State of Illinois
92nd General Assembly
Legislation

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92_SB0873ham001

 










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 1                    AMENDMENT TO SENATE BILL 873

 2        AMENDMENT NO.     .  Amend Senate Bill 873  by  replacing
 3    everything after the enacting clause with the following:

 4        "Section 5.  The University of Illinois Act is amended by
 5    changing Section 7 as follows:

 6        (110 ILCS 305/7) (from Ch. 144, par. 28)
 7        Sec. 7.  Powers of trustees.
 8        (a)  The  trustees  shall  have  power to provide for the
 9    requisite buildings, apparatus, and conveniences; to fix  the
10    rates   for   tuition;   to   appoint   such  professors  and
11    instructors, and to establish and provide for the  management
12    of  such  model  farms,  model art, and other departments and
13    professorships, as may be required  to  teach,  in  the  most
14    thorough  manner, such branches of learning as are related to
15    agriculture and the  mechanic  arts,  and  military  tactics,
16    without excluding other scientific and classical studies. The
17    trustees  shall,  upon  the  written  request  of an employee
18    withhold from the compensation of  that  employee  any  dues,
19    payments  or  contributions  payable  by such employee to any
20    labor organization as defined  in  the  Illinois  Educational
21    Labor Relations Act.  Under such arrangement, an amount shall
22    be  withheld  from each regular payroll period which is equal
 
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 1    to the pro rata share of the annual dues plus any payments or
 2    contributions,  and  the   trustees   shall   transmit   such
 3    withholdings  to  the  specified labor organization within 10
 4    working days from the time  of  the  withholding.   They  may
 5    accept   the   endowments  and  voluntary  professorships  or
 6    departments in the University, from any person or persons  or
 7    corporations  who  may  offer  the  same, and, at any regular
 8    meeting of the board, may prescribe rules and regulations  in
 9    relation  to  such  endowments  and  declare  on what general
10    principles they may be admitted: Provided, that such  special
11    voluntary   endowments   or   professorships   shall  not  be
12    incompatible with the true design and scope  of  the  act  of
13    congress,  or of this Act: Provided, that no student shall at
14    any time be allowed to remain in or about the  University  in
15    idleness,  or  without  full mental or industrial occupation:
16    And provided further, that the trustees, in the  exercise  of
17    any of the powers conferred by this Act, shall not create any
18    liability or indebtedness in excess of the funds in the hands
19    of  the  treasurer  of the University at the time of creating
20    such liability or indebtedness, and which  may  be  specially
21    and properly applied to the payment of the same. Any lease to
22    the  trustees  of  lands,  buildings or facilities which will
23    support scientific research and development in such areas  as
24    high    technology,    super   computing,   microelectronics,
25    biotechnology, robotics, physics and engineering shall be for
26    a term not to exceed 18 years, and may grant to the  trustees
27    the  option  to  purchase the lands, buildings or facilities.
28    The lease shall recite that it is subject to termination  and
29    cancellation in any year for which the General Assembly fails
30    to  make  an  appropriation to pay the rent payable under the
31    terms of the lease.
32        Leases for the  purposes  described  herein  exceeding  5
33    years shall have the approval of the Illinois Board of Higher
34    Education.
 
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 1        The  Board  of  Trustees  may, directly or in cooperation
 2    with other  institutions  of  higher  education,  acquire  by
 3    purchase  or  lease  or  otherwise,  and  construct, enlarge,
 4    improve, equip, complete, operate, control and manage medical
 5    research  and  high  technology  parks,  together  with   the
 6    necessary   lands,   buildings,   facilities,  equipment  and
 7    personal property therefor, to encourage and  facilitate  (a)
 8    the  location and development of business and industry in the
 9    State of Illinois, and  (b)  the  increased  application  and
10    development   of  technology  and  (c)  the  improvement  and
11    development of the State's economy. The Board of Trustees may
12    lease to nonprofit corporations all or any part of the  land,
13    buildings,  facilities,  equipment or other property included
14    in a medical research and  high  technology  park  upon  such
15    terms  and  conditions as the University of Illinois may deem
16    advisable and enter into any contract or agreement with  such
17    nonprofit  corporations  as  may be necessary or suitable for
18    the construction, financing, operation  and  maintenance  and
19    management  of  any  such  park; and may lease to any person,
20    firm, partnership or corporation, either public  or  private,
21    any  part or all of the land, building, facilities, equipment
22    or other property of such park for  such  purposes  and  upon
23    such rentals, terms and conditions as the University may deem
24    advisable;  and  may  finance  all or part of the cost of any
25    such  park,  including  the  purchase,  lease,  construction,
26    reconstruction, improvement,  remodeling,  addition  to,  and
27    extension  and  maintenance  of  all  or  part  of  such high
28    technology  park,  and  all  equipment  and  furnishings,  by
29    legislative  appropriations,  government  grants,  contracts,
30    private gifts, loans, receipts from  the  operation  of  such
31    high  technology  park, rentals and similar receipts; and may
32    make its other facilities and services available  to  tenants
33    or  other  occupants  of  any  such  park  at rates which are
34    reasonable and appropriate.
 
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 1        The Trustees  shall  have  power  (a)  to  purchase  real
 2    property  and easements, and (b) to acquire real property and
 3    easements in the manner provided by law for the  exercise  of
 4    the  right  of  eminent domain, and in the event negotiations
 5    for the acquisition of real property or easements for  making
 6    any  improvement  which  the  Trustees are authorized to make
 7    shall have proven unsuccessful and the Trustees shall have by
 8    resolution adopted a schedule or plan of  operation  for  the
 9    execution  of  the project and therein made a finding that it
10    is necessary to take such property or  easements  immediately
11    or  at  some specified later date in order to comply with the
12    schedule, the Trustees may acquire such property or easements
13    in the same manner provided in Sections 7-103  through  7-112
14    of the Code of Civil Procedure.
15        The Board of Trustees also shall have power to agree with
16    the State's Attorney of the county in which any properties of
17    the  Board  are  located  to pay for services rendered by the
18    various taxing districts for the years 1944 through 1949  and
19    to  pay  annually  for  services  rendered thereafter by such
20    district such sums as may be determined  by  the  Board  upon
21    properties  used  solely for income producing purposes, title
22    to which is held by said Board of Trustees,  upon  properties
23    leased to members of the staff of the University of Illinois,
24    title  to  which  is held in trust for said Board of Trustees
25    and upon properties leased to for-profit entities  the  title
26    to  which  properties  is  held  by  the Board of Trustees. A
27    certified copy of any such agreement made  with  the  State's
28    Attorney  shall  be filed with the County Clerk and such sums
29    shall be distributed to the respective  taxing  districts  by
30    the  County  Collector  in  such proportions that each taxing
31    district will receive therefrom such proportion  as  the  tax
32    rate of such taxing district bears to the total tax rate that
33    would  be  levied  against  such  properties if they were not
34    exempt from taxation under the Property Tax Code.
 
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 1        The Board of Trustees  of  the  University  of  Illinois,
 2    subject  to  the  applicable  civil  service law, may appoint
 3    persons to be members of the University  of  Illinois  Police
 4    Department.  Members  of the Police Department shall be peace
 5    officers and as such have all powers possessed  by  policemen
 6    in  cities, and sheriffs, including the power to make arrests
 7    on view or warrants of violations of state statutes and  city
 8    or  county  ordinances,  except  that  they may exercise such
 9    powers only in counties wherein the University and any of its
10    branches or properties are located when such is required  for
11    the  protection  of  university properties and interests, and
12    its  students  and  personnel,  and  otherwise,  within  such
13    counties, when requested by appropriate state  or  local  law
14    enforcement  officials;  provided, however, that such officer
15    shall have no power to serve and execute civil processes.
16        The Board of Trustees must authorize to  each  member  of
17    the University of Illinois Police Department and to any other
18    employee  of the University of Illinois exercising the powers
19    of a peace officer a distinct badge that, on  its  face,  (i)
20    clearly states that the badge is authorized by the University
21    of Illinois and (ii) contains a unique identifying number. No
22    other   badge  shall  be  authorized  by  the  University  of
23    Illinois.
24        The Board of Trustees may own, operate, or govern, by  or
25    through  the  College  of  Medicine at Peoria, a managed care
26    community network established under  subsection  (b)  (r)  of
27    Section 5-11 5-16.3 of the Illinois Public Aid Code.
28        The  powers  of  the  trustees  as  herein designated are
29    subject to the provisions of "An  Act  creating  a  Board  of
30    Higher  Education,  defining its powers and duties, making an
31    appropriation therefor, and repealing an Act  herein  named",
32    approved August 22, 1961, as amended.
33        The  Board  of Trustees shall have the authority to adopt
34    all administrative rules  which  may  be  necessary  for  the
 
