Full Text of HB0122 99th General Assembly
HB0122ham001 99TH GENERAL ASSEMBLY | Rep. Mary E. Flowers Filed: 3/4/2015
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| 1 | | AMENDMENT TO HOUSE BILL 122
| 2 | | AMENDMENT NO. ______. Amend House Bill 122 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Counties Code is amended by changing | 5 | | Section 5-1069.3 as
follows:
| 6 | | (55 ILCS 5/5-1069.3)
| 7 | | Sec. 5-1069.3. Required health benefits. If a county, | 8 | | including a home
rule
county, is a self-insurer for purposes of | 9 | | providing health insurance coverage
for its employees, the | 10 | | coverage shall include coverage for the post-mastectomy
care | 11 | | benefits required to be covered by a policy of accident and | 12 | | health
insurance under Section 356t and the coverage required | 13 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 14 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 15 | | 356z.14, 356z.15, and 356z.22 , 356z.23, 356z.24, and 356z.25 of
| 16 | | the Illinois Insurance Code. The coverage shall comply with |
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| 1 | | Sections 155.22a, 355b, and 356z.19 of
the Illinois Insurance | 2 | | Code. The requirement that health benefits be covered
as | 3 | | provided in this Section is an
exclusive power and function of | 4 | | the State and is a denial and limitation under
Article VII, | 5 | | Section 6, subsection (h) of the Illinois Constitution. A home
| 6 | | rule county to which this Section applies must comply with | 7 | | every provision of
this Section.
| 8 | | Rulemaking authority to implement Public Act 95-1045, if | 9 | | any, is conditioned on the rules being adopted in accordance | 10 | | with all provisions of the Illinois Administrative Procedure | 11 | | Act and all rules and procedures of the Joint Committee on | 12 | | Administrative Rules; any purported rule not so adopted, for | 13 | | whatever reason, is unauthorized. | 14 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 15 | | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .)
| 16 | | Section 10. The Illinois Municipal Code is amended by | 17 | | changing Section
10-4-2.3 as follows:
| 18 | | (65 ILCS 5/10-4-2.3)
| 19 | | Sec. 10-4-2.3. Required health benefits. If a | 20 | | municipality, including a
home rule municipality, is a | 21 | | self-insurer for purposes of providing health
insurance | 22 | | coverage for its employees, the coverage shall include coverage | 23 | | for
the post-mastectomy care benefits required to be covered by | 24 | | a policy of
accident and health insurance under Section 356t |
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| 1 | | and the coverage required
under Sections 356g, 356g.5, | 2 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 3 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, and 356z.22 , | 4 | | 356z.23, 356z.24, and 356z.25 of the Illinois
Insurance
Code. | 5 | | The coverage shall comply with Sections 155.22a, 355b, and | 6 | | 356z.19 of
the Illinois Insurance Code. The requirement that | 7 | | health
benefits be covered as provided in this is an exclusive | 8 | | power and function of
the State and is a denial and limitation | 9 | | under Article VII, Section 6,
subsection (h) of the Illinois | 10 | | Constitution. A home rule municipality to which
this Section | 11 | | applies must comply with every provision of this Section.
| 12 | | Rulemaking authority to implement Public Act 95-1045, if | 13 | | any, is conditioned on the rules being adopted in accordance | 14 | | with all provisions of the Illinois Administrative Procedure | 15 | | Act and all rules and procedures of the Joint Committee on | 16 | | Administrative Rules; any purported rule not so adopted, for | 17 | | whatever reason, is unauthorized. | 18 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 19 | | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .)
| 20 | | Section 15. The School Code is amended by changing Section | 21 | | 10-22.3f as
follows:
| 22 | | (105 ILCS 5/10-22.3f)
| 23 | | Sec. 10-22.3f. Required health benefits. Insurance | 24 | | protection and
benefits
for employees shall provide the |
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| 1 | | post-mastectomy care benefits required to be
covered by a | 2 | | policy of accident and health insurance under Section 356t and | 3 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 4 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 5 | | 356z.13, 356z.14, 356z.15, and 356z.22 , 356z.23, and 356z.24 of
| 6 | | the
Illinois Insurance Code.
Insurance policies shall comply | 7 | | with Section 356z.19 of the Illinois Insurance Code. The | 8 | | coverage shall comply with Sections 155.22a and 355b of
the | 9 | | Illinois Insurance Code.
| 10 | | Rulemaking authority to implement Public Act 95-1045, if | 11 | | any, is conditioned on the rules being adopted in accordance | 12 | | with all provisions of the Illinois Administrative Procedure | 13 | | Act and all rules and procedures of the Joint Committee on | 14 | | Administrative Rules; any purported rule not so adopted, for | 15 | | whatever reason, is unauthorized. | 16 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 17 | | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .)
| 18 | | Section 20. The Emergency Medical Treatment Act is amended | 19 | | by changing Section 1 as follows:
| 20 | | (210 ILCS 70/1) (from Ch. 111 1/2, par. 6151)
| 21 | | Sec. 1.
No hospital, physician, dentist or other provider | 22 | | of professional
health care licensed under the laws of this | 23 | | State may refuse to provide
needed emergency treatment to any | 24 | | person whose life would be threatened
in the absence of such |
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| 1 | | treatment, because of that person's inability to
pay therefor, | 2 | | nor because of the source of any payment promised therefor. | 3 | | Every hospital licensed under the Hospital Licensing Act shall | 4 | | comply with the Hospital Emergency Service Act.
| 5 | | (Source: P.A. 83-723.)
| 6 | | Section 25. The Hospital Emergency Service Act is amended | 7 | | by changing Section 1 as follows:
| 8 | | (210 ILCS 80/1) (from Ch. 111 1/2, par. 86)
| 9 | | Sec. 1.
Every hospital required to be licensed by the | 10 | | Department of Public
Health pursuant to the Hospital Licensing | 11 | | Act which provides general medical
and surgical
hospital | 12 | | services , except long-term acute care hospitals and | 13 | | rehabilitation hospitals identified in Section 1.3 of this Act, | 14 | | shall provide a hospital emergency service in accordance
with | 15 | | rules and regulations adopted by the Department of Public | 16 | | Health which shall be consistent with the federal Emergency | 17 | | Medical Treatment and Active Labor Act (42 U.S.C. 1395dd) and
| 18 | | shall furnish such hospital emergency services to any applicant | 19 | | who applies
for the same in case of injury or acute medical | 20 | | condition where the same is
liable to cause death or severe | 21 | | injury or serious illness.
