed Co-Sponsor Rep. Lou Lang
3/3/2009	House	Assigned to Health Care Availability and Accessibility Committee
3/4/2009	House	Added Co-Sponsor Rep. Deborah Mell
3/5/2009	House	Added Co-Sponsor Rep. Kevin Joyce
3/9/2009	House	Added Co-Sponsor Rep. Maria Antonia Berrios
3/10/2009	House	House Committee Amendment No. 1 Filed with Clerk by Health Care Availability and Accessibility Committee
3/10/2009	House	House Committee Amendment No. 1 Adopted in Health Care Availability and Accessibility Committee; by Voice Vote
3/10/2009	House	Remains in Health Care Availability and Accessibility Committee
3/11/2009	House	House Committee Amendment No. 2 Filed with Clerk by Health Care Availability and Accessibility Committee
3/11/2009	House	House Committee Amendment No. 2 Adopted in Health Care Availability and Accessibility Committee; by Voice Vote
3/11/2009	House	Do Pass as Amended / Standard Debate Health Care Availability and Accessibility Committee; 007-005-000
3/12/2009	House	Placed on Calendar 2nd Reading - Standard Debate
3/18/2009	House	Added Co-Sponsor Rep. Esther Golar
3/31/2009	House	House Floor Amendment No. 3 Filed with Clerk by Rep. Greg Harris
3/31/2009	House	House Floor Amendment No. 3 Referred to Rules Committee
3/31/2009	House	Added Co-Sponsor Rep. Eddie Washington
3/31/2009	House	Added Chief Co-Sponsor Rep. Julie Hamos
3/31/2009	House	Added Co-Sponsor Rep. Sara Feigenholtz
3/31/2009	House	Added Co-Sponsor Rep. Kathleen A. Ryg
3/31/2009	House	Added Co-Sponsor Rep. Linda Chapa LaVia
3/31/2009	House	Added Co-Sponsor Rep. Annazette Collins
3/31/2009	House	Added Co-Sponsor Rep. Arthur L. Turner
3/31/2009	House	Added Co-Sponsor Rep. Daniel J. Burke
4/1/2009	House	Added Co-Sponsor Rep. Mike Boland
4/1/2009	House	Added Co-Sponsor Rep. William Davis
4/1/2009	House	Added Co-Sponsor Rep. Al Riley
4/1/2009	House	House Floor Amendment No. 4 Filed with Clerk by Rep. Greg Harris
4/1/2009	House	House Floor Amendment No. 4 Referred to Rules Committee
4/1/2009	House	Added Co-Sponsor Rep. Jay C. Hoffman
4/1/2009	House	Added Co-Sponsor Rep. Dan Reitz
4/1/2009	House	Added Co-Sponsor Rep. Marlow H. Colvin
4/1/2009	House	House Floor Amendment No. 3 Rules Refers to Health Care Availability and Accessibility Committee
4/1/2009	House	Added Co-Sponsor Rep. Edward J. Acevedo
4/1/2009	House	Added Co-Sponsor Rep. Michael K. Smith
4/1/2009	House	Added Co-Sponsor Rep. Kenneth Dunkin
4/1/2009	House	Added Co-Sponsor Rep. David E. Miller
4/1/2009	House	Added Co-Sponsor Rep. Elizabeth Hernandez
4/1/2009	House	Second Reading - Standard Debate
4/1/2009	House	Held on Calendar Order of Second Reading - Standard Debate
4/1/2009	House	House Floor Amendment No. 3 Recommends Be Adopted Health Care Availability and Accessibility Committee; 007-001-001
4/2/2009	House	House Floor Amendment No. 4 Recommends Be Adopted Rules Committee; 005-000-000
4/2/2009	House	Added Co-Sponsor Rep. Patrick J. Verschoore
4/2/2009	House	Added Co-Sponsor Rep. Brandon W. Phelps
4/2/2009	House	Added Co-Sponsor Rep. Harry Osterman
4/2/2009	House	Added Co-Sponsor Rep. John E. Bradley
4/2/2009	House	Added Co-Sponsor Rep. Robert F. Flider
4/2/2009	House	Added Co-Sponsor Rep. Eddie Lee Jackson, Sr.
