Full Text of SB1756 101st General Assembly
SB1756ham001 101ST GENERAL ASSEMBLY | Rep. Bob Morgan Filed: 10/28/2019
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| 1 | | AMENDMENT TO SENATE BILL 1756
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1756 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 155.36 as follows:
| 6 | | (215 ILCS 5/155.36)
| 7 | | Sec. 155.36. Managed Care Reform and Patient Rights Act. | 8 | | Insurance
companies that transact the kinds of insurance | 9 | | authorized under Class 1(b) or
Class 2(a) of Section 4 of this | 10 | | Code shall comply
with Sections 45, 45.1, 45.2, and 85 , | 11 | | subsection (d) of Section 30, and the definition of the term | 12 | | "emergency medical
condition" in Section
10 of the Managed Care | 13 | | Reform and Patient Rights Act.
| 14 | | (Source: P.A. 98-1035, eff. 8-25-14.)
| 15 | | (215 ILCS 125/5-10 rep.) |
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| 1 | | Section 10. The Health Maintenance Organization Act is | 2 | | amended by repealing Section 5-10. | 3 | | Section 15. The Managed Care Reform and Patient Rights Act | 4 | | is amended by changing Section 30 as follows:
| 5 | | (215 ILCS 134/30)
| 6 | | (Text of Section before amendment by P.A. 101-452 )
| 7 | | Sec. 30. Prohibitions.
| 8 | | (a) No health care plan or its subcontractors may prohibit | 9 | | or discourage
health care providers
by contract or policy from
| 10 | | discussing any health care services and health care providers, | 11 | | utilization
review and quality assurance policies, terms and | 12 | | conditions of plans and plan
policy with enrollees, prospective | 13 | | enrollees, providers, or the public.
| 14 | | (b) No health care plan by contract, written policy, or | 15 | | procedure may
permit or allow an individual or entity to | 16 | | dispense a different
drug in place of the drug or brand of drug | 17 | | ordered or prescribed without the
express permission of the | 18 | | person ordering or prescribing the drug, except as
provided | 19 | | under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.
| 20 | | (c) No health care plan or its subcontractors may by | 21 | | contract, written
policy, procedure, or otherwise mandate or | 22 | | require an enrollee
to substitute his or her participating | 23 | | primary care physician
under the plan during inpatient | 24 | | hospitalization, such as with a hospitalist physician licensed |
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| 1 | | to practice medicine in all its branches,
without the agreement | 2 | | of that enrollee's
participating primary care physician. | 3 | | "Participating primary care
physician" for health care plans | 4 | | and subcontractors that do not require
coordination of care by | 5 | | a primary care physician means the participating
physician | 6 | | treating the patient. All health care plans shall inform | 7 | | enrollees
of any policies, recommendations, or guidelines | 8 | | concerning the
substitution of the enrollee's primary care | 9 | | physician when hospitalization is
necessary in the manner set | 10 | | forth in subsections (d) and (e) of Section 15.
| 11 | | (d) Any violation of this Section shall be subject to the
| 12 | | penalties under this Act.
| 13 | | (Source: P.A. 94-866, eff. 6-16-06.)
| 14 | | (Text of Section after amendment by P.A. 101-452 )
| 15 | | Sec. 30. Prohibitions.
| 16 | | (a) No health care plan or its subcontractors may prohibit | 17 | | or discourage
health care providers
by contract or policy from
| 18 | | discussing any health care services and health care providers, | 19 | | utilization
review and quality assurance policies, terms and | 20 | | conditions of plans and plan
policy with enrollees, prospective | 21 | | enrollees, providers, or the public.
| 22 | | (b) No health care plan by contract, written policy, or | 23 | | procedure may
permit or allow an individual or entity to | 24 | | dispense a different
drug in place of the drug or brand of drug | 25 | | ordered or prescribed without the
express permission of the |
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| 1 | | person ordering or prescribing the drug, except as
provided | 2 | | under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.
| 3 | | (c) No health care plan or its subcontractors may by | 4 | | contract, written
policy, procedure, or otherwise mandate or | 5 | | require an enrollee
to substitute his or her participating | 6 | | primary care physician
under the plan during inpatient | 7 | | hospitalization, such as with a hospitalist physician licensed | 8 | | to practice medicine in all its branches,
without the agreement | 9 | | of that enrollee's
participating primary care physician. | 10 | | "Participating primary care
physician" for health care plans | 11 | | and subcontractors that do not require
coordination of care by | 12 | | a primary care physician means the participating
physician | 13 | | treating the patient. All health care plans shall inform | 14 | | enrollees
of any policies, recommendations, or guidelines | 15 | | concerning the
substitution of the enrollee's primary care | 16 | | physician when hospitalization is
necessary in the manner set | 17 | | forth in subsections (d) and (e) of Section 15.
| 18 | | (d) A health care plan shall apply any third-party | 19 | | payments, financial assistance, discount, product vouchers, or | 20 | | any other reduction in out-of-pocket expenses made by or on | 21 | | behalf of such insured for prescription drugs toward a covered | 22 | | individual's deductible, copay, or cost-sharing | 23 | | responsibility, or out-of-pocket maximum associated with the | 24 | | individual's health insurance. The provisions of this | 25 | | subsection do not apply to the minimum extent they would | 26 | | disqualify a high-deductible health plan from eligibility for a |
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| 1 | | health savings account pursuant to Section 223 of the federal | 2 | | Internal Revenue Code (26 U.S.C. 223). | 3 | | (e) Any violation of this Section shall be subject to the
| 4 | | penalties under this Act.
| 5 | | (Source: P.A. 101-452, eff. 1-1-20.)
| 6 | | Section 20. The Illinois Public Aid Code is amended by | 7 | | adding Section 5H-9 as follows: | 8 | | (305 ILCS 5/5H-9 new) | 9 | | Sec. 5H-9. Managed care organizations; revenue data. | 10 | | (a) No managed care organization shall pass the cost of the | 11 | | assessment imposed pursuant to this Article on to consumers as | 12 | | a discrete addition to their premiums. | 13 | | (b) With respect to health maintenance organizations, the | 14 | | Department of Insurance shall provide the Department with | 15 | | member months and premium revenue data needed for implementing | 16 | | the assessment imposed under this Article. | 17 | | Section 95. No acceleration or delay. Where this Act makes | 18 | | changes in a statute that is represented in this Act by text | 19 | | that is not yet or no longer in effect (for example, a Section | 20 | | represented by multiple versions), the use of that text does | 21 | | not accelerate or delay the taking effect of (i) the changes | 22 | | made by this Act or (ii) provisions derived from any other | 23 | | Public Act.
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| 1 | | Section 99. Effective date. This Act takes effect upon | 2 | | becoming law.".
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