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90_HB3269
New Act
Creates the Health Care Professional Selection Act. Sets
forth the manner and conditions under which a managed care
plan shall select health care professionals for participation
in the plan. Provides the procedures necessary for
termination of health care professionals. Prohibits
restrictions on disclosures by health care professionals to
patients.
LRB9011442JSmg
LRB9011442JSmg
1 AN ACT concerning the selection of health care
2 professionals by managed care plans.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 1. Short title. This Act may be cited as the
6 Health Care Professional Selection Act.
7 Section 5. Definitions. For purposes of this Act, the
8 following words shall have the meanings provided in this
9 Section, unless otherwise indicated:
10 "Degenerative or disabling condition or disease" means a
11 condition or disease that is permanent or of indefinite
12 duration, that is likely to become worse or more advanced
13 over time, and that substantially impairs a major life
14 function.
15 "Department" means the Department of Public Health.
16 "Director" means the Director of Public Health.
17 "Enrollee" means a person enrolled in a managed care
18 plan.
19 "Health care professional" means a physician, registered
20 professional nurse, or other person appropriately licensed or
21 registered pursuant to the laws of this State to provide
22 health care services.
23 "Health care provider" means a health care professional,
24 hospital, facility, or other person appropriately licensed or
25 otherwise authorized to furnish health care services or
26 arrange for the delivery of health care services in this
27 State.
28 "Health care services" means services included in the (i)
29 furnishing of medical care, (ii) hospitalization incident to
30 the furnishing of medical care, and (iii) furnishing of
31 services, including pharmaceuticals, for the purpose of
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1 preventing, alleviating, curing, or healing human illness or
2 injury to an individual.
3 "Informal policy or procedure" means a nonwritten policy
4 or procedure, the existence of which may be proven by an
5 admission of an authorized agent of a managed care plan or
6 statistical evidence supported by anecdotal evidence.
7 "Life threatening condition or disease" means any
8 condition, illness, or injury that, in the opinion of a
9 licensed physician, (i) may directly lead to a patient's
10 death, (ii) results in a period of unconsciousness which is
11 indeterminate at the present, or (iii) imposes severe pain or
12 an inhumane burden on the patient.
13 "Managed care plan" means a plan that establishes,
14 operates, or maintains a network of health care providers
15 that have entered into agreements with the plan to provide
16 health care services to enrollees where the plan has the
17 obligation to the enrollee to arrange for the provision of or
18 pay for services through:
19 (1) organizational arrangements for ongoing quality
20 assurance, utilization review programs, or dispute
21 resolution; or
22 (2) financial incentives for persons enrolled in
23 the plan to use the participating providers and
24 procedures covered by the plan.
25 A managed care plan may be established or operated by any
26 entity including, but not necessarily limited to, a licensed
27 insurance company, hospital or medical service plan, health
28 maintenance organization, limited health service
29 organization, preferred provider organization, third party
30 administrator, independent practice association, or employer
31 or employee organization.
32 For purposes of this definition, "managed care plan"
33 shall not include the following:
34 (1) strict indemnity health insurance policies or
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1 plans issued by an insurer that does not require approval
2 of a primary care provider or other similar coordinator
3 to access health care services; and
4 (2) managed care plans that offer only dental or
5 vision coverage.
6 "Primary care provider" means a physician licensed to
7 practice medicine in all its branches who provides a broad
8 range of personal medical care (preventive, diagnostic,
9 curative, counseling, or rehabilitative) in a comprehensive
10 and coordinated manner over time for a managed care plan.
11 "Specialist" means a health care professional who
12 concentrates practice in a recognized specialty field of
13 care.
14 "Speciality care center" means only a center that is
15 accredited by an agency of the State or federal government or
16 by a voluntary national health organization as having special
17 expertise in treating the life-threatening disease or
18 condition or degenerative or disabling disease or condition
19 for which it is accredited.
20 Section 10. Health care professional applications and
21 terminations.
22 (a) A managed care plan shall, upon request, make
23 available and disclose to health care professionals written
24 application procedures and minimum qualification
25 requirements that a health care professional must meet in
26 order to be considered by the managed care plan. The
27 managed care plan shall consult with appropriately qualified
28 health care professionals in developing its qualification
29 requirements.
