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90_HB1042
New Act
Creates the Managed Care Responsibility to Members Act.
Provides for the regulation of managed care plans by the
Department of Insurance. Creates specific patient rights to
disclosure, quality of care, and confidentiality. Prohibits
restraints on communications between physicians and patients.
Requires the establishment of grievance procedures. Requires
utilization review programs to register with the Department
of Insurance. Effective January 1, 1998.
LRB9004798JScc
LRB9004798JScc
1 AN ACT concerning managed care arrangements.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 1. Short title. This Act may be cited as the
5 Managed Care Responsibility to Members Act.
6 Section 5. Purpose. This Act addresses changes in managed
7 care practice and operations in Illinois. This Act enhances
8 quality, affordable, and accessible health care coverage for
9 Illinois citizens, families, and businesses. Through the
10 provisions of this Act, health care plan members will be
11 provided:
12 (1) Detailed information about health care plans, the
13 scope of coverage available, and the physicians' professional
14 qualifications so that they can make informed choices about
15 their health care.
16 (2) Notification of termination or change in any
17 benefits, services, or service delivery. This includes a
18 provision allowing enrollees to continue with a nonnetwork
19 physician under certain specific circumstances.
20 (3) Detailed grievance procedures and medical necessity
21 appeals procedures, which include an expedited appeal
22 process. This Act also ensures health care plan
23 accountability for accessible hospital and physician services
24 and reimbursement for covered emergency services.
25 Section 10. Definitions. As used in this Act:
26 "Basic health care services" means emergency care, and
27 inpatient hospital and physician care, outpatient medical
28 services, mental health services and care for alcohol and
29 drug abuse, including any reasonable deductibles and
30 copayments, all of which are subject to such limitations as
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1 are determined by the Director.
2 "Department" means the Department of Insurance.
3 "Director" means the Director of Insurance.
4 "Emergency services" means the provision of care for the
5 sudden and, at the time, unexpected onset of a health
6 condition which would lead a prudent lay person to believe
7 that failure to receive immediate medical attention would
8 result in serious impairment to bodily function, serious
9 dysfunction to any bodily organ or part, or would place the
10 person's health in serious jeopardy.
11 "Enrollee" means an individual enrolled in a health care
12 plan.
13 "Governing body" means the board of trustees, or
14 directors, or if otherwise designated in the basic
15 organizational document bylaws, those individuals vested with
16 the ultimate responsibility for the management of the health
17 care plan.
18 "Grievance" means any written complaint submitted to the
19 health care plan by or on behalf of an enrollee regarding any
20 aspect of the plan relative to the enrollee, but shall not
21 include a complaint by or on behalf of a provider.
22 "Grievance committee" means individuals who have been
23 appointed by the health care plan to respond to grievances
24 which have been filed on appeal from the plan's simplified
25 complaint process. At least 50% of the individuals on this
26 committee shall be composed of enrollees who are consumers.
27 A grievance may not be heard or voted upon unless at least
28 50% of the voting individuals at the committee hearing are
29 enrollees.
30 "Health care plan" means any arrangement whereby an
31 organization undertakes to provide or arrange for and pay for
32 or reimburse the cost of basic health care services from
33 providers selected by the plan and the arrangement consists
34 of arranging for or the provision of health care services, as
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1 distinguished from mere indemnification against the cost of
2 those services, on a per capita prepaid basis, through
3 insurance or otherwise.
4 "Health care services" means any services included in the
5 furnishing to any individual of medical or dental care, the
6 hospitalization incident to the furnishing of such care, and
7 the furnishing to any person of any and all other services
8 for the purpose of preventing, alleviating, curing, or
9 healing human illness or injury.
10 "Insurance company" means companies in this State
11 authorized to transact the kind or kinds of business
12 enumerated in Class 1(a), Class 1(b) or Class 2(a) of Section
13 4 of the Illinois Insurance Code.
14 "Insured" means an individual entitled to coverage of
15 expenses of health care services under a policy issued or
16 administered by an insurance company.
17 "Life threatening condition" means any condition, illness
18 or injury which (i) may directly lead to a patient's death,
19 (ii) results in a period of unconsciousness which is
20 indeterminate at the present, or (iii) imposes severe pain or
21 an inhumane burden on the patient.
