FLOWERS-FEIGENHOLTZ-SCHOENBERG-WOJCIK-KRAUSE, GASH, MURPHY, JONES,SHIRLEY, MCKEON, HARTKE, DART, SCOTT, SMITH,MICHAEL, HOLBROOK, ACEVEDO, STROGER, SCHAKOWSKY, LANG, ERWIN, RONEN, CURRY,JULIE, FANTIN, O'BRIEN, HANNIG, DAVIS,STEVE, WOOLARD, YOUNGE, LYONS,JOSEPH, CROTTY, MCGUIRE, BROSNAHAN, GIGLIO, PUGH, TURNER,ART, MCCARTHY, GILES, HOWARD, MULLIGAN, KLINGLER, JONES,LOU, BUGIELSKI, KENNER, BRADLEY, CAPPARELLI, FRITCHEY, SCULLY AND SLONE. (CRONIN-BERMAN-HALVORSON-TROTTER-FARLEY) 215 ILCS 125/2-1.1 new 215 ILCS 125/2-1.2 new 215 ILCS 125/2-1.3 new 215 ILCS 125/2-1.4 new 215 ILCS 125/2-1.5 new 215 ILCS 125/2-1.6 new 215 ILCS 125/2-1.7 new 215 ILCS 125/Art. VII heading new 215 ILCS 125/7-1 new 215 ILCS 125/7-5 new 215 ILCS 125/7-10 new 215 ILCS 125/7-15 new 215 ILCS 125/7-20 new 215 ILCS 125/7-25 new 215 ILCS 125/7-30 new 215 ILCS 125/7-35 new 215 ILCS 125/7-40 new 215 ILCS 125/4-6 rep. Amends the Health Maintenance Organization Act. Establishes requirements for disclosure of information to subscribers and enrollees. Sets forth standards for the handling of grievances by enrollees. Specifies procedures and timelines. Establishes the procedures for terminating health care professionals. Prohibits an organization from restricting information that a health care provider may give to a patient. Requires that an adequate network of providers be maintained. Creates the Utilization Review Law. Sets forth standards and procedures for determining whether services are covered. Establishes timeframes for making utilization review determinations. Sets forth requirements for appeals from adverse decisions. FISCAL NOTE (Dept. of Insurance) HB626 could cost as much as $500,000 for nurse assessment costs and funding a new staff for regulation of the entities. HOUSE AMENDMENT NO. 1. Deletes reference to: 215 ILCS 125/2-1.1 new 215 ILCS 125/2-1.2 new 215 ILCS 125/2-1.3 new 215 ILCS 125/2-1.4 new 215 ILCS 125/2-1.5 new 215 ILCS 125/2-1.6 new 215 ILCS 125/2-1.7 new 215 ILCS 125/Art. VII heading new 215 ILCS 125/7-1 new 215 ILCS 125/7-5 new 215 ILCS 125/7-10 new 215 ILCS 125/7-15 new 215 ILCS 125/7-20 new 215 ILCS 125/7-25 new 215 ILCS 125/7-30 new 215 ILCS 125/7-35 new 215 ILCS 125/7-40 new 215 ILCS 125/4-6 rep. Adds reference to: New Act Replaces everything after the clause. Creates the Managed Care Entity Responsibility and Patient Rights Act. Establishes requirements for disclosure of information to subscribers and enrollees. Sets forth standards for the handling of grievances by enrollees. Specifies procedures and timelines. Establishes the procedures for terminating health care professionals. Prohibits a managed care plan from restricting information that a health care provider may give to a patient. Requires that an adequate network of providers be maintained. Establishes grievance procedures. Provides for the registration of utilization review agents. Sets forth standards and procedures for determining whether services are covered. Establishes timeframes for making utilization review determinations. Sets forth requirements for appeals from adverse decisions. Provides for administration by the Department of Public Health. Authorizes