State of Illinois
90th General Assembly
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[ House Amendment 003 ]

90_HB1490eng

      215 ILCS 125/2-3.1        from Ch. 111 1/2, par. 1405.1
          Amends the Health Maintenance Organization Act.   Adds  a
      caption  and  makes technical changes to a Section concerning
      the dispensing of drugs.
                                                     LRB9003498JSgc
HB1490 Engrossed                               LRB9003498JSgc
 1        AN ACT concerning the provision of health care  services,
 2    amending named Acts.
 3        Be  it  enacted  by  the People of the State of Illinois,
 4    represented in the General Assembly:
 5        Section 5.  The Health Maintenance  Organization  Act  is
 6    amended  by  changing Sections 1-2 and 5-5 and adding Section
 7    2-10 as follows:
 8        (215 ILCS 125/1-2) (from Ch. 111 1/2, par. 1402)
 9        Sec. 1-2.  Definitions. As used in this Act,  unless  the
10    context  otherwise  requires,  the following terms shall have
11    the meanings ascribed to them:
12        (1)  "Advertisement"  means  any  printed  or   published
13    material,  audiovisual material and descriptive literature of
14    the  health  care  plan  used  in  direct  mail,  newspapers,
15    magazines, radio scripts, television scripts, billboards  and
16    similar  displays;  and  any  descriptive literature or sales
17    aids of all kinds disseminated by  a  representative  of  the
18    health  care  plan  for presentation to the public including,
19    but  not   limited   to,   circulars,   leaflets,   booklets,
20    depictions,  illustrations,  form  letters and prepared sales
21    presentations.
22        (2)  "Director" means the Director of Insurance.
23        (3)  "Basic Health Care Services" means  emergency  care,
24    and inpatient hospital and physician care, outpatient medical
25    services,  mental  health  services  and care for alcohol and
26    drug  abuse,  including  any   reasonable   deductibles   and
27    co-payments,  all of which are subject to such limitations as
28    are determined by the Director pursuant to rule.
29        (4)  "Enrollee" means an individual who has been enrolled
30    in a health care plan.
31        (5)  "Evidence  of  Coverage"  means   any   certificate,
HB1490 Engrossed            -2-                LRB9003498JSgc
 1    agreement,  or contract issued to an enrollee setting out the
 2    coverage to which he is entitled in exchange for a per capita
 3    prepaid sum.
 4        (6)  "Group Contract" means a contract  for  health  care
 5    services  which by its terms limits eligibility to members of
 6    a specified group.
 7        (7)  "Health Care Plan" means any arrangement whereby any
 8    organization undertakes to provide or arrange for and pay for
 9    or reimburse the cost of  basic  health  care  services  from
10    providers selected by the Health Maintenance Organization and
11    such  arrangement  consists of arranging for or the provision
12    of such health care  services,  as  distinguished  from  mere
13    indemnification  against the cost of such services, except as
14    otherwise authorized by Section 2-3 of this  Act,  on  a  per
15    capita  prepaid  basis,  through  insurance  or otherwise.  A
16    "health care plan" also includes any arrangement  whereby  an
17    organization  undertakes to provide or arrange for or pay for
18    or reimburse the cost of any health care service for  persons
19    who  are  enrolled  in  the  integrated  health  care program
20    established under Section 5-16.3 of the Illinois  Public  Aid
21    Code  through  providers selected by the organization and the
22    arrangement consists of making provision for the delivery  of
23    health    care   services,   as   distinguished   from   mere
24    indemnification.   Nothing  in  this   definition,   however,
25    affects  the  total  medical  services  available  to persons
26    eligible for medical assistance under the Illinois Public Aid
27    Code.
28        (8)  "Health Care Services" means any  services  included
29    in  the  furnishing  to  any  individual of medical or dental
30    care, or the hospitalization or incident to the furnishing of
31    such care or hospitalization as well as the furnishing to any
32    person of any and all  other  services  for  the  purpose  of
33    preventing,  alleviating,  curing or healing human illness or
34    injury.
HB1490 Engrossed            -3-                LRB9003498JSgc
 1        (9)  "Health   Maintenance   Organization"   means    any
 2    organization  formed  under the laws of this or another state
 3    to provide or arrange for one or more health care plans under
 4    a system which causes any part of the  risk  of  health  care
 5    delivery to be borne by the organization or its providers.
