Full Text of HB0465 101st General Assembly
HB0465eng 101ST GENERAL ASSEMBLY |
| | HB0465 Engrossed | | LRB101 03398 JRG 48406 b |
|
| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois, | 3 | | represented in the General Assembly:
| 4 | | Section 1. The Freedom of Information Act is amended by | 5 | | changing Sections 7 and 7.5 as follows: | 6 | | (5 ILCS 140/7) (from Ch. 116, par. 207) | 7 | | Sec. 7. Exemptions.
| 8 | | (1) When a request is made to inspect or copy a public | 9 | | record that contains information that is exempt from disclosure | 10 | | under this Section, but also contains information that is not | 11 | | exempt from disclosure, the public body may elect to redact the | 12 | | information that is exempt. The public body shall make the | 13 | | remaining information available for inspection and copying. | 14 | | Subject to this requirement, the following shall be exempt from | 15 | | inspection and copying:
| 16 | | (a) Information specifically prohibited from | 17 | | disclosure by federal or
State law or rules and regulations | 18 | | implementing federal or State law.
| 19 | | (b) Private information, unless disclosure is required | 20 | | by another provision of this Act, a State or federal law or | 21 | | a court order. | 22 | | (b-5) Files, documents, and other data or databases | 23 | | maintained by one or more law enforcement agencies and |
| | | HB0465 Engrossed | - 2 - | LRB101 03398 JRG 48406 b |
|
| 1 | | specifically designed to provide information to one or more | 2 | | law enforcement agencies regarding the physical or mental | 3 | | status of one or more individual subjects. | 4 | | (c) Personal information contained within public | 5 | | records, the disclosure of which would constitute a clearly
| 6 | | unwarranted invasion of personal privacy, unless the | 7 | | disclosure is
consented to in writing by the individual | 8 | | subjects of the information. "Unwarranted invasion of | 9 | | personal privacy" means the disclosure of information that | 10 | | is highly personal or objectionable to a reasonable person | 11 | | and in which the subject's right to privacy outweighs any | 12 | | legitimate public interest in obtaining the information. | 13 | | The
disclosure of information that bears on the public | 14 | | duties of public
employees and officials shall not be | 15 | | considered an invasion of personal
privacy.
| 16 | | (d) Records in the possession of any public body | 17 | | created in the course of administrative enforcement
| 18 | | proceedings, and any law enforcement or correctional | 19 | | agency for
law enforcement purposes,
but only to the extent | 20 | | that disclosure would:
| 21 | | (i) interfere with pending or actually and | 22 | | reasonably contemplated
law enforcement proceedings | 23 | | conducted by any law enforcement or correctional
| 24 | | agency that is the recipient of the request;
| 25 | | (ii) interfere with active administrative | 26 | | enforcement proceedings
conducted by the public body |
| | | HB0465 Engrossed | - 3 - | LRB101 03398 JRG 48406 b |
|
| 1 | | that is the recipient of the request;
| 2 | | (iii) create a substantial likelihood that a | 3 | | person will be deprived of a fair trial or an impartial | 4 | | hearing;
| 5 | | (iv) unavoidably disclose the identity of a | 6 | | confidential source, confidential information | 7 | | furnished only by the confidential source, or persons | 8 | | who file complaints with or provide information to | 9 | | administrative, investigative, law enforcement, or | 10 | | penal agencies; except that the identities of | 11 | | witnesses to traffic accidents, traffic accident | 12 | | reports, and rescue reports shall be provided by | 13 | | agencies of local government, except when disclosure | 14 | | would interfere with an active criminal investigation | 15 | | conducted by the agency that is the recipient of the | 16 | | request;
| 17 | | (v) disclose unique or specialized investigative | 18 | | techniques other than
those generally used and known or | 19 | | disclose internal documents of
correctional agencies | 20 | | related to detection, observation or investigation of
| 21 | | incidents of crime or misconduct, and disclosure would | 22 | | result in demonstrable harm to the agency or public | 23 | | body that is the recipient of the request;
| 24 | | (vi) endanger the life or physical safety of law | 25 | | enforcement personnel
or any other person; or
| 26 | | (vii) obstruct an ongoing criminal investigation |
| | | HB0465 Engrossed | - 4 - | LRB101 03398 JRG 48406 b |
|
| 1 | | by the agency that is the recipient of the request.
| 2 | | (d-5) A law enforcement record created for law | 3 | | enforcement purposes and contained in a shared electronic | 4 | | record management system if the law enforcement agency that | 5 | | is the recipient of the request did not create the record, | 6 | | did not participate in or have a role in any of the events | 7 | | which are the subject of the record, and only has access to | 8 | | the record through the shared electronic record management | 9 | | system. | 10 | | (e) Records that relate to or affect the security of | 11 | | correctional
institutions and detention facilities.
| 12 | | (e-5) Records requested by persons committed to the | 13 | | Department of Corrections, Department of Human Services | 14 | | Division of Mental Health, or a county jail if those | 15 | | materials are available in the library of the correctional | 16 | | institution or facility or jail where the inmate is | 17 | | confined. | 18 | | (e-6) Records requested by persons committed to the | 19 | | Department of Corrections, Department of Human Services | 20 | | Division of Mental Health, or a county jail if those | 21 | | materials include records from staff members' personnel | 22 | | files, staff rosters, or other staffing assignment | 23 | | information. | 24 | | (e-7) Records requested by persons committed to the | 25 | | Department of Corrections or Department of Human Services | 26 | | Division of Mental Health if those materials are available |
| | | HB0465 Engrossed | - 5 - | LRB101 03398 JRG 48406 b |
|
| 1 | | through an administrative request to the Department of | 2 | | Corrections or Department of Human Services Division of | 3 | | Mental Health. | 4 | | (e-8) Records requested by a person committed to the | 5 | | Department of Corrections, Department of Human Services | 6 | | Division of Mental Health, or a county jail, the disclosure | 7 | | of which would result in the risk of harm to any person or | 8 | | the risk of an escape from a jail or correctional | 9 | | institution or facility. | 10 | | (e-9) Records requested by a person in a county jail or | 11 | | committed to the Department of Corrections or Department of | 12 | | Human Services Division of Mental Health, containing | 13 | | personal information pertaining to the person's victim or | 14 | | the victim's family, including, but not limited to, a | 15 | | victim's home address, home telephone number, work or | 16 | | school address, work telephone number, social security | 17 | | number, or any other identifying information, except as may | 18 | | be relevant to a requester's current or potential case or | 19 | | claim. | 20 | | (e-10) Law enforcement records of other persons | 21 | | requested by a person committed to the Department of | 22 | | Corrections, Department of Human Services Division of | 23 | | Mental Health, or a county jail, including, but not limited | 24 | | to, arrest and booking records, mug shots, and crime scene | 25 | | photographs, except as these records may be relevant to the | 26 | | requester's current or potential case or claim. |
| | | HB0465 Engrossed | - 6 - | LRB101 03398 JRG 48406 b |
|
| 1 | | (f) Preliminary drafts, notes, recommendations, | 2 | | memoranda and other
records in which opinions are | 3 | | expressed, or policies or actions are
formulated, except | 4 | | that a specific record or relevant portion of a
record | 5 | | shall not be exempt when the record is publicly cited
and | 6 | | identified by the head of the public body. The exemption | 7 | | provided in
this paragraph (f) extends to all those records | 8 | | of officers and agencies
of the General Assembly that | 9 | | pertain to the preparation of legislative
documents.
| 10 | | (g) Trade secrets and commercial or financial | 11 | | information obtained from
a person or business where the | 12 | | trade secrets or commercial or financial information are | 13 | | furnished under a claim that they are
proprietary, | 14 | | privileged or confidential, and that disclosure of the | 15 | | trade
secrets or commercial or financial information would | 16 | | cause competitive harm to the person or business, and only | 17 | | insofar as the claim directly applies to the records | 18 | | requested. | 19 | | The information included under this exemption includes | 20 | | all trade secrets and commercial or financial information | 21 | | obtained by a public body, including a public pension fund, | 22 | | from a private equity fund or a privately held company | 23 | | within the investment portfolio of a private equity fund as | 24 | | a result of either investing or evaluating a potential | 25 | | investment of public funds in a private equity fund. The | 26 | | exemption contained in this item does not apply to the |
| | | HB0465 Engrossed | - 7 - | LRB101 03398 JRG 48406 b |
|
| 1 | | aggregate financial performance information of a private | 2 | | equity fund, nor to the identity of the fund's managers or | 3 | | general partners. The exemption contained in this item does | 4 | | not apply to the identity of a privately held company | 5 | | within the investment portfolio of a private equity fund, | 6 | | unless the disclosure of the identity of a privately held | 7 | | company may cause competitive harm. | 8 | | Nothing contained in this
paragraph (g) shall be | 9 | | construed to prevent a person or business from
consenting | 10 | | to disclosure.
| 11 | | (h) Proposals and bids for any contract, grant, or | 12 | | agreement, including
information which if it were | 13 | | disclosed would frustrate procurement or give
an advantage | 14 | | to any person proposing to enter into a contractor | 15 | | agreement
with the body, until an award or final selection | 16 | | is made. Information
prepared by or for the body in | 17 | | preparation of a bid solicitation shall be
exempt until an | 18 | | award or final selection is made.
| 19 | | (i) Valuable formulae,
computer geographic systems,
| 20 | | designs, drawings and research data obtained or
produced by | 21 | | any public body when disclosure could reasonably be | 22 | | expected to
produce private gain or public loss.
