SB0802 99TH GENERAL ASSEMBLY

LRB099 07540 MLM 27663 b

99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB0802

Introduced 2/5/2015, by Sen. William R. Haine

SYNOPSIS AS INTRODUCED:

215 ILCS 134/30

Amends the Managed Care Reform and Patient Rights Act. Provides that no health care plan or its subcontractors may by contract, written policy, procedure, or otherwise (1) mandate or require an optometrist licensed under the Illinois Optometric Practice Act of 1987 to meet requirements not required of other eye care providers as a condition for participation in the health care plan or (2) reimburse the optometrist at a rate lower than other licensed providers based on class of licensure for equal services provided by the optometrist under the plan. Provides that all health care plans shall upon enrollment or renewal inform the plan participant that he or she has a right to choose an optometrist as his or her medical eye care provider.

A BILL FOR

AN ACT concerning regulation.

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

Section 5. The Managed Care Reform and Patient Rights Act is amended by changing Section 30 as follows:

(215 ILCS 134/30)

Sec. 30. Prohibitions.

(a) No health care plan or its subcontractors may prohibit or discourage health care providers by contract or policy from discussing any health care services and health care providers, utilization review and quality assurance policies, terms and conditions of plans and plan policy with enrollees, prospective enrollees, providers, or the public.

(b) No health care plan by contract, written policy, or procedure may permit or allow an individual or entity to dispense a different drug in place of the drug or brand of drug ordered or prescribed without the express permission of the person ordering or prescribing the drug, except as provided under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.

(c) No health care plan or its subcontractors may by contract, written policy, procedure, or otherwise mandate or require an enrollee to substitute his or her participating primary care physician under the plan during inpatient hospitalization, such as with a hospitalist physician licensed to practice medicine in all its branches, without the agreement of that enrollee's participating primary care physician. "Participating primary care physician" for health care plans and subcontractors that do not require coordination of care by a primary care physician means the participating physician treating the patient. All health care plans shall inform enrollees of any policies, recommendations, or guidelines concerning the substitution of the enrollee's primary care physician when hospitalization is necessary in the manner set forth in subsections (d) and (e) of Section 15.

(c-5) No health care plan or its subcontractors may by contract, written policy, procedure, or otherwise (1) mandate or require an optometrist licensed under the Illinois Optometric Practice Act of 1987 to meet requirements not required of other eye care providers as a condition for participation in the health care plan or (2) reimburse the optometrist at a rate lower than other licensed providers based on class of licensure for equal services provided by the optometrist under the plan. All health care plans shall, upon enrollment or renewal, inform the plan participant that he or she has a right to choose an optometrist as his or her medical eye care provider.

(d) Any violation of this Section shall be subject to the penalties under this Act.

(Source: P.A. 94-866, eff. 6-16-06.)