4/2/2009	House	Added Co-Sponsor Rep. Charles E. Jefferson
4/2/2009	House	Added Co-Sponsor Rep. Cynthia Soto
4/2/2009	House	House Floor Amendment No. 3 Adopted by Voice Vote
4/2/2009	House	House Floor Amendment No. 4 Adopted by Voice Vote
4/2/2009	House	Held on Calendar Order of Second Reading - Standard Debate
4/2/2009	House	House Floor Amendment No. 3 Fiscal Note Requested as Amended by Rep. JoAnn D. Osmond
4/2/2009	House	House Floor Amendment No. 4 Fiscal Note Requested as Amended by Rep. JoAnn D. Osmond
4/2/2009	House	Added Co-Sponsor Rep. Jehan A. Gordon
4/2/2009	House	Removed Co-Sponsor Rep. Dan Reitz
4/2/2009	House	Removed Co-Sponsor Rep. Michael K. Smith
4/2/2009	House	Removed Co-Sponsor Rep. Patrick J. Verschoore
4/2/2009	House	Removed Co-Sponsor Rep. Brandon W. Phelps
4/2/2009	House	Removed Co-Sponsor Rep. Robert F. Flider
4/2/2009	House	Removed Co-Sponsor Rep. Jehan A. Gordon
4/3/2009	House	House Floor Amendment No. 3 Fiscal Note Filed as Amended
4/3/2009	House	House Floor Amendment No. 4 Fiscal Note Filed as Amended
4/3/2009	House	House Floor Amendment No. 3 State Mandates Fiscal Note Requested as Amended by Rep. JoAnn D. Osmond
4/3/2009	House	House Floor Amendment No. 4 State Mandates Fiscal Note Requested as Amended by Rep. JoAnn D. Osmond
4/3/2009	House	Held on Calendar Order of Second Reading - Standard Debate
4/3/2009	House	Note / Motion Filed - Note Act Does Not Apply Rep. Greg Harris
4/3/2009	House	Motion Prevailed 067-047-000
4/3/2009	House	State Mandates Fiscal Note Request is Inapplicable
4/3/2009	House	Placed on Calendar Order of 3rd Reading - Standard Debate
4/3/2009	House	Third Reading - Standard Debate - Passed 062-045-001
4/3/2009	House	Verified
4/3/2009	House	Added Co-Sponsor Rep. Jehan A. Gordon
4/15/2009	Senate	Arrive in Senate
4/15/2009	Senate	Placed on Calendar Order of First Reading
4/15/2009	Senate	Chief Senate Sponsor Sen. Heather Steans
4/15/2009	Senate	First Reading
4/15/2009	Senate	Referred to Assignments
4/21/2009	Senate	Added as Alternate Chief Co-Sponsor Sen. M. Maggie Crotty
4/21/2009	Senate	Added as Alternate Chief Co-Sponsor Sen. Michael Noland
4/21/2009	Senate	Added as Alternate Chief Co-Sponsor Sen. Mattie Hunter
4/22/2009	Senate	Added as Alternate Chief Co-Sponsor Sen. William Delgado
4/22/2009	Senate	Added as Alternate Co-Sponsor Sen. Jacqueline Y. Collins
4/22/2009	Senate	Added as Alternate Co-Sponsor Sen. Susan Garrett
4/22/2009	Senate	Assigned to Executive
4/22/2009	Senate	Added as Alternate Co-Sponsor Sen. Gary Forby
4/22/2009	Senate	Added as Alternate Co-Sponsor Sen. Rickey R. Hendon
4/22/2009	Senate	Added as Alternate Co-Sponsor Sen. Don Harmon
4/22/2009	Senate	Added as Alternate Co-Sponsor Sen. Kwame Raoul
4/22/2009	Senate	Added as Alternate Co-Sponsor Sen. David Koehler
4/23/2009	Senate	Added as Alternate Co-Sponsor Sen. Donne E. Trotter
4/24/2009	Senate	Added as Alternate Co-Sponsor Sen. Toi W. Hutchinson
4/24/2009	Senate	Added as Alternate Co-Sponsor Sen. Dan Kotowski
4/28/2009	Senate	Added as Alternate Co-Sponsor Sen. Ira I. Silverstein
4/28/2009	Senate	Added as Alternate Co-Sponsor Sen. Iris Y. Martinez
4/29/2009	Senate	Added as Alternate Co-Sponsor Sen. Kimberly A. Lightford
4/29/2009	Senate	Added as Alternate Co-Sponsor Sen. Jeffrey M. Schoenberg
4/29/2009	Senate	Added as Alternate Co-Sponsor Sen. Emil Jones, III
4/30/2009	Senate	Postponed - Executive
4/30/2009	Senate	Added as Alternate Co-Sponsor Sen. Deanna Demuzio
4/30/2009	Senate	Added as Alternate Co-Sponsor Sen. Antonio Muñoz
4/30/2009	Senate	Rule 2-10 Committee Deadline Established As May 31, 2009
4/30/2009	Senate	Rule 2-10 Third Reading Deadline Established As May 31, 2009
5/6/2009	Senate	Added as Alternate Co-Sponsor Sen. James F. Clayborne, Jr.