For purposes of this Act, | 22 | | "applicant" includes any person who is brought
to a hospital by | 23 | | ambulance or specialized emergency medical services
vehicle as | 24 | | defined in the Emergency Medical Services (EMS) Systems Act.
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| 1 | | (Source: P.A. 97-667, eff. 1-13-12; 98-683, eff. 6-30-14.)
| 2 | | Section 30. The Illinois Insurance Code is amended by | 3 | | adding Sections
356z.23, 356z.24, and 356z.25
as
follows:
| 4 | | (215 ILCS 5/356z.23 new) | 5 | | Sec. 356z.23. Intravenous feeding. A group or individual | 6 | | policy of
accident and health insurance or managed care plan | 7 | | amended, delivered, issued,
or renewed after the effective date | 8 | | of this amendatory Act of the 99th General
Assembly must | 9 | | provide coverage for intravenous feeding. The benefits under
| 10 | | this Section shall be at least as favorable as for other | 11 | | coverages under the
policy and may be subject to the same | 12 | | dollar amount limits, deductibles, and
co-insurance | 13 | | requirements applicable generally to other coverages under the
| 14 | | policy. | 15 | | (215 ILCS 5/356z.24 new) | 16 | | Sec. 356z.24. Prescription nutritional supplements. A | 17 | | group or individual
policy of
accident and health insurance or | 18 | | managed care plan amended, delivered, issued,
or renewed
after | 19 | | the effective date of this amendatory Act of the 99th General | 20 | | Assembly
that provides
coverage for prescription drugs must | 21 | | provide coverage for reimbursement for
medically
appropriate | 22 | | prescription nutritional supplements when ordered by a | 23 | | physician
licensed to
practice medicine in all its branches and |
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| 1 | | the insured suffers from a condition
that prevents
him or her | 2 | | from taking sufficient oral nourishment to sustain life. | 3 | | (215 ILCS 5/356z.25 new) | 4 | | Sec. 356z.25. Hospital patient assessments. A group or | 5 | | individual policy of accident and health insurance or managed | 6 | | care plan amended, delivered, issued, or renewed after the | 7 | | effective date of this amendatory Act of the 99th General | 8 | | Assembly that provides coverage for hospital care shall include | 9 | | in that coverage all services ordered by a physician and | 10 | | provided in the hospital that are considered medically | 11 | | necessary for the evaluation, assessment, and diagnosis of the | 12 | | illness or condition that resulted in the hospital stay of the | 13 | | enrollee or recipient. Such services are subject to reasonable | 14 | | review and utilization standards required by the policy or plan | 15 | | for all hospital services, as defined by the Department of | 16 | | Insurance or its successor agency.
| 17 | | Section 35. The Health Maintenance Organization Act is | 18 | | amended by changing
Section 5-3 as follows:
| 19 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 20 | | Sec. 5-3. Insurance Code provisions.
| 21 | | (a) Health Maintenance Organizations
shall be subject to | 22 | | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
| 23 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, |
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| 1 | | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | 2 | | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | 3 | | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | 4 | | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | 5 | | 356z.22, 356z.23, 356z.24, 364.01, 367.2, 367.2-5, 367i, 368a, | 6 | | 368b, 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, | 7 | | 403A,
408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of | 8 | | subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
| 9 | | XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois | 10 | | Insurance Code.
| 11 | | (b) For purposes of the Illinois Insurance Code, except for | 12 | | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 13 | | Maintenance Organizations in
the following categories are | 14 | | deemed to be "domestic companies":
| 15 | | (1) a corporation authorized under the
Dental Service | 16 | | Plan Act or the Voluntary Health Services Plans Act;
| 17 | | (2) a corporation organized under the laws of this | 18 | | State; or
| 19 | | (3) a corporation organized under the laws of another | 20 | | state, 30% or more
of the enrollees of which are residents | 21 | | of this State, except a
corporation subject to | 22 | | substantially the same requirements in its state of
| 23 | | organization as is a "domestic company" under Article VIII | 24 | | 1/2 of the
Illinois Insurance Code.
| 25 | | (c) In considering the merger, consolidation, or other | 26 | | acquisition of
control of a Health Maintenance Organization |
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| 1 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 2 | | (1) the Director shall give primary consideration to | 3 | | the continuation of
benefits to enrollees and the financial | 4 | | conditions of the acquired Health
Maintenance Organization | 5 | | after the merger, consolidation, or other
acquisition of | 6 | | control takes effect;
| 7 | | (2)(i) the criteria specified in subsection (1)(b) of | 8 | | Section 131.8 of
the Illinois Insurance Code shall not | 9 | | apply and (ii) the Director, in making
his determination | 10 | | with respect to the merger, consolidation, or other
| 11 | | acquisition of control, need not take into account the | 12 | | effect on
competition of the merger, consolidation, or | 13 | | other acquisition of control;
| 14 | | (3) the Director shall have the power to require the | 15 | | following
information:
| 16 | | (A) certification by an independent actuary of the | 17 | | adequacy
of the reserves of the Health Maintenance | 18 | | Organization sought to be acquired;
| 19 | | (B) pro forma financial statements reflecting the | 20 | | combined balance
sheets of the acquiring company and | 21 | | the Health Maintenance Organization sought
to be | 22 | | acquired as of the end of the preceding year and as of | 23 | | a date 90 days
prior to the acquisition, as well as pro | 24 | | forma financial statements
reflecting projected | 25 | | combined operation for a period of 2 years;
| 26 | | (C) a pro forma business plan detailing an |
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| 1 | | acquiring party's plans with
respect to the operation | 2 | | of the Health Maintenance Organization sought to
be | 3 | | acquired for a period of not less than 3 years; and
| 4 | | (D) such other information as the Director shall | 5 | | require.
