House Sponsors: FLOWERS-KLINGLER-SCOTT-MCKEON-GASH, SILVA, FANTIN, JONES,LOU, BURKE, PHELPS, PUGH, REITZ, RODRIGUEZ, SCHAKOWSKY, SCULLY, SLONE, MCAULIFFE, DEUCHLER, DART, HANNIG, GIGLIO, CURRY,JULIE, ACEVEDO, BOLAND, BRADLEY, BUGIELSKI, CAPPARELLI, CROTTY, CURRIE, DAVIS,STEVE, ERWIN, FEIGENHOLTZ, FRITCHEY, GILES, HARTKE, HOFFMAN, HOWARD, JONES,SHIRLEY, KENNER, LANG, LOPEZ, LYONS,JOSEPH, MORROW, MURPHY, NOVAK, SMITH,MICHAEL, STROGER, YOUNGE, GRANBERG, MCGUIRE AND MOORE,EUGENE. Short description: HMO HLTH ADVOCACY OFFICE Synopsis of Bill as introduced: Amends the Health Maintenance Organization Act. Establishes the office of health care consumer assistance, advocacy, and information within the Department of Insurance. Provides for an executive director appointed by the Governor to a 3-year term. Directs the office to assist health care consumers on a statewide basis in asserting their contractual and legal rights, resolving consumer complaints, and obtaining appropriate referrals. Requires the executive director to make quarterly reports to the Director of Insurance and the Governor. Requires an annual report to the General Assembly including recommendations for improving the health care consumer assistance and complaint resolution process. Effective immediately. HOUSE AMENDMENT NO. 1. Adds reference to: New Act 5 ILCS 375/6.12 new 30 ILCS 105/5.480 new 30 ILCS 805/8.22 new 55 ILCS 5/5-1069.8 new 65 ILCS 5/10-4-2.8 new 105 ILCS 5/10-22.3g 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 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. Requires the Department of Public Health to establish a Managed Care Ombudsman Program. Amends the State Finance Act to create the Managed 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 Organization Act to provide for 2 public members to be appointed to the Health Maintenance Organization Guaranty Association Board. Effective July 1, 1999. HOUSE AMENDMENT NO. 2. Provides that health insurance carriers, health care plans, and other managed care entities for health care plans have the duty to exercise ordinary care when making health care treatment decisions and are liable for damages for harm to an insured or enrollee proximately caused by the failure to exercise ordinary care. Authorizes a private right of action. Defines terms. Applies only to causes of action that accrue on or after the effective date of the Act. FISCAL NOTE, AMENDED (Dpt. of Insurance) Staffing could cost as much as $250,000 annually. STATE MANDATES ACT FISCAL NOTE, H-AMS 1 & 2 Creates a "personnel mandate" requiring 100% reimbursement. Last action on Bill: SESSION SINE DIE Last action date: 99-01-12 Location: House Amendments to Bill: AMENDMENTS ADOPTED: HOUSE - 2 SENATE - 0 END OF INQUIRY Full Text Bill Status