 6        (10)  "Net  Worth"  means  admitted assets, as defined in
 7    Section 1-3 of this Act, minus liabilities.
 8        (11)  "Organization" means any insurance  company,  or  a
 9    nonprofit  corporation  authorized  under the Medical Service
10    Plan Act, the Dental Service Plan  Act,  the  Vision  Service
11    Plan  Act, the Pharmaceutical Service Plan Act, the Voluntary
12    Health Services Plans  Act  or  the  Non-profit  Health  Care
13    Service  Plan  Act, or a corporation organized under the laws
14    of this or another state for the purpose of operating one  or
15    more  health care plans and doing no business other than that
16    of a Health Maintenance Organization or an insurance company.
17    Organization shall  also  mean  the  University  of  Illinois
18    Hospital  as  defined  in the University of Illinois Hospital
19    Act.
20        (12)  "Provider" means any physician, hospital  facility,
21    or  other person which is licensed or otherwise authorized to
22    furnish health care services  and  also  includes  any  other
23    entity that arranges for the delivery or furnishing of health
24    care service.
25        (13)  "Producer"  means  a  person directly or indirectly
26    associated  with  a  health  care   plan   who   engages   in
27    solicitation or enrollment.
28        (14)  "Per capita prepaid" means a basis of prepayment by
29    which  a  fixed  amount of money is prepaid per individual or
30    any  other  enrollment  unit  to   the   Health   Maintenance
31    Organization  or  for health care services which are provided
32    during a definite time period regardless of the frequency  or
33    extent  of  the  services  rendered by the Health Maintenance
34    Organization,  except  for  copayments  and  deductibles  and
HB1490 Engrossed            -4-                LRB9003498JSgc
 1    except as provided in subsection (f) of Section 5-3  of  this
 2    Act.
 3        (15)  "Subscriber"  means a person who has entered into a
 4    contractual  relationship   with   the   Health   Maintenance
 5    Organization  for the provision of or arrangement of at least
 6    basic health care  services  to  the  beneficiaries  of  such
 7    contract.
 8        (16)  "Accreditation   organization"  means  all  of  the
 9    following  entities:  the  National  Committee   of   Quality
10    Assurance,   the   Joint   Commission   on  Accreditation  of
11    Healthcare Organizations, the Accreditation  Association  for
12    Ambulatory  Health Care, and such other nationally recognized
13    accreditation organizations as may be approved by rule by the
14    Department of Insurance.
15    (Source: P.A. 88-554, eff. 7-26-94; 89-90, eff. 6-30-95.)
16        (215 ILCS 125/2-10 new)
17        Sec. 2-10.  Accreditation.
18        (a)  As a condition of doing business in  this  State,  a
19    health  maintenance  organization  issued  a  certificate  of
20    authority  under this Act shall apply for accreditation by an
21    accreditation  organization  within  24  months   after   its
22    licensure  and shall be accredited within 36 months after the
23    health maintenance organization's receipt of its  certificate
24    of  authority.   A  health  maintenance  organization with an
25    existing   certificate   of   authority   must   apply    for
26    accreditation  by  an  accreditation  organization  within 24
27    months after the effective date of  this  amendatory  Act  of
28    1997  and  shall  be  accredited  within  36 months after the
29    effective date of this amendatory  Act  of  1997.   A  health
30    maintenance   organization   shall   be  reaccredited  by  an
31    accreditation organization not less than once every 3 years.
32        (b)  If a contract  for  the  provision  of  health  care
33    services   between   a  provider  and  a  health  maintenance
HB1490 Engrossed            -5-                LRB9003498JSgc
 1    organization issued a certificate of authority  at  any  time
 2    covers   (i)   at   least   15%  of  the  health  maintenance
 3    organization's current enrollment  or  (ii)  at  least  5,000
 4    enrollees  of  the  health maintenance organization's current
 5    enrollment, the contracting  provider  shall  apply  for  and
 6    obtain  accreditation by an accreditation organization within
 7    (A) 24 months after the effective date of this amendatory Act
 8    of 1997 and shall be accredited within 36  months  after  the
 9    effective  date  of this amendatory Act of 1997 or (B) within
10    24 months after the first day of the month in  which  (i)  or
11    (ii) applies.  This subsection does not apply to any licensed
12    physician  or  physician group including, but not limited to,
13    physicians organized  as  a  partnership,  limited  liability
14    partnership,  limited liability company, medical corporation,
15    professional service corporation,  professional  association,
16    or  a  joint  venture  of  partnerships  or  corporations.  A
17    health  maintenance  organization  may   contract   for   the
18    provision  of  health  care  services  with  an  unaccredited
19    provider  that  would  otherwise be required to be accredited
20    pursuant to this Section, but that has been licensed for less
21    than 24 months (or, in  the  case  licensure  of  a  provider
22    entity  is  not required, that has been in existence for less
23    than 24 months) upon the condition that the provider will (i)
24    apply for accreditation from  an  accreditation  organization
25    within  24  months  after  the effective date of the contract
26    between the provider and the health maintenance  organization
27    and   (ii)   obtain   accreditation   from  an  accreditation
28    organization within 36 months after the effective date of the
29    contract.