30 (b) A managed care plan may not terminate a contract of
31 employment or refuse to renew a contract on the basis of any
32 action protected under Section 15 of this Act or solely
33 because a health care professional has:
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1 (1) filed a complaint against the managed care
2 plan;
3 (2) appealed a decision of the managed care plan;
4 or
5 (3) requested a hearing pursuant to this Section.
6 (c) A managed care plan shall provide to a health care
7 professional, in writing, the reasons for the contract
8 termination or non-renewal.
9 (d) A managed care plan shall provide an opportunity
10 for a hearing to any health care professional terminated by
11 the managed care plan, or non-renewed if the health care
12 professional has had a contract or contracts with the managed
13 care plan for at least 24 of the past 36 months.
14 (e) After the notice provided pursuant to subsection
15 (c), the health care professional shall have 21 days to
16 request a hearing, and the hearing must be held within 15
17 days after receipt of the request for a hearing. The hearing
18 shall be held before a panel appointed by the managed care
19 plan.
20 The hearing panel shall be composed of 5 individuals, the
21 majority of whom shall be clinical peer reviewers and, to the
22 extent possible, in the same discipline and the same or
23 similar specialty as the health care professional under
24 review.
25 The hearing panel shall render a written decision on the
26 proposed action within 14 business days. The decision shall
27 be one of the following:
28 (1) reinstatement of the health care professional
29 by the managed care plan;
30 (2) provisional reinstatement subject to
31 conditions set forth by the panel; or
32 (3) termination of the health care professional.
33 The decision of the hearing panel shall be final.
34 A decision by the hearing panel to terminate a health
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1 care professional shall be effective not less than 15 days
2 after the receipt by the health care professional of the
3 hearing panel's decision.
4 A hearing under this subsection shall provide the health
5 care professional in question with the right to examine
6 pertinent information, to present witnesses, and to ask
7 questions of an authorized representative of the plan.
8 (f) A managed care plan may terminate or decline to
9 renew a health care professional, without a prior hearing, in
10 cases involving imminent harm to patient care, a
11 determination of intentional falsification of reports to the
12 plan or a final disciplinary action by a state licensing
13 board or other governmental agency that impairs the health
14 care professional's ability to practice. A professional
15 terminated for one of the these reasons shall be given
16 written notice to that effect. Within 21 days after the
17 termination, a health care professional terminated because of
18 imminent harm to patient care or a determination of
19 intentional falsification of reports to the plan shall
20 receive a hearing. The hearing shall be held before a panel
21 appointed by the managed care plan. The panel shall be
22 composed of 5 individuals the majority of whom shall be
23 clinical peer reviewers and, to the extent possible, in the
24 same discipline and the same or similar specialty as the
25 health care professional under review. The hearing panel
26 shall render a decision on the proposed action within 14
27 days. The panel shall issue a written decision either
28 supporting the termination or ordering the health care
29 professional's reinstatement. The decision of the hearing
30 panel shall be final.
31 If the hearing panel upholds the managed care plan's
32 termination of the health care professional under this
33 subsection, the managed care plan shall forward the decision
34 to the appropriate professional disciplinary agency in
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1 accordance with subsection (b) of Section 25.
2 Any hearing under this subsection shall provide the
3 health care professional in question with the right to
4 examine pertinent information, to present witnesses, and to
5 ask questions of an authorized representative of the plan.
6 For any hearing under this Section, because the candid
7 and conscientious evaluation of clinical practices is
8 essential to the provision of health care, it is the policy
9 of this State to encourage peer review by health care
10 professionals. Therefore, no managed care plan and no
11 individual who participates in a hearing or who is a member,
12 agent, or employee of a managed care plan shall be liable for
13 criminal or civil damages or professional discipline as a
14 result of the acts, omissions, decisions, or any other
15 conduct, direct or indirect, associated with a hearing panel,
16 except for wilful and wanton misconduct. Nothing in this
17 Section shall relieve any person, health care provider,
18 health care professional, facility, organization, or
19 corporation from liability for his, her, or its own
20 negligence in the performance of his, her, or its duties or
21 arising from treatment of a patient. The hearing panel
22 information shall not be subject to inspection or disclosure
23 except upon formal written request by an authorized
24 representative of a duly authorized State agency or pursuant
25 to a court order issued in a pending action or proceeding.