| 6 | | (d) The provisions of Article VIII 1/2 of the Illinois | 7 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 8 | | any health maintenance
organization of greater than 10% of its
| 9 | | enrollee population (including without limitation the health | 10 | | maintenance
organization's right, title, and interest in and to | 11 | | its health care
certificates).
| 12 | | (e) In considering any management contract or service | 13 | | agreement subject
to Section 141.1 of the Illinois Insurance | 14 | | Code, the Director (i) shall, in
addition to the criteria | 15 | | specified in Section 141.2 of the Illinois
Insurance Code, take | 16 | | into account the effect of the management contract or
service | 17 | | agreement on the continuation of benefits to enrollees and the
| 18 | | financial condition of the health maintenance organization to | 19 | | be managed or
serviced, and (ii) need not take into account the | 20 | | effect of the management
contract or service agreement on | 21 | | competition.
| 22 | | (f) Except for small employer groups as defined in the | 23 | | Small Employer
Rating, Renewability and Portability Health | 24 | | Insurance Act and except for
medicare supplement policies as | 25 | | defined in Section 363 of the Illinois
Insurance Code, a Health | 26 | | Maintenance Organization may by contract agree with a
group or |
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| 1 | | other enrollment unit to effect refunds or charge additional | 2 | | premiums
under the following terms and conditions:
| 3 | | (i) the amount of, and other terms and conditions with | 4 | | respect to, the
refund or additional premium are set forth | 5 | | in the group or enrollment unit
contract agreed in advance | 6 | | of the period for which a refund is to be paid or
| 7 | | additional premium is to be charged (which period shall not | 8 | | be less than one
year); and
| 9 | | (ii) the amount of the refund or additional premium | 10 | | shall not exceed 20%
of the Health Maintenance | 11 | | Organization's profitable or unprofitable experience
with | 12 | | respect to the group or other enrollment unit for the | 13 | | period (and, for
purposes of a refund or additional | 14 | | premium, the profitable or unprofitable
experience shall | 15 | | be calculated taking into account a pro rata share of the
| 16 | | Health Maintenance Organization's administrative and | 17 | | marketing expenses, but
shall not include any refund to be | 18 | | made or additional premium to be paid
pursuant to this | 19 | | subsection (f)). The Health Maintenance Organization and | 20 | | the
group or enrollment unit may agree that the profitable | 21 | | or unprofitable
experience may be calculated taking into | 22 | | account the refund period and the
immediately preceding 2 | 23 | | plan years.
| 24 | | The Health Maintenance Organization shall include a | 25 | | statement in the
evidence of coverage issued to each enrollee | 26 | | describing the possibility of a
refund or additional premium, |
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| 1 | | and upon request of any group or enrollment unit,
provide to | 2 | | the group or enrollment unit a description of the method used | 3 | | to
calculate (1) the Health Maintenance Organization's | 4 | | profitable experience with
respect to the group or enrollment | 5 | | unit and the resulting refund to the group
or enrollment unit | 6 | | or (2) the Health Maintenance Organization's unprofitable
| 7 | | experience with respect to the group or enrollment unit and the | 8 | | resulting
additional premium to be paid by the group or | 9 | | enrollment unit.
| 10 | | In no event shall the Illinois Health Maintenance | 11 | | Organization
Guaranty Association be liable to pay any | 12 | | contractual obligation of an
insolvent organization to pay any | 13 | | refund authorized under this Section.
| 14 | | (g) Rulemaking authority to implement Public Act 95-1045, | 15 | | if any, is conditioned on the rules being adopted in accordance | 16 | | with all provisions of the Illinois Administrative Procedure | 17 | | Act and all rules and procedures of the Joint Committee on | 18 | | Administrative Rules; any purported rule not so adopted, for | 19 | | whatever reason, is unauthorized. | 20 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437, | 21 | | eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, | 22 | | eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; | 23 | | 98-1091, eff. 1-1-15 .)
| 24 | | Section 40. The Voluntary Health Services Plans Act is | 25 | | amended by changing
Section 10 as follows:
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| 1 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 2 | | Sec. 10. Application of Insurance Code provisions. Health | 3 | | services
plan corporations and all persons interested therein | 4 | | or dealing therewith
shall be subject to the provisions of | 5 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | 6 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g, | 7 | | 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 356y, | 8 | | 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
| 9 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, | 10 | | 356z.19, 356z.21, 356z.22, 356z.23, 356z.24, 364.01, 367.2, | 11 | | 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, and | 12 | | paragraphs (7) and (15) of Section 367 of the Illinois
| 13 | | Insurance Code.
| 14 | | Rulemaking authority to implement Public Act 95-1045, if | 15 | | any, is conditioned on the rules being adopted in accordance | 16 | | with all provisions of the Illinois Administrative Procedure | 17 | | Act and all rules and procedures of the Joint Committee on | 18 | | Administrative Rules; any purported rule not so adopted, for | 19 | | whatever reason, is unauthorized. | 20 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486, | 21 | | eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, | 22 | | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .)