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 1    effective  administration,  enforcement and regulation of all
 2    matters   for   which   the   Board   has   jurisdiction   or
 3    responsibility.
 4        (b)  To  assist  in  the  provision  of   buildings   and
 5    facilities  beneficial  to,  useful  for,  or  supportive  of
 6    University  purposes, the Board of Trustees of the University
 7    of Illinois may exercise the following powers with regard  to
 8    the area located on or adjacent to the University of Illinois
 9    at  Chicago  campus  and  bounded  as follows: on the West by
10    Morgan Street; on the North by Roosevelt Road; on the East by
11    Union Street; and on the South by 16th Street, in the City of
12    Chicago:
13             (1)  Acquire any interests in  land,  buildings,  or
14        facilities  by  purchase,  including installments payable
15        over a period allowed by law, by lease  over  a  term  of
16        such  duration  as the Board of Trustees shall determine,
17        or by exercise of the power of eminent domain;
18             (2)  Sub-lease  or  contract  to  purchase   through
19        installments   all   or   any  portion  of  buildings  or
20        facilities for such duration and on  such  terms  as  the
21        Board  of Trustees shall determine, including a term that
22        exceeds  5  years,  provided  that  each  such  lease  or
23        purchase contract shall be and shall recite  that  it  is
24        subject  to  termination and cancellation in any year for
25        which the General Assembly fails to make an appropriation
26        to pay the rent or purchase  installments  payable  under
27        the terms of such lease or purchase contract; and
28             (3)  Sell property without compliance with the State
29        Property   Control   Act   and  retain  proceeds  in  the
30        University Treasury in a  special,  separate  development
31        fund  account  which the Auditor General shall examine to
32        assure compliance with this Act.
33    Any buildings or facilities to be developed on the land shall
34    be buildings or facilities that, in the determination of  the
 
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 1    Board  of  Trustees,  in whole or in part: (i) are for use by
 2    the University; or (ii) otherwise advance  the  interests  of
 3    the  University,  including,  by  way of example, residential
 4    facilities for University staff and students  and  commercial
 5    facilities  which  provide  services needed by the University
 6    community.  Revenues from the development fund account may be
 7    withdrawn by the University for the purpose of demolition and
 8    the processes associated with demolition;  routine  land  and
 9    property  acquisition;  extension  of  utilities; streetscape
10    work;  landscape  work;  surface   and   structure   parking;
11    sidewalks,  recreational  paths, and street construction; and
12    lease and lease purchase arrangements  and  the  professional
13    services  associated with the planning and development of the
14    area.  Moneys from the development fund account used for  any
15    other  purpose  must  be deposited into and appropriated from
16    the General Revenue Fund.  Buildings or facilities leased  to
17    an  entity  or  person other than the University shall not be
18    subject to any limitations applicable to  a  State  supported
19    college  or university under any law.  All development on the
20    land and all use of any  buildings  or  facilities  shall  be
21    subject to the control and approval of the Board of Trustees.
22    (Source: P.A. 90-730, eff. 8-10-98; 91-883, eff. 1-1-01.)

23        Section  10.  The Southern Illinois University Management
24    Act is amended by changing Section 8 as follows:

25        (110 ILCS 520/8) (from Ch. 144, par. 658)
26        Sec. 8.  Powers and Duties of the Board.  The Board shall
27    have power and it shall be its duty:
28             1.  To make  rules,  regulations  and  by-laws,  not
29        inconsistent  with law, for the government and management
30        of Southern Illinois University and its branches;
31             2.  To employ, and, for  good  cause,  to  remove  a
32        president   of  Southern  Illinois  University,  and  all
 
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 1        necessary  deans,   professors,   associate   professors,
 2        assistant  professors, instructors, and other educational
 3        and administrative assistants, and  all  other  necessary
 4        employees,  and  contract with them upon matters relating
 5        to tenure, salaries and retirement benefits in accordance
 6        with the State Universities Civil Service Act; the  Board
 7        shall,  upon  the  written  request  of  an  employee  of
 8        Southern   Illinois   University,   withhold   from   the
 9        compensation  of  that  employee  any  dues,  payments or
10        contributions payable  by  such  employee  to  any  labor
11        organization as defined in the Illinois Educational Labor
12        Relations Act. Under such arrangement, an amount shall be
13        withheld  from each regular payroll period which is equal
14        to the pro  rata  share  of  the  annual  dues  plus  any
15        payments  or  contributions, and the Board shall transmit
16        such withholdings to  the  specified  labor  organization
17        within  10 working days from the time of the withholding.
18        Whenever the Board establishes a search committee to fill
19        the  position   of   president   of   Southern   Illinois
20        University,   there  shall  be  minority  representation,
21        including women, on that search committee;
22             3.  To prescribe the course of study to be followed,
23        and textbooks  and  apparatus  to  be  used  at  Southern
24        Illinois University;
25             4.  To issue upon the recommendation of the faculty,
26        diplomas to such persons as have satisfactorily completed
27        the required studies of Southern Illinois University, and
28        confer  such  professional  and  literary  degrees as are
29        usually conferred by other institutions of like character
30        for similar or equivalent courses of study,  or  such  as
31        the Board may deem appropriate;
32             5.  To  examine into the conditions, management, and
33        administration  of  Southern  Illinois   University,   to
34        provide the requisite buildings, apparatus, equipment and
 
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 1        auxiliary   enterprises,   and   to   fix   and   collect
 2        matriculation   fees;  tuition  fees;  fees  for  student
 3        activities; fees for student facilities such  as  student
 4        union  buildings  or  field  houses  or  stadium or other
 5        recreational facilities; student welfare fees; laboratory
 6        fees and similar fees for supplies and material;
 7             6.  To succeed to  and  to  administer  all  trusts,
 8        trust  property,  and gifts now or hereafter belonging or
 9        pertaining to Southern Illinois University;
10             7.  To  accept  endowments  of   professorships   or
11        departments  in  the  University  from any person who may
12        proffer them and, at regular meetings, to prescribe rules
13        and regulations in relation to endowments and declare  on
14        what general principles they may be accepted;
15             8.  To   enter   into  contracts  with  the  Federal
16        government for providing courses of instruction and other
17        services at  Southern  Illinois  University  for  persons
18        serving  in  or  with the military or naval forces of the
19        United States, and to provide such courses of instruction
20        and other services;
21             9.  To provide for the receipt and  expenditures  of
22        Federal  funds,  paid to the Southern Illinois University
23        by the  Federal  government  for  instruction  and  other
24        services  for  persons serving in or with the military or
25        naval forces of the United  States  and  to  provide  for
26        audits of such funds;
27             10.  To  appoint,  subject  to  the applicable civil
28        service law,  persons  to  be  members  of  the  Southern
29        Illinois  University  Police  Department.  Members of the
30        Police Department shall be conservators of the peace  and
31        as such have all powers possessed by policemen in cities,
32        and sheriffs, including the power to make arrests on view
33        or  warrants  of violations of state statutes, university
34        rules and regulations  and  city  or  county  ordinances,
 
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 1        except  that  they  may  exercise such powers only within
 2        counties wherein the university and any of  its  branches
 3        or  properties  are located when such is required for the
 4        protection of university properties  and  interests,  and
 5        its  students  and  personnel, and otherwise, within such
 6        counties, when requested by appropriate  State  or  local
 7        law  enforcement  officials. However, such officers shall
 8        have no power to serve and execute civil processes.
 9             The Board must  authorize  to  each  member  of  the
10        Southern Illinois University Police Department and to any
11        other employee of Southern Illinois University exercising
12        the  powers  of a peace officer a distinct badge that, on
13        its face, (i) clearly states that the badge is authorized
14        by Southern  Illinois  University  and  (ii)  contains  a
15        unique  identifying  number.   No  other  badge  shall be
16        authorized by Southern Illinois University.
17             11.  To administer a plan or  plans  established  by
18        the  clinical  faculty  of the School of Medicine for the
19        billing, collection and disbursement of charges  made  by
20        individual  faculty  members  for  professional  services
21        performed by them in the course of or in support of their
22        academic  responsibilities,  provided  that such plan has
23        been first approved by Board action. All such collections
24        shall  be  deposited  into  a  special  fund   or   funds
25        administered by the Board from which disbursements may be
26        made  according  to  the  provisions  of  said  plan. The
27        reasonable   costs   incurred,   by    the    University,
28        administering  the  billing,  collection and disbursement
29        provisions of  a  plan  shall  have  first  priority  for
30        payment before distribution or disbursement for any other
31        purpose.  Charges  established pursuant to this plan must
32        be itemized in any  billing  and  any  amounts  collected
33        which  are  not  used to off-set the cost of operating or
34        maintaining  the  activity  which  generated  the   funds
 
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 1        collected,   must   be  accounted  for  separately.  This
 2        accounting must clearly show the use and application made
 3        of the funds and the Board shall report such  accountings
 4        for  the  previous  fiscal  year to the Legislative Audit
 5        Commission annually by December 31 of each fiscal year.
 6             The Board of Trustees may own, operate,  or  govern,
 7        by  or  through  the  School  of Medicine, a managed care
 8        community network established under subsection (b) (r) of
 9        Section 5-11 5-16.3 of the Illinois Public Aid Code.
10             12.  The Board  of  Trustees  may,  directly  or  in
11        cooperation  with other institutions of higher education,
12        acquire by purchase or lease or otherwise, and construct,
13        enlarge, improve, equip, complete, operate,  control  and
14        manage   medical  research  and  high  technology  parks,
15        together with the necessary lands, buildings, facilities,
16        equipment, and personal property therefor,  to  encourage
17        and  facilitate  (a)  the  location  and  development  of
18        business  and  industry in the State of Illinois, and (b)
19        the increased application and development  of  technology
20        and  (c)  the  improvement and development of the State's
21        economy.  The Board of Trustees may  lease  to  nonprofit
22        corporations  all  or  any  part  of the land, buildings,
23        facilities, equipment or other  property  included  in  a
24        medical research and high technology park upon such terms
25        and   conditions  as  the  Board  of  Trustees  may  deem
26        advisable and enter into any contract or  agreement  with
27        such  nonprofit  corporations  as  may  be  necessary  or
28        suitable  for  the construction, financing, operation and
29        maintenance and management of  any  such  park;  and  may
30        lease  to  any  person, firm, partnership or corporation,
31        either public or private, any part or all  of  the  land,
32        building, facilities, equipment or other property of such
33        park  for  such purposes and upon such rentals, terms and
34        conditions as the Board of Trustees may  deem  advisable;
 