The | 23 | | exemption for "computer geographic systems" provided in | 24 | | this paragraph
(i) does not extend to requests made by news | 25 | | media as defined in Section 2 of
this Act when the | 26 | | requested information is not otherwise exempt and the only
|
| | | HB0465 Engrossed | - 8 - | LRB101 03398 JRG 48406 b |
|
| 1 | | purpose of the request is to access and disseminate | 2 | | information regarding the
health, safety, welfare, or | 3 | | legal rights of the general public.
| 4 | | (j) The following information pertaining to | 5 | | educational matters: | 6 | | (i) test questions, scoring keys and other | 7 | | examination data used to
administer an academic | 8 | | examination;
| 9 | | (ii) information received by a primary or | 10 | | secondary school, college, or university under its | 11 | | procedures for the evaluation of faculty members by | 12 | | their academic peers; | 13 | | (iii) information concerning a school or | 14 | | university's adjudication of student disciplinary | 15 | | cases, but only to the extent that disclosure would | 16 | | unavoidably reveal the identity of the student; and | 17 | | (iv) course materials or research materials used | 18 | | by faculty members. | 19 | | (k) Architects' plans, engineers' technical | 20 | | submissions, and
other
construction related technical | 21 | | documents for
projects not constructed or developed in | 22 | | whole or in part with public funds
and the same for | 23 | | projects constructed or developed with public funds, | 24 | | including but not limited to power generating and | 25 | | distribution stations and other transmission and | 26 | | distribution facilities, water treatment facilities, |
| | | HB0465 Engrossed | - 9 - | LRB101 03398 JRG 48406 b |
|
| 1 | | airport facilities, sport stadiums, convention centers, | 2 | | and all government owned, operated, or occupied buildings, | 3 | | but
only to the extent
that disclosure would compromise | 4 | | security.
| 5 | | (l) Minutes of meetings of public bodies closed to the
| 6 | | public as provided in the Open Meetings Act until the | 7 | | public body
makes the minutes available to the public under | 8 | | Section 2.06 of the Open
Meetings Act.
| 9 | | (m) Communications between a public body and an | 10 | | attorney or auditor
representing the public body that would | 11 | | not be subject to discovery in
litigation, and materials | 12 | | prepared or compiled by or for a public body in
| 13 | | anticipation of a criminal, civil or administrative | 14 | | proceeding upon the
request of an attorney advising the | 15 | | public body, and materials prepared or
compiled with | 16 | | respect to internal audits of public bodies.
| 17 | | (n) Records relating to a public body's adjudication of | 18 | | employee grievances or disciplinary cases; however, this | 19 | | exemption shall not extend to the final outcome of cases in | 20 | | which discipline is imposed.
| 21 | | (o) Administrative or technical information associated | 22 | | with automated
data processing operations, including but | 23 | | not limited to software,
operating protocols, computer | 24 | | program abstracts, file layouts, source
listings, object | 25 | | modules, load modules, user guides, documentation
| 26 | | pertaining to all logical and physical design of |
| | | HB0465 Engrossed | - 10 - | LRB101 03398 JRG 48406 b |
|
| 1 | | computerized systems,
employee manuals, and any other | 2 | | information that, if disclosed, would
jeopardize the | 3 | | security of the system or its data or the security of
| 4 | | materials exempt under this Section.
| 5 | | (p) Records relating to collective negotiating matters
| 6 | | between public bodies and their employees or | 7 | | representatives, except that
any final contract or | 8 | | agreement shall be subject to inspection and copying.
| 9 | | (q) Test questions, scoring keys, and other | 10 | | examination data used to determine the qualifications of an | 11 | | applicant for a license or employment.
| 12 | | (r) The records, documents, and information relating | 13 | | to real estate
purchase negotiations until those | 14 | | negotiations have been completed or
otherwise terminated. | 15 | | With regard to a parcel involved in a pending or
actually | 16 | | and reasonably contemplated eminent domain proceeding | 17 | | under the Eminent Domain Act, records, documents and
| 18 | | information relating to that parcel shall be exempt except | 19 | | as may be
allowed under discovery rules adopted by the | 20 | | Illinois Supreme Court. The
records, documents and | 21 | | information relating to a real estate sale shall be
exempt | 22 | | until a sale is consummated.
| 23 | | (s) Any and all proprietary information and records | 24 | | related to the
operation of an intergovernmental risk | 25 | | management association or
self-insurance pool or jointly | 26 | | self-administered health and accident
cooperative or pool.
|
| | | HB0465 Engrossed | - 11 - | LRB101 03398 JRG 48406 b |
|
| 1 | | Insurance or self insurance (including any | 2 | | intergovernmental risk management association or self | 3 | | insurance pool) claims, loss or risk management | 4 | | information, records, data, advice or communications.
| 5 | | (t) Information contained in or related to | 6 | | examination, operating, or
condition reports prepared by, | 7 | | on behalf of, or for the use of a public
body responsible | 8 | | for the regulation or supervision of financial
| 9 | | institutions , or insurance companies, or pharmacy benefit | 10 | | managers, unless disclosure is otherwise
required by State | 11 | | law.
| 12 | | (u) Information that would disclose
or might lead to | 13 | | the disclosure of
secret or confidential information, | 14 | | codes, algorithms, programs, or private
keys intended to be | 15 | | used to create electronic or digital signatures under the
| 16 | | Electronic Commerce Security Act.
| 17 | | (v) Vulnerability assessments, security measures, and | 18 | | response policies
or plans that are designed to identify, | 19 | | prevent, or respond to potential
attacks upon a community's | 20 | | population or systems, facilities, or installations,
the | 21 | | destruction or contamination of which would constitute a | 22 | | clear and present
danger to the health or safety of the | 23 | | community, but only to the extent that
disclosure could | 24 | | reasonably be expected to jeopardize the effectiveness of | 25 | | the
measures or the safety of the personnel who implement | 26 | | them or the public.
Information exempt under this item may |
| | | HB0465 Engrossed | - 12 - | LRB101 03398 JRG 48406 b |
|
| 1 | | include such things as details
pertaining to the | 2 | | mobilization or deployment of personnel or equipment, to | 3 | | the
operation of communication systems or protocols, or to | 4 | | tactical operations.
| 5 | | (w) (Blank). | 6 | | (x) Maps and other records regarding the location or | 7 | | security of generation, transmission, distribution, | 8 | | storage, gathering,
treatment, or switching facilities | 9 | | owned by a utility, by a power generator, or by the | 10 | | Illinois Power Agency.
| 11 | | (y) Information contained in or related to proposals, | 12 | | bids, or negotiations related to electric power | 13 | | procurement under Section 1-75 of the Illinois Power Agency | 14 | | Act and Section 16-111.5 of the Public Utilities Act that | 15 | | is determined to be confidential and proprietary by the | 16 | | Illinois Power Agency or by the Illinois Commerce | 17 | | Commission.
| 18 | | (z) Information about students exempted from | 19 | | disclosure under Sections 10-20.38 or 34-18.29 of the | 20 | | School Code, and information about undergraduate students | 21 | | enrolled at an institution of higher education exempted | 22 | | from disclosure under Section 25 of the Illinois Credit | 23 | | Card Marketing Act of 2009. | 24 | | (aa) Information the disclosure of which is
exempted | 25 | | under the Viatical Settlements Act of 2009.
| 26 | | (bb) Records and information provided to a mortality |
| | | HB0465 Engrossed | - 13 - | LRB101 03398 JRG 48406 b |
|
| 1 | | review team and records maintained by a mortality review | 2 | | team appointed under the Department of Juvenile Justice | 3 | | Mortality Review Team Act. | 4 | | (cc) Information regarding interments, entombments, or | 5 | | inurnments of human remains that are submitted to the | 6 | | Cemetery Oversight Database under the Cemetery Care Act or | 7 | | the Cemetery Oversight Act, whichever is applicable. | 8 | | (dd) Correspondence and records (i) that may not be | 9 | | disclosed under Section 11-9 of the Illinois Public Aid | 10 | | Code or (ii) that pertain to appeals under Section 11-8 of | 11 | | the Illinois Public Aid Code. | 12 | | (ee) The names, addresses, or other personal | 13 | | information of persons who are minors and are also | 14 | | participants and registrants in programs of park | 15 | | districts, forest preserve districts, conservation | 16 | | districts, recreation agencies, and special recreation | 17 | | associations. | 18 | | (ff) The names, addresses, or other personal | 19 | | information of participants and registrants in programs of | 20 | | park districts, forest preserve districts, conservation | 21 | | districts, recreation agencies, and special recreation | 22 | | associations where such programs are targeted primarily to | 23 | | minors. | 24 | | (gg) Confidential information described in Section | 25 | | 1-100 of the Illinois Independent Tax Tribunal Act of 2012. | 26 | | (hh) The report submitted to the State Board of |
| | | HB0465 Engrossed | - 14 - | LRB101 03398 JRG 48406 b |
|
| 1 | | Education by the School Security and Standards Task Force | 2 | | under item (8) of subsection (d) of Section 2-3.160 of the | 3 | | School Code and any information contained in that report. | 4 | | (ii) Records requested by persons committed to or | 5 | | detained by the Department of Human Services under the | 6 | | Sexually Violent Persons Commitment Act or committed to the | 7 | | Department of Corrections under the Sexually Dangerous | 8 | | Persons Act if those materials: (i) are available in the | 9 | | library of the facility where the individual is confined; | 10 | | (ii) include records from staff members' personnel files, | 11 | | staff rosters, or other staffing assignment information; | 12 | | or (iii) are available through an administrative request to | 13 | | the Department of Human Services or the Department of | 14 | | Corrections. | 15 | | (jj) Confidential information described in Section | 16 | | 5-535 of the Civil Administrative Code of Illinois. | 17 | | (1.5) Any information exempt from disclosure under the | 18 | | Judicial Privacy Act shall be redacted from public records | 19 | | prior to disclosure under this Act. | 20 | | (2) A public record that is not in the possession of a | 21 | | public body but is in the possession of a party with whom the | 22 | | agency has contracted to perform a governmental function on | 23 | | behalf of the public body, and that directly relates to the | 24 | | governmental function and is not otherwise exempt under this | 25 | | Act, shall be considered a public record of the public body, | 26 | | for purposes of this Act. |
| | | HB0465 Engrossed | - 15 - | LRB101 03398 JRG 48406 b |
|
| 1 | | (3) This Section does not authorize withholding of | 2 | | information or limit the
availability of records to the public, | 3 | | except as stated in this Section or
otherwise provided in this | 4 | | Act.