| 23 | | Section 45. The Health Carrier External Review Act is | 24 | | amended by changing Section 35 and by adding Sections 25.1, |
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| 1 | | 25.2, 25.3, 25.4, 25.5, and 25.6 as follows: | 2 | | (215 ILCS 180/25.1 new) | 3 | | Sec. 25.1. Standard
information for application forms. | 4 | | (a) The Director shall establish standard
information and | 5 | | health history questions that shall be used by all
health care | 6 | | service plans for their individual health care coverage
| 7 | | application forms for individual health plan contracts and
| 8 | | individual health insurance policies. The health care service | 9 | | plan
and health insurance application forms for individual | 10 | | health plan
contracts and health insurance policies may only | 11 | | contain questions
approved by the Director. | 12 | | (b) The standard information and health history questions
| 13 | | developed by the Director shall contain clear and unambiguous
| 14 | | information and questions designed to ascertain the health | 15 | | history of
the applicant and shall be based on the medical | 16 | | information that is
reasonable and necessary for medical | 17 | | underwriting purposes. | 18 | | (c) The application form shall include a prominently | 19 | | displayed
notice that shall read:
"Illinois law prohibits an | 20 | | HIV test from being required or used
by health care service | 21 | | plans as a condition of obtaining coverage.". | 22 | | (d) No later than 6 months after the adoption of the | 23 | | regulation
under subsection (a) of this Section, all individual | 24 | | health care service plan
application forms shall utilize only | 25 | | the pool of approved questions
and the standardized information |
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| 1 | | established pursuant to subsection (a). | 2 | | (e) On and after January 1, 2015, all individual health | 3 | | care
service plan applications shall be reviewed and approved | 4 | | by the
Director before they may be used by a health care | 5 | | service plan. | 6 | | (215 ILCS 180/25.2 new) | 7 | | Sec. 25.2. Medical
underwriting. | 8 | | (a) "Medical underwriting" means the completion of a | 9 | | reasonable
investigation of the applicant's health history | 10 | | information, which
includes, but is not limited to, the | 11 | | following: | 12 | | (1) Ensuring that the information submitted on the | 13 | | application
form and the material submitted with the | 14 | | application form are
complete and accurate. | 15 | | (2) Resolving all reasonable questions arising from | 16 | | the
application form or any materials submitted with the | 17 | | application form or
any information obtained by the health | 18 | | care service plan as part of
its verification of the | 19 | | accuracy and completeness of the application
form. | 20 | | (b) A health care service plan shall complete medical
| 21 | | underwriting prior to issuing an enrollee or subscriber health | 22 | | care
service plan contract. | 23 | | (c) A health care service plan shall adopt and implement | 24 | | written
medical underwriting policies and procedures to ensure | 25 | | that the
health care service plan does all of the following |
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| 1 | | with respect to an
application for health care coverage: | 2 | | (1) Reviews all of the following:
| 3 | | (A) Information on the application and any | 4 | | materials submitted
with the application form for | 5 | | accuracy and completeness.
| 6 | | (B) Claims information about the applicant that is | 7 | | within the
health care service plan's own claims | 8 | | information.
| 9 | | (C) At least one commercially available | 10 | | prescription drug database
for information about the | 11 | | applicant.
| 12 | | (2) Identifies and makes inquiries, including | 13 | | contacting the
applicant about any questions raised by | 14 | | omissions, ambiguities, or
inconsistencies based upon the | 15 | | information collected pursuant to
item (1) of this | 16 | | subsection (c).
| 17 | | (d) The plan shall document all information collected | 18 | | during the
underwriting review process.
| 19 | | (e) On or before January 1, 2015, a health care service | 20 | | plan shall
file its medical underwriting policies and | 21 | | procedures with the
Department.
| 22 | | (215 ILCS 180/25.3 new) | 23 | | Sec. 25.3. Copies of application and contract; notice. | 24 | | (a) Within 10 business days after issuing a health care
| 25 | | service plan contract, the health care service plan shall send |
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| 1 | | a copy
of the completed written application to the applicant | 2 | | with a copy of
the health care service plan contract issued by | 3 | | the health care
service plan, along with a notice that states | 4 | | all of the following:
| 5 | | (1) The applicant should review the completed | 6 | | application
carefully and notify the health care service | 7 | | plan within 30 days of
any inaccuracy in the application.
| 8 | | (2) Any intentional material misrepresentation or | 9 | | intentional
material omission in the information submitted | 10 | | in the application may
result in the cancellation or | 11 | | rescission of the plan contract.
| 12 | | (3) The applicant should retain a copy of the completed | 13 | | written
application for the applicant's records.
| 14 | | (b) If new information is provided by the applicant within | 15 | | the
30-day period permitted by subsection (a), then the | 16 | | provisions concerning medical underwriting shall apply to the | 17 | | new information.
| 18 | | (215 ILCS 180/25.4 new) | 19 | | Sec. 25.4. Rescission; cancellation. | 20 | | (a) Once a plan has issued an individual health care
| 21 | | service plan contract, the health care service plan shall not | 22 | | rescind
or cancel the health care service plan contract unless | 23 | | all of the
following apply:
| 24 | | (1) There was a material misrepresentation or material | 25 | | omission in
the information submitted by the applicant in |
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| 1 | | the written
application to the health care service plan | 2 | | prior to the issuance of
the health care service plan | 3 | | contract that would have prevented the
contract from being | 4 | | entered into.
| 5 | | (2) The health care service plan completed medical | 6 | | underwriting before issuing the plan contract.
| 7 | | (3) The health care service plan demonstrates that the | 8 | | applicant
intentionally misrepresented or intentionally | 9 | | omitted material
information on the application prior to | 10 | | the issuance of the plan
contract with the purpose of | 11 | | misrepresenting his or her health
history in order to | 12 | | obtain health care coverage.
| 13 | | (4) The application form was approved by the | 14 | | Department.
| 15 | | (5) The health care service plan sent a copy of the | 16 | | completed
written application to the applicant with a copy | 17 | | of the health care
service plan contract issued by the | 18 | | health care service plan.
| 19 | | (b) Notwithstanding subsection (a) of this Section, an | 20 | | enrollment or subscription
may be canceled or not renewed for | 21 | | failure to pay the fees for
that coverage.
| 22 | | (215 ILCS 180/25.5 new) | 23 | | Sec. 25.5. Postcontract investigation. | 24 | | (a) If a health care service plan obtains information
after | 25 | | issuing an individual health care service plan contract that
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| 1 | | the subscriber or enrollee may have intentionally omitted or
| 2 | | intentionally misrepresented material information during the
| 3 | | application for coverage process, then the health care service | 4 | | plan may
investigate the potential omissions or | 5 | | misrepresentations in order to
determine whether the | 6 | | subscriber's or enrollee's health care service
plan contract | 7 | | may be rescinded or canceled.
| 8 | | (b) The following provisions shall apply to a postcontract | 9 | | issuance investigation: | 10 | | (1) Upon initiating a postcontract issuance | 11 | | investigation for
potential rescission or cancellation of | 12 | | health care coverage, the
plan shall provide a written | 13 | | notice to the enrollee or subscriber by
regular and | 14 | | certified mail that it has initiated an investigation of
| 15 | | intentional material misrepresentation or intentional | 16 | | material
omission on the part of the enrollee or subscriber | 17 | | and that the
investigation could lead to the rescission or | 18 | | cancellation of the
enrollee's or subscriber's health care | 19 | | service plan contract. The
notice shall be provided by the | 20 | | health care service plan within 5
days of the initiation of | 21 | | the investigation.