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 1        and may finance all or part of the cost of any such park,
 2        including     the    purchase,    lease,    construction,
 3        reconstruction, improvement, remodeling, addition to, and
 4        extension and maintenance of all or  part  of  such  high
 5        technology  park,  and  all equipment and furnishings, by
 6        legislative appropriations, government grants, contracts,
 7        private gifts, loans, receipts from the operation of such
 8        high technology park, rentals and similar  receipts;  and
 9        may  make  its other facilities and services available to
10        tenants or other occupants of  any  such  park  at  rates
11        which are reasonable and appropriate.
12        The  powers of the Board as herein designated are subject
13    to the  Board of Higher Education Act.
14    (Source: P.A. 91-883, eff. 1-1-01.)

15        Section 15.  The Illinois Insurance Code  is  amended  by
16    changing Section 352 as follows:

17        (215 ILCS 5/352) (from Ch. 73, par. 964)
18        Sec. 352.  Scope of Article.
19        (a)  Except as provided in subsections (b), (c), (d), and
20    (e), this Article shall apply to all companies transacting in
21    this  State the kinds of business enumerated in clause (b) of
22    Class 1 and clause (a) of Class 2 of section  4.  Nothing  in
23    this Article shall apply to, or in any way affect policies or
24    contracts  described  in  clause (a) of Class 1 of Section 4;
25    however, this Article shall apply to policies  and  contracts
26    which   contain  benefits  providing  reimbursement  for  the
27    expenses of long term health  care  which  are  certified  or
28    ordered   by   a  physician  including  but  not  limited  to
29    professional  nursing  care,  custodial  nursing  care,   and
30    non-nursing custodial care provided in a nursing home or at a
31    residence of the insured.
32        (b)  This  Article does not apply to policies of accident
 
                            -13-           LRB9201523DJgcam01
 1    and health insurance issued in compliance with  Article  XIXB
 2    of this Code.
 3        (c)  A  policy  issued  and  delivered in this State that
 4    provides coverage under that policy for  certificate  holders
 5    who  are neither residents of nor employed in this State does
 6    not need to provide to those nonresident certificate  holders
 7    who  are not employed in this State the coverages or services
 8    mandated by this Article.
 9        (d)  Stop-loss  insurance  is exempt from all Sections of
10    this Article, except this Section  and  Sections  353a,  354,
11    357.30,  and  370.  For purposes of this exemption, stop-loss
12    insurance is further defined as follows:
13             (1)  The policy must be  issued  to  and  insure  an
14        employer,  trustee,  or other sponsor of the plan, or the
15        plan itself, but not employees, members, or participants.
16             (2)  Payments by the insurer must  be  made  to  the
17        employer,  trustee, or other sponsors of the plan, or the
18        plan  itself,  but  not  to   the   employees,   members,
19        participants, or health care providers.
20        (e)  A  policy  issued  or delivered in this State to the
21    Illinois Department of Public  Aid  and  providing  coverage,
22    under  clause  (b)  of  Class  1  or clause (a) of Class 2 as
23    described in Section 4, to persons who are  enrolled  in  the
24    integrated  health  care  program established under Article V
25    Section 5-16.3 of the Illinois Public Aid Code or  under  the
26    Children's  Health  Insurance  Program Act is exempt from all
27    restrictions, limitations, standards, rules,  or  regulations
28    respecting  benefits  imposed  by  or under authority of this
29    Code, except those specified by  subsection  (1)  of  Section
30    143.   Nothing in this subsection, however, affects the total
31    medical services available to persons  eligible  for  medical
32    assistance under the Illinois Public Aid Code.
33    (Source: P.A. 87-435; 87-757; 87-938; 87-956; 88-364; 88-554,
34    eff. 7-26-94.)
 
                            -14-           LRB9201523DJgcam01
 1        Section  20.  The  Health Maintenance Organization Act is
 2    amended by changing Sections 1-2, 2-1, and 6-3 as follows:

 3        (215 ILCS 125/1-2) (from Ch. 111 1/2, par. 1402)
 4        Sec. 1-2. Definitions.  As used in this Act,  unless  the
 5    context  otherwise  requires,  the following terms shall have
 6    the meanings ascribed to them:
 7        (1)  "Advertisement"  means  any  printed  or   published
 8    material,  audiovisual material and descriptive literature of
 9    the  health  care  plan  used  in  direct  mail,  newspapers,
10    magazines, radio scripts, television scripts, billboards  and
11    similar  displays;  and  any  descriptive literature or sales
12    aids of all kinds disseminated by  a  representative  of  the
13    health  care  plan  for presentation to the public including,
14    but  not   limited   to,   circulars,   leaflets,   booklets,
15    depictions,  illustrations,  form  letters and prepared sales
16    presentations.
17        (2)  "Director" means the Director of Insurance.
18        (3)  "Basic health care services" means  emergency  care,
19    and inpatient hospital and physician care, outpatient medical
20    services,  mental  health  services  and care for alcohol and
21    drug  abuse,  including  any   reasonable   deductibles   and
22    co-payments,  all of which are subject to such limitations as
23    are determined by the Director pursuant to rule.
24        (4)  "Enrollee" means an individual who has been enrolled
25    in a health care plan.
26        (5)  "Evidence  of  coverage"  means   any   certificate,
27    agreement,  or contract issued to an enrollee setting out the
28    coverage to which he is entitled in exchange for a per capita
29    prepaid sum.
30        (6)  "Group contract" means a contract  for  health  care
31    services  which by its terms limits eligibility to members of
32    a specified group.
33        (7)  "Health care plan" means any arrangement whereby any
 
                            -15-           LRB9201523DJgcam01
 1    organization undertakes to provide or arrange for and pay for
 2    or reimburse the cost of  basic  health  care  services  from
 3    providers selected by the Health Maintenance Organization and
 4    such  arrangement  consists of arranging for or the provision
 5    of such health care  services,  as  distinguished  from  mere
 6    indemnification  against the cost of such services, except as
 7    otherwise authorized by Section 2-3 of this  Act,  on  a  per
 8    capita  prepaid  basis,  through  insurance  or otherwise.  A
 9    "health care plan" also includes any arrangement  whereby  an
10    organization  undertakes to provide or arrange for or pay for
11    or reimburse the cost of any health care service for  persons
12    who  are  enrolled  in  the  integrated  health  care program
13    established under Article V Section 5-16.3  of  the  Illinois
14    Public  Aid  Code  or  under  the Children's Health Insurance
15    Program Act through providers selected  by  the  organization
16    and  the  arrangement  consists  of  making provision for the
17    delivery of health care services, as distinguished from  mere
18    indemnification.   A  "health  care  plan"  also includes any
19    arrangement  pursuant  to  Section  4-17.   Nothing  in  this
20    definition,  however,  affects  the  total  medical  services
21    available to persons eligible for  medical  assistance  under
22    the Illinois Public Aid Code.
23        (8)  "Health  care  services" means any services included
24    in the furnishing to any  individual  of  medical  or  dental
25    care, or the hospitalization or incident to the furnishing of
26    such care or hospitalization as well as the furnishing to any
27    person  of  any  and  all  other  services for the purpose of
28    preventing, alleviating, curing or healing human  illness  or
29    injury.
30        (9)  "Health    Maintenance   Organization"   means   any
31    organization formed under the laws of this or  another  state
32    to provide or arrange for one or more health care plans under
33    a  system  which  causes  any part of the risk of health care
34    delivery to be borne by the organization or its providers.
 