| 5 | | (Source: P.A. 99-298, eff. 8-6-15; 99-346, eff. 1-1-16; 99-642, | 6 | | eff. 7-28-16; 100-26, eff. 8-4-17; 100-201, eff. 8-18-17; | 7 | | 100-732, eff. 8-3-18.) | 8 | | (5 ILCS 140/7.5) | 9 | | Sec. 7.5. Statutory exemptions. To the extent provided for | 10 | | by the statutes referenced below, the following shall be exempt | 11 | | from inspection and copying: | 12 | | (a) All information determined to be confidential | 13 | | under Section 4002 of the Technology Advancement and | 14 | | Development Act. | 15 | | (b) Library circulation and order records identifying | 16 | | library users with specific materials under the Library | 17 | | Records Confidentiality Act. | 18 | | (c) Applications, related documents, and medical | 19 | | records received by the Experimental Organ Transplantation | 20 | | Procedures Board and any and all documents or other records | 21 | | prepared by the Experimental Organ Transplantation | 22 | | Procedures Board or its staff relating to applications it | 23 | | has received. | 24 | | (d) Information and records held by the Department of | 25 | | Public Health and its authorized representatives relating |
| | | HB0465 Engrossed | - 16 - | LRB101 03398 JRG 48406 b |
|
| 1 | | to known or suspected cases of sexually transmissible | 2 | | disease or any information the disclosure of which is | 3 | | restricted under the Illinois Sexually Transmissible | 4 | | Disease Control Act. | 5 | | (e) Information the disclosure of which is exempted | 6 | | under Section 30 of the Radon Industry Licensing Act. | 7 | | (f) Firm performance evaluations under Section 55 of | 8 | | the Architectural, Engineering, and Land Surveying | 9 | | Qualifications Based Selection Act. | 10 | | (g) Information the disclosure of which is restricted | 11 | | and exempted under Section 50 of the Illinois Prepaid | 12 | | Tuition Act. | 13 | | (h) Information the disclosure of which is exempted | 14 | | under the State Officials and Employees Ethics Act, and | 15 | | records of any lawfully created State or local inspector | 16 | | general's office that would be exempt if created or | 17 | | obtained by an Executive Inspector General's office under | 18 | | that Act. | 19 | | (i) Information contained in a local emergency energy | 20 | | plan submitted to a municipality in accordance with a local | 21 | | emergency energy plan ordinance that is adopted under | 22 | | Section 11-21.5-5 of the Illinois Municipal Code. | 23 | | (j) Information and data concerning the distribution | 24 | | of surcharge moneys collected and remitted by carriers | 25 | | under the Emergency Telephone System Act. | 26 | | (k) Law enforcement officer identification information |
| | | HB0465 Engrossed | - 17 - | LRB101 03398 JRG 48406 b |
|
| 1 | | or driver identification information compiled by a law | 2 | | enforcement agency or the Department of Transportation | 3 | | under Section 11-212 of the Illinois Vehicle Code. | 4 | | (l) Records and information provided to a residential | 5 | | health care facility resident sexual assault and death | 6 | | review team or the Executive Council under the Abuse | 7 | | Prevention Review Team Act. | 8 | | (m) Information provided to the predatory lending | 9 | | database created pursuant to Article 3 of the Residential | 10 | | Real Property Disclosure Act, except to the extent | 11 | | authorized under that Article. | 12 | | (n) Defense budgets and petitions for certification of | 13 | | compensation and expenses for court appointed trial | 14 | | counsel as provided under Sections 10 and 15 of the Capital | 15 | | Crimes Litigation Act. This subsection (n) shall apply | 16 | | until the conclusion of the trial of the case, even if the | 17 | | prosecution chooses not to pursue the death penalty prior | 18 | | to trial or sentencing. | 19 | | (o) Information that is prohibited from being | 20 | | disclosed under Section 4 of the Illinois Health and | 21 | | Hazardous Substances Registry Act. | 22 | | (p) Security portions of system safety program plans, | 23 | | investigation reports, surveys, schedules, lists, data, or | 24 | | information compiled, collected, or prepared by or for the | 25 | | Regional Transportation Authority under Section 2.11 of | 26 | | the Regional Transportation Authority Act or the St. Clair |
| | | HB0465 Engrossed | - 18 - | LRB101 03398 JRG 48406 b |
|
| 1 | | County Transit District under the Bi-State Transit Safety | 2 | | Act. | 3 | | (q) Information prohibited from being disclosed by the | 4 | | Personnel Record Records Review Act. | 5 | | (r) Information prohibited from being disclosed by the | 6 | | Illinois School Student Records Act. | 7 | | (s) Information the disclosure of which is restricted | 8 | | under Section 5-108 of the Public Utilities Act.
| 9 | | (t) All identified or deidentified health information | 10 | | in the form of health data or medical records contained in, | 11 | | stored in, submitted to, transferred by, or released from | 12 | | the Illinois Health Information Exchange, and identified | 13 | | or deidentified health information in the form of health | 14 | | data and medical records of the Illinois Health Information | 15 | | Exchange in the possession of the Illinois Health | 16 | | Information Exchange Authority due to its administration | 17 | | of the Illinois Health Information Exchange. The terms | 18 | | "identified" and "deidentified" shall be given the same | 19 | | meaning as in the Health Insurance Portability and | 20 | | Accountability Act of 1996, Public Law 104-191, or any | 21 | | subsequent amendments thereto, and any regulations | 22 | | promulgated thereunder. | 23 | | (u) Records and information provided to an independent | 24 | | team of experts under the Developmental Disability and | 25 | | Mental Health Safety Act (also known as Brian's Law ) . | 26 | | (v) Names and information of people who have applied |
| | | HB0465 Engrossed | - 19 - | LRB101 03398 JRG 48406 b |
|
| 1 | | for or received Firearm Owner's Identification Cards under | 2 | | the Firearm Owners Identification Card Act or applied for | 3 | | or received a concealed carry license under the Firearm | 4 | | Concealed Carry Act, unless otherwise authorized by the | 5 | | Firearm Concealed Carry Act; and databases under the | 6 | | Firearm Concealed Carry Act, records of the Concealed Carry | 7 | | Licensing Review Board under the Firearm Concealed Carry | 8 | | Act, and law enforcement agency objections under the | 9 | | Firearm Concealed Carry Act. | 10 | | (w) Personally identifiable information which is | 11 | | exempted from disclosure under subsection (g) of Section | 12 | | 19.1 of the Toll Highway Act. | 13 | | (x) Information which is exempted from disclosure | 14 | | under Section 5-1014.3 of the Counties Code or Section | 15 | | 8-11-21 of the Illinois Municipal Code. | 16 | | (y) Confidential information under the Adult | 17 | | Protective Services Act and its predecessor enabling | 18 | | statute, the Elder Abuse and Neglect Act, including | 19 | | information about the identity and administrative finding | 20 | | against any caregiver of a verified and substantiated | 21 | | decision of abuse, neglect, or financial exploitation of an | 22 | | eligible adult maintained in the Registry established | 23 | | under Section 7.5 of the Adult Protective Services Act. | 24 | | (z) Records and information provided to a fatality | 25 | | review team or the Illinois Fatality Review Team Advisory | 26 | | Council under Section 15 of the Adult Protective Services |
| | | HB0465 Engrossed | - 20 - | LRB101 03398 JRG 48406 b |
|
| 1 | | Act. | 2 | | (aa) Information which is exempted from disclosure | 3 | | under Section 2.37 of the Wildlife Code. | 4 | | (bb) Information which is or was prohibited from | 5 | | disclosure by the Juvenile Court Act of 1987. | 6 | | (cc) Recordings made under the Law Enforcement | 7 | | Officer-Worn Body Camera Act, except to the extent | 8 | | authorized under that Act. | 9 | | (dd) Information that is prohibited from being | 10 | | disclosed under Section 45 of the Condominium and Common | 11 | | Interest Community Ombudsperson Act. | 12 | | (ee) Information that is exempted from disclosure | 13 | | under Section 30.1 of the Pharmacy Practice Act. | 14 | | (ff) Information that is exempted from disclosure | 15 | | under the Revised Uniform Unclaimed Property Act. | 16 | | (gg) Information that is prohibited from being | 17 | | disclosed under Section 7-603.5 of the Illinois Vehicle | 18 | | Code. | 19 | | (hh) Records that are exempt from disclosure under | 20 | | Section 1A-16.7 of the Election Code. | 21 | | (ii) Information which is exempted from disclosure | 22 | | under Section 2505-800 of the Department of Revenue Law of | 23 | | the Civil Administrative Code of Illinois. | 24 | | (jj) Information and reports that are required to be | 25 | | submitted to the Department of Labor by registering day and | 26 | | temporary labor service agencies but are exempt from |
| | | HB0465 Engrossed | - 21 - | LRB101 03398 JRG 48406 b |
|