5/6/2009	Senate	Added as Alternate Co-Sponsor Sen. Terry Link
5/6/2009	Senate	Added as Alternate Co-Sponsor Sen. Michael Bond
5/6/2009	Senate	Added as Alternate Co-Sponsor Sen. Martin A. Sandoval
5/7/2009	Senate	Postponed - Executive
5/7/2009	Senate	Added as Alternate Co-Sponsor Sen. Edward D. Maloney
5/11/2009	Senate	Added as Alternate Co-Sponsor Sen. James A. DeLeo
5/12/2009	Senate	Added as Alternate Co-Sponsor Sen. Louis S. Viverito
5/12/2009	Senate	Added as Alternate Co-Sponsor Sen. James T. Meeks
5/12/2009	Senate	Sponsor Removed Sen. Kimberly A. Lightford
5/13/2009	Senate	Added as Alternate Co-Sponsor Sen. Kimberly A. Lightford
5/15/2009	Senate	Rule 2-10 Committee Deadline Established As May 31, 2009
5/15/2009	Senate	Rule 2-10 Third Reading Deadline Established As May 31, 2009
5/18/2009	Senate	Senate Committee Amendment No. 1 Filed with Secretary by Sen. William R. Haine
5/18/2009	Senate	Senate Committee Amendment No. 1 Referred to Assignments
5/26/2009	Senate	Senate Committee Amendment No. 2 Filed with Secretary by Sen. Heather Steans
5/26/2009	Senate	Senate Committee Amendment No. 2 Referred to Assignments
5/27/2009	Senate	Senate Committee Amendment No. 2 Assignments Refers to Executive
5/27/2009	Senate	Added as Alternate Co-Sponsor Sen. Dale A. Righter
5/27/2009	Senate	Senate Committee Amendment No. 3 Filed with Secretary by Sen. Heather Steans
5/27/2009	Senate	Senate Committee Amendment No. 3 Referred to Assignments
5/27/2009	Senate	Senate Committee Amendment No. 3 Assignments Refers to Executive
5/27/2009	Senate	Waive Posting Notice
5/28/2009	Senate	Senate Committee Amendment No. 4 Filed with Secretary by Sen. Heather Steans
5/28/2009	Senate	Senate Committee Amendment No. 4 Referred to Assignments
5/28/2009	Senate	Senate Committee Amendment No. 4 Assignments Refers to Executive
5/28/2009	Senate	Senate Committee Amendment No. 3 Adopted
5/28/2009	Senate	Senate Committee Amendment No. 4 Adopted
5/28/2009	Senate	Do Pass as Amended Executive; 013-000-000
5/28/2009	Senate	Placed on Calendar Order of 2nd Reading May 29, 2009
5/28/2009	Senate	Senate Floor Amendment No. 5 Filed with Secretary by Sen. Heather Steans
5/28/2009	Senate	Senate Floor Amendment No. 5 Referred to Assignments
5/29/2009	Senate	Senate Floor Amendment No. 5 Be Approved for Consideration Assignments
5/29/2009	Senate	Second Reading
5/29/2009	Senate	Senate Floor Amendment No. 5 Adopted; Steans
5/29/2009	Senate	Placed on Calendar Order of 3rd Reading May 30, 2009
5/30/2009	Senate	Added as Alternate Co-Sponsor Sen. Michael W. Frerichs
5/30/2009	Senate	Added as Alternate Co-Sponsor Sen. Linda Holmes
5/30/2009	Senate	Third Reading - Passed; 054-001-000
5/30/2009	Senate	Senate Committee Amendment No. 1 Tabled Pursuant to Rule 5-4(a)
5/30/2009	Senate	Senate Committee Amendment No. 2 Tabled Pursuant to Rule 5-4(a)
5/30/2009	House	Arrived in House
5/30/2009	House	Placed on Calendar Order of Concurrence Senate Amendment(s) 3, 4, 5
5/30/2009	House	Senate Committee Amendment No. 3 Motion Filed Concur Rep. Greg Harris; Motion #1
5/30/2009	House	Senate Committee Amendment No. 4 Motion Filed Concur Rep. Greg Harris; Motion #1
5/30/2009	House	Senate Floor Amendment No. 5 Motion Filed Concur Rep. Greg Harris; Motion #1
5/30/2009	House	Senate Committee Amendment No. 3 Motion to Concur Referred to Rules Committee; Motion #1
5/30/2009	House	Senate Committee Amendment No. 4 Motion to Concur Referred to Rules Committee; Motion #1