22 "Medical director" means a physician licensed to practice
23 medicine in all its branches in Illinois who is employed by
24 or contracted with a health care plan and who shall be
25 responsible for final review when questions of medical
26 practice arise in the health care plan in order to assure the
27 quality of health care services provided.
28 "Patient" means any person who has received or is
29 receiving medical care, treatment, or services from an
30 individual or institution licensed to provide medical care or
31 treatment in this State.
32 "Primary care physician" means a provider who has
33 contracted with a health care plan to provide primary care
34 services as defined by the contract and who is (1) a
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1 physician licensed to practice medicine in all of its
2 branches who spends a majority of clinical time engaged in
3 general practice or in the practice of internal medicine,
4 pediatrics, gynecology, obstetrics, or family practice or (2)
5 a chiropractic physician licensed to treat human ailments
6 without the use of drugs or operative surgery.
7 "Provider" means any physician, hospital facility, or
8 other person which is licensed or otherwise authorized to
9 furnish health care services and also includes any other
10 entity that arranges for the delivery or furnishing of health
11 care services.
12 "Stabilization" means the provision of medical treatment
13 to assure within reasonable medical probability that no
14 material deterioration of the condition is likely to result
15 from the transfer of the individual from a facility.
16 "Utilization review" means the study of the
17 appropriateness of the use of particular services and the
18 appropriateness of the volume of services used.
19 "Utilization review program" means an entity performing
20 utilization review, except an agency of the federal
21 government or its agent, but only to the extent that agent is
22 providing services to the federal government.
23 Section 15. Patient rights. The following rights are
24 hereby established:
25 (1) The right of each patient to be provided with
26 information about the health care plan and the providers
27 rendering care. For health care plans this right calls for
28 compliance with Section 20 of this Act.
29 (2) The right of each patient to a full disclosure of
30 the patient costs, benefits, risks, and alternatives related
31 to the treatment options and care, including health care plan
32 requirements, coverage, exclusions, or limitations that could
33 affect the enrollee's access to coverage or treatment
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1 options. For health care plans this right calls for
2 compliance with Section 25 of this Act. Insurance companies
3 and health care plans are prohibited from terminating or
4 suspending a provider from its network for advocating
5 appropriate health care services because the provider
6 advocated for what he or she considered to be appropriate
7 health care.
8 (3) The right of each patient to care, consistent with
9 nursing and medical practices, to be informed of the name of
10 the physician responsible for coordinating his or her care,
11 to receive information from his or her physician concerning
12 his or her condition and proposed treatment, to refuse any
13 treatment to the extent permitted by law, and to privacy and
14 confidentiality of records except as otherwise provided by
15 law.
16 (4) The right of each patient, regardless of source of
17 payment, to examine and receive a reasonable explanation of
18 his or her total bill for services where such a bill is
19 rendered by his or her physician or health care provider,
20 including the itemized charges for specific services
21 received. Each provider shall be responsible for a reasonable
22 explanation of those specific services provided by such
23 physician or health care provider.
24 (5) In the event an insurance company or health care
25 plan cancels or refuses to renew an individual policy or
26 plan, the insured or enrollee shall be entitled to timely,
27 prior notice of the termination of such policy or plan.
28 An insurance company or health care plan that requires
29 any insured, enrollee, or applicant for new or continued
30 insurance or coverage to be tested for infection with HIV or
31 any other identified causative agent of AIDS shall (i) give
32 the patient or applicant prior written notice of such
33 requirement, (ii) proceed with such testing only upon the
34 written authorization of the insured, enrollee, or applicant,
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1 and (iii) keep the results of such testing confidential.
2 Notice of an adverse underwriting or coverage decision may be
3 given to any appropriately interested party, but the
4 insurance company or health care plan may only disclose the
5 test result itself to a physician designated by the insured,
6 enrollee or applicant, and any such disclosure shall be in a
7 manner that assures confidentiality.
8 (6) At the time of renewal, the right of each patient to
9 notification of termination or change in any benefits,
10 services, or service delivery location.