30        (c)  The Director  shall  provide  technical  assistance,
31    upon  request  by a health maintenance organization, in order
32    to assist it in developing and maintaining quality  assurance
33    systems   and   for   the   purpose  of  complying  with  the
34    accreditation requirement.
HB1490 Engrossed            -6-                LRB9003498JSgc
 1        (d)  The  Director  shall  monitor  and   determine   the
 2    accreditation  status  of  all  existing  health  maintenance
 3    organizations  on an ongoing basis and group them into one of
 4    the following categories:
 5             (1)  three year accreditation obtained;
 6             (2)  not  applied  and  surveyed  for  accreditation
 7        within the appropriate time frame;
 8             (3)  applied for  accreditation,  but  not  surveyed
 9        within the appropriate time frame;
10             (4)  surveyed,   findings   of   the   accreditation
11        organization not final; or
12             (5)  failed accreditation survey.
13        (e)  The Director shall verify the compliance of a health
14    maintenance  organization  with the accreditation requirement
15    with the appropriate  accreditation  organization  and  shall
16    initiate   action   for  a  health  maintenance  organization
17    classified under item (2), (3), or (5) of subsection (d).
18        (f)  The Director shall file an administrative  order  to
19    show   cause   against   a  health  maintenance  organization
20    classified under item (2), (3),  or  (5)  of  subsection  (d)
21    which   is   not   in   compliance   with  the  accreditation
22    requirement.
23        (g)  If a health maintenance organization fails to comply
24    with the requirements of this  Section,  the  Director  shall
25    sanction  the noncompliant health maintenance organization as
26    follows:
27             (1)  If  a  health   maintenance   organization   is
28        classified  under  item (2) of subsection (d), the health
29        maintenance organization shall suspend  the  offering  of
30        health  care  plans  pursuant to a new group contract and
31        suspend the enrollment of medical assistance  recipients.
32        The   suspension  of  enrollment  of  medical  assistance
33        recipients shall preclude the enrollment  by  the  health
34        maintenance   organization   of   individuals   currently
HB1490 Engrossed            -7-                LRB9003498JSgc
 1        receiving medical assistance as well as the enrollment of
 2        new medical assistance recipients, but shall not preclude
 3        the  enrollment  of  a  dependent of a medical assistance
 4        recipient  currently  enrolled  with  the   noncompliance
 5        health  maintenance  organization.   The  limitations  on
 6        enrollment  contained  in  this subsection shall continue
 7        until the noncompliant  health  maintenance  organization
 8        obtains accreditation as required under this Section; and
 9             (2)  in   addition   to   the  mandatory  enrollment
10        restrictions, the Director, in his discretion,  may  take
11        action   against   the  health  maintenance  organization
12        pursuant to Section 5-5  and  may  impose  the  following
13        monetary  fines  on  a  noncompliant  health  maintenance
14        organization:
15                  (A)  if  a  health maintenance organization has
16             not applied for accreditation  within  the  required
17             time  frames, a fine not to exceed $500 for each day
18             of noncompliance with this Section; and
19                  (B)  if a health maintenance  organization  has
20             applied  for  the  accreditation  required  by  this
21             Section,  but  has  not  been  surveyed  within  the
22             required  time frames, a fine not to exceed $250 for
23             each day of noncompliance with this Section.
24        (h)  The enrollment of a health maintenance  organization
25    that   contracts  with  an  unaccredited  provider  which  is
26    required to be accredited by  an  accreditation  organization
27    pursuant  to  this Section shall be suspended as described in
28    item  (1)  of  subsection  (g)  during  the  period  that  it
29    maintains the contract that causes it to be out of compliance
30    with this Section and may have imposed  upon  it  a  monetary
31    fine  not  to  exceed  $20,000  for  each  contract  with  an
32    unaccredited provider which is required to be accredited.