5/30/2009	House	Senate Floor Amendment No. 5 Motion to Concur Referred to Rules Committee; Motion #1
5/31/2009	House	Final Action Deadline Extended-9(b) November 30, 2009
10/8/2009	House	Senate Committee Amendment No. 3 Motion to Concur Rules Referred to Health Care Availability and Accessibility Committee; Motion #1
10/8/2009	House	Senate Committee Amendment No. 4 Motion to Concur Rules Referred to Health Care Availability and Accessibility Committee; Motion #1
10/8/2009	House	Senate Floor Amendment No. 5 Motion to Concur Rules Referred to Health Care Availability and Accessibility Committee; Motion #1
10/29/2009	House	Added Co-Sponsor Rep. Joseph M. Lyons
10/29/2009	House	Senate Committee Amendment No. 3 Motion Filed Concur Rep. Greg Harris; Motion #2
10/29/2009	House	Senate Committee Amendment No. 4 Motion Filed Concur Rep. Greg Harris; Motion #2
10/29/2009	House	Senate Floor Amendment No. 5 Motion Filed Concur Rep. Greg Harris; Motion #2
10/29/2009	House	Senate Committee Amendment No. 3 Motion to Concur Referred to Rules Committee; Motion #2
10/29/2009	House	Senate Committee Amendment No. 4 Motion to Concur Referred to Rules Committee; Motion #2
10/29/2009	House	Senate Floor Amendment No. 5 Motion to Concur Referred to Rules Committee; Motion #2
10/29/2009	House	Senate Committee Amendment No. 3 Motion to Concur Rules Referred to Executive Committee; Motion #2
10/29/2009	House	Senate Committee Amendment No. 4 Motion to Concur Rules Referred to Executive Committee; Motion #2
10/29/2009	House	Senate Floor Amendment No. 5 Motion to Concur Rules Referred to Executive Committee; Motion #2
10/29/2009	House	Remove Chief Co-Sponsor Rep. Mary E. Flowers
10/29/2009	House	Senate Committee Amendment No. 3 Motion to Concur Recommends Be Adopted Executive Committee; 011-000-000; Motion #2
10/29/2009	House	Senate Committee Amendment No. 4 Motion to Concur Recommends Be Adopted Executive Committee; 011-000-000; Motion #2
10/29/2009	House	Senate Floor Amendment No. 5 Motion to Concur Recommends Be Adopted Executive Committee; 011-000-000; Motion #2
10/29/2009	House	Added Chief Co-Sponsor Rep. Arthur L. Turner
10/29/2009	House	Removed Co-Sponsor Rep. Arthur L. Turner
10/29/2009	House	Added Co-Sponsor Rep. Fred Crespo
10/29/2009	House	Senate Committee Amendment No. 3 House Concurs 106-010-000; Motion #2
10/29/2009	House	Senate Committee Amendment No. 4 House Concurs 106-010-000; Motion #2
10/29/2009	House	Senate Floor Amendment No. 5 House Concurs 106-010-000; Motion #2
10/29/2009	House	Passed Both Houses
11/25/2009	House	Sent to the Governor
1/5/2010	House	Governor Approved
1/5/2010	House	Effective Date January 5, 2010
1/5/2010	House	Public Act . . . . . . . . . 96-0857

	Fiscal Note, House Floor Amendment No. 3 (Financial & Professional Regulation)
	HB 3923 (H-AM 3) has a projected fiscal impact of $503,000 to the Illinois Department of Financial and Professional Regulation. Funding for this legislation will be paid from the Insurance Producer Administration and Insurance Financial Regulations funds, and no GRF funding will be required.

	Fiscal Note, House Floor Amendment No. 4 (Financial & Professional Regulation)
	HB 3923 (H-AM 4) has a projected fiscal impact of $503,000 to the Illinois Department of Financial and Professional Regulation. Funding for this legislation will be paid from the Insurance Producer Administration and Insurance Financial Regulations funds, and no GRF funding will be required.