                            -16-           LRB9201523DJgcam01
 1        (10)  "Net worth" means admitted assets,  as  defined  in
 2    Section 1-3 of this Act, minus liabilities.
 3        (11)  "Organization"   means  any  insurance  company,  a
 4    nonprofit corporation authorized  under  the  Dental  Service
 5    Plan  Act  or  the  Voluntary Health Services Plans Act, or a
 6    corporation organized under the laws of this or another state
 7    for the purpose of operating one or more  health  care  plans
 8    and doing no business other than that of a Health Maintenance
 9    Organization  or  an insurance company.  "Organization" shall
10    also mean the University of Illinois Hospital as  defined  in
11    the University of Illinois Hospital Act.
12        (12)  "Provider"  means any physician, hospital facility,
13    or other person which is licensed or otherwise authorized  to
14    furnish  health  care  services  and  also includes any other
15    entity that arranges for the delivery or furnishing of health
16    care service.
17        (13)  "Producer" means a person  directly  or  indirectly
18    associated   with   a   health   care  plan  who  engages  in
19    solicitation or enrollment.
20        (14)  "Per capita prepaid" means a basis of prepayment by
21    which a fixed amount of money is prepaid  per  individual  or
22    any   other   enrollment   unit  to  the  Health  Maintenance
23    Organization or for health care services which  are  provided
24    during  a definite time period regardless of the frequency or
25    extent of the services rendered  by  the  Health  Maintenance
26    Organization,  except  for  copayments  and  deductibles  and
27    except  as  provided in subsection (f) of Section 5-3 of this
28    Act.
29        (15)  "Subscriber" means a person who has entered into  a
30    contractual   relationship   with   the   Health  Maintenance
31    Organization for the provision of or arrangement of at  least
32    basic  health  care  services  to  the  beneficiaries of such
33    contract.
34    (Source: P.A. 89-90,  eff.  6-30-95;  90-177,  eff.  7-23-97;
 
                            -17-           LRB9201523DJgcam01
 1    90-372,  eff.  7-1-98;  90-376,  eff.  8-14-97;  90-655, eff.
 2    7-30-98.)

 3        (215 ILCS 125/2-1) (from Ch. 111 1/2, par. 1403)
 4        Sec. 2-1.   Certificate  of  authority  -  Exception  for
 5    corporate   employee   programs  -  Applications  -  Material
 6    modification of operation.
 7        (a)  No organization shall establish or operate a  Health
 8    Maintenance  Organization  in  this State without obtaining a
 9    certificate of authority under this  Act.   No  person  other
10    than  an  organization  may  lawfully  establish or operate a
11    Health Maintenance Organization in  this  State.    This  Act
12    shall  not  apply  to  the  establishment  and operation of a
13    Health  Maintenance  Organization  exclusively  providing  or
14    arranging  for  health  care  services  to  employees  of   a
15    corporate  affiliate of such Health Maintenance Organization.
16    This exclusion  shall  be  available  only  to  those  Health
17    Maintenance     Organizations    which    require    employee
18    contributions which equal less than 50% of the total cost  of
19    the  health  care  plan, with the remainder of the cost being
20    paid by the corporate affiliate which is the employer of  the
21    participants  in  the   plan. This Act shall not apply to the
22    establishment  and  operation   of   a   Health   Maintenance
23    Organization  exclusively  providing or arranging health care
24    services under contract with the State to  persons  committed
25    to  the  custody  of  the Illinois Department of Corrections.
26    This Act does not apply to the establishment and operation of
27    (i) a managed care community network providing  or  arranging
28    health   care   services   under   contract  with  the  State
29    exclusively to persons who are  enrolled  in  the  integrated
30    health  care  program established under Section 5-16.3 of the
31    Illinois Public Aid Code or (ii)  a  managed  care  community
32    network  owned, operated, or governed by a county provider as
33    defined in Section 15-1 of that Code.
 
                            -18-           LRB9201523DJgcam01
 1        This  Act  does  not  apply  to  the  establishment   and
 2    operation   of  managed  care  community  networks  that  are
 3    certified as risk-bearing entities under Section 5-11 of  the
 4    Illinois  Public Aid Code and that contract with the Illinois
 5    Department of Public Aid pursuant to that Section.
 6        (b)  Any organization may apply to the Director  for  and
 7    obtain  a certificate of authority to establish and operate a
 8    Health Maintenance Organization in compliance with this  Act.
 9    A  foreign corporation may qualify under this Act, subject to
10    its registration to do business in this State  as  a  foreign
11    corporation.
12        (c)  Each  application  for  a  certificate  of authority
13    shall be filed in triplicate and verified by  an  officer  or
14    authorized  representative  of  the  applicant, shall be in a
15    form prescribed by the Director, and shall set forth, without
16    limiting what may be required by the Director, the following:
17             (1)  A copy of the organizational document;
18             (2)  A copy of the bylaws, rules and regulations, or
19        similar document regulating the conduct of  the  internal
20        affairs of the applicant, which shall include a mechanism
21        to  afford the enrollees an opportunity to participate in
22        an advisory capacity in matters of policy and operations;
23             (3)  A list of the names,  addresses,  and  official
24        positions  of  the  persons who are to be responsible for
25        the conduct of the affairs of the  applicant;  including,
26        but   not  limited  to,  all  members  of  the  board  of
27        directors, executive committee, the  principal  officers,
28        and  any  person  or entity owning or having the right to
29        acquire  10%  or  more  of  the  voting   securities   or
30        subordinated debt of the applicant;
31             (4)  A statement generally describing the applicant,
32        geographic  area  to be served, its facilities, personnel
33        and the health care services to be offered;
34             (5)  A copy of the form of any contract made  or  to
 
                            -19-           LRB9201523DJgcam01
 1        be made between the applicant and any providers regarding
 2        the provision of health care services to enrollees;
 3             (6)  A  copy  of the form of any contract made or to
 4        be made between the applicant and any  person  listed  in
 5        paragraph (3) of this subsection;
 6             (7)  A  copy  of the form of any contract made or to
 7        be  made  between   the   applicant   and   any   person,
 8        corporation,   partnership   or   other  entity  for  the
 9        performance on the applicant's behalf  of  any  functions
10        including, but not limited to, marketing, administration,
11        enrollment,  investment management and subcontracting for
12        the provision of health services to enrollees;
13             (8)  A copy of the form of any group contract  which
14        is  to be issued to employers, unions, trustees, or other
15        organizations and a copy  of  any  form  of  evidence  of
16        coverage  to  be issued to any enrollee or subscriber and
17        any advertising material;
18             (9)  Descriptions of the applicant's procedures  for
19        resolving   enrollee   grievances   which   must  include
20        procedures providing for enrollees participation  in  the
21        resolution of grievances;
22             (10)  A   copy   of   the  applicant's  most  recent
23        financial statements audited by an independent  certified
24        public  accountant.   If  the  financial  affairs  of the
25        applicant's parent company are audited by an  independent
26        certified  public  accountant  but those of the applicant
27        are not, then a copy of the most recent audited financial
28        statement of the applicant's parent,  attached  to  which
29        shall be consolidating financial statements of the parent
30        including  separate unaudited financial statements of the
31        applicant, unless the Director determines that additional
32        or more recent financial information is required for  the
33        proper administration of this Act;
34             (11)  A  copy  of  the  applicant's  financial plan,
 
                            -20-           LRB9201523DJgcam01
 1        including  a   three-year   projection   of   anticipated
 2        operating  results, a statement of the sources of working
 3        capital, and any other sources of funding and  provisions
 4        for contingencies;
 5             (12)  A description of rate methodology;
 6             (13)  A   description  of  the  proposed  method  of
 7        marketing;
 8             (14)  A copy of every filing made with the  Illinois
 9        Secretary  of  State  which  relates  to  the applicant's
10        registered agent or registered office;
11             (15)  A description of the complaint  procedures  to
12        be  established  and maintained as required under Section
13        4-6 of this Act;
14             (16)  A description, in accordance with  regulations
15        promulgated  by the Illinois Department of Public Health,
16        of  the  quality  assessment   and   utilization   review
17        procedures to be utilized by the applicant;
18             (17)  The fee for filing an application for issuance
19        of  a certificate of authority provided in Section 408 of
20        the Illinois Insurance Code, as now or hereafter amended;
21        and
22             (18)  Such other information  as  the  Director  may
23        reasonably require to make the determinations required by
24        this Act.
25    (Source: P.A. 90-618, eff. 7-10-98.)

26        (215 ILCS 125/6-3) (from Ch. 111 1/2, par. 1418.3)
27        Sec.   6-3.   Scope.   This  Article  applies  to  direct
28    individual contracts, group contracts and certificates issued
29    thereunder, or any other evidence of coverage, each of  which
30    provides  for coverage under a health care plan, and has been
31    issued  by  organizations   licensed   to   transact   health
32    maintenance  organization  business  in  this State under the
33    Health Maintenance Organization Act, but not to any  business
 
                            -21-           LRB9201523DJgcam01
 1    of   such   organization  not  transacted  under  its  health
 2    maintenance  organization  certificate  of  authority.   This
 3    Article does not  apply  to  (i)  a  managed  care  community
 4    network  providing  or  arranging  health care services under
 5    contract with  the  State  exclusively  to  persons  who  are
 6    enrolled  in  the  integrated health care program established
 7    under Section 5-16.3 of the Illinois Public Aid Code or  (ii)
 8    a managed care community network owned, operated, or governed
 9    by a county provider as defined in Section 15-1 of that Code.
10    (Source: P.A. 88-554, eff. 7-26-94.)

