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.
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
HOUSE AMENDMENT NO. 1.
Adds reference to:
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
Amendments to Bill: AMENDMENTS ADOPTED: HOUSE - 2 SENATE - 0
END OF INQUIRY
Full Text Bill Status