HB5339 Engrossed

LRB094 16810 LJB 52086 b






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    AN ACT concerning insurance.

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



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    (215 ILCS 134/30)



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    Sec. 30. Prohibitions. 

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    (a) No health care plan or its subcontractors may prohibit 
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or discourage
health care providers
by contract or policy from

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discussing any health care services and health care providers, 
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utilization
review and quality assurance policies, terms and 
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conditions of plans and plan
policy with enrollees, prospective 
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enrollees, providers, or the public.

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    (b) No health care plan by contract, written policy, or 
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procedure may
permit or allow an individual or entity to 
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dispense a different
drug in place of the drug or brand of drug 
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ordered or prescribed without the
express permission of the 
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person ordering or prescribing the drug, except as
provided 
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under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.

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    (c) No health care plan or its subcontractors may by 
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contract, written
policy, procedure, or otherwise mandate or 
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require an enrollee
to substitute his or her participating 
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primary care physician
under the plan during inpatient 
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hospitalization, such as with a hospitalist physician licensed 
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to practice medicine in all its branches,
without the agreement 
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of that enrollee's
participating primary care physician.  
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"Participating primary care
physician" for health care plans 
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and subcontractors that do not require
coordination of care by 
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a primary care physician means the participating
physician 
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treating the patient.  All health care plans shall inform 
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enrollees
of any policies, recommendations, or guidelines 
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concerning the
substitution of the enrollee's primary care 
 


 






HB5339 Engrossed
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LRB094 16810 LJB 52086 b




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physician when hospitalization is
necessary in the manner set 
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forth in subsections (d) and (e) of Section 15.

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    (d) Any violation of this Section shall be subject to the

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penalties under this Act.

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(Source: P.A. 91-617, eff. 1-1-00; 92-770, eff. 1-1-03.)

 

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