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90_SB0457enr
215 ILCS 125/4-17 new
Amends the Health Maintenance Organization Act. Provides
that enrollees who are residents of a retirement facility
consisting of a long-term care facility and residential
apartments may be referred to that facility's long-term care
facility even though the facility is not part of the health
maintenance organization network. Specifies conditions that
must be met.
LRB9000384JSgc
SB457 Enrolled LRB9000384JSgc
1 AN ACT to amend the Health Maintenance Organization Act
2 by adding Section 4-17.
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 adding Section 4-17 as follows:
7 (215 ILCS 125/4-17 new)
8 Sec. 4-17. Retirement facility residents. With respect
9 to an enrollee who is a resident of a retirement facility
10 consisting of a long-term care facility, as defined in the
11 Nursing Home Care Act, and residential apartments, a contract
12 or evidence of coverage issued, amended, delivered, or
13 renewed after the effective date of this amendatory Act of
14 1997 shall provide that the enrollee's primary care physician
15 must refer the enrollee to the retirement facility's
16 long-term care facility for Medicare covered skilled nursing
17 services if the primary care physician finds that:
18 (1) it is in the best interests of the patient;
19 (2) the facility, if not a participating provider
20 in the specific health maintenance organization, agrees
21 during the preauthorization period to a negotiated rate
22 for skilled nursing services covered in that
23 organization's health care plan; and
24 (3) the facility meets all the requirements of a
25 participating provider for skilled nursing services as
26 defined and covered under the health maintenance
27 organization's health care plan.
28 Both the facility and the health maintenance organization
29 must fully disclose all pertinent information to consumers to
SB457 Enrolled -2- LRB9000384JSgc
1 assure that their decisions are based upon full knowledge of
2 the implications of their decision making.