33        (i)  For  a  health  maintenance  organization classified
34    under item (2) or (3) of subsection (d), the  Director  shall
HB1490 Engrossed            -8-                LRB9003498JSgc
 1    assess  the need to mitigate the monetary penalties specified
 2    under subsection (g) based upon:
 3             (1)  the  potential  threat  to  enrollees'  health,
 4        safety, and welfare as determined by assessing compliance
 5        with standards specified in this  Section;  the  Director
 6        shall  also  assess  the  findings  of  the accreditation
 7        survey;
 8             (2)  the   financial   viability   of   the   health
 9        maintenance organization; and
10             (3)  the   extent   of   the   health    maintenance
11        organization's efforts to initiate corrective action.
12        (j)  For  those  health maintenance organizations failing
13    the initial or renewal accreditation survey,  the  Department
14    of  Human  Services  shall  require  the  health  maintenance
15    organization  to  enter  into a corrective action process for
16    the purpose of achieving accreditation.   The  Department  of
17    Human  Services  shall  monitor  the progress of those health
18    maintenance organizations not in  compliance  in  cooperation
19    with  the  accreditation  organization  to ensure that health
20    maintenance  organizations  come  into  compliance  with  the
21    accreditation requirement.
22        (k)  Those health maintenance  organizations  failing  an
23    initial   or   renewal   accreditation  survey  must  receive
24    accreditation during a  subsequent  survey  by  the  original
25    accrediting  organization.   Accreditation  must  be received
26    within one year of the final accreditation  decision  by  the
27    accrediting  agency or within a time frame mutually agreeable
28    to the Director,  the  accreditation  organization,  and  the
29    health   maintenance   organization.   A  health  maintenance
30    organization  may,  at  any  time,  seek  accreditation  from
31    another accreditation organization provided that  the  health
32    maintenance  organization  enters  into  a  corrective action
33    process under subsection (j) to  achieve  accreditation  with
34    the original accreditation organization.
HB1490 Engrossed            -9-                LRB9003498JSgc
 1        (l)  The  Department  of  Human  Services  shall  conduct
 2    annual  validation  surveys  on accredited health maintenance
 3    organizations to ensure ongoing compliance with accreditation
 4    standards.  Selection of the health maintenance organizations
 5    to be surveyed shall be based on the following information:
 6             (1)  reports   received   from   the   accreditation
 7        organization, the Department of Insurance, or other State
 8        or federal regulatory agency  regarding  the  quality  of
 9        care provided by the organization;
10             (2)  quality  of  care  complaints  received  by the
11        Director from enrollees or providers; and
12             (3)  such other information as the Director, in  his
13        discretion,  shall determine is relevant in the selection
14        process.
15        (215 ILCS 125/5-5) (from Ch. 111 1/2, par. 1413)
16        Sec.  5-5.    Suspension,   revocation   or   denial   of
17    certification  of  authority.  The  Director  may  suspend or
18    revoke any  certificate  of  authority  issued  to  a  health
19    maintenance   organization   under   this   Act  or  deny  an
20    application for a certificate of authority if he finds any of
21    the following:
22        (a)  The health  maintenance  organization  is  operating
23    significantly  in  contravention  of its basic organizational
24    document, its health care plan, or in a  manner  contrary  to
25    that described in any information submitted under Section 2-1
26    or 4-12.
27        (b)  The health maintenance organization issues contracts
28    or  evidences  of  coverage or uses a schedule of charges for
29    health care services that do not comply with the  requirement
30    of Section 2-1 or 4-12.
31        (c)  The health care plan does not provide or arrange for
32    basic  health  care  services,  except as provided in Section
33    4-13 concerning mental health services  for  clients  of  the
HB1490 Engrossed            -10-               LRB9003498JSgc
 1    Department of Children and Family Services.
 2        (d)  The  Director  of  Public  Health  certifies  to the
 3    Director that (1) the health  maintenance  organization  does
 4    not  meet  the  requirements of Section 2-2 or (2) the health
 5    maintenance organization is unable to fulfill its obligations
 6    to furnish health care services as required under its  health
 7    care  plan.  The Department of Public Health shall promulgate
 8    by rule, pursuant to the  Illinois  Administrative  Procedure
 9    Act,   the   precise  standards  used  for  determining  what
10    constitutes a material misrepresentation, what constitutes  a
11    material  violation of a contract or evidence of coverage, or
12    what constitutes good  faith  with  regard  to  certification
13    under this paragraph.