11        Section  25.  The Health Care Worker Self-Referral Act is
12    amended by changing Section 20 as follows:

13        (225 ILCS 47/20)
14        Sec. 20.  Prohibited referrals and claims for payment.
15        (a)  A health care worker shall not refer a  patient  for
16    health services to an entity outside the health care worker's
17    office  or  group practice in which the health care worker is
18    an investor, unless the health care worker directly  provides
19    health  services  within  the  entity  and will be personally
20    involved with the provision of care to the referred patient.
21        (b)  Pursuant to Board determination that  the  following
22    exception  is  applicable, a health care worker may invest in
23    and refer to an entity, whether or not the health care worker
24    provides direct services within said entity, if  there  is  a
25    demonstrated  need  in  the  community  for  the  entity  and
26    alternative financing is not available.  For purposes of this
27    subsection  (b), "demonstrated need" in the community for the
28    entity may exist if (1) there is no  facility  of  reasonable
29    quality  that provides medically appropriate service, (2) use
30    of existing facilities is onerous  or  creates  too  great  a
31    hardship  for  patients,  (3)  the entity is formed to own or
32    lease medical equipment which replaces obsolete or  otherwise
 
                            -22-           LRB9201523DJgcam01
 1    inadequate  equipment  in  or under the control of a hospital
 2    located in a federally designated  health  manpower  shortage
 3    area, or (4) such other standards as established, by rule, by
 4    the  Board.   "Community"  shall be defined as a metropolitan
 5    area for a city, and a county for a rural area.  In addition,
 6    the following provisions must be met to be exempt under  this
 7    Section:
 8             (1)  Individuals  who are not in a position to refer
 9        patients to an entity are given a bona  fide  opportunity
10        to  also  invest in the entity on the same terms as those
11        offered a referring health care worker; and
12             (2)  No health care  worker  who  invests  shall  be
13        required or encouraged to make referrals to the entity or
14        otherwise generate business as a condition of becoming or
15        remaining an investor; and
16             (3)  The entity shall market or furnish its services
17        to  referring  health  care  worker  investors  and other
18        investors on equal terms; and
19             (4)  The entity shall not loan  funds  or  guarantee
20        any  loans  for health care workers who are in a position
21        to refer to an entity; and
22             (5)  The  income  on  the   health   care   worker's
23        investment  shall  be  tied  to  the health care worker's
24        equity in the facility  rather  than  to  the  volume  of
25        referrals made; and
26             (6)  Any  investment contract between the entity and
27        the health care worker shall not include any covenant  or
28        non-competition clause that prevents a health care worker
29        from investing in other entities; and
30             (7)  When  making  a  referral, a health care worker
31        must disclose his investment interest in an entity to the
32        patient being referred to  such  entity.  If  alternative
33        facilities  are  reasonably  available,  the  health care
34        worker  must  provide  the  patient  with   a   list   of
 
                            -23-           LRB9201523DJgcam01
 1        alternative  facilities.  The  health  care  worker shall
 2        inform the patient that they have the option  to  use  an
 3        alternative  facility  other than one in which the health
 4        care worker has an investment interest  and  the  patient
 5        will not be treated differently by the health care worker
 6        if  the patient chooses to use another entity. This shall
 7        be  applicable  to  all  health  care  worker  investors,
 8        including those who provide direct care or  services  for
 9        their   patients   in   entities   outside  their  office
10        practices; and
11             (8)  If a third  party  payor  requests  information
12        with   regard   to  a  health  care  worker's  investment
13        interest, the same shall be disclosed; and
14             (9)  The  entity   shall   establish   an   internal
15        utilization  review  program  to  ensure  that  investing
16        health  care  workers  provided  appropriate or necessary
17        utilization; and
18             (10)  If a health care worker's  financial  interest
19        in  an  entity  is incompatible with a referred patient's
20        interest, the health care worker shall  make  alternative
21        arrangements for the patient's care.
22        The  Board  shall  make such a determination for a health
23    care worker within 90 days of a  completed  written  request.
24    Failure  to  make such a determination within the 90 day time
25    frame shall mean that no alternative is practical based  upon
26    the facts set forth in the completed written request.
27        (c)  It shall not be a violation of this Act for a health
28    care  worker  to  refer  a  patient  for health services to a
29    publicly traded entity in which he or she has  an  investment
30    interest provided that:
31             (1)  the  entity  is  listed  for trading on the New
32        York Stock Exchange or on the American Stock Exchange, or
33        is a national market  system  security  traded  under  an
34        automated  inter-dealer  quotation system operated by the
 
                            -24-           LRB9201523DJgcam01
 1        National Association of Securities Dealers; and
 2             (2)  the entity had, at the end of the corporation's
 3        most recent fiscal year, total net  assets  of  at  least
 4        $30,000,000 related to the furnishing of health services;
 5        and
 6             (3)  any  investment  interest  obtained  after  the
 7        effective  date  of  this  Act is traded on the exchanges
 8        listed in paragraph 1 of subsection (c) of  this  Section
 9        after  the  entity  became a publicly traded corporation;
10        and
11             (4)  the entity markets or furnishes its services to
12        referring health care worker investors and  other  health
13        care workers on equal terms; and
14             (5)  all   stock   held   in  such  publicly  traded
15        companies,  including  stock  held  in  the   predecessor
16        privately  held  company,  shall  be of one class without
17        preferential treatment as to status or remuneration; and
18             (6)  the entity does not loan funds or guarantee any
19        loans for health care workers who are in a position to be
20        referred to an entity; and
21             (7)  the  income  on  the   health   care   worker's
22        investment  is tied to the health care worker's equity in
23        the entity rather than to the volume of  referrals  made;
24        and
25             (8)  the  investment interest does not exceed 1/2 of
26        1% of the entity's total equity.
27        (d)  Any hospital licensed under the  Hospital  Licensing
28    Act  shall  not  discriminate against or otherwise penalize a
29    health care worker for compliance with this Act.
30        (e)  Any health care worker or  other  entity  shall  not
31    enter into an arrangement or scheme seeking to make referrals
32    to  another  health  care  worker  or  entity  based upon the
33    condition that the health care worker  or  entity  will  make
34    referrals  with  an  intent to evade the prohibitions of this
 
                            -25-           LRB9201523DJgcam01
 1    Act by inducing patient referrals which would  be  prohibited
 2    by  this Section if the health care worker or entity made the
 3    referral directly.
 4        (f)  If compliance with the need and alternative investor
 5    criteria is not  practical,  the  health  care  worker  shall
 6    identify  to  the  patient  reasonably  available alternative
 7    facilities.  The  Board  shall,  by  rule,   designate   when
 8    compliance is "not practical".
 9        (g)  Health  care workers may request from the Board that
10    it render an advisory opinion that a referral to an  existing
11    or proposed entity under specified circumstances does or does
12    not  violate the provisions of this Act.  The Board's opinion
13    shall be presumptively correct.  Failure to  render  such  an
14    advisory  opinion  within  90  days  of  a  completed written
15    request pursuant to this Section shall  create  a  rebuttable
16    presumption  that  a  referral  described  in  the  completed
17    written  request  is  not  or will not be a violation of this
18    Act.
19        (h)  Notwithstanding any provision of  this  Act  to  the
20    contrary, a health care worker may refer  a patient, who is a
21    member of a health maintenance organization "HMO" licensed in
22    this  State,  for  health  services to an entity, outside the
23    health care worker's office or group practice, in  which  the
24    health  care  worker  is  an investor, provided that any such
25    referral is  made  pursuant  to  a  contract  with  the  HMO.
26    Furthermore, notwithstanding any provision of this Act to the
27    contrary,  a  health  care  worker may refer an enrollee of a
28    "managed care community network", as  defined  in  subsection
29    (b)  of  Section 5-11 5-16.3 of the Illinois Public Aid Code,
30    for health services to an entity,  outside  the  health  care
31    worker's  office  or group practice, in which the health care
32    worker is an investor, provided that  any  such  referral  is
33    made  pursuant  to a contract with the managed care community
34    network.
 
                            -26-           LRB9201523DJgcam01
 1    (Source: P.A. 87-1207; 88-554, eff. 7-26-94.)

 2        Section 30.  The Illinois Public Aid Code is  amended  by
 3    changing  Sections  5-11,  5-16.9, 5-16.11, 15-2, 15-3, 15-4,
 4    and 15-5 as follows:

 5        (305 ILCS 5/5-11) (from Ch. 23, par. 5-11)
 6        Sec.  5-11.  Co-operative  arrangements;  contracts  with
 7    other  State  agencies,  health   care   and   rehabilitation
 8    organizations, and fiscal intermediaries.
 9        (a)  The  Illinois Department may enter into co-operative
10    arrangements   with   State    agencies    responsible    for
11    administering  or  supervising  the  administration of health
12    services and vocational rehabilitation services  to  the  end
13    that there may be maximum utilization of such services in the
14    provision of medical assistance.
15        The  Illinois  Department  shall, not later than June 30,
16    1993, enter into one or more co-operative  arrangements  with
17    the   Department   of   Mental   Health   and   Developmental
18    Disabilities  providing  that the Department of Mental Health
19    and  Developmental  Disabilities  will  be  responsible   for
20    administering  or  supervising  all  programs for services to
21    persons  in  community  care  facilities  for  persons   with
22    developmental  disabilities,  including  but  not  limited to
23    intermediate care facilities, that  are  supported  by  State
24    funds  or  by  funding  under Title XIX of the federal Social
25    Security Act.  The  responsibilities  of  the  Department  of
26    Mental  Health  and  Developmental  Disabilities  under these
27    agreements  are  transferred  to  the  Department  of   Human
28    Services as provided in the Department of Human Services Act.
29        The  Department  may also contract with such State health
30    and rehabilitation  agencies  and  other  public  or  private
31    health care and rehabilitation organizations to act for it in
32    supplying  designated  medical  services  to persons eligible
 