11 (7) The right of each patient to privacy and
12 confidentiality in health care. Each physician, health care
13 provider, health care plan and insurance company shall not
14 disclose the nature or details of services provided to
15 insureds and enrollees, except that such information may be
16 disclosed to the patient, the party making treatment
17 decisions if the patient is incapable of making decisions
18 regarding the health services provided, those parties
19 directly involved with providing treatment to the patient or
20 processing the payment for that treatment, those parties
21 responsible for peer review, utilization review and quality
22 assurance, and those parties required to be notified under
23 the Abused and Neglected Child Reporting Act, the Illinois
24 Sexually Transmissible Disease Control Act or where otherwise
25 authorized or required by law. This right may be waived in
26 writing by the patient or the patient's guardian, but a
27 physician or other health care provider may not condition the
28 provision of services on the patient's or guardian's
29 agreement to sign such a waiver.
30 Section 20. Provision of information.
31 (a) A health care plan shall provide to enrollees a
32 description of the terms and conditions of the evidence of
33 coverage. The form shall provide a description of all of the
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1 following:
2 (1) The service area.
3 (2) Covered benefits, exclusions or limitations.
4 (3) Precertification and other utilization review
5 procedures requirements.
6 (4) A list of primary care physicians in the health
7 care plan's service area and a description of the
8 limitations to access specialists.
9 (5) Emergency coverage and benefits.
10 (6) Out-of-area coverages and benefits.
11 (7) The enrollee's financial responsibility for
12 copayments, deductibles, and any other out-of-pocket
13 expenses.
14 (8) Provisions for continuity of treatment in the
15 event a provider's participation terminates during the
16 course of an insured's or enrollee's treatment by that
17 provider.
18 (9) The grievance process, including the telephone
19 number to call to receive information concerning
20 grievance procedures.
21 (b) Upon written request, a health care plan shall
22 provide to applicants and enrollees a description of the
23 financial relationships between the health care plan and any
24 provider, except that no health care plan shall be required
25 to disclose specific reimbursement to providers.
26 (c) A participating provider shall provide all of the
27 following to enrollees upon request:
28 (1) Information related to the health care
29 professional's educational background, experience,
30 training, specialty, and board certification, if
31 applicable.
32 (2) The names of licensed facilities on the
33 provider panel where the health professional presently
34 has privileges for the treatment, illness, or procedure
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1 that is the subject of the request.
2 (3) Information regarding the health care
3 professional's participation in continuing education
4 programs and compliance with any licensure,
5 certification, or registration requirements, if
6 applicable.
7 Section 25. Prohibited restraints on communication.
8 Nothing in a physician's contract with a health care plan
9 shall be construed to impair the physician's ethical and
10 legal duty to provide full informed consent and medical
11 counsel to enrollees, including full discussion of the costs,
12 benefits, risks, and alternatives related to the enrollee's
13 treatment options and care and health care plan policies
14 related to those options, including health care plan
15 requirements, coverage, exclusions, or other policies or
16 practices that affect enrollees' access to coverage or
17 treatment options.
18 Section 30. Access to personnel and facilities.
19 (a) A health care plan shall include a sufficient number
20 and type of primary care physicians and specialists,
21 throughout the service area, to meet the needs of enrollees
22 and to provide meaningful choice. A health care plan shall
23 offer:
24 (1) accessible acute care hospital services, within
25 a reasonable distance or travel time;
26 (2) primary care physicians, within a reasonable
27 distance or travel time; and
28 (3) specialists within a reasonable distance or
29 travel time.
30 When the type of medical service needed for a specific
31 condition is not represented in the provider network, the
32 health care plan shall arrange for the enrollee to have
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1 access to qualified nonparticipating health care
2 professionals as authorized by the primary care physician.
3 (b) A health care plan shall provide telephone access to
4 the health care plan for sufficient time during business
5 hours to assure enrollee access for routine care, and 24 hour
6 telephone access to the health care plan or, if so delegated
7 by the health care plan, a participating physician or group
8 for emergency care or authorization for care.
9 (c) A health care plan shall establish reasonable
10 standards for waiting times to obtain appointments, except as
11 provided below for emergency services.
12 Such standards shall include appointment scheduling
13 guidelines used for each type of health care service,
14 including prenatal care appointments, well-child visits and
15 immunizations, routine physicals, follow-up appointments for
16 chronic conditions, and urgent care.
