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Public Act 102-0704


 

Public Act 0704 102ND GENERAL ASSEMBLY

  
  
  

 


 
Public Act 102-0704
 
HB4433 EnrolledLRB102 23892 BMS 33089 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Managed Care Reform and Patient Rights Act
is amended by changing Section 30 as follows:
 
    (215 ILCS 134/30)
    Sec. 30. Prohibitions.
    (a) No health care plan or its subcontractors may prohibit
or discourage health care providers by contract or policy from
discussing any health care services and health care providers,
utilization review and quality assurance policies, terms and
conditions of plans and plan policy with enrollees,
prospective enrollees, providers, or the public.
    (b) No health care plan by contract, written policy, or
procedure may permit or allow an individual or entity to
dispense a different drug in place of the drug or brand of drug
ordered or prescribed without the express permission of the
person ordering or prescribing the drug, except as provided
under Section 3.14 of the Illinois Food, Drug and Cosmetic
Act.
    (c) No health care plan or its subcontractors may by
contract, written policy, procedure, or otherwise mandate or
require an enrollee to substitute his or her participating
primary care physician under the plan during inpatient
hospitalization, such as with a hospitalist physician licensed
to practice medicine in all its branches, without the
agreement of that enrollee's participating primary care
physician. "Participating primary care physician" for health
care plans and subcontractors that do not require coordination
of care by a primary care physician means the participating
physician treating the patient. All health care plans shall
inform enrollees of any policies, recommendations, or
guidelines concerning the substitution of the enrollee's
primary care physician when hospitalization is necessary in
the manner set forth in subsections (d) and (e) of Section 15.
    (d) A health care plan shall apply any third-party
payments, financial assistance, discount, product vouchers, or
any other reduction in out-of-pocket expenses made by or on
behalf of such insured for prescription drugs toward a covered
individual's deductible, copay, or cost-sharing
responsibility, or out-of-pocket maximum associated with the
individual's health insurance. If, under federal law,
application of this requirement would result in health savings
account ineligibility under Section 223 of the Internal
Revenue Code, this requirement applies to health savings
account-qualified high deductible health plans with respect to
the deductible of such a plan after the enrollee has satisfied
the minimum deductible under Section 223, except with respect
to items or services that are preventive care pursuant to
Section 223(c)(2)(C) of the Internal Revenue Code, in which
case the requirement of this subsection applies regardless of
whether the minimum deductible under Section 223 has been
satisfied.
    (e) Any violation of this Section shall be subject to the
penalties under this Act.
(Source: P.A. 101-452, eff. 1-1-20.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 4/22/2022