                            -27-           LRB9201523DJgcam01
 1    therefor  under  this  Article.  Any  contracts  with  health
 2    services  or  health  maintenance  organizations   shall   be
 3    restricted  to  organizations  which  have  been certified as
 4    being in compliance with standards  promulgated  pursuant  to
 5    the  laws  of  this  State  governing  the  establishment and
 6    operation  of   health   services   or   health   maintenance
 7    organizations.   The   Department   may  also  contract  with
 8    insurance companies or other corporate  entities  serving  as
 9    fiscal   intermediaries   in   this  State  for  the  Federal
10    Government in respect to Medicare payments under Title  XVIII
11    of  the Federal Social Security Act to act for the Department
12    in paying medical care suppliers.  The provisions of  Section
13    9 of "An Act in relation to State finance", approved June 10,
14    1919,  as amended, notwithstanding, such contracts with State
15    agencies, other health care and rehabilitation organizations,
16    or fiscal intermediaries may provide for advance payments.
17        (b)  For purposes of this subsection (b),  "managed  care
18    community  network"  means  an  entity,  other  than a health
19    maintenance  organization,  that  is  owned,   operated,   or
20    governed  by  providers  of  health care services within this
21    State and that provides or arranges primary,  secondary,  and
22    tertiary managed health care services under contract with the
23    Illinois  Department  exclusively to persons participating in
24    programs administered by the Illinois Department.
25        The  Illinois  Department  may   certify   managed   care
26    community networks, including managed care community networks
27    owned, operated, managed, or governed by State-funded medical
28    schools,  as  risk-bearing entities eligible to contract with
29    the   Illinois   Department   as   Medicaid   managed    care
30    organizations.   The  Illinois  Department  may contract with
31    those managed care community networks to furnish health  care
32    services   to  or  arrange  those  services  for  individuals
33    participating  in  programs  administered  by  the   Illinois
34    Department.    The   rates   for   those   provider-sponsored
 
                            -28-           LRB9201523DJgcam01
 1    organizations  may  be  determined  on  a  prepaid, capitated
 2    basis.  A  managed  care  community  network  may  choose  to
 3    contract   with  the  Illinois  Department  to  provide  only
 4    pediatric health care services. The Illinois Department shall
 5    by rule adopt the  criteria,  standards,  and  procedures  by
 6    which  a  managed  care community network may be permitted to
 7    contract with the Illinois Department and shall consult  with
 8    the Department of Insurance in adopting these rules.
 9        A county provider as defined in Section 15-1 of this Code
10    may contract with the Illinois Department to provide primary,
11    secondary,  or  tertiary  managed  health  care services as a
12    managed care community network without the need to  establish
13    a  separate  entity  and  shall  be  deemed  a  managed  care
14    community  network  for  purposes  of  this  Code only to the
15    extent it provides services to participating individuals.   A
16    county  provider  is  entitled  to contract with the Illinois
17    Department with respect to any contracting region located  in
18    whole or in part within the county.  A county provider is not
19    required  to  accept  enrollees  who do not reside within the
20    county.
21        In order to (i) accelerate and facilitate the development
22    of  integrated  health  care  in  contracting  areas  outside
23    counties with populations in excess of 3,000,000 and counties
24    adjacent to those counties and (ii) maintain and sustain  the
25    high  quality of education and residency programs coordinated
26    and  associated  with  local  area  hospitals,  the  Illinois
27    Department may develop and implement a demonstration  program
28    from   managed   care  community  networks  owned,  operated,
29    managed, or governed by State-funded  medical  schools.   The
30    Illinois  Department  shall  prescribe  by rule the criteria,
31    standards, and procedures for  effecting  this  demonstration
32    program.
33        A  managed care community network that contracts with the
34    Illinois Department to furnish health  care  services  to  or
 
                            -29-           LRB9201523DJgcam01
 1    arrange   those   services  for  enrollees  participating  in
 2    programs administered by the Illinois Department shall do all
 3    of the following:
 4             (1)  Provide that any provider affiliated  with  the
 5        managed  care community network may also provide services
 6        on a fee-for-service basis to Illinois Department clients
 7        not enrolled in such managed care entities.
 8             (2)  Provide client education services as determined
 9        and approved by the Illinois  Department,  including  but
10        not   limited  to  (i)  education  regarding  appropriate
11        utilization of health care services  in  a  managed  care
12        system, (ii) written disclosure of treatment policies and
13        restrictions   or   limitations   on   health   services,
14        including,   but   not  limited  to,  physical  services,
15        clinical  laboratory   tests,   hospital   and   surgical
16        procedures,   prescription   drugs   and  biologics,  and
17        radiological examinations, and (iii) written notice  that
18        the  enrollee  may  receive  from  another provider those
19        covered services that are not  provided  by  the  managed
20        care community network.
21             (3)  Provide  that  enrollees  within the system may
22        choose the site for provision of services and  the  panel
23        of health care providers.
24             (4)  Not discriminate in enrollment or disenrollment
25        practices   among   recipients  of  medical  services  or
26        enrollees based on health status.
27             (5)  Provide a  quality  assurance  and  utilization
28        review program that meets the requirements established by
29        the  Illinois  Department in rules that incorporate those
30        standards   set   forth   in   the   Health   Maintenance
31        Organization Act.
32             (6)  Issue  a   managed   care   community   network
33        identification  card  to  each  enrollee upon enrollment.
34        The card must contain all of the following:
 
                            -30-           LRB9201523DJgcam01
 1                  (A)  The enrollee's health plan.
 2                  (B)  The  name  and  telephone  number  of  the
 3             enrollee's primary care physician or  the  site  for
 4             receiving primary care services.
 5                  (C)  A  telephone  number to be used to confirm
 6             eligibility  for  benefits  and  authorization   for
 7             services  that is available 24 hours per day, 7 days
 8             per week.
 9             (7)  Ensure that every primary  care  physician  and
10        pharmacy  in the managed care community network meets the
11        standards established  by  the  Illinois  Department  for
12        accessibility   and   quality  of  care.    The  Illinois
13        Department shall arrange for and oversee an evaluation of
14        the standards established under this  paragraph  (7)  and
15        may recommend any necessary changes to these standards.
16             (8)  Provide  a  procedure  for  handling complaints
17        that meets the requirements established by  the  Illinois
18        Department  in rules that incorporate those standards set
19        forth in the Health Maintenance Organization Act.
20             (9)  Maintain, retain, and  make  available  to  the
21        Illinois  Department records, data, and information, in a
22        uniform manner determined  by  the  Illinois  Department,
23        sufficient   for   the  Illinois  Department  to  monitor
24        utilization, accessibility, and quality of care.
25             (10)  Provide that the pharmacy  formulary  used  by
26        the  managed  care  community  network  and  its contract
27        providers  be  no  more  restrictive  than  the  Illinois
28        Department's pharmaceutical program on the effective date
29        of this amendatory Act of 1998 and as amended after  that
30        date.
31        The  Illinois Department shall contract with an entity or
32    entities to provide  external  peer-based  quality  assurance
33    review  for  the managed health care programs administered by
34    the Illinois Department.  The entity shall be  representative
 
                            -31-           LRB9201523DJgcam01
 1    of  Illinois  physicians licensed to practice medicine in all
 2    its branches and have statewide geographic representation  in
 3    all specialities of medical care that are provided in managed
 4    health care programs administered by the Illinois Department.
 5    The  entity may not be a third party payer and shall maintain
 6    offices in locations around the State  in  order  to  provide
 7    service   and   continuing  medical  education  to  physician
 8    participants  within  those  managed  health  care   programs
 9    administered  by the Illinois Department.  The review process
10    shall be  developed  and  conducted  by  Illinois  physicians
11    licensed  to  practice  medicine  in  all  its  branches.  In
12    consultation with the entity,  the  Illinois  Department  may
13    contract  with  other  entities  for  professional peer-based
14    quality assurance review of individual categories of services
15    other than services provided, supervised, or  coordinated  by
16    physicians licensed to practice medicine in all its branches.
17    The Illinois Department shall establish, by rule, criteria to
18    avoid  conflicts  of  interest  in  the  conduct  of  quality
19    assurance activities consistent with professional peer-review
20    standards.    All   quality  assurance  activities  shall  be
21    coordinated by the Illinois Department.
22        Each managed care community network must demonstrate  its
23    ability  to  bear  the  financial risk of serving individuals
24    under this program. The Illinois  Department  shall  by  rule
25    adopt  standards  for  assessing  the  solvency and financial
26    soundness  of  each  managed  care  community  network.   Any
27    solvency  and  financial  standards  adopted for managed care
28    community networks shall be  no  more  restrictive  than  the
29    solvency   and  financial  standards  adopted  under  Section
30    1856(a) of the Social  Security  Act  for  provider-sponsored
31    organizations  under  Part  C  of  Title  XVIII of the Social
32    Security Act.
33        The Illinois  Department  may  implement  the  amendatory
34    changes  to  this  Code  made  by this amendatory Act of 1998
 