17 (d) A health care plan shall provide for continuity of
18 care for its enrollees as follows:
19 (1) If an enrollee's physician leaves the health
20 care plan's network of providers for reasons other than
21 termination with cause and the physician remains within
22 the health care plan's service area, the health care plan
23 shall permit the enrollee to continue an ongoing course
24 of treatment with that physician during a transitional
25 period of:
26 (A) up to 60 days from the date of the notice
27 of physician's termination from the health care plan
28 network to the enrollee of the physician's
29 disaffiliation from the health care plan's network
30 if the enrollee has a life threatening disease or
31 condition; or
32 (B) if the enrollee has entered the third
33 trimester of pregnancy at the time of the
34 physician's disaffiliation, for a transitional
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1 period that includes the provision of post-partum
2 care directly related to the delivery.
3 (2) Notwithstanding the provisions in item (1) of
4 this subsection, such care shall be authorized by the
5 health care plan during the transitional period only if
6 the physician agrees:
7 (A) to continue to accept reimbursement from
8 the health care plan at the rates applicable prior
9 to the start of the transitional period as payment
10 in full;
11 (B) to adhere to the health care plan's
12 quality assurance requirements and to provide to the
13 health care plan necessary medical information
14 related to such care; and
15 (C) to otherwise adhere to the organization's
16 policies and procedures, including but not limited
17 to procedures regarding referrals and obtaining
18 preauthorizations and a treatment plan approved by
19 the health care plan.
20 (e) A health care plan shall provide for continuity of
21 care for new enrollees as follows:
22 (1) If a new enrollee whose physician is not a
23 member of the health care plan's provider network, but is
24 within the health care plan's service area, enrolls in
25 the health care plan, the health care plan shall permit
26 the enrollee to continue an ongoing course of treatment
27 with the enrollee's current physician during a
28 transitional period of up to 60 days from the effective
29 date of enrollment, if:
30 (A) the enrollee has a life-threatening
31 disease or condition; or
32 (B) the enrollee has entered the third
33 trimester of pregnancy at the effective date of
34 enrollment, in which case the transitional period
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1 shall include the provision of post-partum care
2 directly related to the delivery.
3 (2) If an enrollee elects to continue to receive
4 care from such physician pursuant to item (1) of this
5 subsection, such care shall be authorized by the health
6 care plan for the transitional period only if the
7 physician agrees:
8 (A) to accept reimbursement from the health
9 care plan at rates established by the health care
10 plan as payment in full, such rates shall be no more
11 than the level of reimbursement applicable to
12 similar physicians within the health care plan's
13 network for such services;
14 (B) to adhere to the health care plan's
15 quality assurance requirements and agrees to
16 provide to the health care plan necessary medical
17 information related to such care; and
18 (C) to otherwise adhere to the health care
19 plan's policies and procedures including, but not
20 limited to procedures regarding referrals and
21 obtaining preauthorization and a treatment plan
22 approved by the health care plan. In no event
23 shall this section be construed to require a health
24 care plan to provide coverage for benefits not
25 otherwise covered or to diminish or impair
26 preexisting condition limitations contained in the
27 subscriber's contract.
28 Section 35. Emergency services.
29 (a) Health care plans shall provide reimbursement for
30 covered emergency services provided at a participating or
31 nonparticipating emergency department up to the point of
32 stabilization of an enrollee.
33 (b) Once the enrollee is stabilized, the emergency
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1 department shall contact the primary care physician or health
2 care plan as specified on the identification card to seek
3 prior authorization for any additional nonemergency services
4 beyond stabilization.
5 (c) With any claim for reimbursement, the emergency
6 department shall provide the health plan with the medical
7 record documenting the presenting symptoms of the enrollee at
8 the time care was sought and the objective findings of the
9 medical examination.
10 (d) The health care plan's medical director's
11 determination of whether the enrollee meets the standard of
12 emergency shall take into account the presenting symptoms at
13 the time care was sought.
14 (e) Health care plans may require an enrollee to pay a
15 copayment for emergency services.
16 (f) Health care plans shall provide enrollees with
17 information on procedures for the coverage of emergency
18 services both inside and out of the plan service area.
