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91_SB0579sam002
SRS91SB0579MNsaam05
1 AMENDMENT TO SENATE BILL 579
2 AMENDMENT NO. . Amend Senate Bill 579 on page 1 by
3 inserting immediately below line 31 the following:
4 "(f) Nothing in this Section shall preclude the health
5 care plan from sharing information for plan quality
6 assessment and improvement purposes as required by Section
7 70."; and
8 on page 2 by inserting immediately below line 14 the
9 following:
10 ""Emergency medical screening examination" means a
11 medical screening examination and evaluation by a physician
12 licensed to practice medicine in all its branches, or to the
13 extent permitted by applicable laws, by other appropriately
14 licensed personnel under the supervision of or in
15 collaboration with a physician licensed to practice medicine
16 in all its branches to determine whether the need for
17 emergency services exists."; and
18 on page 2, line 5, by replacing "including" with "including,
19 but not limited to,"; and
20 on page 3, line 14 by replacing "services." with "services.
21 Nothing in this Act shall be construed to define Independent
22 Practice Associations or Physician-Hospital Organizations as
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1 health care providers."; and
2 on page 3 by replacing lines 17 and 18 with the following:
3 "hospitalization incident to the furnishing of such care, as
4 well as the furnishing to any person of"; and
5 on page 3 by replacing lines 29 and 30 with the following:
6 ""Physician" means a person licensed under the Medical
7 Practice Act of 1987."; and
8 on page 4 by deleting lines 3 through 14; and
9 on page 4 by replacing lines 26 through 30 with the
10 following:
11 "(a) A health care plan shall provide to enrollees and
12 prospective enrollees, upon request, a list of participating
13 health care providers in the health care plan's service area
14 and a description of the following terms of coverage:"; and
15 on page 4, on line 32, by replacing "covered benefits," with
16 "covered benefits and services,"; and
17 on page 5, line 10, by replacing "provider's" with "health
18 care provider's"; and
19 on page 5, line 17, by replacing "provider" with "health care
20 provider"; and
21 on page 5, line 27, by replacing "health" with "health care";
22 and
23 on page 6, line 19, by replacing "providers" with "health
24 care providers"; and
25 on page 7 by replacing line 29 with the following:
26 "(A) of 90 days from the effective"; and
27 on page 8, line 26, by replacing "from" with "by contract or
28 policy from"; and
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1 on page 8 by replacing line 27 with the following:
2 "any health care services and health care providers,"; and
3 on page 8 by deleting lines 31 through 33; and
4 on page 9 by deleting line 1; and
5 on page 9, line 2, by replacing "(c)" with "(b)"; and
6 on page 9, line 6, by replacing "plan" with "plan or its
7 subcontractors"; and
8 on page 9, line 26, by replacing "plan" with "plan or its
9 subcontractors"; and
10 on page 10, line 12, by replacing "allow all enrollees to"
11 with "ensure that any enrollee may"; and
12 on page 10 by replacing line 14 with the following:
13 "its branches participating"; and
14 on page 10, line 17, by replacing "qualified." with
15 "qualified. Nothing in this Act shall be construed to
16 prohibit a health care plan from requiring a health care
17 provider to meet the health care plan's criteria in order to
18 coordinate access to health care."; and
19 on page 10, line 29, by replacing "a period of up to one
20 year." with "the period necessary to provide the referred
21 services or one year, except in the event of termination of a
22 contract or policy in which case Section 25 on transition of
23 services shall apply, if applicable."; and
24 on page 11, line 14, by replacing "time." with "time. The
25 referring physician shall notify the plan when a referral is
26 made outside the network."; and
27 on page 13, line 14, by replacing "provider" with "physician
28 licensed to practice medicine in all its branches or health
29 care provider"; and
-4- SRS91SB0579MNsaam05
1 on page 13, line 17, by replacing "Payment" with "Coverage
2 and payment"; and
3 on page 14, line 3, by replacing "physician" with "physician
4 licensed to practice medicine in all its branches"; and
5 on page 14, line 5, by replacing "a physician" with "or in
6 collaboration with a physician licensed to practice medicine
7 in all its branches"; and
8 on page 14, line 26, by replacing "treating" with "treating
9 physician licensed to practice medicine in all its branches
10 or"; and
11 on page 14, line 27, by replacing "provider" with "health
12 care provider"; and
13 on page 14, line 31, by replacing "treating" with "treating
14 physician licensed to practice medicine in all its branches
15 or"; and
16 on page 15 by replacing line 16 with the following:
17 "request. "Two documented good faith efforts" means
18 the"; and
19 on page 15, line 20, by replacing "Good faith" with ""Good
20 faith""; and
21 on page 15, line 25, by replacing "treating" with "treating
22 physician licensed to practice medicine in all its branches
23 or"; and
24 on page 16, line 22, by replacing "entity." with "entity.
25 However, the ultimate responsibility for coverage and payment
26 decisions may not be delegated."; and
27 on page 24, line 12, by replacing "plan" with "plan or its
28 subcontractors"; and
29 on page 24, line 15, by replacing "or otherwise, any" with ",
-5- SRS91SB0579MNsaam05
1 hold harmless, or contribution requirements concerning any";
2 and
3 on page 24 by replacing lines 17 and 18 with the following:
4 "care plan or its officers, employees, or agents. Nothing in
5 this Section shall relieve any person or health care provider
6 from liability for his, her, or its own negligence in the
7 performance of his, her, or its duties arising from treatment
8 of a patient. The Illinois General Assembly finds it to be
9 against public policy for a person to transfer liability in
10 such a manner."; and
11 on page 27, by replacing line 1 with the following:
12 "changing Section 370g and adding Sections 155.36, 370s";
13 and
14 on page 27, line 7, by changing "Sections 80 and" with
15 "Section"; and.
16 on page 38, line 15, by replacing "2000." with "2000, except
17 that Section 85 takes effect July 1, 2000.".