                            -32-           LRB9201523DJgcam01
 1    through the use of emergency rules in accordance with Section
 2    5-45 of  the  Illinois  Administrative  Procedure  Act.   For
 3    purposes  of  that  Act,  the  adoption of rules to implement
 4    these changes is deemed an emergency and  necessary  for  the
 5    public interest, safety, and welfare.
 6        (c)  Not   later   than   June  30,  1996,  the  Illinois
 7    Department  shall  enter  into  one   or   more   cooperative
 8    arrangements  with  the  Department  of Public Health for the
 9    purpose of developing a single survey for nursing facilities,
10    including but not limited to facilities  funded  under  Title
11    XVIII  or  Title  XIX  of  the federal Social Security Act or
12    both, which shall be administered and conducted solely by the
13    Department of Public Health. The Departments shall  test  the
14    single  survey  process  on  a  pilot  basis,  with  both the
15    Departments of Public Aid and Public  Health  represented  on
16    the consolidated survey team.  The pilot will sunset June 30,
17    1997.   After  June  30, 1997, unless otherwise determined by
18    the Governor, a single survey shall  be  implemented  by  the
19    Department  of  Public  Health which would not preclude staff
20    from the Department of  Public  Aid  from  going  on-site  to
21    nursing  facilities  to  perform necessary audits and reviews
22    which shall not replicate  the  single  State  agency  survey
23    required  by  this  Act.   This  Section  shall  not apply to
24    community or intermediate care facilities  for  persons  with
25    developmental disabilities.
26        (d)  Nothing  in this Code in any way limits or otherwise
27    impairs the authority or power of the Illinois Department  to
28    enter  into  a  negotiated  contract pursuant to this Section
29    with a managed care community network or a health maintenance
30    organization,  as   defined   in   the   Health   Maintenance
31    Organization Act, that provides for termination or nonrenewal
32    of the contract without cause, upon notice as provided in the
33    contract, and without a hearing.
34    (Source: P.A.  89-415,  eff.  1-1-96;  89-507,  eff.  7-1-97;
 
                            -33-           LRB9201523DJgcam01
 1    90-618, eff. 7-10-98.)

 2        (305 ILCS 5/5-16.9)
 3        Sec.  5-16.9.  Woman's health care provider.  The medical
 4    assistance program is subject to the  provisions  of  Section
 5    356r of the Illinois Insurance Code.  The Illinois Department
 6    shall  adopt  rules  to implement the requirements of Section
 7    356r of the Illinois Insurance Code in the medical assistance
 8    program including managed care components defined in  Section
 9    5-16.3.
10    (Source: P.A. 89-514, eff. 7-17-96.)

11        (305 ILCS 5/5-16.11)
12        Sec.  5-16.11.  Uniform standards applied to managed care
13    entities.  Any managed care entity providing  services  under
14    this  Code  shall  use  a  pharmacy formulary that is no more
15    restrictive than  the  Illinois  Department's  pharmaceutical
16    program  comply  with the criteria, standards, and procedures
17    imposed on managed care  entities  under  paragraph  (14)  of
18    subsection (d) of Section 5-16.3 of this Code.
19    (Source: P.A. 90-538, eff. 12-1-97.)

20        (305 ILCS 5/15-2) (from Ch. 23, par. 15-2)
21        Sec. 15-2. County Provider Trust Fund.
22        (a)  There  is  created  in the State Treasury the County
23    Provider Trust Fund.  Interest earned by the  Fund  shall  be
24    credited  to the Fund.  The Fund shall not be used to replace
25    any funds appropriated to the Medicaid program by the General
26    Assembly.
27        (b)  The Fund is  created  solely  for  the  purposes  of
28    receiving,  investing,  and distributing monies in accordance
29    with this Article XV.  The Fund shall consist of:
30             (1)  All  monies  collected  or  received   by   the
31        Illinois Department under Section 15-3 of this Code;
 
                            -34-           LRB9201523DJgcam01
 1             (2)  All   federal  financial  participation  monies
 2        received by the Illinois Department pursuant to Title XIX
 3        of  the  Social  Security   Act,   42   U.S.C.   1396(b),
 4        attributable   to   eligible  expenditures  made  by  the
 5        Illinois Department pursuant  to  Section  15-5  of  this
 6        Code;
 7             (3)  All  federal  moneys  received  by the Illinois
 8        Department pursuant to Title XXI of the  Social  Security
 9        Act  attributable  to  eligible  expenditures made by the
10        Illinois Department pursuant  to  Section  15-5  of  this
11        Code; and
12             (4)  All  other monies received by the Fund from any
13        source, including interest thereon.
14        (c)  Disbursements from the Fund  shall  be  by  warrants
15    drawn  by the State Comptroller upon receipt of vouchers duly
16    executed and certified by the Illinois Department  and  shall
17    be made only:
18             (1)  For    hospital    inpatient   care,   hospital
19        outpatient  care,  care  provided  by  other   outpatient
20        facilities  operated  by  a  county, and disproportionate
21        share hospital payments  made  under  Title  XIX  of  the
22        Social  Security  Act  and  Article  V  of  this  Code as
23        required by Section 15-5 of this Code;
24             (1.5)  For services  provided  by  county  providers
25        pursuant to Section 5-11 or 5-16.3 of this Code;
26             (2)  For   the   reimbursement   of   administrative
27        expenses  incurred  by  county providers on behalf of the
28        Illinois Department as permitted by Section 15-4 of  this
29        Code;
30             (3)  For the reimbursement of monies received by the
31        Fund through error or mistake;
32             (4)  For  the  payment  of  administrative  expenses
33        necessarily  incurred  by  the Illinois Department or its
34        agent in  performing  the  activities  required  by  this
 
                            -35-           LRB9201523DJgcam01
 1        Article XV;
 2             (5)  For   the  payment  of  any  amounts  that  are
 3        reimbursable  to  the  federal  government,  attributable
 4        solely to the Fund, and required  to  be  paid  by  State
 5        warrant; and
 6             (6)  For    hospital    inpatient   care,   hospital
 7        outpatient  care,  care  provided  by  other   outpatient
 8        facilities  operated  by  a  county, and disproportionate
 9        share hospital payments  made  under  Title  XXI  of  the
10        Social  Security  Act,  pursuant  to Section 15-5 of this
11        Code.
12    (Source: P.A. 90-618, eff. 7-10-98; 91-24, eff. 7-1-99.)

13        (305 ILCS 5/15-3) (from Ch. 23, par. 15-3)
14        Sec. 15-3.  Intergovernmental Transfers.
15        (a)  Each  qualifying  county  shall   make   an   annual
16    intergovernmental  transfer  to the Illinois Department in an
17    amount equal to 71.7% of the  difference  between  the  total
18    payments  made  by  the  Illinois  Department  to such county
19    provider for hospital services under Titles XIX  and  XXI  of
20    the Social Security Act or pursuant to Section 5-11 or 5-16.3
21    of  this Code in each fiscal year ending June 30 (or fraction
22    thereof during the fiscal year  ending  June  30,  1993)  and
23    $108,800,000  (or  fraction  thereof), except that the annual
24    intergovernmental  transfer  shall  not  exceed   the   total
25    payments  made  by  the  Illinois  Department  to such county
26    provider for hospital services under this Code or pursuant to
27    Section 5-16.3 of this Code, less  the  sum  of  (i)  50%  of
28    payments reimbursable under the Social Security Act at a rate
29    of 50% and (ii) 65% of payments reimbursable under the Social
30    Security  Act  at  a  rate of 65%, in each fiscal year ending
31    June 30 (or fraction thereof).
32        (b)  The  payment  schedule  for  the   intergovernmental
33    transfer    made    hereunder   shall   be   established   by
 
                            -36-           LRB9201523DJgcam01
 1    intergovernmental agreement between the  Illinois  Department
 2    and the applicable county, which agreement shall at a minimum
 3    provide:
 4             (1)  For  periodic  payments no less frequently than
 5        monthly  to  the  county  provider  for   inpatient   and
 6        outpatient   approved   or  adjudicated  claims  and  for
 7        disproportionate share payments under Section  5-5.02  of
 8        this  Code  (in the initial year, for services after July
 9        1, 1991, or such other date as an approved State  Medical
10        Assistance Plan shall provide) and to the county provider
11        pursuant to Section 5-16.3 of this Code.
12             (2)  For  periodic  payments no less frequently than
13        monthly  to  the   county   provider   for   supplemental
14        disproportionate  share  payments  hereunder  based  on a
15        federally approved State Medical Assistance Plan.
16             (3)  For  calculation   of   the   intergovernmental
17        transfer  payment to be made by the county equal to 71.7%
18        of the difference between  the  amount  of  the  periodic
19        payment  and  the base amount; provided, however, that if
20        the periodic payment for any period is less than the base
21        amount  for  such  period,  the  base  amount   for   the
22        succeeding   period   (and   any   successive  period  if
23        necessary) shall be  increased  by  the  amount  of  such
24        shortfall.
25             (4)  For  an  intergovernmental transfer methodology
26        which obligates the Illinois  Department  to  notify  the
27        county  and  county provider in writing of each impending
28        periodic  payment  and  the  intergovernmental   transfer
29        payment  attributable  thereto  and  which  obligates the
30        Comptroller to release the periodic payment to the county
31        provider  within  one  working  day  of  receipt  of  the
32        intergovernmental transfer payment from the county.
33    (Source: P.A. 90-618, eff. 7-10-98; 91-24, eff. 7-1-99.)
 