| 22 | | (2) The written notice required under item (1) of this | 23 | | subsection (b) shall include
full disclosure of the | 24 | | allegedly intentional material omission or
| 25 | | misrepresentation and a clear and concise explanation of | 26 | | why the
information has resulted in the health care service |
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| 1 | | plan's initiation
of an investigation to determine whether | 2 | | rescission or cancellation
is warranted. The notice shall | 3 | | invite the enrollee or subscriber to
provide any evidence | 4 | | or information within 45 business days to negate
the plan's | 5 | | reasons for initiating the postissuance investigation.
| 6 | | (3) The plan shall complete its investigation no later | 7 | | than 90
days after the date that the notice is sent to the | 8 | | enrollee or subscriber
pursuant to item (1) of this | 9 | | subsection (b).
| 10 | | (4) Upon completion of its postissuance investigation, | 11 | | the plan
shall provide written notice by regular and | 12 | | certified mail to the
subscriber or enrollee that it has | 13 | | concluded its investigation and
has made one of the | 14 | | following determinations:
| 15 | | (A) The plan has determined that the enrollee or | 16 | | subscriber did
not intentionally misrepresent or | 17 | | intentionally omit material
information during the | 18 | | application process and that the subscriber's
or | 19 | | enrollee's health care coverage will not be canceled or | 20 | | rescinded.
| 21 | | (B) The plan intends to seek approval from the | 22 | | Director to cancel
or rescind the enrollee's or | 23 | | subscriber's health care service plan
contract for | 24 | | intentional misrepresentation or intentional omission | 25 | | of
material information during the application for | 26 | | coverage process.
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| 1 | | (5) The written notice required under paragraph (B) of
| 2 | | item (4) of this subsection (b) shall do all of the | 3 | | following:
| 4 | | (A) Include full disclosure of the nature and | 5 | | substance of any
information that led to the plan's | 6 | | determination that the enrollee or
subscriber | 7 | | intentionally misrepresented or intentionally omitted
| 8 | | material information on the application form.
| 9 | | (B) Provide the enrollee or subscriber with | 10 | | information indicating
that the health plan's | 11 | | determination shall not become final until it
is | 12 | | reviewed and approved by the Department's independent | 13 | | review
process.
| 14 | | (C) Provide the enrollee or subscriber with | 15 | | information regarding
the Department's independent | 16 | | review process and the right of the
enrollee or | 17 | | subscriber to opt out of that review process within 45
| 18 | | days of the date upon which an independent review | 19 | | organization
receives a request for independent | 20 | | review.
| 21 | | (D) Provide a statement that the health care | 22 | | service plan's
proposed decision to cancel or rescind | 23 | | the health care service plan
contract shall not become | 24 | | effective unless the Department's
independent review | 25 | | organization upholds the health care service plan's | 26 | | decision or unless the enrollee or subscriber has opted |
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| 1 | | out of the
independent review. | 2 | | (215 ILCS 180/25.6 new) | 3 | | Sec. 25.6. Continuation. | 4 | | (a) A health care service plan shall continue to
authorize | 5 | | and provide all medically necessary health care services
| 6 | | required to be covered under an enrollee's or subscriber's | 7 | | health
care service plan contract until the effective date of | 8 | | cancellation
or rescission.
| 9 | | (b) The effective date of the health care service plan's
| 10 | | cancellation or the date upon which the plan may initiate a
| 11 | | rescission shall be no earlier than the date that the enrollee | 12 | | or
subscriber receives notification via regular and certified | 13 | | mail that
the independent review organization has made a | 14 | | determination
upholding the health care service plan's | 15 | | decision to rescind or
cancel.
| 16 | | (215 ILCS 180/35)
| 17 | | Sec. 35. Standard external review. | 18 | | (a) Within 4 months after the date of receipt of a notice | 19 | | of an adverse determination or final adverse determination, a | 20 | | covered person or the covered person's authorized | 21 | | representative may file a request for an external review with | 22 | | the Director. Within one business day after the date of receipt | 23 | | of a request for external review, the Director shall send a | 24 | | copy of the request to the health carrier. |
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| 1 | | (b) Within 5 business days following the date of receipt of | 2 | | the external review request, the health carrier shall complete | 3 | | a preliminary review of the request to determine whether:
| 4 | | (1) the individual is or was a covered person in the | 5 | | health benefit plan at the time the health care service was | 6 | | requested or at the time the health care service was | 7 | | provided; | 8 | | (2) the health care service that is the subject of the | 9 | | adverse determination or the final adverse determination | 10 | | is a covered service under the covered person's health | 11 | | benefit plan, but the health carrier has determined that | 12 | | the health care service is not covered; | 13 | | (3) the covered person has exhausted the health | 14 | | carrier's internal appeal process unless the covered | 15 | | person is not required to exhaust the health carrier's | 16 | | internal appeal process pursuant to this Act; | 17 | | (4) (blank); and | 18 | | (5) the covered person has provided all the information | 19 | | and forms required to process an external review, as | 20 | | specified in this Act. | 21 | | (c) Within one business day after completion of the | 22 | | preliminary review, the health carrier shall notify the | 23 | | Director and covered person and, if applicable, the covered | 24 | | person's authorized representative in writing whether the | 25 | | request is complete and eligible for external review. If the | 26 | | request: |
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| 1 | | (1) is not complete, the health carrier shall inform | 2 | | the Director and covered person and, if applicable, the | 3 | | covered person's authorized representative in writing and | 4 | | include in the notice what information or materials are | 5 | | required by this Act to make the request complete; or | 6 | | (2) is not eligible for external review, the health | 7 | | carrier shall inform the Director and covered person and, | 8 | | if applicable, the covered person's authorized | 9 | | representative in writing and include in the notice the | 10 | | reasons for its ineligibility.