| 1 | | disclosure under subsection (a-1) of Section 45 of the Day | 2 | | and Temporary Labor Services Act. | 3 | | (kk) Information prohibited from disclosure under the | 4 | | Seizure and Forfeiture Reporting Act. | 5 | | (ll) Information the disclosure of which is restricted | 6 | | and exempted under Section 5-30.8 of the Illinois Public | 7 | | Aid Code. | 8 | | (mm) (ll) Records that are exempt from disclosure under | 9 | | Section 4.2 of the Crime Victims Compensation Act. | 10 | | (nn) (ll) Information that is exempt from disclosure | 11 | | under Section 70 of the Higher Education Student Assistance | 12 | | Act. | 13 | | (oo) Information that is exempt from disclosure under | 14 | | subsections (f) and (j) of Section 5-36 of the Illinois | 15 | | Public Aid Code. | 16 | | (Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, | 17 | | eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16; | 18 | | 99-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; | 19 | | 100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. | 20 | | 8-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517, | 21 | | eff. 6-1-18; 100-646, eff. 7-27-18; 100-690, eff. 1-1-19; | 22 | | 100-863, eff. 8-14-18; 100-887, eff. 8-14-18; revised | 23 | | 10-12-18.) | 24 | | Section 5. The State Employees Group Insurance Act of 1971 | 25 | | is amended by changing Section 6.11 as follows:
|
| | | HB0465 Engrossed | - 22 - | LRB101 03398 JRG 48406 b |
|
| 1 | | (5 ILCS 375/6.11)
| 2 | | (Text of Section after amendment by P.A. 100-1170 ) | 3 | | Sec. 6.11. Required health benefits; Illinois Insurance | 4 | | Code
requirements. The program of health
benefits shall provide | 5 | | the post-mastectomy care benefits required to be covered
by a | 6 | | policy of accident and health insurance under Section 356t of | 7 | | the Illinois
Insurance Code. The program of health benefits | 8 | | shall provide the coverage
required under Sections 356g, | 9 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 10 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 11 | | 356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, | 12 | | and 356z.32 of the
Illinois Insurance Code.
The program of | 13 | | health benefits must comply with Sections 155.22a, 155.37, | 14 | | 355b, 356z.19, 370c, and 370c.1 , and Article XXXIIB of the
| 15 | | Illinois Insurance Code. The Department of Insurance shall | 16 | | enforce the requirements of this Section with respect to | 17 | | Sections 370c and 370c.1 of the Illinois Insurance Code; all | 18 | | other requirements of this Section shall be enforced by the | 19 | | Department of Central Management Services.
| 20 | | Rulemaking authority to implement Public Act 95-1045, if | 21 | | any, is conditioned on the rules being adopted in accordance | 22 | | with all provisions of the Illinois Administrative Procedure | 23 | | Act and all rules and procedures of the Joint Committee on | 24 | | Administrative Rules; any purported rule not so adopted, for | 25 | | whatever reason, is unauthorized. |
| | | HB0465 Engrossed | - 23 - | LRB101 03398 JRG 48406 b |
|
| 1 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 2 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. | 3 | | 1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; | 4 | | 100-1170, eff. 6-1-19.) | 5 | | Section 10. The Illinois Insurance Code is amended by | 6 | | adding Article XXXIIB as follows: | 7 | | (215 ILCS 5/Art. XXXIIB heading new) | 8 | | ARTICLE XXXIIB. PHARMACY BENEFIT MANAGERS | 9 | | (215 ILCS 5/513b1 new) | 10 | | Sec. 513b1. Pharmacy benefit manager contracts. | 11 | | (a) As used in this Section: | 12 | | "Biological product" has the meaning ascribed to that term | 13 | | in Section 19.5 of the Pharmacy Practice Act. | 14 | | "Maximum allowable cost" means the maximum amount that a | 15 | | pharmacy benefit manager will reimburse a pharmacy for the cost | 16 | | of a drug. | 17 | | "Maximum allowable cost list" means a list of drugs for | 18 | | which a maximum allowable cost has been established by a | 19 | | pharmacy benefit manager. | 20 | | "Pharmacy benefit manager" means a person, business, or | 21 | | entity, including a wholly or partially owned or controlled | 22 | | subsidiary of a pharmacy benefit manager, that provides claims | 23 | | processing services or other prescription drug or device |
| | | HB0465 Engrossed | - 24 - | LRB101 03398 JRG 48406 b |
|
| 1 | | services, or both, for health benefit plans. | 2 | | "Retail price" means the price an individual without | 3 | | prescription drug coverage would pay at a retail pharmacy, not | 4 | | including a pharmacist dispensing fee. | 5 | | (b) A contract between a health insurer and a pharmacy | 6 | | benefit manager must require that the pharmacy benefit manager: | 7 | | (1) Update maximum allowable cost pricing information | 8 | | at least every 7 calendar days. | 9 | | (2) Maintain a process that will, in a timely manner, | 10 | | eliminate drugs from maximum allowable cost lists or modify | 11 | | drug prices to remain consistent with changes in pricing | 12 | | data used in formulating maximum allowable cost prices and | 13 | | product availability. | 14 | | (3) Provide access to its maximum allowable cost list | 15 | | to each pharmacy or pharmacy services administrative | 16 | | organization subject to the maximum allowable cost list. | 17 | | Access may include a real-time pharmacy website portal to | 18 | | be able to view the maximum allowable cost list. As used in | 19 | | this Section, "pharmacy services administrative | 20 | | organization" means an entity operating within the State | 21 | | that contracts with independent pharmacies to conduct | 22 | | business on their behalf with third-party payers. A | 23 | | pharmacy services administrative organization may provide | 24 | | administrative services to pharmacies and negotiate and | 25 | | enter into contracts with third-party payers or pharmacy | 26 | | benefit managers on behalf of pharmacies. |
| | | HB0465 Engrossed | - 25 - | LRB101 03398 JRG 48406 b |
|
| 1 | | (4) Provide a process by which a contracted pharmacy | 2 | | can appeal the provider's reimbursement for a drug subject | 3 | | to maximum allowable cost pricing. The appeals process | 4 | | must, at a minimum, include the following: | 5 | | (A) A requirement that a contracted pharmacy has 14 | 6 | | calendar days after the applicable fill date to appeal | 7 | | a maximum allowable cost if the reimbursement for the | 8 | | drug is less than the net amount that the network | 9 | | provider paid to the supplier of the drug. | 10 | | (B) A requirement that a pharmacy benefit manager | 11 | | must respond to a challenge within 14 calendar days of | 12 | | the contracted pharmacy making the claim for which the | 13 | | appeal has been submitted. | 14 | | (C) A telephone number and e-mail address or | 15 | | website to network providers, at which the provider can | 16 | | contact the pharmacy benefit manager to process and | 17 | | submit an appeal. | 18 | | (D) A requirement that, if an appeal is denied, the | 19 | | pharmacy benefit manager must provide the reason for | 20 | | the denial and the name and the national drug code | 21 | | number from national or regional wholesalers. | 22 | | (E) A requirement that, if an appeal is sustained, | 23 | | the pharmacy benefit manager must make an adjustment in | 24 | | the drug price effective the date the challenge is | 25 | | resolved and make the adjustment applicable to all | 26 | | similarly situated network pharmacy providers, as |
| | | HB0465 Engrossed | - 26 - | LRB101 03398 JRG 48406 b |
|
| 1 | | determined by the managed care organization or | 2 | | pharmacy benefit manager. | 3 | | (5) Allow a plan sponsor contracting with a pharmacy | 4 | | benefit manager an annual right to audit compliance with | 5 | | the terms of the contract by the pharmacy benefit manager, | 6 | | including, but not limited to, full disclosure of any and | 7 | | all rebate amounts secured, whether product specific or | 8 | | generalized rebates, that were provided to the pharmacy | 9 | | benefit manager by a pharmaceutical manufacturer. | 10 | | (6) Allow a plan sponsor contracting with a pharmacy | 11 | | benefit manager to request that the pharmacy benefit | 12 | | manager disclose the actual amounts paid by the pharmacy | 13 | | benefit manager to the pharmacy. | 14 | | (7) Provide notice to the party contracting with the | 15 | | pharmacy benefit manager of any consideration that the | 16 | | pharmacy benefit manager receives from the manufacturer | 17 | | for dispense as written prescriptions once a generic or | 18 | | biologically similar product becomes available. | 19 | | (c) In order to place a particular prescription drug on a | 20 | | maximum allowable cost list, the pharmacy benefit manager must, | 21 | | at a minimum, ensure that: | 22 | | (1) if the drug is a generically equivalent drug, it is | 23 | | listed as therapeutically equivalent and pharmaceutically | 24 | | equivalent "A" or "B" rated in the United States Food and | 25 | | Drug Administration's most recent version of the "Orange | 26 | | Book" or have an NR or NA rating by Medi-Span, Gold |
| | | HB0465 Engrossed | - 27 - | LRB101 03398 JRG 48406 b |
|
