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90_HB3271
215 ILCS 125/2-2 from Ch. 111 1/2, par. 1404
215 ILCS 125/6-7 from Ch. 111 1/2, par. 1418.7
Amends the Health Maintenance Organization Act.
Increases from 9 to 11 the number of members on the Health
Maintenance Advisory Board. Provides for 2 members to be
representatives of the general public. Increases the number
of directors of the Illinois Health Maintenance Organization
Guaranty Association from 9 to 11. Provides that 2 of the
members shall be enrollees of health maintenance
organizations.
LRB9011499JSmg
LRB9011499JSmg
1 AN ACT to amend the Health Maintenance Organization Act
2 by changing Sections 2-2 and 6-7.
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 2-2 and 6-7 as follows:
7 (215 ILCS 125/2-2) (from Ch. 111 1/2, par. 1404)
8 Sec. 2-2. Determination by Director; Health Maintenance
9 Advisory Board.
10 (a) Upon receipt of an application for issuance of a
11 certificate of authority, the Director shall transmit copies
12 of such application and accompanying documents to the
13 Director of the Illinois Department of Public Health. The
14 Director of the Department of Public Health shall then
15 determine whether the applicant for certificate of authority,
16 with respect to health care services to be furnished: (1) has
17 demonstrated the willingness and potential ability to assure
18 that such health care service will be provided in a manner to
19 insure both availability and accessibility of adequate
20 personnel and facilities and in a manner enhancing
21 availability, accessibility, and continuity of service; and
22 (2) has arrangements, established in accordance with rules
23 regulations promulgated by the Department of Public Health
24 for an ongoing quality of health care assurance program
25 concerning health care processes and outcomes. Upon
26 investigation, the Director of the Department of Public
27 Health shall certify to the Director whether the proposed
28 Health Maintenance Organization meets the requirements of
29 this subsection (a). If the Director of the Department of
30 Public Health certifies that the Health Maintenance
31 Organization does not meet such requirements, he or she shall
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1 specify in what respect it is deficient.
2 There is created in the Department of Public Health a
3 Health Maintenance Advisory Board composed of 11 members.
4 Nine of the 11 9 members shall who have practiced in the
5 health field and, 4 of those 9 which shall have been or shall
6 be are currently affiliated with a Health Maintenance
7 Organization. Two of the members shall be members of the
8 general public, one of whom is over 65 years of age. Each
9 member shall be appointed by the Director of the Department
10 of Public Health and serve at the pleasure of that Director
11 and shall receive no compensation for services rendered other
12 than reimbursement for expenses. Six Five members of the
13 Board shall constitute a quorum. A vacancy in the membership
14 of the Advisory Board shall not impair the right of a quorum
15 to exercise all rights and perform all duties of the Board.
16 The Health Maintenance Advisory Board has the power to review
17 and comment on proposed rules and regulations to be
18 promulgated by the Director of the Department of Public
19 Health within 30 days after those proposed rules and
20 regulations have been submitted to the Advisory Board.
21 (b) Issuance of a certificate of authority shall be
22 granted if the following conditions are met:
23 (1) the requirements of subsection (c) of Section
24 2-1 have been fulfilled;
25 (2) the persons responsible for the conduct of the
26 affairs of the applicant are competent, trustworthy, and
27 possess good reputations, and have had appropriate
28 experience, training or education;
29 (3) the Director of the Department of Public Health
30 certifies that the Health Maintenance Organization's
31 proposed plan of operation meets the requirements of this
32 Act;
33 (4) the Health Care Plan furnishes basic health
34 care services on a prepaid basis, through insurance or
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1 otherwise, except to the extent of reasonable
2 requirements for co-payments or deductibles as authorized
3 by this Act;
4 (5) the Health Maintenance Organization is
5 financially responsible and may reasonably be expected to
6 meet its obligations to enrollees and prospective
7 enrollees; in making this determination, the Director
8 shall consider:
9 (A) the financial soundness of the applicant's
10 arrangements for health services and the minimum
11 standard rates, co-payments and other patient
12 charges used in connection therewith;
13 (B) the adequacy of working capital, other
14 sources of funding, and provisions for
15 contingencies; and
16 (C) that no certificate of authority shall be
17 issued if the initial minimum net worth of the
18 applicant is less than $2,000,000. The initial net
19 worth shall be provided in cash and securities in
20 combination and form acceptable to the Director;
21 (6) the agreements with providers for the provision
22 of health services contain the provisions required by
23 Section 2-8 of this Act; and
24 (7) any deficiencies identified by the Director
25 have been corrected.
26 (Source: P.A. 86-620; 86-1475.)
27 (215 ILCS 125/6-7) (from Ch. 111 1/2, par. 1418.7)
28 Sec. 6-7. Board of Directors. The board of directors of
29 the Association shall consist consists of not less than 7 5
30 nor more than 11 9 members serving terms as established in
31 the plan of operation. The members of the board are to be
32 selected by member organizations subject to the approval of
33 the Director provided, however, that 2 members shall be
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1 enrollees, one of whom is over 65 years of age. Vacancies on
2 the board must be filled for the remaining period of the term
3 in the manner described in the plan of operation. To select
4 the initial board of directors, and initially organize the
5 Association, the Director must give notice to all member
6 organizations of the time and place of the organizational
7 meeting. In determining voting rights at the organizational
8 meeting each member organization is entitled to one vote in
9 person or by proxy. If the board of directors is not
10 selected at the organizational meeting, the Director may
11 appoint the initial members.
12 In approving selections or in appointing members to the
13 board, the Director must consider, whether all member
14 organizations are fairly represented.
15 Members of the board may be reimbursed from the assets of
16 the Association for expenses incurred by them as members of
17 the board of directors but members of the board may not
18 otherwise be compensated by the Association for their
19 services.
20 (Source: P.A. 85-20.)