19 Section 40. Grievance procedures.
20 (a) Every health care plan shall submit for the
21 Director's approval, and thereafter maintain, a system for
22 the resolution of grievances concerning the provision of
23 health care services or other matters concerning operation
24 of the health care plan as follows. A health care plan shall
25 do all of the following:
26 (1) Submit to the Director for prior approval any
27 proposed changes to the system by which grievances may be
28 filed and reviewed;
29 (2) Maintain records on each grievance filed with
30 the health care plan until the grievance is resolved and
31 for a period of at least 3 years to include:
32 (A) a copy of the grievance and the date of
33 its filing;
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1 (B) the date and outcome of all consultations,
2 hearings and hearing findings;
3 (C) the date and decisions of any appeal
4 proceedings; and
5 (D) the date and proceeding of any litigation.
6 (3) Submit to the Director in a form prescribed by
7 the Director, a report by March 1 for the previous
8 calendar year which shall include at least the following:
9 (A) the total number of grievances handled;
10 (B) a compilation of causes underlying the
11 grievances;
12 (C) the outcomes of the grievances;
13 (D) the elapsed time from receipt of the
14 grievance by the health care plan until its
15 conclusion; and
16 (E) the number of malpractice claims filed and
17 if such claims have been completely adjudicated, a
18 compilation of causes, disposition, form, and amount
19 of any settlements.
20 (b) A health care plan shall have a grievance committee
21 which shall have the authority to hear and resolve by
22 majority vote grievances submitted to it as provided in
23 subsection (a).
24 Notwithstanding any other provisions of this Section, the
25 grievance committee may, but is not required to, hear any
26 grievance which alleges or indicates possible professional
27 liability, commonly known as "malpractice."
28 The committee is not empowered to resolve grievances in
29 any manner which, or prescribe any actions, that are in
30 conflict with written policies of the health care plan's
31 governing body, but the committee may hear such grievances
32 for the purpose of providing input to the governing body.
33 The grievance committee shall meet at the main office of
34 the health care plan, or such other office designated by the
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1 health care plan where the main office is not within 50 miles
2 of the grievant's home address. Consideration shall be given
3 to the enrollee's request pertaining to the time and date of
4 such meeting. The enrollee shall have the right to attend
5 and participate in the formal grievance proceedings. The
6 enrollee shall have the right to be accompanied by a
7 designated representative of his or her choice.
8 The filing of a grievance shall not preclude the enrollee
9 from filing a complaint with the Department nor shall it
10 preclude the Department from investigating a complaint
11 pursuant to its authority under Section 4-6 of the Health
12 Maintenance Organization Act.
13 (c) The grievance procedures must be fully and clearly
14 communicated to all enrollees and information concerning such
15 procedures shall be readily available to the enrollee.
16 (d) A health care plan shall have simplified procedure
17 for resolving complaints. Such procedures do not require
18 review of the complaint by the grievance committee, but a
19 log, file, or other similar records must be maintained to
20 identify the general nature of such complaints. Resolution
21 of such complaints shall not preclude the enrollees' rightful
22 access to review by the grievance committee of a grievance.
23 (e) The health care plan shall institute procedures
24 which would require grievances to have a determination made
25 by the grievance committee within 60 days from the date the
26 grievance is received by the health care plan. A grievance
27 may not be heard or voted upon unless 50% of the voting
28 individuals of the committee present at the hearing are
29 enrollees. The determination by the grievance committee may
30 be extended for a period not to exceed 30 days in the event
31 of delay in obtaining documents or records necessary for the
32 resolution of the grievance. All requests for documents or
33 records necessary for the resolution of the grievance shall
34 be maintained in the health care plan's grievance file.
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1 (f) The grievance procedure shall provide the enrollee
2 with a written acknowledgment of their grievance within 10
3 business days after receipt by the health care plan.
4 (g) The enrollee shall be notified at the time of the
5 hearing of the name and affiliation of those grievance
6 committee members who are representatives of the health care
7 plan.
8 (h) The health care plan shall institute procedures
9 whereby any document furnished to the members of the
10 grievance committee shall also be made available to the
11 enrollee not less than 5 business days prior to the hearing
12 of their grievance. The health care plan shall not present
13 any evidence without the enrollee having been given the
14 opportunity to be present.