| 11 | | The Department may specify the form for the health | 12 | | carrier's notice of initial determination under this | 13 | | subsection (c) and any supporting information to be included in | 14 | | the notice. | 15 | | The notice of initial determination of ineligibility shall | 16 | | include a statement informing the covered person and, if | 17 | | applicable, the covered person's authorized representative | 18 | | that a health carrier's initial determination that the external | 19 | | review request is ineligible for review may be appealed to the | 20 | | Director by filing a complaint with the Director. | 21 | | Notwithstanding a health carrier's initial determination | 22 | | that the request is ineligible for external review, the | 23 | | Director may determine that a request is eligible for external | 24 | | review and require that it be referred for external review. In | 25 | | making such determination, the Director's decision shall be in | 26 | | accordance with the terms of the covered person's health |
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| 1 | | benefit plan, unless such terms are inconsistent with | 2 | | applicable law, and shall be subject to all applicable | 3 | | provisions of this Act. | 4 | | (d) Whenever the Director receives notice that a request is | 5 | | eligible for external review following the preliminary review | 6 | | conducted pursuant to this Section, within one business day | 7 | | after the date of receipt of the notice, the Director shall: | 8 | | (1) assign an independent review organization from the | 9 | | list of approved independent review organizations compiled | 10 | | and maintained by the Director pursuant to this Act and | 11 | | notify the health carrier of the name of the assigned | 12 | | independent review organization; and | 13 | | (2) notify in writing the covered person and, if | 14 | | applicable, the covered person's authorized representative | 15 | | of the request's eligibility and acceptance for external | 16 | | review and the name of the independent review organization. | 17 | | The Director shall include in the notice provided to the | 18 | | covered person and, if applicable, the covered person's | 19 | | authorized representative a statement that the covered person | 20 | | or the covered person's authorized representative may, within 5 | 21 | | business days following the date of receipt of the notice | 22 | | provided pursuant to item (2) of this subsection (d), submit in | 23 | | writing to the assigned independent review organization | 24 | | additional information that the independent review | 25 | | organization shall consider when conducting the external | 26 | | review. The independent review organization is not required to, |
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| 1 | | but may, accept and consider additional information submitted | 2 | | after 5 business days. | 3 | | (e) The assignment by the Director of an approved | 4 | | independent review organization to conduct an external review | 5 | | in accordance with this Section shall be done on a random basis | 6 | | among those independent review organizations approved by the | 7 | | Director pursuant to this Act. | 8 | | (f) Within 5 business days after the date of receipt of the | 9 | | notice provided pursuant to item (1) of subsection (d) of this | 10 | | Section, the health carrier or its designee utilization review | 11 | | organization shall provide to the assigned independent review | 12 | | organization the documents and any information considered in | 13 | | making the adverse determination or final adverse | 14 | | determination; in such cases, the following provisions shall | 15 | | apply: | 16 | | (1) Except as provided in item (2) of this subsection | 17 | | (f), failure by the health carrier or its utilization | 18 | | review organization to provide the documents and | 19 | | information within the specified time frame shall not delay | 20 | | the conduct of the external review. | 21 | | (2) If the health carrier or its utilization review | 22 | | organization fails to provide the documents and | 23 | | information within the specified time frame, the assigned | 24 | | independent review organization may terminate the external | 25 | | review and make a decision to reverse the adverse | 26 | | determination or final adverse determination. |
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| 1 | | (3) Within one business day after making the decision | 2 | | to terminate the external review and make a decision to | 3 | | reverse the adverse determination or final adverse | 4 | | determination under item (2) of this subsection (f), the | 5 | | independent review organization shall notify the Director, | 6 | | the health carrier, the covered person and, if applicable, | 7 | | the covered person's authorized representative, of its | 8 | | decision to reverse the adverse determination. | 9 | | (g) Upon receipt of the information from the health carrier | 10 | | or its utilization review organization, the assigned | 11 | | independent review organization shall review all of the | 12 | | information and documents and any other information submitted | 13 | | in writing to the independent review organization by the | 14 | | covered person and the covered person's authorized | 15 | | representative. | 16 | | (h) Upon receipt of any information submitted by the | 17 | | covered person or the covered person's authorized | 18 | | representative, the independent review organization shall | 19 | | forward the information to the health carrier within 1 business | 20 | | day. | 21 | | (1) Upon receipt of the information, if any, the health | 22 | | carrier may reconsider its adverse determination or final | 23 | | adverse determination that is the subject of the external | 24 | | review.
| 25 | | (2) Reconsideration by the health carrier of its | 26 | | adverse determination or final adverse determination shall |
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| 1 | | not delay or terminate the external review.