the Attorney General to seek civil penalties for violations. HOUSE AMENDMENT NO. 2. Adds reference to: 5 ILCS 375/6.9 new 55 ILCS 5/5-1069.8 new 65 ILCS 5/10-4-2.8 new 105 ILCS 5/10-22.3f new 215 ILCS 5/356t new 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 Replaces the title and everything after the enacting clause. Creates the Managed Care Reform Act. Specifies information that must be disclosed by a managed care plan. Establishes a multi-level grievance procedure and also provides for an independent external review. Requires a managed care plan to maintain a grievance register. Requires managed care plans to be certified by the Director of Public Health with respect to adequacy of provider networks. Authorizes the Department of Public Health to impose civil penalties. Establishes a process, including hearings, for termination of a health care provid- er. Requires managed care plans to report to professional disciplinary agencies. Provides for the registration of utilization service agents. Establishes utilization review program standards. Provides for general administration of the Act by the Department of Insurance. Requires the Department of Insurance to establish a Managed Care Ombudsman Program. Amends the Illinois Insurance Code to require point-of-service coverage for managed care plans. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code to impose the requirements of the Managed Care Reform Act upon the provision of health care under those Acts. Amends the Health Maintenance Organization Act to provide for 2 public members to be appointed to the Health Maintenance Advisory Board and the Board of Directors of the Health Maintenance Organiza- tion Guaranty Association Board. Effective immediately. FISCAL NOTE, H-AMS 1 & 2 (Dept. of Insurance) No change from previous note. FISCAL NOTE, H-AM 2 (Dept. of Public Health) This program would cost approximately $219,800 annually and would require at least 3 additional nurse surveyors and 2 clerical/administrative staff. CORRECTIONAL NOTE, H-AM 2 There would be no prison population impact on DOC. STATE MANDATES FISCAL NOTE, H-AM 2 (DCCA) HB626, with H-am 2, creates a personnel mandate which requires 100% reimbursement. HOME RULE NOTE, H-AM 2 HB626, with H-am 2, does not preempt home rule authority. JUDICIAL NOTE, H-AMS 1 & 2 Impact on the number of judges needed cannot be determined. JUDICIAL NOTE, H-AM 3 There may be an increase in judicial workloads; impact on the number of judges needed cannot be determined. FISCAL NOTE, H-AM 3 (Dept. of Public Health) Adding a minimum of 25 FTEs would cost approximately $2,000,000 annually. STATE MANDATES FISCAL NOTE, H-AM 3 (DCCA) No change from previous mandates note. HOME RULE NOTE, H-AM 3 HB626, with H-am 3, contains an express denial and limitation under the Ill. Constitution, and, therefore preempts home rule. HOUSE AMENDMENT NO. 3. Adds reference to: 5 ILCS 375/6.9 new 30 ILCS 105/5.449 new 30 ILCS 805/8.21 new 55 ILCS 5/5-1069.8 new 65 ILCS 5/10-4-2.8 new 105 ILCS 5/10-22.3f new 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 Replaces the title and everything after the enacting clause. Creates the