26 (g) A managed care plan shall develop and implement
27 policies and procedures to ensure that health care
28 professionals are at least annually informed of information
29 maintained by the managed care plan to evaluate the
30 performance or practice of the health care professional. The
31 managed care plan shall consult with health care
32 professionals in developing methodologies to collect and
33 analyze health care professional data. Managed care plans
34 shall provide the information and data and analysis to health
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1 care professionals. The information, data, or analysis
2 shall be provided on at least an annual basis in a format
3 appropriate to the nature and amount of data and the volume
4 and scope of services provided. Any data used to evaluate
5 the performance or practice of a health care professional
6 shall be measured against stated criteria and a comparable
7 group of health care professionals who use similar treatment
8 modalities and serve a comparable patient population. Upon
9 receipt of the information or data, a health care
10 professional shall be given the opportunity to explain the
11 unique nature of the health care professional's patient
12 population that may have a bearing on the health care
13 professional's data and to work cooperatively with the
14 managed care plan to improve performance.
15 (h) Any contract provision or procedure or informal
16 policy or procedure in violation of this Section violates the
17 public policy of the State of Illinois and is void and
18 unenforceable.
19 Section 15. Prohibitions.
20 (a) No managed care plan shall by contract, written
21 policy or written procedure, or informal policy or procedure
22 prohibit or restrict any health care provider from
23 disclosing to any enrollee, patient, designated
24 representative or, where appropriate, prospective
25 enrollee, (hereinafter collectively referred to as
26 enrollee) any information that the provider deems appropriate
27 regarding:
28 (1) a condition or a course of treatment with an
29 enrollee including the availability of other therapies,
30 consultations, or tests; or
31 (2) the provisions, terms, or requirements of the
32 managed care plan's products as they relate to the
33 enrollee, where applicable.
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1 (b) No managed care plan shall by contract, written
2 policy or procedure, or informal policy or procedure prohibit
3 or restrict any health care provider from filing a
4 complaint, making a report, or commenting to an appropriate
5 governmental body regarding the policies or practices of the
6 managed care plan that the provider believes may
7 negatively impact upon the quality of, or access to, patient
8 care.
9 (c) No managed care plan shall by contract, written
10 policy or procedure, or informal policy or procedure prohibit
11 or restrict any health care provider from advocating to the
12 managed care plan on behalf of the enrollee for approval or
13 coverage of a particular course of treatment or for the
14 provision of health care services.
15 (d) No contract or agreement between a managed care
16 plan and a health care provider shall contain any clause
17 purporting to transfer to the health care provider by
18 indemnification or otherwise any liability relating to
19 activities, actions, or omissions of the managed care plan
20 as opposed to those of the health care provider.
21 (e) No contract between a managed care plan and a health
22 care provider shall contain any incentive plan that includes
23 specific payment made directly, in any form, to a health care
24 provider as an inducement to deny, reduce, limit, or delay
25 specific, medically necessary and appropriate services
26 provided with respect to a specific enrollee or groups of
27 enrollees with similar medical conditions. Nothing in this
28 Section shall be construed to prohibit contracts that contain
29 incentive plans that involve general payments, such as
30 capitation payments or shared-risk arrangements, that are not
31 tied to specific medical decisions involving specific
32 enrollees or groups of enrollees with similar medical
33 conditions. The payments rendered or to be rendered to
34 health care provider under these arrangements shall be deemed
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1 confidential information.