| 2 | | (3) The external review may only be terminated if the | 3 | | health carrier decides, upon completion of its | 4 | | reconsideration, to reverse its adverse determination or | 5 | | final adverse determination and provide coverage or | 6 | | payment for the health care service that is the subject of | 7 | | the adverse determination or final adverse determination. | 8 | | In such cases, the following provisions shall apply: | 9 | | (A) Within one business day after making the | 10 | | decision to reverse its adverse determination or final | 11 | | adverse determination, the health carrier shall notify | 12 | | the Director, the covered person and, if applicable, | 13 | | the covered person's authorized representative, and | 14 | | the assigned independent review organization in | 15 | | writing of its decision. | 16 | | (B) Upon notice from the health carrier that the | 17 | | health carrier has made a decision to reverse its | 18 | | adverse determination or final adverse determination, | 19 | | the assigned independent review organization shall | 20 | | terminate the external review. | 21 | | (i) In addition to the documents and information provided | 22 | | by the health carrier or its utilization review organization | 23 | | and the covered person and the covered person's authorized | 24 | | representative, if any, the independent review organization, | 25 | | to the extent the information or documents are available and | 26 | | the independent review organization considers them |
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| 1 | | appropriate, shall consider the following in reaching a | 2 | | decision: | 3 | | (1) the covered person's pertinent medical records; | 4 | | (2) the covered person's health care provider's | 5 | | recommendation; | 6 | | (3) consulting reports from appropriate health care | 7 | | providers and other documents submitted by the health | 8 | | carrier or its designee utilization review organization, | 9 | | the covered person, the covered person's authorized | 10 | | representative, or the covered person's treating provider; | 11 | | (4) the terms of coverage under the covered person's | 12 | | health benefit plan with the health carrier to ensure that | 13 | | the independent review organization's decision is not | 14 | | contrary to the terms of coverage under the covered | 15 | | person's health benefit plan with the health carrier, | 16 | | unless the terms are inconsistent with applicable law; | 17 | | (5) the most appropriate practice guidelines, which | 18 | | shall include applicable evidence-based standards and may | 19 | | include any other practice guidelines developed by the | 20 | | federal government, national or professional medical | 21 | | societies, boards, and associations; | 22 | | (6) any applicable clinical review criteria developed | 23 | | and used by the health carrier or its designee utilization | 24 | | review organization; | 25 | | (7) the opinion of the independent review | 26 | | organization's clinical reviewer or reviewers after |
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| 1 | | considering items (1) through (6) of this subsection (i) to | 2 | | the extent the information or documents are available and | 3 | | the clinical reviewer or reviewers considers the | 4 | | information or documents appropriate; and | 5 | | (8) (blank). | 6 | | (j) Within 5 days after the date of receipt of all | 7 | | necessary information, but in no event more than 45 days after | 8 | | the date of receipt of the request for an external review, the | 9 | | assigned independent review organization shall provide written | 10 | | notice of its decision to uphold or reverse the adverse | 11 | | determination or the final adverse determination to the | 12 | | Director, the health carrier, the covered person, and, if | 13 | | applicable, the covered person's authorized representative. In | 14 | | reaching a decision, the assigned independent review | 15 | | organization is not bound by any claim determinations reached | 16 | | prior to the submission of information to the independent | 17 | | review organization. The assigned independent review | 18 | | organization shall independently determine if the health care | 19 | | services under review are the medically necessary health care | 20 | | services that a physician, exercising prudent clinical | 21 | | judgment, would provide to a patient for the purpose of | 22 | | preventing, evaluating, diagnosing, or treating an illness, | 23 | | injury, disease, or its symptoms and are: (i) in accordance | 24 | | with generally accepted standards of medical practice; (ii) | 25 | | clinically appropriate, in terms of type, frequency, extent, | 26 | | site, and duration and considered effective for the patient's |
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| 1 | | illness, injury, or disease; and (iii) not primarily for the | 2 | | convenience of the patient, physician, or other health care | 3 | | provider. For the purposes of this subsection (j), "generally | 4 | | accepted standards of medical practice" means standards that | 5 | | are based on credible scientific evidence published in | 6 | | peer-reviewed medical literature generally recognized by the | 7 | | relevant medical community, physician specialty society | 8 | | recommendations, and the views of physicians practicing in | 9 | | relevant clinical areas and any other relevant factors. In such | 10 | | cases, the following provisions shall apply: | 11 | | (1) The independent review organization shall include | 12 | | in the notice: | 13 | | (A) a general description of the reason for the | 14 | | request for external review; | 15 | | (B) the date the independent review organization | 16 | | received the assignment from the Director to conduct | 17 | | the external review; | 18 | | (C) the time period during which the external | 19 | | review was conducted; | 20 | | (D) references to the evidence or documentation, | 21 | | including the evidence-based standards, considered in | 22 | | reaching its decision; | 23 | | (E) the date of its decision; | 24 | | (F) the principal reason or reasons for its | 25 | | decision, including what applicable, if any, | 26 | | evidence-based standards that were a basis for its |
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| 1 | | decision; and
| 2 | | (G) the rationale for its decision. | 3 | | (2) (Blank). | 4 | | (3) (Blank). | 5 | | (4) Upon receipt of a notice of a decision reversing | 6 | | the adverse determination or final adverse determination, | 7 | | the health carrier immediately shall approve the coverage | 8 | | that was the subject of the adverse determination or final | 9 | | adverse determination.
| 10 | | (Source: P.A. 96-857, eff. 7-1-10; 96-967, eff. 1-1-11; 97-574, | 11 | | eff. 8-26-11.) | 12 | | Section 50. The Illinois Public Aid Code is amended by | 13 | | changing Section 5-16.8 as follows:
| 14 | | (305 ILCS 5/5-16.8)
| 15 | | Sec. 5-16.8. Required health benefits. The medical | 16 | | assistance program
shall
(i) provide the post-mastectomy care | 17 | | benefits required to be covered by a policy of
accident and | 18 | | health insurance under Section 356t and the coverage required
| 19 | | under Sections 356g.5, 356u, 356w, 356x, and 356z.6 , and | 20 | | 356z.25 of the Illinois
Insurance Code and (ii) be subject to | 21 | | the provisions of Sections 356z.19 and 364.01 of the Illinois
| 22 | | Insurance Code.
| 23 | | On and after July 1, 2012, the Department shall reduce any | 24 | | rate of reimbursement for services or other payments or alter |
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| 1 | | any methodologies authorized by this Code to reduce any rate of | 2 | | reimbursement for services or other payments in accordance with | 3 | | Section 5-5e. | 4 | | (Source: P.A. 97-282, eff. 8-9-11; 97-689, eff. 6-14-12.)
| 5 | | Section 55. The Medical Patient Rights Act is amended by | 6 | | changing Sections 2.04 and 3 and by adding Section 2.06 as | 7 | | follows:
| 8 | | (410 ILCS 50/2.04) (from Ch. 111 1/2, par. 5402.04)
| 9 | | Sec. 2.04.
"Insurance company" means (1) an insurance | 10 | | company, fraternal
benefit society, and any other insurer | 11 | | subject to regulation under the
Illinois Insurance Code; or (2) | 12 | | a health maintenance organization , a limited health service | 13 | | organization under the Limited Health Service Organization | 14 | | Act, or a voluntary health services plan under the Voluntary | 15 | | Health Services Plans Act .
| 16 | | (Source: P.A. 85-677; 85-679.)
| 17 | | (410 ILCS 50/2.06 new) | 18 | | Sec. 2.06. Health insurance policy or health care plan. | 19 | | "Health insurance policy or health care plan" means any policy | 20 | | of health or accident insurance provided by a health insurance | 21 | | company or under the Counties Code, or the Illinois Municipal | 22 | | Code or medical assistance provided under the Illinois Public | 23 | | Aid Code.