15 (i) Notice in writing of the determination of the
16 grievance committee shall be mailed to the enrollee within 5
17 business days of such determination. Notice of the
18 determination made at the final appeal step of the health
19 care plan's grievance process shall include a notice of the
20 availability of the Department to receive complaints under
21 Section 4-6 of the Health Maintenance Organization Act.
22 (j) Prior to the resolution of a grievance filed by a
23 subscriber or enrollee, coverage shall not be terminated for
24 any reason which is the subject of the written grievance,
25 except where the health care plan has, in good faith, made a
26 reasonable effort to resolve the written grievance through
27 its grievance procedure and coverage is being terminated as a
28 result of good cause.
29 Section 45. Review of medical necessity. A health care
30 plan shall provide a mechanism for the timely review by a
31 physician holding the same class of license as the primary
32 care physician, who is unaffiliated with health care plan,
33 jointly selected by the patient (or the patient's next of kin
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1 or legal representative if the patient is unable to act for
2 himself or herself), primary care physician and the health
3 care plan in the event of a dispute between the primary care
4 physician and the health care plan regarding the medical
5 necessity of a covered service proposed by the primary care
6 physician. In the event that the reviewing physician
7 determines the covered service to be medically necessary, the
8 health care plan shall provide the covered service. Future
9 contractual or employment action by the health care plan
10 regarding the primary care physician shall not be based
11 solely on the physician's participation in this procedure.
12 Section 50. Expedited review of medical necessity.
13 (a) A health care plan shall have an expedited review
14 procedure whereby an enrollee with a life-threatening
15 condition, or physician authorized in writing to act on
16 behalf of the enrollee with a life-threatening condition, may
17 appeal a health care plan's decision of medical necessity of
18 a covered service.
19 (b) The expedited review procedure shall provide that an
20 initial determination of the review will be made by the
21 health care plan not later than 3 business days after
22 receipt of all necessary information to complete the review
23 process.
24 (c) After the initial adverse determination by the
25 health care plan, the enrollee, or physician authorized in
26 writing to act on behalf of the enrollee, may request further
27 review by the health care plan. If further review is
28 requested, a final determination by the health care plan
29 shall be made not later than 30 days after receipt of all
30 necessary information to complete further review. Upon
31 notification to the enrollee of the health care plan's final
32 determination resulting from the expedited review process,
33 the plan shall provide the enrollee a notice of the
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1 availability of the Department to receive complaints as
2 provided in Section 4-6 of the Health Maintenance
3 Organization Act.
4 (d) A request for an expedited review under this Section
5 must contain a statement submitted by the physician, orally
6 or in writing, substantiating that the enrollee has a
7 life-threatening condition. This subsection does not apply to
8 a provider's complaint concerning claims payment, handling,
9 or reimbursement for health care services.
10 (e) If the expedited review process is invoked it shall
11 be in place of and not in addition to the regular review
12 process.
13 Section 55. Registration of utilization review programs.
14 (a) All utilization review programs shall register
15 annually with the Department.
16 (b) The utilization review program will submit all of
17 the following:
18 (1) The name, address and telephone of the
19 registrant.
20 (2) The organization and governing structure of the
21 registrant.
22 (3) List of insurance companies and health care
23 plans for which the utilization review program performs
24 utilization review in this State and the number of lives
25 for which utilization review is conducted.
26 (4) Hours of operation.
27 (5) Description of the grievance process.
28 (6) Number of covered lives for which utilization
29 review was conducted for the previous calendar year.
30 (7) Written policies and procedures for protecting
31 confidential information according to applicable State
32 and federal laws.
33 (c) If the Director determines that an insurance company
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1 or health care plan licensed by the Department meets the
2 provisions of the requirements of this Section under its
3 certification process, he or she may exempt the insurance
4 company or health care plan from providing duplicate
5 information.
6 Section 60. Severability. If any Section, term or
7 provision of this Act shall be adjudged invalid for any
8 reason, such judgment shall not affect, impair, or invalidate
9 any other Section, term, or provision of this Act, and the
10 remaining Sections, terms, and provisions shall be and remain
11 in full force and effect.
12 Section 65. Applicability of Act. A health care plan
13 amended, delivered, issued, or renewed in this State after
14 the effective date of this Act must comply with the terms of
15 this Act.
16 Section 99. Effective date. This Act takes effect
17 January 1, 1998.