14        (e)  The  health  maintenance  organization  is no longer
15    financially responsible and may reasonably be expected to  be
16    unable  to  meet  its obligations to enrollees or prospective
17    enrollees.
18        (f)  The health maintenance organization, or  any  person
19    on its behalf, has advertised or merchandised its services in
20    an   untrue,  misrepresentative,  misleading,  deceptive,  or
21    unfair manner.
22        (g)  The continued operation of  the  health  maintenance
23    organization would be hazardous to its enrollees.
24        (h)  The health maintenance organization has neglected to
25    correct,  within  the  time  prescribed  by subsection (c) of
26    Section  2-4,   any   deficiency   occurring   due   to   the
27    organization's   prescribed  minimum  net  worth  or  special
28    contingent reserve being impaired.
29        (i)  The health maintenance  organization  has  otherwise
30    failed to substantially comply with this Act.
31        (j)  The  health  maintenance  organization has failed to
32    meet the  requirements  for  issuance  of  a  certificate  of
33    authority set forth in Section 2-2.
34        (k)  The  health  maintenance  organization has failed to
HB1490 Engrossed            -11-               LRB9003498JSgc
 1    obtain  and  maintain  accreditation  by   an   accreditation
 2    organization pursuant to Section 2-10.
 3        When the certificate of authority of a health maintenance
 4    organization  is  revoked,  the  organization  shall proceed,
 5    immediately following the effective  date  of  the  order  of
 6    revocation,  to  wind  up  its  affairs  and shall conduct no
 7    further business except as may be essential  to  the  orderly
 8    conclusion  of  the affairs of the organization. The Director
 9    may permit further operation  of  the  organization  that  he
10    finds to be in the best interest of enrollees to the end that
11    the   enrollees  will  be  afforded  the  greatest  practical
12    opportunity to obtain health care services.
13    (Source: P.A. 88-487.)
14        Section 10.  The Illinois Public Aid Code is  amended  by
15    adding Section 5-23:
16        (305 ILCS 5/5-23 new)
17        Sec. 5-23.  Accreditation.
18        (a)  A  managed  care community network or prepaid health
19    plan that contracts with  the  Illinois  Department  for  the
20    provision of medical care to recipients entitled to aid under
21    this   Article   shall   apply   for   accreditation   by  an
22    accreditation  organization  within  24  months   after   the
23    effective  date  of  this  amendatory  Act of 1997 and obtain
24    accreditation within 36 months after the  effective  date  of
25    this  amendatory  Act  of  1997.   The managed care community
26    network and prepaid health plan shall be reaccredited  by  an
27    accreditation  organization not less than once every 3 years.
28    For   the   purposes   of   this   Section,    "accreditation
29    organization"  means  all  of  the  following  entities:  the
30    National Committee of Quality Assurance, the Joint Commission
31    on    Accreditation    of   Healthcare   Organizations,   the
32    Accreditation Association for  Ambulatory  Health  Care,  and
HB1490 Engrossed            -12-               LRB9003498JSgc
 1    such  other nationally recognized accreditation organizations
 2    as may be approved by rule by the Illinois Department.
 3        (b)  The Illinois Department shall monitor and  determine
 4    the  accreditation  status  of  all  managed  care  community
 5    networks  and  prepaid  health  plans  that contract with the
 6    Illinois  Department  for  the  provision  of   services   to
 7    recipients  entitled  to aid under this Article on an ongoing
 8    basis  and  shall  group  them  into  one  of  the  following
 9    categories:
10             (1)  three year accreditation obtained;
11             (2)  not  applied  and  surveyed  for  accreditation
12        within the appropriate time frame;
13             (3)  applied for  accreditation,  but  not  surveyed
14        within the appropriate time frame;
15             (4)  surveyed,  findings of the accreditation agency
16        not final; or
17             (5)  failed accreditation survey.
18        (c)  The Illinois Department shall verify the  compliance
19    of  managed  care community networks and prepaid health plans
20    with the accreditation  requirement  with  the  accreditation
21    organizations   and   shall   initiate  action  for  entities
22    classified under item (2), (3), or (5) of subsection (b).
23        (d)  The Illinois Department shall file an administrative
24    order to show cause against those entities categorized  under
25    item  (2),  (3),  or  (5), of subsection (b) which are not in
26    compliance with the accreditation requirement.