2 (f) No managed care plan shall by contract, written
3 policy or procedure, or informal policy or procedure permit,
4 allow, or encourage an individual or entity to dispense a
5 different drug in place of the drug or brand of drug ordered
6 or prescribed without the express permission of the person
7 ordering or prescribing, except this prohibition does not
8 prohibit the interchange of different brands of the same
9 generically equivalent drug product, as provided under
10 Section 3.14 of the Illinois Food, Drug and Cosmetic Act.
11 (g) Any contract provision, written policy or
12 procedure, or informal policy or procedure in violation of
13 this Section violates the public policy of the State of
14 Illinois and is void and unenforceable.
15 Section 20. Network of providers.
16 (a) At least once every 3 years, and upon application
17 for expansion of service area, a managed care plan shall
18 obtain certification from the Director of Public Health that
19 the managed care plan maintains a network of health care
20 providers and facilities adequate to meet the comprehensive
21 health needs of its enrollees and to provide an appropriate
22 choice of providers sufficient to provide the services
23 covered under its enrollee's contracts by determining that:
24 (1) there are a sufficient number of geographically
25 accessible participating providers and facilities;
26 (2) there are opportunities to select from at least
27 3 primary care providers pursuant to travel and
28 distance time standards, providing that these standards
29 account for the conditions of accessing providers in
30 rural areas; and
31 (3) there are sufficient providers in all covered
32 areas of specialty practice to meet the needs of the
33 enrollment population.
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1 (b) The following criteria shall be considered by the
2 Director of Public Health at the time of a review:
3 (1) provider-enrollee ratios by specialty;
4 (2) primary care provider-enrollee ratios;
5 (3) safe and adequate staffing of health care
6 providers in all participating facilities based on:
7 (A) severity of patient illness and functional
8 capacity;
9 (B) factors affecting the period and quality
10 of patient recovery; and
11 (C) any other factor substantially related to
12 the condition and health care needs of patients;
13 (4) geographic accessibility;
14 (5) the number of grievances filed by enrollees
15 relating to waiting times for appointments,
16 appropriateness of referrals, and other indicators of a
17 managed care plan's capacity;
18 (6) hours of operation;
19 (7) the managed care plan's ability to provide
20 culturally and linguistically competent care to meet the
21 needs of its enrollee population; and
22 (8) the volume of technological and speciality
23 services available to serve the needs of enrollees
24 requiring technologically advanced or specialty care.
25 (c) A managed care plan shall report on an annual basis
26 the number of enrollees and the number of participating
27 providers in the managed care plan.
28 (d) If a managed care plan determines that it does not
29 have a health care provider with appropriate training and
30 experience in its panel or network to meet the particular
31 health care needs of an enrollee, the managed care plan
32 shall make a referral to an appropriate provider, pursuant to
33 a treatment plan approved by the primary care provider, in
34 consultation with the managed care plan, the
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1 non-participating provider, and the enrollee or enrollee's
2 designee, at no additional cost to the enrollee beyond what
3 the enrollee would otherwise pay for services received within
4 the network.
5 (e) A managed care plan shall have a procedure by which
6 an enrollee who needs ongoing health care services,
7 provided or coordinated by a specialist focused on a specific
8 organ system, disease or condition, shall receive a referral
9 to the specialist. If the primary care provider, after
10 consultation with the medical director or other
11 contractually authorized representative of the managed care
12 plan, determines that a referral is appropriate, the primary
13 care provider shall make such a referral to a specialist. In
14 no event shall a managed care plan be required to permit
15 an enrollee to elect to have a non-participating
16 specialist, except pursuant to the provisions of subsection
17 (d). The referral made under this subsection shall be
18 pursuant to a treatment plan approved by the enrollee or
19 enrollee's designee, the primary care provider, and the
20 specialist in consultation with the managed care plan. The
21 treatment plan shall authorize the specialist to treat the
22 ongoing injury, disease, or condition. It also may limit the
23 number of visits or the period during which visits are
24 authorized and may require the specialists to provide the
25 primary care provider with regular updates on the specialty
26 care provided, as well as all necessary medical information.
