Public Act 90-0408 of the 90th General Assembly
Public Act 90-0408
SB457 Enrolled LRB9000384JSgc
AN ACT to amend the Health Maintenance Organization Act
by adding Section 4-17.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Health Maintenance Organization Act is
amended by adding Section 4-17 as follows:
(215 ILCS 125/4-17 new)
Sec. 4-17. Retirement facility residents. With respect
to an enrollee who is a resident of a retirement facility
consisting of a long-term care facility, as defined in the
Nursing Home Care Act, and residential apartments, a contract
or evidence of coverage issued, amended, delivered, or
renewed after the effective date of this amendatory Act of
1997 shall provide that the enrollee's primary care physician
must refer the enrollee to the retirement facility's
long-term care facility for Medicare covered skilled nursing
services if the primary care physician finds that:
(1) it is in the best interests of the patient;
(2) the facility, if not a participating provider
in the specific health maintenance organization, agrees
during the preauthorization period to a negotiated rate
for skilled nursing services covered in that
organization's health care plan; and
(3) the facility meets all the requirements of a
participating provider for skilled nursing services as
defined and covered under the health maintenance
organization's health care plan.
Both the facility and the health maintenance organization
must fully disclose all pertinent information to consumers to
assure that their decisions are based upon full knowledge of
the implications of their decision making.