Managed Care Reform Act. Specifies information that must be disclosed by a managed care plan. Establishes a multi-level grievance procedure and also provides for an independent external review. Requires a managed care plan to maintain a grievance register. Requires managed care plans to be certified by the Director of Public Health with respect to adequacy of provider networks. Authorizes the Department of Public Health to impose civil penalties. Establishes a process, including hearing, for termination of a health care provider. Requires managed care plans to report to professional disciplinary agencies. Provides for the registration of utilization service agents. Establishes utilization review program standards. Provides for general administration of the Act by the Department of Insurance. Requires the Department of Insurance to establish a Managed Care Ombudsman Program. Amends the State Finance Act to create the Manag- ed Care Entity Responsibility and Patients Rights Fund. Amends the State Mandates Act to require implementation without reimbursement. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code to impose the requirements of the Managed Care Reform Act upon the provision of health care under those Acts. Amends the Health Maintenance Organiza- tion Act to provide for 2 public members to be appointed to the Health Maintenance Organization Guaranty Association Board. Effective immedi- ately. HOUSE AMENDMENT NO. 5 Requires physician peer reviewers to be State licensed. Excludes State government agencies from the definition of "utilization review agent". Shortens the time within which certain notices must be provided to enrollees and within which actions must be taken in a grievance proceeding. Changes the effective date to July 1, 1998. Makes other changes. 97-02-10 H FILED WITH CLERK 97-02-10 H FIRST READING 97-02-10 H REFERRED TO HOUSE RULES COMMITTEE RULES 97-02-19 H ASSIGNED TO COMMITTEE HEALTH CARE 97-02-19 H ADDED AS A JOINT SPONSOR KRAUSE 97-02-27 H FISCAL NOTE FILED 97-02-27 H COMMITTEE HEALTH CARE 97-02-27 H ADDED AS A CO-SPONSOR WOJCIK 97-03-05 H AMENDMENT NO. 01-HTHCR-AVB-ACS H 97-03-05 H ADOPTED 029-000-000 97-03-05 H REMAINS IN COMMITTEE HEALTH CARE 97-03-21 H AMENDMENT NO. 02-HTHCR-AVB-ACS H 97-03-21 H ADOPTED 97-03-21 H DO PASS AMENDED/SHORT DEBATE 020-003-000 HCAA 97-03-21 H PLACED CALENDAR 2ND READING-SHORT DEBATE 97-03-21 H FISCAL NOTE REQUESTED AS AMENDED/KRAUSE 97-03-21 H STATE MANDATES FISCAL NOTE REQUESTED AS AMENDED/KRAUSE 97-03-21 H HOME RULE NOTE REQUESTED AS AMENDED/KRAUSE 97-03-21 H JUDICIAL NOTE REQUESTED AS AMENDED/KRAUSE 97-03-21 H CALENDAR ORDER 2ND READING-SHORT DEBATE 97-03-21 H ADDED AS A CO-SPONSOR SCHOENBERG 97-03-21 H ADDED AS A CO-SPONSOR FEIGENHOLTZ 97-03-26 H FISCAL NOTE FILED AS AMENDED 97-03-26 H CALENDAR ORDER 2ND READING-SHORT DEBATE 97-04-08 H FISCAL NOTE FILED AS AMENDED 97-04-08 H FISCAL NOTE REQUESTED AS AMENDED BY #2 97-04-08 H KRAUSE 97-04-08 H STATE MANDATES FISCAL NOTE REQUESTED AS AMENDED BY #2 97-04-08 H KRAUSE 97-04-08 H CORRECTIONAL NOTE REQUESTED AS AMENDED BY #2 97-04-08 H KRAUSE 97-04-08 H HOME RULE NOTE REQUESTED AS AMENDED BY #2 97-04-08 