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| 1 | | (410 ILCS 50/3) (from Ch. 111 1/2, par. 5403)
| 2 | | Sec. 3. The following rights are hereby established:
| 3 | | (a) The right of each patient to care consistent with sound | 4 | | nursing and
medical practices, to be informed of the name of | 5 | | the physician responsible
for coordinating his or her care, to | 6 | | receive information concerning his or
her condition and | 7 | | proposed treatment, to refuse any treatment to the extent
| 8 | | permitted by law, and to privacy and confidentiality of records | 9 | | except as
otherwise provided by law. Each patient has a right | 10 | | to be informed of his or her inpatient or outpatient status | 11 | | while undergoing evaluation, assessment, diagnosis, treatment, | 12 | | or observation in a hospital. The patient must be informed of | 13 | | this status and put on notice that this admission status may | 14 | | affect coverage by his or her health insurance policy or health | 15 | | care plan or his or her personal responsibility for payment.
| 16 | | (b) The right of each patient, regardless of source of | 17 | | payment, to examine
and receive a reasonable explanation of his | 18 | | total bill for services rendered
by his physician or health | 19 | | care provider, including the itemized charges
for specific | 20 | | services received. Each physician or health care provider
shall | 21 | | be responsible only for a reasonable explanation of those | 22 | | specific
services provided by such physician or health care | 23 | | provider.
| 24 | | (c) In the event an insurance company or health services | 25 | | corporation cancels
or refuses to renew an individual policy or |
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| 1 | | plan, the insured patient shall
be entitled to timely, prior | 2 | | notice of the termination of such policy or plan.
| 3 | | An insurance company or health services corporation that | 4 | | requires any
insured patient or applicant for new or continued | 5 | | insurance or coverage to
be tested for infection with human | 6 | | immunodeficiency virus (HIV) or any
other identified causative | 7 | | agent of acquired immunodeficiency syndrome
(AIDS) shall (1) | 8 | | give the patient or applicant prior written notice of such
| 9 | | requirement, (2) proceed with such testing only upon the | 10 | | written
authorization of the applicant or patient, and (3) keep | 11 | | the results of such
testing confidential. Notice of an adverse | 12 | | underwriting or coverage
decision may be given to any | 13 | | appropriately interested party, but the
insurer may only | 14 | | disclose the test result itself to a physician designated
by | 15 | | the applicant or patient, and any such disclosure shall be in a | 16 | | manner
that assures confidentiality.
| 17 | | The Department of Insurance shall enforce the provisions of | 18 | | this subsection.
| 19 | | (d) The right of each patient to privacy and | 20 | | confidentiality in health
care. Each physician, health care | 21 | | provider, health services corporation and
insurance company | 22 | | shall refrain from disclosing the nature or details of
services | 23 | | provided to patients, except that such information may be | 24 | | disclosed: (1) to the
patient, (2) to the party making | 25 | | treatment decisions if the patient is incapable
of making | 26 | | decisions regarding the health services provided, (3) for |
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| 1 | | treatment in accordance with 45 CFR 164.501 and 164.506, (4) | 2 | | for
payment in accordance with 45 CFR 164.501 and 164.506, (5) | 3 | | to those parties responsible for peer review,
utilization | 4 | | review, and quality assurance, (6) for health care operations | 5 | | in accordance with 45 CFR 164.501 and 164.506, (7) to those | 6 | | parties required to
be notified under the Abused and Neglected | 7 | | Child Reporting Act or the
Illinois Sexually Transmissible | 8 | | Disease Control Act, or (8) as otherwise permitted,
authorized, | 9 | | or required by State or federal law. This right may be waived | 10 | | in writing by the
patient or the patient's guardian or legal | 11 | | representative, but a physician or other health care
provider | 12 | | may not condition the provision of services on the patient's,
| 13 | | guardian's, or legal representative's agreement to sign such a | 14 | | waiver. In the interest of public health, safety, and welfare, | 15 | | patient information, including, but not limited to, health | 16 | | information, demographic information, and information about | 17 | | the services provided to patients, may be transmitted to or | 18 | | through a health information exchange, as that term is defined | 19 | | in Section 2 of the Mental Health and Developmental | 20 | | Disabilities Confidentiality Act, in accordance with the | 21 | | disclosures permitted pursuant to this Section. Patients shall | 22 | | be provided the opportunity to opt out of their health | 23 | | information being transmitted to or through a health | 24 | | information exchange in accordance with the regulations, | 25 | | standards, or contractual obligations adopted by the Illinois | 26 | | Health Information Exchange Authority in accordance with |
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| 1 | | Section 9.6 of the Mental Health and Developmental Disabilities | 2 | | Confidentiality Act, Section 9.6 of the AIDS Confidentiality | 3 | | Act, or Section 31.8 of the Genetic Information Privacy Act, as | 4 | | applicable. In the case of a patient choosing to opt out of | 5 | | having his or her information available on an HIE, nothing in | 6 | | this Act shall cause the physician or health care provider to | 7 | | be liable for the release of a patient's health information by | 8 | | other entities that may possess such information, including, | 9 | | but not limited to, other health professionals, providers, | 10 | | laboratories, pharmacies, hospitals, ambulatory surgical | 11 | | centers, and nursing homes.
| 12 | | (Source: P.A. 98-1046, eff. 1-1-15 .)
| 13 | | Section 90. The State Mandates Act is amended by adding | 14 | | Section 8.39 as follows: | 15 | | (30 ILCS 805/8.39 new) | 16 | | Sec. 8.39. Exempt mandate. Notwithstanding Sections 6 and 8 | 17 | | of this Act, no reimbursement by the State is required for the | 18 | | implementation of any mandate created by this amendatory Act of | 19 | | the 99th General Assembly.
| 20 | | (210 ILCS 80/1.3 rep.) | 21 | | Section 95. The Hospital Emergency Service Act is amended | 22 | | by repealing Section 1.3. |
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| 1 | | Section 99. Effective date. This Act takes effect upon | 2 | | becoming law.".
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