27        (e)  If an entity required to do so fails to comply  with
28    the  requirements  of  this  Section, the Illinois Department
29    shall sanction the entity as follows:
30             (1)  If the entity is categorized under item (2)  or
31        (3)  of  subsection  (b),  the  entity  shall suspend the
32        enrollment  of  medical   assistance   recipients.    The
33        suspension of enrollment of medical assistance recipients
34        shall  preclude  the  enrollment of individuals currently
HB1490 Engrossed            -13-               LRB9003498JSgc
 1        receiving medical assistance as well as the enrollment of
 2        new medical assistance recipients, but shall not preclude
 3        the enrollment of a dependent  of  a  medical  assistance
 4        recipient   currently   enrolled  with  the  noncompliant
 5        entity.  The  limitation  on  enrollment  shall  continue
 6        until  the  noncompliant  entity obtains accreditation as
 7        required under this Section; and
 8             (2)  in  addition  to   the   mandatory   enrollment
 9        restriction,  the Director, in his discretion, may impose
10        the  following   monetary   fines   on   a   noncompliant
11        organization:
12                  (A)  if   the   entity   has  not  applied  for
13             accreditation within the  required  time  frames,  a
14             fine   not   to   exceed   $500   for  each  day  of
15             noncompliance with this Section; and
16                  (B)  if  the  entity  has   applied   for   the
17             accreditation  required by this Section, but has not
18             been surveyed within the  required  time  frames,  a
19             fine   not   to   exceed   $250   for  each  day  of
20             noncompliance with this Section.
21             (3)  If  a  prepaid  health  plan  or  managed  care
22        community network fails a follow-up accreditation  survey
23        conducted  subsequent  to  a failed accreditation survey,
24        the contract for the provision of medical care to medical
25        assistance recipients of the noncompliant entity shall be
26        terminated.
27        (f)  For an entity failing an accreditation  survey,  the
28    Director  shall  assess  the  need  to  mitigate the monetary
29    penalties specified under item (2) of  subsection  (e)  based
30    upon:
31             (1)  the  potential  threat  to  recipients' health,
32        safety, and welfare as determined by assessing compliance
33        with standards specified in this  Section;  the  Illinois
34        Department   shall   also  assess  the  findings  of  the
HB1490 Engrossed            -14-               LRB9003498JSgc
 1        accreditation survey;
 2             (2)  the financial viability of the entity; and
 3             (3)  the extent of the entity's efforts to  initiate
 4        corrective action.
 5        (g)  Those  contracting  entities  classified  under item
 6    (2), (3), or (5) of subsection (b) shall be surveyed  by  the
 7    Illinois   Department   to   ensure   compliance  with  their
 8    contractual  obligations  under  their  contracts  with   the
 9    Illinois Department.
10        (h)  An  entity  failing the initial accreditation survey
11    shall enter into a corrective action process for the  purpose
12    of  achieving  accreditation.  The  Illinois Department shall
13    monitor the progress of those  contracting  entities  not  in
14    compliance in cooperation with the accreditation organization
15    to  ensure that the contracting entities gain compliance with
16    the accreditation  requirement.  Those  contracting  entities
17    failing  an  initial  or  renewal  accreditation  survey must
18    receive  accreditation  during  a  subsequent   accreditation
19    survey    by   the   original   accreditation   organization.
20    Accreditation must be received within one year of  the  final
21    accreditation  decision  by  the  accrediting organization or
22    within a  time  frame  mutually  agreeable  to  the  Illinois
23    Department,   the   accreditation   organization,   and   the
24    contracting  entity.    A contracting entity may, at any time
25    seek accreditation from  another  accreditation  organization
26    provided that the contracting entity enters into a corrective
27    action process under this subsection to achieve accreditation
28    with the original accreditation organization.
29        (i)  The   Illinois   Department   shall  conduct  annual
30    validation surveys  on  accredited  contracting  entities  to
31    ensure   ongoing  compliance  with  accreditation  standards.
32    Selection of the contracting entities to be surveyed shall be
33    based on the following information:
34             (1)  reports   received   from   the   accreditation
HB1490 Engrossed            -15-               LRB9003498JSgc
 1        organization, the Illinois Department or other  State  or
 2        federal  regulatory  agency regarding the quality of care
 3        provided by the entity;
 4             (2)  quality of  care  complaints  received  by  the
 5        Illinois Department from recipients or providers; and
 6             (3)  such  other information as the Director, in his
 7        discretion, shall determine is relevant in the  selection
 8        process.

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