H KRAUSE 97-04-08 H JUDICIAL NOTE REQUESTED AS AMENDED BY #2 97-04-08 H KRAUSE 97-04-08 H CALENDAR ORDER 2ND READING-SHORT DEBATE 97-04-09 H CORRECTIONAL NOTE FILED AS AMENDED 97-04-09 H CALENDAR ORDER 2ND READING-SHORT DEBATE 97-04-09 H ADDED AS A CO-SPONSOR GASH 97-04-09 H ADDED AS A CO-SPONSOR MURPHY 97-04-09 H ADDED AS A CO-SPONSOR JONES,SHIRLEY 97-04-09 H ADDED AS A CO-SPONSOR MCKEON 97-04-09 H ADDED AS A CO-SPONSOR BOLAND 97-04-09 H ADDED AS A CO-SPONSOR HARTKE 97-04-09 H ADDED AS A CO-SPONSOR DART 97-04-09 H ADDED AS A CO-SPONSOR SCOTT 97-04-09 H ADDED AS A CO-SPONSOR GRANBERG 97-04-09 H ADDED AS A CO-SPONSOR SMITH,MICHAEL 97-04-09 H ADDED AS A CO-SPONSOR HOLBROOK 97-04-09 H ADDED AS A CO-SPONSOR ACEVEDO 97-04-09 H ADDED AS A CO-SPONSOR STROGER 97-04-09 H ADDED AS A CO-SPONSOR DAVIS,MONIQUE 97-04-09 H ADDED AS A CO-SPONSOR SCHAKOWSKY 97-04-09 H ADDED AS A CO-SPONSOR LANG 97-04-10 H ADDED AS A CO-SPONSOR ERWIN 97-04-10 H ADDED AS A CO-SPONSOR RONEN 97-04-10 H ADDED AS A CO-SPONSOR CURRY,JULIE 97-04-10 H ADDED AS A CO-SPONSOR FANTIN 97-04-10 H ADDED AS A CO-SPONSOR CURRIE 97-04-10 H ADDED AS A CO-SPONSOR O'BRIEN 97-04-10 H ADDED AS A CO-SPONSOR HANNIG 97-04-10 H ADDED AS A CO-SPONSOR DAVIS,STEVE 97-04-10 H ADDED AS A CO-SPONSOR WOOLARD 97-04-10 H ADDED AS A CO-SPONSOR YOUNGE 97-04-10 H ADDED AS A CO-SPONSOR PHELPS 97-04-10 H ADDED AS A CO-SPONSOR LYONS,JOSEPH 97-04-10 H ADDED AS A CO-SPONSOR CROTTY 97-04-10 H ADDED AS A CO-SPONSOR MCGUIRE 97-04-10 H ADDED AS A CO-SPONSOR BROSNAHAN 97-04-10 H ADDED AS A CO-SPONSOR GIGLIO 97-04-12 H STATE MANDATES FISCAL NOTE FILED AS AMENDED 97-04-12 H HOME RULE NOTE FILED AS AMENDED 97-04-12 H CALENDAR ORDER 2ND READING-SHORT DEBATE 97-04-12 H ADDED AS A CO-SPONSOR PUGH 97-04-12 H ADDED AS A CO-SPONSOR SILVA 97-04-12 H ADDED AS A CO-SPONSOR TURNER,ART 97-04-12 H ADDED AS A CO-SPONSOR MCCARTHY 97-04-12 H ADDED AS A CO-SPONSOR GILES 97-04-12 H ADDED AS A CO-SPONSOR HOWARD 97-04-12 H ADDED AS A CO-SPONSOR MULLIGAN 97-04-14 H JUDICIAL NOTE FILED AS AMENDED 97-04-14 H CALENDAR ORDER 2ND READING-SHORT DEBATE 97-04-15 H ADDED AS A CO-SPONSOR KLINGLER 97-04-15 H ADDED AS A CO-SPONSOR SAVIANO 97-04-15 H ADDED AS A CO-SPONSOR JONES,LOU 97-04-15 H ADDED AS A CO-SPONSOR BUGIELSKI 97-04-15 H ADDED AS A CO-SPONSOR KENNER 97-04-16 H AMENDMENT NO. 03-FLOWERS 97-04-16 H AMENDMENT REFERRED TO HRUL 97-04-16 H STATE MANDATES FISCAL NOTE REQUESTED AS AMENDED/BLACK 97-04-16 H AMENDMENT NO. 03-FLOWERS 97-04-16 H RULES REFERS TO HCAA 97-04-16 H FISCAL NOTE REQUESTED AS AMENDED/MAUTINO 97-04-16 H STATE MANDATES FISCAL NOTE REQUESTED AS AMENDED/WIRSING 97-04-16 H CALENDAR ORDER 2ND READING-SHORT DEBATE 97-04-17 H JUDICIAL NOTE FILED AS AMENDED 97-04-17 H CALENDAR ORDER 2ND READING-SHORT DEBATE 97-04-18 H AMENDMENT NO. 03-FLOWERS 97-04-18 H BE ADOPTED HCAA/017-005-004 97-04-18 H FISCAL NOTE FILED AS AMENDED 97-04-18 H CALENDAR ORDER 2ND READING-SHORT DEBATE 97-04-19 H JOINT-SPONSOR CHANGED TO FEIGENHOLTZ 97-04-19 H ADDED AS A CO-SPONSOR GASH 97-04-19 H ADDED AS A CO-SPONSOR BOLAND 97-04-23 H AMENDMENT NO. 04-FLOWERS 97-04-23 H AMENDMENT REFERRED TO HRUL 97-04-23 H STATE MANDATES FISCAL NOTE FILED