| 1 | | Standard, or a similar rating by a nationally recognized | 2 | | reference; | 3 | | (2) the drug is available for purchase by each pharmacy | 4 | | in the State from national or regional wholesalers | 5 | | operating in Illinois; and | 6 | | (3) the drug is not obsolete. | 7 | | (d) A pharmacy benefit manager is prohibited from limiting | 8 | | a pharmacist's ability to disclose whether the cost-sharing | 9 | | obligation exceeds the retail price for a covered prescription | 10 | | drug, and the availability of a more affordable alternative | 11 | | drug, if one is available in accordance with Section 42 of the | 12 | | Pharmacy Practice Act. | 13 | | (e) A health insurer or pharmacy benefit manager shall not | 14 | | require an insured to make a payment for a prescription drug at | 15 | | the point of sale in an amount that exceeds the lesser of: | 16 | | (1) the applicable cost-sharing amount; or | 17 | | (2) the retail price of the drug in the absence of | 18 | | prescription drug coverage. | 19 | | (f) This Section applies to contracts entered into or | 20 | | renewed on or after July 1, 2020. | 21 | | (g) This Section applies to any group or individual policy | 22 | | of accident and health insurance or managed care plan that | 23 | | provides coverage for prescription drugs and that is amended, | 24 | | delivered, issued, or renewed on or after July 1, 2020. | 25 | | (215 ILCS 5/513b2 new) |
| | | HB0465 Engrossed | - 28 - | LRB101 03398 JRG 48406 b |
|
| 1 | | Sec. 513b2. Licensure requirements. | 2 | | (a) Beginning on July 1, 2020, to conduct business in this | 3 | | State, a pharmacy benefit manager must register with the | 4 | | Director. To initially register or renew a registration, a | 5 | | pharmacy benefit manager shall submit: | 6 | | (1) A nonrefundable fee not to exceed $500. | 7 | | (2) A copy of the registrant's corporate charter, | 8 | | articles of incorporation, or other charter document. | 9 | | (3) A completed registration form adopted by the | 10 | | Director containing: | 11 | | (A) The name and address of the registrant. | 12 | | (B) The name, address, and official position of | 13 | | each officer and director of the registrant. | 14 | | (b) The registrant shall report any change in information | 15 | | required under this Section to the Director in writing within | 16 | | 60 days after the change occurs. | 17 | | (c) Upon receipt of a completed registration form, the | 18 | | required documents, and the registration fee, the Director | 19 | | shall issue a registration certificate. The certificate may be | 20 | | in paper or electronic form, and shall clearly indicate the | 21 | | expiration date of the registration. Registration certificates | 22 | | are nontransferable. | 23 | | (d) A registration certificate is valid for 2 years after | 24 | | its date of issue. The Director shall adopt by rule an initial | 25 | | registration fee not to exceed $500 and a registration renewal | 26 | | fee not to exceed $500, both of which shall be nonrefundable. |
| | | HB0465 Engrossed | - 29 - | LRB101 03398 JRG 48406 b |
|
| 1 | | Total fees may not exceed the cost of administering this | 2 | | Section. | 3 | | (e) The Department shall adopt any rules necessary to | 4 | | implement this Section. | 5 | | (215 ILCS 5/513b3 new) | 6 | | Sec. 513b3. Examination. | 7 | | (a) The Director, or his or her designee, may examine a | 8 | | registered pharmacy benefit manager. | 9 | | (b) Any pharmacy benefit manager being examined shall | 10 | | provide to the Director, or his or her designee, convenient and | 11 | | free access to all books, records, documents, and other papers | 12 | | relating to such pharmacy benefit manager's business affairs at | 13 | | all reasonable hours at its offices. | 14 | | (c) The Director, or his or her designee, may administer | 15 | | oaths and thereafter examine the pharmacy benefit manager's | 16 | | designee, representative, or any officer or senior manager as | 17 | | listed on the license or registration certificate about the | 18 | | business of the pharmacy benefit manager. | 19 | | (d) The examiners designated by the Director under this | 20 | | Section may make reports to the Director. Any report alleging | 21 | | substantive violations of this Article, any applicable | 22 | | provisions of this Code, or any applicable Part of Title 50 of | 23 | | the Illinois Administrative Code shall be in writing and be | 24 | | based upon facts obtained by the examiners. The report shall be | 25 | | verified by the examiners. |
| | | HB0465 Engrossed | - 30 - | LRB101 03398 JRG 48406 b |
|
| 1 | | (e) If a report is made, the Director shall either deliver | 2 | | a duplicate report to the pharmacy benefit manager being | 3 | | examined or send such duplicate by certified or registered mail | 4 | | to the pharmacy benefit manager's address specified in the | 5 | | records of the Department. The Director shall afford the | 6 | | pharmacy benefit manager an opportunity to request a hearing to | 7 | | object to the report. The pharmacy benefit manager may request | 8 | | a hearing within 30 days after receipt of the duplicate report | 9 | | by giving the Director written notice of such request together | 10 | | with written objections to the report. Any hearing shall be | 11 | | conducted in accordance with Sections 402 and 403 of this Code. | 12 | | The right to a hearing is waived if the delivery of the report | 13 | | is refused or the report is otherwise undeliverable or the | 14 | | pharmacy benefit manager does not timely request a hearing. | 15 | | After the hearing or upon expiration of the time period during | 16 | | which a pharmacy benefit manager may request a hearing, if the | 17 | | examination reveals that the pharmacy benefit manager is | 18 | | operating in violation of any applicable provision of this | 19 | | Code, any applicable Part of Title 50 of the Illinois | 20 | | Administrative Code, a provision of this Article, or prior | 21 | | order, the Director, in the written order, may require the | 22 | | pharmacy benefit manager to take any action the Director | 23 | | considers necessary or appropriate in accordance with the | 24 | | report or examination hearing. If the Director issues an order, | 25 | | it shall be issued within 90 days after the report is filed, or | 26 | | if there is a hearing, within 90 days after the conclusion of |
| | | HB0465 Engrossed | - 31 - | LRB101 03398 JRG 48406 b |
|
| 1 | | the hearing. The order is subject to review under the | 2 | | Administrative Review Law. | 3 | | (215 ILCS 5/513b4 new) | 4 | | Sec. 513b4. Denial, revocation, or suspension of | 5 | | registration; administrative fines. | 6 | | (a) Denial of an application or suspension or revocation of | 7 | | a registration in accordance with this Section shall be by | 8 | | written order sent to the applicant or registrant by certified | 9 | | or registered mail at the address specified in the records of | 10 | | the Department. The written order shall state the grounds, | 11 | | charges, or conduct on which denial, suspension, or revocation | 12 | | is based. The applicant or registrant may in writing request a | 13 | | hearing within 30 days from the date of mailing. Upon receipt | 14 | | of a written request, the Director shall issue an order | 15 | | setting: (i) a specific time for the hearing, which may not be | 16 | | less than 20 nor more than 30 days after receipt of the | 17 | | request; and (ii) a specific place for the hearing, which may | 18 | | be in either the city of Springfield or in the county in | 19 | | Illinois where the applicant's or registrant's principal place | 20 | | of business is located. If no written request is received by | 21 | | the Director, such order shall be final upon the expiration of | 22 | | said 30 days. | 23 | | (b) If the Director finds that one or more grounds exist | 24 | | for the revocation or suspension of a registration issued under | 25 | | this Article, the Director may, in lieu of or in addition to |
| | | HB0465 Engrossed | - 32 - | LRB101 03398 JRG 48406 b |
|
| 1 | | such suspension or revocation, impose a fine upon the pharmacy | 2 | | benefit manager as provided under subsection (c). | 3 | | (c) With respect to any knowing and willful violation of a | 4 | | lawful order of the Director, any applicable portion of this | 5 | | Code, Part of Title 50 of the Illinois Administrative Code, or | 6 | | provision of this Article, the Director may impose a fine upon | 7 | | the pharmacy benefit manager in an amount not to exceed $50,000 | 8 | | for each violation. | 9 | | (215 ILCS 5/513b5 new) | 10 | | Sec. 513b5. Failure to register. Any pharmacy benefit | 11 | | manager that operates without a registration or fails to | 12 | | register with the Director and pay the fee prescribed by this | 13 | | Article is an unauthorized insurer as defined in Article VII of | 14 | | this Code and shall be subject to all penalties provided for | 15 | | therein. | 16 | | (215 ILCS 5/513b6 new) | 17 | | Sec. 513b6. Insurance Producer Administration Fund. All | 18 | | fees and fines paid to and collected by the Director under this | 19 | | Article shall be paid promptly after receipt thereof, together | 20 | | with a detailed statement of such fees, into the Insurance | 21 | | Producer Administration Fund. The moneys deposited into the | 22 | | Insurance Producer Administration Fund may be transferred to | 23 | | the Professions Indirect Cost Fund, as authorized under Section | 24 | | 2105-300 of the Department of Professional Regulation Law of |
| | | HB0465 Engrossed | - 33 - | LRB101 03398 JRG 48406 b |
|
| 1 | | the Civil Administrative Code of Illinois. | 2 | | Section 15. The Health Maintenance Organization Act is | 3 | | amended by changing Section 5-3 as follows:
| 4 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 5 | | Sec. 5-3. Insurance Code provisions.
