Full Text of SB2534 95th General Assembly
SB2534sam001 95TH GENERAL ASSEMBLY
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Sen. Dan Kotowski
Filed: 2/29/2008
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| AMENDMENT TO SENATE BILL 2534
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| AMENDMENT NO. ______. Amend Senate Bill 2534 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 1. Short title. This Act may be cited as the | 5 |
| Health Plan Consumer Protection and Ethics Act. | 6 |
| Section 10. Purpose. The purpose of this Act is to make it | 7 |
| illegal to engage in unethical health care professional | 8 |
| reimbursement practices that create a conflict of interest on | 9 |
| the part of the provider with respect to patient care. This Act | 10 |
| is intended to specify those categories of reimbursement and | 11 |
| incentive compensation that are considered inappropriate and | 12 |
| are thus consider illegal in this State. | 13 |
| Section 15. Definitions. As used in this Act: | 14 |
| "Healthcare insurance company" means a provider of health | 15 |
| insurance that pays specified sums for benefits or treatments. |
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| "Pharmacy benefit manager" is an organization that | 2 |
| provides administrative services in processing and analyzing | 3 |
| prescription claims for pharmacy benefit and coverage | 4 |
| programs. "Pharmacy benefit manager" services may include | 5 |
| contracting with a network of pharmacies; establishing payment | 6 |
| levels for provider pharmacies; negotiating rebate | 7 |
| arrangements; developing and managing formularies, preferred | 8 |
| drug lists, and prior authorization programs; maintaining | 9 |
| patient compliance programs; performing drug utilization | 10 |
| review; and operating disease management programs. A "pharmacy | 11 |
| benefit manager" may operate mail order pharmacies or have | 12 |
| arrangements to include prescription availability through mail | 13 |
| order pharmacies. | 14 |
| Section 20. Application of Act; exclusions. | 15 |
| (a) This Act shall apply to all health insurance companies, | 16 |
| pharmacy benefit managers, or other entities acting on behalf | 17 |
| of one of these entities or on its own behalf. | 18 |
| (b) No other law of this State setting language | 19 |
| simplification standards shall apply to any incentives to | 20 |
| health care professionals. | 21 |
| Section 25. Unlawful acts. It shall be unlawful for a | 22 |
| health plan, pharmacy benefit manager, pharmaceutical benefit | 23 |
| manager, or other entity acting on behalf of one of these | 24 |
| entities or on its own behalf to engage in the following |
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| practices:
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| (a) pay a physician or other health care professional | 3 |
| to prescribe a specific medication or type of medication;
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| (b) pay a physician, pharmacist, or other health care | 5 |
| professional to switch a stable patient from one medication | 6 |
| to another specific medication or type of medication; | 7 |
| (c) provide financial incentives to prescribe a | 8 |
| specific medication or type of medication; | 9 |
| (d) provide a cash bonus or other reward to a physician | 10 |
| or other health care professional for compliance with | 11 |
| health plan guidelines for medications to be used; | 12 |
| (e) withhold a portion of a physician's or other health | 13 |
| care professional's compensation or financially penalize a | 14 |
| healthcare provider in some other way for failure to comply | 15 |
| with specific medication use mandates; | 16 |
| (f) provide an incentive or induce a physician or other | 17 |
| health care professional to prescribe a specific | 18 |
| medication or type of medication; or
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| (g) engage in any other activity that may be viewed as | 20 |
| a kickback for prescribing a specific medication or type of | 21 |
| medication.
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| Section 30. Reporting requirements. The following | 23 |
| information must be submitted to the Attorney General on a | 24 |
| quarterly basis: | 25 |
| (a) Information that must be submitted by health plans, |
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| pharmacy benefit managers, pharmaceutical companies, or | 2 |
| their agents must include any financial payments or | 3 |
| incentives to physicians or other health care | 4 |
| professionals that may be an inducement to prescribe a | 5 |
| specific medication or type of medication.
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| (b) Information to be reported by physicians or other | 7 |
| health care professionals licensed to prescribe must | 8 |
| include any payments or financial inducement to prescribe a | 9 |
| specific medication or class of medications. This shall not | 10 |
| include regular compensation that is paid for the health | 11 |
| care or consulting services of a physician, unless it is | 12 |
| tied to the prescribing of a specific medication or set of | 13 |
| medications. | 14 |
| (c) Information to be reported by pharmacists and | 15 |
| others licensed to dispense medications must include any | 16 |
| payments or financial inducements to seek the switching of | 17 |
| one medication to another different medication.
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| Section 35. Grievances. Patients or other members of the | 19 |
| public may file grievances with the Attorney General for | 20 |
| violations of this Act for further investigation. | 21 |
| Section 40. Penalties. Providing prohibited incentives to | 22 |
| health care providers pursuant to this Act is punishable by a | 23 |
| fine not to exceed $25,000 and is a violation of the Consumer | 24 |
| Fraud and Deceptive Business Practices Act.