27 (f) A managed care plan shall have a procedure by which
28 a new enrollee, upon enrollment, or an enrollee, upon
29 diagnosis, with (i) a life-threatening condition or disease
30 or (ii) a degenerative or disabling condition or disease,
31 either of which requires specialized medical care over a
32 prolonged period of time shall receive a standing referral to
33 a specialist with expertise in treating the life-threatening
34 condition or disease or degenerative or disabling condition
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1 or disease who shall be responsible for and capable of
2 providing and coordinating the enrollee's primary and
3 specialty care. If the primary care provider, after
4 consultation with the enrollee or enrollee's designee and
5 medical director or other contractually authorized
6 representative of the managed care plan, determines that the
7 enrollee's care would most appropriately be coordinated
8 by a specialist, the primary care provider shall refer, on a
9 standing basis, the enrollee to a specialist. In no event
10 shall a managed care plan be required to permit an enrollee
11 to elect to have a non-participating specialist, except
12 pursuant to the provisions of subsection (d). The
13 specialist shall be permitted to treat the enrollee
14 without a referral from the enrollee's primary care
15 provider and shall be authorized to make such referrals,
16 procedures, tests, and other medical services as the
17 enrollee's primary care provider would otherwise be
18 permitted to provide or authorize including, if
19 appropriate, referral to a specialty care center. If a
20 primary care provider refers an enrollee to a
21 non-participating provider pursuant to the provisions of
22 subsection (d), the standing referral shall be pursuant to a
23 treatment plan approved by the enrollee or enrollee's
24 designee and specialist, in consultation with the managed
25 care plan. Services provided pursuant to the approved
26 treatment plan shall be provided at no additional cost to
27 the enrollee beyond what the enrollee would otherwise pay
28 for services received within the network.
29 (g) If an enrollee's health care provider leaves the
30 managed care plan's network of providers for reasons other
31 than those for which the provider would not be eligible to
32 receive a pre-termination hearing pursuant to subsection (f)
33 of Section 10, the managed care plan shall permit the
34 enrollee to continue an ongoing course of treatment
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1 with the enrollee's current health care provider during a
2 transitional period of:
3 (1) up to 90 days from the date of notice to the
4 enrollee of the provider's disaffiliation from the
5 managed care plan's network; or
6 (2) if the enrollee has entered the second trimester
7 of pregnancy at the time of the provider's
8 disaffiliation, for a transitional period that
9 includes the provision of post-partum care directly
10 related to the delivery.
11 Transitional care, however, shall be authorized by the
12 managed care plan during the transitional period only if the
13 health care provider agrees (i) to continue to accept
14 reimbursement from the managed care plan at the rates
15 applicable prior to the start of the transitional period
16 as payment in full, (ii) to adhere to the managed care plan's
17 quality assurance requirements and to provide to the managed
18 care plan necessary medical information related to the care,
19 (iii) to otherwise adhere to the managed care plan's
20 policies and procedures including, but not limited to,
21 procedures regarding referrals and obtaining
22 pre-authorization and a treatment plan approved by the
23 primary care provider or specialist in consultation with the
24 managed care plan, and (iv) if the enrollee is a recipient of
25 services under Article V of the Illinois Public Aid Code, the
26 health care provider has not been subject to a final
27 disciplinary action by a state or federal agency for
28 violations of the Medicaid or Medicare program.
29 (h) If a new enrollee whose health care provider is not
30 a member of the managed care plan's provider network enrolls
31 in the managed care plan, the managed care plan shall permit
32 the enrollee to continue an ongoing course of treatment with
33 the enrollee's current health care provider during a
34 transitional period of up to 90 days from the effective
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1 date of enrollment, if (i) the enrollee has a
2 life-threatening disease or condition or a degenerative or
3 disabling disease or condition or (ii) the enrollee has
4 entered the second trimester of pregnancy at the effective
5 date of enrollment, in which case the transitional period
6 shall include the provision of post-partum care directly
7 related to the delivery. If an enrollee elects to continue
8 to receive payment for care from a health care provider
9 pursuant to this subsection, the care shall be authorized by
10 the managed care plan for the transitional period only if
11 the health care provider agrees (i) to accept reimbursement
12 from the managed care plan at rates established by the
13 managed care plan as payment in full, which rates shall be no
14 more than the level of reimbursement applicable to similar
15 providers within the managed care plan's network for
16 those services, (ii) to adhere to the managed care plan's
17 quality assurance requirements and agrees to provide to the
18 managed care plan necessary medical information related to
19 the care, (iii) to otherwise adhere to the managed care
20 plan's policies and procedures including, but not limited
21 to, procedures regarding referrals and obtaining
22 pre-authorization and a treatment plan approved by the
23 primary care provider or specialist, in consultation with the
24 managed care plan, and (iv) if the enrollee is a recipient of
25 services under Article V of the Illinois Public Aid Code, the
26 health care provider has not been subject to a final
27 disciplinary action by a state or federal agency for
28 violations of the Medicaid or Medicare program. In no
29 event shall this subsection be construed to require a managed
30 care plan to provide coverage for benefits not otherwise
31 covered or to diminish or impair pre-existing condition
32 limitations contained within the enrollee's contract.
