State of Illinois
92^nd General Assembly
Legislation

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92_HB4220enr

 
HB4220 Enrolled                               LRB9211444JSpcA

 1        AN ACT concerning insurance.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  5.  The  Managed  Care Reform and Patient Rights
 5    Act is amended by changing Section 30 as follows:

 6        (215 ILCS 134/30)
 7        Sec. 30.  Prohibitions.
 8        (a)  No  health  care  plan  or  its  subcontractors  may
 9    prohibit or discourage health care providers by  contract  or
10    policy  from  discussing  any health care services and health
11    care providers,  utilization  review  and  quality  assurance
12    policies,  terms and conditions of plans and plan policy with
13    enrollees, prospective enrollees, providers, or the public.
14        (b)  No health care plan by contract, written policy,  or
15    procedure  may  permit  or  allow  an individual or entity to
16    dispense a different drug in place of the drug  or  brand  of
17    drug  ordered or prescribed without the express permission of
18    the person  ordering  or  prescribing  the  drug,  except  as
19    provided  under  Section  3.14 of the Illinois Food, Drug and
20    Cosmetic Act.
21        (c)  No health care plan or  its  subcontractors  may  by
22    contract,  written policy, procedure, or otherwise mandate or
23    require an enrollee to substitute his  or  her  participating
24    primary  care  physician  under  the  plan  during  inpatient
25    hospitalization  without  the  agreement  of  that enrollee's
26    participating primary care physician.  "Participating primary
27    care physician" for health care plans and subcontractors that
28    do not  require  coordination  of  care  by  a  primary  care
29    physician  means  the  participating  physician  treating the
30    patient.  All health care plans shall inform enrollees of any
31    policies,  recommendations,  or  guidelines  concerning   the
 
HB4220 Enrolled             -2-               LRB9211444JSpcA
 1    substitution  of  the  enrollee's primary care physician when
 2    hospitalization is necessary  in  the  manner  set  forth  in
 3    subsections (d) and (e) of Section 15.
 4        (d) (c)  Any  violation  of this Section shall be subject
 5    to the penalties under this Act.
 6    (Source: P.A. 91-617, eff. 1-1-00.)

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