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| Section 90. The Consumer Fraud and Deceptive Business | 2 |
| Practices Act is amended by changing Section 2Z as follows:
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| (815 ILCS 505/2Z) (from Ch. 121 1/2, par. 262Z)
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| (Text of Section before amendment by P.A. 95-562 ) | 5 |
| Sec. 2Z. Violations of other Acts. Any person who knowingly | 6 |
| violates
the Automotive Repair Act, the Automotive Collision | 7 |
| Repair Act,
the Home Repair and Remodeling Act,
the Dance | 8 |
| Studio Act,
the Physical Fitness Services Act,
the Hearing | 9 |
| Instrument Consumer Protection Act,
the Illinois Union Label | 10 |
| Act,
the Job Referral and Job Listing Services Consumer | 11 |
| Protection Act,
the Travel Promotion Consumer Protection Act,
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| the Credit Services Organizations Act,
the Automatic Telephone | 13 |
| Dialers Act,
the Pay-Per-Call Services Consumer Protection | 14 |
| Act,
the Telephone Solicitations Act,
the Illinois Funeral or | 15 |
| Burial Funds Act,
the Cemetery Care Act,
the Safe and Hygienic | 16 |
| Bed Act,
the Pre-Need Cemetery Sales Act,
the High Risk Home | 17 |
| Loan Act, the Payday Loan Reform Act, the Mortgage Rescue Fraud | 18 |
| Act, subsection (a) or (b) of Section 3-10 of the
Cigarette Tax | 19 |
| Act, the Payday Loan Reform Act, subsection
(a) or (b) of | 20 |
| Section 3-10 of the Cigarette Use Tax Act, the Electronic
Mail | 21 |
| Act, the Internet Caller Identification Act, paragraph (6)
of
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| subsection (k) of Section 6-305 of the Illinois Vehicle Code, | 23 |
| Article 3 of the Residential Real Property Disclosure Act, the | 24 |
| Automatic Contract Renewal Act, or the Personal Information |
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| Protection Act , or the Health Plan Consumer Protection and | 2 |
| Ethics Act commits an unlawful practice within the meaning of | 3 |
| this Act.
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| (Source: P.A. 94-13, eff. 12-6-05; 94-36, eff. 1-1-06; 94-280, | 5 |
| eff. 1-1-06; 94-292, eff. 1-1-06; 94-822, eff. 1-1-07; 95-413, | 6 |
| eff. 1-1-08.)
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| (Text of Section after amendment by P.A. 95-562 ) | 8 |
| Sec. 2Z. Violations of other Acts. Any person who knowingly | 9 |
| violates
the Automotive Repair Act, the Automotive Collision | 10 |
| Repair Act,
the Home Repair and Remodeling Act,
the Dance | 11 |
| Studio Act,
the Physical Fitness Services Act,
the Hearing | 12 |
| Instrument Consumer Protection Act,
the Illinois Union Label | 13 |
| Act,
the Job Referral and Job Listing Services Consumer | 14 |
| Protection Act,
the Travel Promotion Consumer Protection Act,
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| the Credit Services Organizations Act,
the Automatic Telephone | 16 |
| Dialers Act,
the Pay-Per-Call Services Consumer Protection | 17 |
| Act,
the Telephone Solicitations Act,
the Illinois Funeral or | 18 |
| Burial Funds Act,
the Cemetery Care Act,
the Safe and Hygienic | 19 |
| Bed Act,
the Pre-Need Cemetery Sales Act,
the High Risk Home | 20 |
| Loan Act, the Payday Loan Reform Act, the Mortgage Rescue Fraud | 21 |
| Act, subsection (a) or (b) of Section 3-10 of the
Cigarette Tax | 22 |
| Act, the Payday Loan Reform Act, subsection
(a) or (b) of | 23 |
| Section 3-10 of the Cigarette Use Tax Act, the Electronic
Mail | 24 |
| Act, the Internet Caller Identification Act, paragraph (6)
of
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| subsection (k) of Section 6-305 of the Illinois Vehicle Code, |
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| Section 18d-115, 18d-120, 18d-125, 18d-135, or 18d-150 of the | 2 |
| Illinois Vehicle Code, Article 3 of the Residential Real | 3 |
| Property Disclosure Act, the Automatic Contract Renewal Act, or | 4 |
| the Personal Information Protection Act , or the Health Plan | 5 |
| Consumer Protection and Ethics Act commits an unlawful practice | 6 |
| within the meaning of this Act.
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| (Source: P.A. 94-13, eff. 12-6-05; 94-36, eff. 1-1-06; 94-280, | 8 |
| eff. 1-1-06; 94-292, eff. 1-1-06; 94-822, eff. 1-1-07; 95-413, | 9 |
| eff. 1-1-08; 95-562, eff. 7-1-08; revised 10-17-07.)
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| Section 95. No acceleration or delay. Where this Act makes | 11 |
| changes in a statute that is represented in this Act by text | 12 |
| that is not yet or no longer in effect (for example, a Section | 13 |
| represented by multiple versions), the use of that text does | 14 |
| not accelerate or delay the taking effect of (i) the changes | 15 |
| made by this Act or (ii) provisions derived from any other | 16 |
| Public Act.
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| Section 99. Effective date. This Act takes effect upon | 18 |
| becoming law.".
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