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| Public Act 100-0063 | ||||
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AN ACT concerning health.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Health Maintenance Organization Act is | ||||
amended by changing Section 2-2 as follows:
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(215 ILCS 125/2-2) (from Ch. 111 1/2, par. 1404)
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Sec. 2-2. Determination by Director; Health Maintenance | ||||
Advisory Board.
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(a) Upon receipt of an application for issuance of a | ||||
certificate of
authority, the Director shall transmit copies of | ||||
such application and
accompanying documents to the Director of | ||||
the Illinois Department of Public
Health. The Director of the | ||||
Department of Public Health shall then
determine whether the | ||||
applicant for certificate of authority, with respect
to health | ||||
care services to be furnished: (1) has demonstrated the
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willingness and potential ability to assure that such health | ||||
care service
will be provided in a manner to insure both | ||||
availability and accessibility
of adequate personnel and | ||||
facilities and in a manner enhancing
availability, | ||||
accessibility, and continuity of service; and (2) has
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arrangements, established in accordance with regulations | ||||
promulgated by the
Department of Public Health for an ongoing | ||||
quality of health care assurance
program concerning health care | ||||
processes and outcomes. Upon investigation,
the Director of the | ||
Department of Public Health shall certify to the
Director | ||
whether the proposed Health Maintenance Organization meets the
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requirements of this subsection (a). If the Director of the | ||
Department of
Public Health certifies that the Health | ||
Maintenance Organization does not
meet such requirements, he | ||
shall specify in what respect it is deficient.
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There is created in the Department of Public Health a | ||
Health Maintenance
Advisory Board composed of 11 members. Nine | ||
members shall have practiced in the health
field, 4 of which | ||
shall have been or are currently affiliated with a
Health | ||
Maintenance Organization. Two of the members shall be members | ||
of the
general public, one of whom is over 50 years of age. | ||
Each member shall be
appointed by the
Director of the | ||
Department of Public Health and serve at the pleasure of
that | ||
Director and shall receive no compensation for services | ||
rendered other
than reimbursement for expenses. Six members of | ||
the Board shall
constitute
a quorum. A vacancy in the | ||
membership of the Advisory Board shall not
impair the right of | ||
a quorum to exercise all rights and perform all duties
of the | ||
Board. The Health Maintenance Advisory Board has the power to | ||
review
and comment on proposed rules and regulations to be | ||
promulgated by the
Director of the Department of Public Health | ||
within 30 days after those
proposed rules and regulations have | ||
been submitted to the Advisory Board.
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(b) Issuance of a certificate of authority shall be granted | ||
if the
following conditions are met:
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(1) the requirements of subsection (c) of
Section 2-1 | ||
have been fulfilled;
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(2) the persons responsible for the conduct
of the | ||
affairs of the applicant are competent, trustworthy, and | ||
possess
good reputations, and have had appropriate | ||
experience, training or
education;
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(3) the Director of the Department of Public Health
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certifies that the Health Maintenance Organization's | ||
proposed plan of
operation meets the requirements of this | ||
Act;
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(4) the Health Care Plan
furnishes basic health care | ||
services on a prepaid basis, through insurance
or | ||
otherwise, except to the extent of reasonable requirements | ||
for
co-payments or deductibles as authorized by this Act;
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(5) the Health
Maintenance Organization is financially | ||
responsible and may reasonably be
expected to meet its | ||
obligations to enrollees and prospective enrollees; in
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making this determination, the Director shall consider:
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(A) the financial soundness of the applicant's | ||
arrangements for health
services and the minimum | ||
standard rates, co-payments and other patient
charges | ||
used in connection therewith;
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(B) the adequacy of working capital, other sources | ||
of funding, and
provisions for contingencies; and
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(C) that no certificate of authority shall be | ||
issued if the initial
minimum net worth of the | ||
applicant is less than $2,000,000. The initial net
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worth shall be provided in cash and securities in | ||
combination and form
acceptable to the Director;
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(6) the agreements with providers for the provision of | ||
health services
contain the provisions required by Section | ||
2-8 of this Act; and
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(7) any deficiencies identified by the Director have | ||
been corrected.
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(Source: P.A. 91-617, eff. 1-1-00.)
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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