| 6 | | (a) Health Maintenance Organizations
shall be subject to | 7 | | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
| 8 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | 9 | | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | 10 | | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | 11 | | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | 12 | | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | 13 | | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 364, | 14 | | 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, | 15 | | 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, 408.2, 409, 412, | 16 | | 444,
and
444.1,
paragraph (c) of subsection (2) of Section 367, | 17 | | and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, | 18 | | and XXVI , and XXXIIB of the Illinois Insurance Code.
| 19 | | (b) For purposes of the Illinois Insurance Code, except for | 20 | | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 21 | | Maintenance Organizations in
the following categories are | 22 | | deemed to be "domestic companies":
| 23 | | (1) a corporation authorized under the
Dental Service | 24 | | Plan Act or the Voluntary Health Services Plans Act;
|
| | | HB0465 Engrossed | - 34 - | LRB101 03398 JRG 48406 b |
|
| 1 | | (2) a corporation organized under the laws of this | 2 | | State; or
| 3 | | (3) a corporation organized under the laws of another | 4 | | state, 30% or more
of the enrollees of which are residents | 5 | | of this State, except a
corporation subject to | 6 | | substantially the same requirements in its state of
| 7 | | organization as is a "domestic company" under Article VIII | 8 | | 1/2 of the
Illinois Insurance Code.
| 9 | | (c) In considering the merger, consolidation, or other | 10 | | acquisition of
control of a Health Maintenance Organization | 11 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 12 | | (1) the Director shall give primary consideration to | 13 | | the continuation of
benefits to enrollees and the financial | 14 | | conditions of the acquired Health
Maintenance Organization | 15 | | after the merger, consolidation, or other
acquisition of | 16 | | control takes effect;
| 17 | | (2)(i) the criteria specified in subsection (1)(b) of | 18 | | Section 131.8 of
the Illinois Insurance Code shall not | 19 | | apply and (ii) the Director, in making
his determination | 20 | | with respect to the merger, consolidation, or other
| 21 | | acquisition of control, need not take into account the | 22 | | effect on
competition of the merger, consolidation, or | 23 | | other acquisition of control;
| 24 | | (3) the Director shall have the power to require the | 25 | | following
information:
| 26 | | (A) certification by an independent actuary of the |
| | | HB0465 Engrossed | - 35 - | LRB101 03398 JRG 48406 b |
|
| 1 | | adequacy
of the reserves of the Health Maintenance | 2 | | Organization sought to be acquired;
| 3 | | (B) pro forma financial statements reflecting the | 4 | | combined balance
sheets of the acquiring company and | 5 | | the Health Maintenance Organization sought
to be | 6 | | acquired as of the end of the preceding year and as of | 7 | | a date 90 days
prior to the acquisition, as well as pro | 8 | | forma financial statements
reflecting projected | 9 | | combined operation for a period of 2 years;
| 10 | | (C) a pro forma business plan detailing an | 11 | | acquiring party's plans with
respect to the operation | 12 | | of the Health Maintenance Organization sought to
be | 13 | | acquired for a period of not less than 3 years; and
| 14 | | (D) such other information as the Director shall | 15 | | require.
| 16 | | (d) The provisions of Article VIII 1/2 of the Illinois | 17 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 18 | | any health maintenance
organization of greater than 10% of its
| 19 | | enrollee population (including without limitation the health | 20 | | maintenance
organization's right, title, and interest in and to | 21 | | its health care
certificates).
| 22 | | (e) In considering any management contract or service | 23 | | agreement subject
to Section 141.1 of the Illinois Insurance | 24 | | Code, the Director (i) shall, in
addition to the criteria | 25 | | specified in Section 141.2 of the Illinois
Insurance Code, take | 26 | | into account the effect of the management contract or
service |
| | | HB0465 Engrossed | - 36 - | LRB101 03398 JRG 48406 b |
|
| 1 | | agreement on the continuation of benefits to enrollees and the
| 2 | | financial condition of the health maintenance organization to | 3 | | be managed or
serviced, and (ii) need not take into account the | 4 | | effect of the management
contract or service agreement on | 5 | | competition.
| 6 | | (f) Except for small employer groups as defined in the | 7 | | Small Employer
Rating, Renewability and Portability Health | 8 | | Insurance Act and except for
medicare supplement policies as | 9 | | defined in Section 363 of the Illinois
Insurance Code, a Health | 10 | | Maintenance Organization may by contract agree with a
group or | 11 | | other enrollment unit to effect refunds or charge additional | 12 | | premiums
under the following terms and conditions:
| 13 | | (i) the amount of, and other terms and conditions with | 14 | | respect to, the
refund or additional premium are set forth | 15 | | in the group or enrollment unit
contract agreed in advance | 16 | | of the period for which a refund is to be paid or
| 17 | | additional premium is to be charged (which period shall not | 18 | | be less than one
year); and
| 19 | | (ii) the amount of the refund or additional premium | 20 | | shall not exceed 20%
of the Health Maintenance | 21 | | Organization's profitable or unprofitable experience
with | 22 | | respect to the group or other enrollment unit for the | 23 | | period (and, for
purposes of a refund or additional | 24 | | premium, the profitable or unprofitable
experience shall | 25 | | be calculated taking into account a pro rata share of the
| 26 | | Health Maintenance Organization's administrative and |
| | | HB0465 Engrossed | - 37 - | LRB101 03398 JRG 48406 b |
|
| 1 | | marketing expenses, but
shall not include any refund to be | 2 | | made or additional premium to be paid
pursuant to this | 3 | | subsection (f)). The Health Maintenance Organization and | 4 | | the
group or enrollment unit may agree that the profitable | 5 | | or unprofitable
experience may be calculated taking into | 6 | | account the refund period and the
immediately preceding 2 | 7 | | plan years.
| 8 | | The Health Maintenance Organization shall include a | 9 | | statement in the
evidence of coverage issued to each enrollee | 10 | | describing the possibility of a
refund or additional premium, | 11 | | and upon request of any group or enrollment unit,
provide to | 12 | | the group or enrollment unit a description of the method used | 13 | | to
calculate (1) the Health Maintenance Organization's | 14 | | profitable experience with
respect to the group or enrollment | 15 | | unit and the resulting refund to the group
or enrollment unit | 16 | | or (2) the Health Maintenance Organization's unprofitable
| 17 | | experience with respect to the group or enrollment unit and the | 18 | | resulting
additional premium to be paid by the group or | 19 | | enrollment unit.
| 20 | | In no event shall the Illinois Health Maintenance | 21 | | Organization
Guaranty Association be liable to pay any | 22 | | contractual obligation of an
insolvent organization to pay any | 23 | | refund authorized under this Section.
| 24 | | (g) Rulemaking authority to implement Public Act 95-1045, | 25 | | if any, is conditioned on the rules being adopted in accordance | 26 | | with all provisions of the Illinois Administrative Procedure |
| | | HB0465 Engrossed | - 38 - | LRB101 03398 JRG 48406 b |
|
| 1 | | Act and all rules and procedures of the Joint Committee on | 2 | | Administrative Rules; any purported rule not so adopted, for | 3 | | whatever reason, is unauthorized. | 4 | | (Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17; | 5 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff. | 6 | | 8-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | 7 | | 10-4-18.) | 8 | | Section 20. The Managed Care Reform and Patient Rights Act | 9 | | is amended by changing Sections 10 and 30 as follows:
| 10 | | (215 ILCS 134/10)
| 11 | | Sec. 10. Definitions.
| 12 | | "Adverse determination" means a determination by a health | 13 | | care plan under
Section 45 or by a utilization review program | 14 | | under Section
85 that
a health care service is not medically | 15 | | necessary.
| 16 | | "Clinical peer" means a health care professional who is in | 17 | | the same
profession and the same or similar specialty as the | 18 | | health care provider who
typically manages the medical | 19 | | condition, procedures, or treatment under
review.
| 20 | | "Department" means the Department of Insurance.
| 21 | | "Emergency medical condition" means a medical condition | 22 | | manifesting itself by
acute symptoms of sufficient severity , | 23 | | regardless of the final diagnosis given, (including, but not | 24 | | limited to, severe
pain) such that a prudent
layperson, who |
| | | HB0465 Engrossed | - 39 - | LRB101 03398 JRG 48406 b |
|
| 1 | | possesses an average knowledge of health and medicine, could
| 2 | | reasonably expect the absence of immediate medical attention to | 3 | | result in:
| 4 | | (1) placing the health of the individual (or, with | 5 | | respect to a pregnant
woman, the
health of the woman or her | 6 | | unborn child) in serious jeopardy;
| 7 | | (2) serious
impairment to bodily functions; or
| 8 | | (3) serious dysfunction of any bodily organ
or part ; .