33 Section 25. Duty to report.
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1 (a) A managed care plan shall report to the
2 appropriate professional disciplinary agency, after
3 compliance and in accordance with the provisions of this
4 Section:
5 (1) termination of a health care provider contract
6 for commission of an act or acts that may directly
7 threaten patient care, and not of an administrative
8 nature, or that a person may be mentally or physically
9 disabled in such a manner as to endanger a patient under
10 that person's care;
11 (2) voluntary or involuntary termination of a
12 contract or employment or other affiliation with the
13 managed care plan to avoid the imposition of disciplinary
14 measures.
15 The managed care plan shall only make the report after it
16 has provided the health care professional with a hearing on
17 the matter. (This hearing shall not impair or limit the
18 managed care plan's ability to terminate the professional.
19 Its purpose is solely to ensure that a sufficient basis
20 exists for making the report.) The hearing shall be held
21 before a panel appointed by the managed care plan. The
22 hearing panel shall be composed of 5 persons appointed by the
23 plan, the majority of whom shall be clinical peer reviewers,
24 to the extent possible, in the same discipline and the same
25 specialty as the health care professional under review. The
26 hearing panel shall determine whether the proposed basis for
27 the report is supported by a preponderance of the evidence.
28 The panel shall render its determination within 14 days. If
29 a majority of the panel finds the proposed basis for the
30 report is supported by a preponderance of the evidence, the
31 managed care plan shall make the required report within 21
32 days.
33 Any hearing under this Section shall provide the health
34 care professional in question with the right to examine
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1 pertinent information, to present witnesses, and to ask
2 questions of an authorized representative of the plan.
3 If a hearing has been held pursuant to subsection (f) of
4 Section 10 and the hearing panel sustained a plan's
5 termination of a health care professional, no additional
6 hearing is required, and the plan shall make the report
7 required under this Section.
8 (b) Reports made pursuant to this Section shall be made
9 in writing to the appropriate professional disciplinary
10 agency. Written reports shall include the name, address,
11 profession, and license number of the individual and a
12 description of the action taken by the managed care plan,
13 including the reason for the action and the date thereof, or
14 the nature of the action or conduct that led to the
15 resignation, termination of contract, or withdrawal, and the
16 date thereof.
17 For any hearing under this Section, because the candid
18 and conscientious evaluation of clinical practices is
19 essential to the provision of health care, it is the policy
20 of this State to encourage peer review by health care
21 professionals. Therefore, no managed care plan and no
22 individual who participates in a hearing or who is a member,
23 agent, or employee of a managed care plan shall be liable for
24 criminal or civil damages or professional discipline as a
25 result of the acts, omissions, decisions, or any other
26 conduct, direct or indirect, associated with a hearing panel,
27 except for wilful and wanton misconduct. Nothing in this
28 Section shall relieve any person, health care provider,
29 health care professional, facility, organization, or
30 corporation from liability for his, her, or its own
31 negligence in the performance of his, her, or its duties or
32 arising from treatment of a patient. The hearing panel
33 information shall not be subject to inspection or disclosure
34 except upon formal written request by an authorized
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1 representative of a duly authorized State agency or pursuant
2 to a court order issued in a pending action or proceeding.
3 Section 30. Disclosure of information.
4 (a) A health care professional affiliated with a
5 managed care plan shall make available, in written form at
6 his or her office, to his or her patients or prospective
7 patients the following:
8 (1) information related to the health care
9 professional's educational background, experience,
10 training, specialty and board certification, if
11 applicable, number of years in practice, and hospitals
12 where he or she has privileges;
13 (2) information regarding the health care
14 professional's participation in continuing education
15 programs and compliance with any licensure,
16 certification, or registration requirements, if
17 applicable;
18 (3) information regarding the health care
19 professional's participation in clinical performance
20 reviews conducted by the Department, where applicable and
21 available; and
22 (4) the location of the health care professional's
23 primary practice setting and the identification of any
24 translation services available.