AS AMENDED 97-04-23 H HOME RULE NOTE FILED AS AMENDED 97-04-23 H AMENDMENT NO. 04-FLOWERS 97-04-23 H BE ADOPTED HRUL 97-04-23 H SECOND READING-SHORT DEBATE 97-04-23 H HELD ON CAL ORDER 2ND RDG - SHORT DEBATE 97-04-24 H ADDED AS A CO-SPONSOR BRADLEY 97-04-24 H ADDED AS A CO-SPONSOR CAPPARELLI 97-04-24 H ADDED AS A CO-SPONSOR BURKE 97-04-24 H ADDED AS A CO-SPONSOR FRITCHEY 97-04-24 H ADDED AS A CO-SPONSOR SCULLY 97-04-24 H AMENDMENT NO. 05-FLOWERS 97-04-24 H AMENDMENT REFERRED TO HRUL 97-04-24 H HELD ON CAL ORDER 2ND RDG - SHORT DEBATE 97-04-25 H AMENDMENT NO. 05-FLOWERS 97-04-25 H BE ADOPTED HRUL 97-04-25 H ADDED AS A CO-SPONSOR SLONE 97-04-25 H AMENDMENT NO. 03-FLOWERS 97-04-25 H ADOPTED 97-04-25 H AMENDMENT NO. 04-FLOWERS 97-04-25 H WITHDRAWN 97-04-25 H AMENDMENT NO. 05-FLOWERS 97-04-25 H ADOPTED 97-04-25 H FISCAL NOTE REQUESTED AS AMEND. #3-BLACK 97-04-25 H STATE MANDATES FISCAL NOTE REQUESTED AS AMEND. #3-BLACK 97-04-25 H HOME RULE NOTE REQUESTED AS AMEND. #3-BLACK 97-04-25 H JUDICIAL NOTE REQUESTED AS AMEND. #3-BLACK 97-04-25 H FISCAL NOTE REQUESTED AS AMEND. #5-BLACK 97-04-25 H STATE MANDATES FISCAL NOTE REQUESTED AS AMEND. #5-BLACK 97-04-25 H HOME RULE NOTE REQUESTED AS AMEND. #5-BLACK 97-04-25 H JUDICIAL NOTE REQUESTED AS AMEND. #5-BLACK 97-04-25 H FLOOR MOTION ALL NOTE REQUESTS 97-04-25 H INAPPLICABLE 97-04-25 H -FLOWERS 97-04-25 H FISCAL NOTE NOT REQUIRED 062-050-001 97-04-25 H STATE MANDATES FISCAL NOTE NOT REQUIRED 063-048-000 97-04-25 H HOME RULE NOTE NOT REQUIRED 066-048-000 97-04-25 H JUDICIAL NOTE NOT REQUIRED 069-045-000 97-04-25 H PLCD CAL ORDER 3RD READING-SHORT DEBATE 97-04-25 H THIRD READING/SHORT DEBATE/PASSED 073-037-004 97-04-29 S ARRIVE IN SENATE 97-04-29 S CHIEF SPONSOR CRONIN 97-04-29 S ADDED AS A CHIEF CO-SPONSOR BERMAN 97-04-29 S PLACED CALENDAR ORDER OF FIRST READING 97-04-29 S FIRST READING 97-04-29 S REFERRED TO SENATE RULES COMMITTEE RULES 97-04-30 S ASSIGNED TO COMMITTEE INS & PENS. 97-04-30 S ADDED AS A CHIEF CO-SPONSOR HALVORSON 97-04-30 S ADDED AS A CHIEF CO-SPONSOR TROTTER 97-05-01 S ADDED AS A CHIEF CO-SPONSOR FARLEY 97-05-01 S ADDED AS A CO-SPONSOR SMITH 97-05-01 S ADDED AS A CO-SPONSOR SEVERNS 97-05-05 S ADDED AS A CO-SPONSOR DEL VALLE 97-05-05 S ADDED AS A CO-SPONSOR MAHAR 97-05-06 S ADDED AS A CO-SPONSOR VIVERITO 97-05-09 S TO SUBCOMMITTEE 97-05-09 S COMMITTEE INS & PENS. 97-05-10 S RE-REFERRED TO RULES COMM/RULE 3-9(A) RULES 97-10-28 S MOTION FILED BERMAN-SUSPEND 97-10-28 S RULES AND 97-10-28 S DISCHARGE FROM 97-10-28 S THE RULES 97-10-28 S COMMITTEE AND 97-10-28 S PLACE ON THE 97-10-28 S ORDER OF 2ND RDG. 97-10-28 S COMMITTEE RULES 97-10-29 S ADDED AS A CO-SPONSOR DUDYCZ 98-05-21 S ASSIGNED TO COMMITTEE EXECUTIVE 98-05-21 S RE-REFERRED TO COMMITTEE RULES 98-05-21 S APPROVED FOR CONSIDERATION SRUL SRUL 98-05-21 S PLACED ON CALENDAR ORDER OF 2ND READING 98-05-21 S 3RD READING AND PASSAGE DEADLINE EXTEND JANUARY 1, 1999 98-05-21 S ADDED AS A CO-SPONSOR COLLINS 98-05-21 S SECOND READING 98-05-21 S PLACED ON CALENDAR ORDER OF 3RD READING 98-05-22 98-06-22 S REFER TO RULES/PURSUANT SEN RULE 3-9 (B) RULES SRUL 99-01-12 H SESSION SINE DIE END OF INQUIRY Full Text Bill Summary