| 9 | | (4) inadequately controlled pain; or | 10 | | (5) with respect to a pregnant woman who is having | 11 | | contractions: | 12 | | (A) inadequate time to complete a safe transfer to | 13 | | another hospital before delivery; or | 14 | | (B) a transfer to another hospital may pose a | 15 | | threat to the health or safety of the woman or unborn | 16 | | child. | 17 | | "Emergency medical screening examination" means a medical | 18 | | screening
examination and
evaluation by a physician licensed to | 19 | | practice medicine in all its branches, or
to the extent | 20 | | permitted
by applicable laws, by other appropriately licensed | 21 | | personnel under the
supervision of or in
collaboration with a | 22 | | physician licensed to practice medicine in all its
branches to | 23 | | determine whether
the need for emergency services exists.
| 24 | | "Emergency services" means, with respect to an enrollee of | 25 | | a health care
plan,
transportation services, including but not | 26 | | limited to ambulance services, and
covered inpatient and |
| | | HB0465 Engrossed | - 40 - | LRB101 03398 JRG 48406 b |
|
| 1 | | outpatient hospital services
furnished by a provider
qualified | 2 | | to furnish those services that are needed to evaluate or | 3 | | stabilize an
emergency medical condition. "Emergency services" | 4 | | does not
refer to post-stabilization medical services.
| 5 | | "Enrollee" means any person and his or her dependents | 6 | | enrolled in or covered
by a health care plan.
| 7 | | "Health care plan" means a plan, including, but not limited | 8 | | to, a health maintenance organization, a managed care community | 9 | | network as defined in the Illinois Public Aid Code, or an | 10 | | accountable care entity as defined in the Illinois Public Aid | 11 | | Code that receives capitated payments to cover medical services | 12 | | from the Department of Healthcare and Family Services, that | 13 | | establishes, operates, or maintains a
network of health care | 14 | | providers that has entered into an agreement with the
plan to | 15 | | provide health care services to enrollees to whom the plan has | 16 | | the
ultimate obligation to arrange for the provision of or | 17 | | payment for services
through organizational arrangements for | 18 | | ongoing quality assurance,
utilization review programs, or | 19 | | dispute resolution.
Nothing in this definition shall be | 20 | | construed to mean that an independent
practice association or a | 21 | | physician hospital organization that subcontracts
with
a | 22 | | health care plan is, for purposes of that subcontract, a health | 23 | | care plan.
| 24 | | For purposes of this definition, "health care plan" shall | 25 | | not include the
following:
| 26 | | (1) indemnity health insurance policies including |
| | | HB0465 Engrossed | - 41 - | LRB101 03398 JRG 48406 b |
|
| 1 | | those using a contracted
provider network;
| 2 | | (2) health care plans that offer only dental or only | 3 | | vision coverage;
| 4 | | (3) preferred provider administrators, as defined in | 5 | | Section 370g(g) of
the
Illinois Insurance Code;
| 6 | | (4) employee or employer self-insured health benefit | 7 | | plans under the
federal Employee Retirement Income | 8 | | Security Act of 1974;
| 9 | | (5) health care provided pursuant to the Workers' | 10 | | Compensation Act or the
Workers' Occupational Diseases | 11 | | Act; and
| 12 | | (6) not-for-profit voluntary health services plans | 13 | | with health maintenance
organization
authority in | 14 | | existence as of January 1, 1999 that are affiliated with a | 15 | | union
and that
only extend coverage to union members and | 16 | | their dependents.
| 17 | | "Health care professional" means a physician, a registered | 18 | | professional
nurse,
or other individual appropriately licensed | 19 | | or registered
to provide health care services.
| 20 | | "Health care provider" means any physician, hospital | 21 | | facility, facility licensed under the Nursing Home Care Act, | 22 | | long-term care facility as defined in Section 1-113 of the | 23 | | Nursing Home Care Act, or other
person that is licensed or | 24 | | otherwise authorized to deliver health care
services. Nothing | 25 | | in this
Act shall be construed to define Independent Practice | 26 | | Associations or
Physician-Hospital Organizations as health |
| | | HB0465 Engrossed | - 42 - | LRB101 03398 JRG 48406 b |
|
| 1 | | care providers.
| 2 | | "Health care services" means any services included in the | 3 | | furnishing to any
individual of medical care, or the
| 4 | | hospitalization incident to the furnishing of such care, as | 5 | | well as the
furnishing to any person of
any and all other | 6 | | services for the purpose of preventing,
alleviating, curing, or | 7 | | healing human illness or injury including home health
and | 8 | | pharmaceutical services and products.
| 9 | | "Medical director" means a physician licensed in any state | 10 | | to practice
medicine in all its
branches appointed by a health | 11 | | care plan.
| 12 | | "Person" means a corporation, association, partnership,
| 13 | | limited liability company, sole proprietorship, or any other | 14 | | legal entity.
| 15 | | "Physician" means a person licensed under the Medical
| 16 | | Practice Act of 1987.
| 17 | | "Post-stabilization medical services" means health care | 18 | | services
provided to an enrollee that are furnished in a | 19 | | licensed hospital by a provider
that is qualified to furnish | 20 | | such services, and determined to be medically
necessary and | 21 | | directly related to the emergency medical condition following
| 22 | | stabilization.
| 23 | | "Stabilization" means, with respect to an emergency | 24 | | medical condition, to
provide such medical treatment of the | 25 | | condition as may be necessary to assure,
within reasonable | 26 | | medical probability, that no material deterioration
of the |
| | | HB0465 Engrossed | - 43 - | LRB101 03398 JRG 48406 b |
|
| 1 | | condition is likely to result.
| 2 | | "Utilization review" means the evaluation of the medical | 3 | | necessity,
appropriateness, and efficiency of the use of health | 4 | | care services, procedures,
and facilities.
| 5 | | "Utilization review program" means a program established | 6 | | by a person to
perform utilization review.
| 7 | | (Source: P.A. 98-651, eff. 6-16-14; 98-841, eff. 8-1-14; 99-78, | 8 | | eff. 7-20-15.)
| 9 | | (215 ILCS 134/30)
| 10 | | Sec. 30. Prohibitions.
| 11 | | (a) No health care plan or its subcontractors may prohibit | 12 | | or discourage
health care providers
by contract or policy from
| 13 | | discussing any health care services and health care providers, | 14 | | utilization
review and quality assurance policies, terms and | 15 | | conditions of plans and plan
policy with enrollees, prospective | 16 | | enrollees, providers, or the public.
| 17 | | (b) No health care plan by contract, written policy, or | 18 | | procedure may
permit or allow an individual or entity to | 19 | | dispense a different
drug in place of the drug or brand of drug | 20 | | ordered or prescribed without the
express permission of the | 21 | | person ordering or prescribing the drug, except as
provided | 22 | | under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.
| 23 | | (c) No health care plan or its subcontractors may by | 24 | | contract, written
policy, procedure, or otherwise mandate or | 25 | | require an enrollee
to substitute his or her participating |
| | | HB0465 Engrossed | - 44 - | LRB101 03398 JRG 48406 b |
|
| 1 | | primary care physician
under the plan during inpatient | 2 | | hospitalization, such as with a hospitalist physician licensed | 3 | | to practice medicine in all its branches,
without the agreement | 4 | | of that enrollee's
participating primary care physician. | 5 | | "Participating primary care
physician" for health care plans | 6 | | and subcontractors that do not require
coordination of care by | 7 | | a primary care physician means the participating
physician | 8 | | treating the patient. All health care plans shall inform | 9 | | enrollees
of any policies, recommendations, or guidelines | 10 | | concerning the
substitution of the enrollee's primary care | 11 | | physician when hospitalization is
necessary in the manner set | 12 | | forth in subsections (d) and (e) of Section 15.
| 13 | | (d) A health care plan shall apply any third-party | 14 | | payments, financial assistance, discount, product vouchers, or | 15 | | any other reduction in out-of-pocket expenses made by or on | 16 | | behalf of such insured for prescription drugs toward a covered | 17 | | individual's deductible, copay, or cost-sharing | 18 | | responsibility, or out-of-pocket maximum associated with the | 19 | | individual's health insurance. | 20 | | (e) (d) Any violation of this Section shall be subject to | 21 | | the
penalties under this Act.
| 22 | | (Source: P.A. 94-866, eff. 6-16-06.)
