Senate Sponsors: WALSH,T-KLEMM-SULLIVAN-RADOGNO-NOLAND, MYERS,J, LUECHTEFELD, BOMKE AND CRONIN. House Sponsors: SCHOENBERG-KRAUSE-KENNER-FEIGENHOLTZ-CROSS Short description: MANAGED CARE PATIENT RGHTS ACT Synopsis of Bill as introduced: Creates the Managed Care Patient Rights Act. Enumerates certain information and quality of care standards to which a patient is entitled. Requires health care plans to disclose to enrollees and prospective enrollees specific information concerning benefits and coverages, emergency services, out-of-area coverages, service area covered, access to specialists, and grievance procedures. Sets forth requirements for continuity of care. Prohibits restraints on communications between health care providers and enrollees and others regarding care alternatives, quality, and utilization review issues. Establishes requirements for access to specialists and the mechanisms for second opinions. Requires health care plans to have a consumer advisory committee made up of enrollees and to establish a quality assessment program. Provides for the registration of utilization review programs. Amends the Health Care Purchasing Group Act to provide that the purchasing group may be formed by 2 or more employers having no more than 500 covered employees each rather than having an aggregate limit of 2,500 covered individuals. Authorizes the sponsorship of health care purchasing groups with up to 100,000 rather than 10,000 covered individuals. Amends the State Employees Group Insurance Plan of 1971, the Counties Code, the Illinois Municipal Code, the Comprehensive Health Insurance Plan Act, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require that health care coverage under those Acts comply with Managed Care Patient Rights Act. Amends the Illinois Insurance Code to require compliance with provisions of the Managed Care Patient Rights Act concerning utilization review and complaint procedures. Amends the State Mandates Act to provide reimbursement by the State is not required. Effective January 1, 2000. SENATE AMENDMENT NO. 2. Provides that certain patient information may be shared for quality assessment purposes. Provides that the term "physician" means any physician licensed under the Medical Practice Act of 1987. Removes provision prohibiting health care plans from imposing restrictions on physicians or health care providers as to recommended health care services. Provides that coverage for emergency services may not be retrospectively denied. Provides that a health care plan may not dele- gate the ultimate responsibility for coverage and payment decisions. Excludes independent practice associations and physician-hospital organizations from the scope of the bill. Delays the effective date with respect to utilization review requirements to July 1, 2000. Last action on Bill: SESSION SINE DIE Last action date: 01-01-09 Location: Senate Amendments to Bill: AMENDMENTS ADOPTED: HOUSE - 0 SENATE - 1 END OF INQUIRY Full Text Bill Status