                            -37-           LRB9201523DJgcam01
 1        (305 ILCS 5/15-4) (from Ch. 23, par. 15-4)
 2        Sec. 15-4. Contractual assumption  of  certain  expenses.
 3    Hospitals  may,  at  their  election,  by  written  agreement
 4    between  the  counties owning and operating the hospitals and
 5    the Illinois Department, assume  specified  expenses  of  the
 6    operation  of  the  Illinois  Department  associated with the
 7    determination  of  eligibility,  direct  payment   of   which
 8    expenses  by  the Illinois Department would qualify as public
 9    funds expended by the Illinois Department  for  the  Illinois
10    Medical  Assistance  Program  or  other  health care programs
11    administered  by  the  Illinois  Department.   The   Illinois
12    Department  shall  open an adequately staffed special on-site
13    office or offices at facilities designated by the county  for
14    the  purpose  of  assisting  the  county in ensuring that all
15    eligible individuals are enrolled  in  the  Illinois  Medical
16    Assistance  Program  and,  to the extent that enrollment into
17    the integrated health care program established under  Section
18    5-16.3  of  this Code is conducted at local public assistance
19    offices in the county,  for  the  purpose  of  enrollment  of
20    persons  into  any managed health care entity operated by the
21    county.  The enrollment process shall meet  the  requirements
22    of  subsection  (e)  of Section 5-16.3.  Each such agreement,
23    executed   in   accordance   with   Section    3    of    the
24    Intergovernmental   Cooperation   Act,   shall  describe  the
25    operational expenses to be assumed in  sufficient  detail  to
26    permit  the  Illinois Department to certify upon such written
27    obligation or  performance  thereunder  that  the  hospital's
28    compliance with the terms of the agreement will amount to the
29    commitment of public funds eligible for the federal financial
30    participation  or  other  federal funding called for in Title
31    XIX or Title XXI of the Social Security Act.
32    (Source: P.A. 91-24, eff. 7-1-99.)

33        (305 ILCS 5/15-5) (from Ch. 23, par. 15-5)
 
                            -38-           LRB9201523DJgcam01
 1        Sec. 15-5. Disbursements from the Fund.
 2        (a)  The monies in the Fund shall be  disbursed  only  as
 3    provided in Section 15-2 of this Code and as follows:
 4             (1)  To   pay   the   county   hospitals'  inpatient
 5        reimbursement rate based on actual costs, trended forward
 6        annually  by  an  inflation  index  and  supplemented  by
 7        teaching, capital, and other direct and  indirect  costs,
 8        according  to  a  State  plan  approved  by  the  federal
 9        government.    Effective  October  1, 1992, the inpatient
10        reimbursement rate  (including  any  disproportionate  or
11        supplemental   disproportionate   share   payments)   for
12        hospital  services provided by county operated facilities
13        within the County shall be no less than the reimbursement
14        rates in effect on June 1, 1992, except that this minimum
15        shall be adjusted as of July 1,  1992  and  each  July  1
16        thereafter  by  the  annual  percentage change in the per
17        diem cost of inpatient hospital services as  reported  in
18        the most recent annual Medicaid cost report.
19             (2)  To  pay  county  hospitals  and county operated
20        outpatient facilities for outpatient services based on  a
21        federally  approved  methodology  to  cover  the  maximum
22        allowable  costs per patient visit.  Effective October 1,
23        1992, the outpatient reimbursement  rate  for  outpatient
24        services provided by county hospitals and county operated
25        outpatient   facilities   shall   be  no  less  than  the
26        reimbursement rates in effect on  June  1,  1992,  except
27        that  this  minimum  shall be adjusted as of July 1, 1992
28        and each July  1  thereafter  by  the  annual  percentage
29        change  in  the  per  diem  cost  of  inpatient  hospital
30        services  as  reported in the most recent annual Medicaid
31        cost report.
32             (3)  To pay the county  hospitals'  disproportionate
33        share  payments as established by the Illinois Department
34        under Section 5-5.02 of this Code.  Effective October  1,
 
                            -39-           LRB9201523DJgcam01
 1        1992,  the  disproportionate  share payments for hospital
 2        services provided by county  operated  facilities  within
 3        the  County shall be no less than the reimbursement rates
 4        in effect on June 1, 1992, except that this minimum shall
 5        be adjusted as of July 1, 1992 and each July 1 thereafter
 6        by the annual percentage change in the per diem  cost  of
 7        inpatient  hospital  services  as  reported  in  the most
 8        recent annual Medicaid cost report.
 9             (3.5)  To pay county providers for services provided
10        pursuant to Section 5-11 or 5-16.3 of this Code.
11             (4)  To reimburse the county providers for  expenses
12        contractually  assumed  pursuant  to Section 15-4 of this
13        Code.
14             (5)  To pay the Illinois  Department  its  necessary
15        administrative  expenses  relative  to the Fund and other
16        amounts agreed to, if any, by the county providers in the
17        agreement provided for in subsection (c).
18             (6)  To  pay  the  county  hospitals'   supplemental
19        disproportionate  share  payments,  hereby authorized, as
20        specified in the agreement provided for in subsection (c)
21        and  according  to  a  federally  approved  State   plan.
22        Effective    October    1,    1992,    the   supplemental
23        disproportionate share  payments  for  hospital  services
24        provided  by county operated facilities within the County
25        shall be no less than the reimbursement rates  in  effect
26        on  June  1,  1992,  except  that  this  minimum shall be
27        adjusted as of July 1, 1992 and each July 1 thereafter by
28        the annual percentage change in  the  per  diem  cost  of
29        inpatient  hospital  services  as  reported  in  the most
30        recent annual Medicaid cost report.
31        (b)  The Illinois  Department  shall  promptly  seek  all
32    appropriate  amendments  to the Illinois State Plan to effect
33    the foregoing payment methodology.
34        (c)  The Illinois Department shall implement the  changes
 
                            -40-           LRB9201523DJgcam01
 1    made  by  Article  3 of this amendatory Act of 1992 beginning
 2    October  1,  1992.   All  terms   and   conditions   of   the
 3    disbursement  of monies from the Fund not set forth expressly
 4    in this Article shall be set forth in the agreement  executed
 5    under  the Intergovernmental Cooperation Act so long as those
 6    terms and conditions are not inconsistent with  this  Article
 7    or  applicable  federal  law.   The Illinois Department shall
 8    report  in  writing  to  the  Hospital  Service   Procurement
 9    Advisory  Board  and the Health Care Cost Containment Council
10    by October 15, 1992, the terms and  conditions  of  all  such
11    initial  agreements  and, where no such initial agreement has
12    yet been executed with  a  qualifying  county,  the  Illinois
13    Department's reasons that each such initial agreement has not
14    been  executed.   Copies  and  reports  of amended agreements
15    following the initial agreements shall likewise be  filed  by
16    the Illinois Department with the Hospital Service Procurement
17    Advisory  Board  and the Health Care Cost Containment Council
18    within 30 days  following  their  execution.   The  foregoing
19    filing   obligations   of   the   Illinois   Department   are
20    informational   only,   to   allow  the  Board  and  Council,
21    respectively, to better  perform their public  roles,  except
22    that  the Board or Council may, at its discretion, advise the
23    Illinois Department  in  the  case  of  the  failure  of  the
24    Illinois  Department  to  reach agreement with any qualifying
25    county by the required date.
26        (d)  The payments provided for  herein  are  intended  to
27    cover  services  rendered  on and after July 1, 1991, and any
28    agreement  executed  between  a  qualifying  county  and  the
29    Illinois Department pursuant to this Section may relate  back
30    to  that  date,  provided  the  Illinois  Department  obtains
31    federal  approval.   Any  changes  in payment rates resulting
32    from the provisions of Article 3 of this  amendatory  Act  of
33    1992  are  intended to apply to services rendered on or after
34    October  1,  1992,  and  any  agreement  executed  between  a
 
                            -41-           LRB9201523DJgcam01
 1    qualifying county and the  Illinois  Department  pursuant  to
 2    this Section may be effective as of that date.
 3        (e)  If  one  or  more  hospitals  file suit in any court
 4    challenging  any  part  of  this  Article  XV,  payments   to
 5    hospitals  from  the Fund under this Article XV shall be made
 6    only to the extent that sufficient monies  are  available  in
 7    the  Fund  and only to the extent that any monies in the Fund
 8    are not prohibited from disbursement  and  may  be  disbursed
 9    under any order of the court.
10        (f)  All  payments under this Section are contingent upon
11    federal approval of  changes  to  the  State  plan,  if  that
12    approval is required.
13    (Source: P.A. 90-618, eff. 7-10-98.)

14        (305 ILCS 5/5-16.3 rep.)
15        Section  31.  The  Illinois Public Aid Code is amended by
16    repealing Section 5-16.3.

17        Section 99.  Effective date.  This Act takes effect  upon
18    becoming law.".

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