| 23 | | Section 25. The Pharmacy Practice Act is amended by adding | 24 | | Section 42 as follows: |
| | | HB0465 Engrossed | - 45 - | LRB101 03398 JRG 48406 b |
|
| 1 | | (225 ILCS 85/42 new) | 2 | | Sec. 42. Information disclosure. A pharmacist or her or his | 3 | | authorized employee must inform customers of a less expensive, | 4 | | generically equivalent drug product for her or his prescription | 5 | | and whether the cost-sharing obligation to the customer exceeds | 6 | | the retail price of the prescription in the absence of | 7 | | prescription drug coverage. | 8 | | Section 30. The Illinois Public Aid Code is amended by | 9 | | adding Section 5-36 as follows: | 10 | | (305 ILCS 5/5-36 new) | 11 | | Sec. 5-36. Pharmacy benefits. | 12 | | (a)(1) The Department may enter into a contract with a | 13 | | third party on a fee-for-service reimbursement model for the | 14 | | purpose of administering pharmacy benefits as provided in this | 15 | | Section for members not enrolled in a Medicaid managed care | 16 | | organization; however, these services shall be approved by the | 17 | | Department. The Department shall ensure coordination of care | 18 | | between the third-party administrator and managed care | 19 | | organizations as a consideration in any contracts established | 20 | | in accordance with this Section. Any managed care techniques, | 21 | | principles, or administration of benefits utilized in | 22 | | accordance with this subsection shall comply with State law. | 23 | | (2) The following shall apply to contracts between entities | 24 | | contracting relating to the Department's third-party |
| | | HB0465 Engrossed | - 46 - | LRB101 03398 JRG 48406 b |
|
| 1 | | administrators and pharmacies: | 2 | | (A) the Department shall approve any contract between a | 3 | | third-party administrator and a pharmacy; | 4 | | (B) the Department's third-party administrator shall | 5 | | not change the terms of a contract between a third-party | 6 | | administrator and a pharmacy without written approval by | 7 | | the Department; and | 8 | | (C) the Department's third-party administrator shall | 9 | | not create, modify, implement, or indirectly establish any | 10 | | fee on a pharmacy, pharmacist, or a recipient of medical | 11 | | assistance without written approval by the Department. | 12 | | (b) The provisions of this Section shall not apply to | 13 | | outpatient pharmacy services provided by a health care facility | 14 | | registered as a covered entity pursuant to 42 U.S.C. 256b or | 15 | | any pharmacy owned by or contracted with the covered entity. A | 16 | | Medicaid managed care organization shall, either directly or | 17 | | through a pharmacy benefit manager, administer and reimburse | 18 | | outpatient pharmacy claims submitted by a health care facility | 19 | | registered as a covered entity pursuant to 42 U.S.C. 256b, its | 20 | | owned pharmacies, and contracted pharmacies in accordance with | 21 | | the contractual agreements the Medicaid managed care | 22 | | organization or its pharmacy benefit manager has with such | 23 | | facilities and pharmacies. Any pharmacy benefit manager that | 24 | | contracts with a Medicaid managed care organization to | 25 | | administer and reimburse pharmacy claims as provided in this | 26 | | Section must be registered with the Director of Insurance in |
| | | HB0465 Engrossed | - 47 - | LRB101 03398 JRG 48406 b |
|
| 1 | | accordance with Section 513b2 of the Illinois Insurance Code. | 2 | | (c) On at least an annual basis, the Director of the | 3 | | Department of Healthcare and Family Services shall submit a | 4 | | report beginning no later than one year after the effective | 5 | | date of this amendatory Act of the 101st General Assembly that | 6 | | provides an update on any contract, contract issues, formulary, | 7 | | dispensing fees, and maximum allowable cost concerns regarding | 8 | | a third-party administrator and managed care. The requirement | 9 | | for reporting to the General Assembly shall be satisfied by | 10 | | filing copies of the report with the Speaker, the Minority | 11 | | Leader, and the Clerk of the House of Representatives and with | 12 | | the President, the Minority leader, and the Secretary of the | 13 | | Senate. The Department shall take care that no proprietary | 14 | | information is included in the report required under this | 15 | | Section. | 16 | | (d) A pharmacy benefit manager shall notify the Department | 17 | | in writing of any activity, policy, or practice of the pharmacy | 18 | | benefit manager that directly or indirectly presents a conflict | 19 | | of interest that interferes with the discharge of the pharmacy | 20 | | benefit manager's duty to a managed care organization to | 21 | | exercise its contractual duties. "Conflict of interest" shall | 22 | | be defined by rule by the Department. | 23 | | (e) A pharmacy benefit manager shall, upon request, | 24 | | disclose to the Department the following information: | 25 | | (1) whether the pharmacy benefit manager has a | 26 | | contract, agreement, or other arrangement with a |
| | | HB0465 Engrossed | - 48 - | LRB101 03398 JRG 48406 b |
|
| 1 | | pharmaceutical manufacturer to exclusively dispense or | 2 | | provide a drug to a managed care organization's enrollees, | 3 | | and the aggregate amounts of consideration of economic | 4 | | benefits collected or received pursuant to that | 5 | | arrangement; | 6 | | (2) the percentage of claims payments made by the | 7 | | pharmacy benefit manager to pharmacies owned, managed, or | 8 | | controlled by the pharmacy benefit manager or any of the | 9 | | pharmacy benefit manager's management companies, parent | 10 | | companies, subsidiary companies, or jointly held | 11 | | companies; | 12 | | (3) the aggregate amount of the fees or assessments | 13 | | imposed on, or collected from, pharmacy providers; and | 14 | | (4) the average annualized percentage of revenue | 15 | | collected by the pharmacy benefit manager as a result of | 16 | | each contract it has executed with a managed care | 17 | | organization contracted by the Department to provide | 18 | | medical assistance benefits which is not paid by the | 19 | | pharmacy benefit manager to pharmacy providers and | 20 | | pharmaceutical manufacturers or labelers or in order to | 21 | | perform administrative functions pursuant to its contracts | 22 | | with managed care organizations. | 23 | | (f) The information disclosed under subsection (e) shall | 24 | | include all retail, mail order, specialty, and compounded | 25 | | prescription products. All information made
available to the | 26 | | Department under subsection (e) is confidential and not subject |
| | | HB0465 Engrossed | - 49 - | LRB101 03398 JRG 48406 b |
|
| 1 | | to disclosure under the Freedom of Information Act. All | 2 | | information made available to the Department under subsection | 3 | | (e) shall not be reported or distributed in any way that | 4 | | compromises its competitive, proprietary, or financial value. | 5 | | The information shall only be used by the Department to assess | 6 | | the contract, agreement, or other arrangements made between a | 7 | | pharmacy benefit manager and a pharmacy provider, | 8 | | pharmaceutical manufacturer or labeler, managed care | 9 | | organization, or other entity, as applicable. | 10 | | (g) A pharmacy benefit manager shall disclose directly in | 11 | | writing to a pharmacy provider or pharmacy services | 12 | | administrative organization contracting with the pharmacy | 13 | | benefit manager of any material change to a contract provision | 14 | | that affects the terms of the reimbursement, the process for | 15 | | verifying benefits and eligibility, dispute resolution, | 16 | | procedures for verifying drugs included on the formulary, and | 17 | | contract termination at least 30 days prior to the date of the | 18 | | change to the provision. The terms of this subsection shall be | 19 | | deemed met if the pharmacy benefit manager posts the | 20 | | information on a website, viewable by the public. A pharmacy | 21 | | service administration organization shall notify all contract | 22 | | pharmacies of any material change, as described in this | 23 | | subsection, within 2 days of notification. As used in this | 24 | | Section, "pharmacy services administrative organization" means | 25 | | an entity operating within the State that contracts with | 26 | | independent pharmacies to conduct business on their behalf with |
| | | HB0465 Engrossed | - 50 - | LRB101 03398 JRG 48406 b |
|
| 1 | | third-party payers. A pharmacy services administrative | 2 | | organization may provide administrative services to pharmacies | 3 | | and negotiate and enter into contracts with third-party payers | 4 | | or pharmacy benefit managers on behalf of pharmacies. | 5 | | (h) A pharmacy benefit manager shall not include the | 6 | | following in a contract with a pharmacy provider: | 7 | | (1) a provision prohibiting the provider from | 8 | | informing a patient of a less costly alternative to a | 9 | | prescribed medication; or | 10 | | (2) a provision that prohibits the provider from | 11 | | dispensing a particular amount of a prescribed medication, | 12 | | if the pharmacy benefit manager allows that amount to be | 13 | | dispensed through a pharmacy owned or controlled by the | 14 | | pharmacy benefit manager, unless the prescription drug is | 15 | | subject to restricted distribution by the United States | 16 | | Food and Drug Administration or requires special handling, | 17 | | provider coordination, or patient education that cannot be | 18 | | provided by a retail pharmacy. | 19 | | (i) Nothing in this Section shall be construed to prohibit | 20 | | a pharmacy benefit manager from requiring the same | 21 | | reimbursement and terms and conditions for a pharmacy provider | 22 | | as for a pharmacy owned, controlled, or otherwise associated | 23 | | with the pharmacy benefit manager. | 24 | | (j) A pharmacy benefit manager shall establish and | 25 | | implement a process for the resolution of disputes arising out | 26 | | of this Section, which shall be approved by the Department. |
| | | HB0465 Engrossed | - 51 - | LRB101 03398 JRG 48406 b |
|
| 1 | | (k) The Department shall adopt rules establishing | 2 | | reasonable dispensing fees for fee-for-service payments in | 3 | | accordance with guidance or guidelines from the federal Centers | 4 | | for Medicare and Medicaid Services.
| 5 | | Section 97. Severability. If any provision of this Act or | 6 | | the application of this Act to any person or circumstance is | 7 | | held invalid, the invalidity shall not affect other provisions | 8 | | or applications of this Act which can be given effect without | 9 | | the invalid provision or application, and to this end, the | 10 | | provisions of this Act are declared severable. |
|