93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB6975

 

Introduced 2/9/2004, by Sara Feigenholtz

 

SYNOPSIS AS INTRODUCED:
 
20 ILCS 2310/2310-345   was 20 ILCS 2310/55.49
215 ILCS 5/356u
215 ILCS 105/8   from Ch. 73, par. 1308
215 ILCS 125/5-3   from Ch. 111 1/2, par. 1411.2
305 ILCS 5/5-5   from Ch. 23, par. 5-5

    Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Requires the Department of Public Health, from funds available for this purpose, to publish a summary outlining methods for the early detection and diagnosis of cervical cancer and breast cancer (now, just breast cancer). Requires the summary to include a suggestion that women seek a human papillomavirus (HPV) test as a diagnostic tool for cervical cancer. Makes corresponding changes. Amends provisions of the Illinois Insurance Code setting forth coverage requirements that apply to programs of health benefits, insurance protection, and benefits for State, municipal, county, and school employees, group or individual policies of accident and health insurance and managed care plans, and health services plan corporations. Requires coverage for the human papillomavirus (HPV) test for female insureds as a diagnostic tool for cervical cancer. Amends the Comprehensive Health Insurance Plan (CHIP) Act, the Health Maintenance Organization Act, and the Illinois Public Aid Code. Requires coverage for hospital or medical treatment or services for illness on an expense-incurred basis and coverage for an annual cervical smear or Pap smear test and papillomavirus (HPV) test for women and an annual digital rectal examination and a prostate-specific antigen test for men.


LRB093 16063 SAS 41689 b

FISCAL NOTE ACT MAY APPLY
HOME RULE NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

HB6975 LRB093 16063 SAS 41689 b

1     AN ACT concerning cervical cancer.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Department of Public Health Powers and
5 Duties Law of the Civil Administrative Code of Illinois is
6 amended by changing Section 2310-345 as follows:
 
7     (20 ILCS 2310/2310-345)  (was 20 ILCS 2310/55.49)
8     Sec. 2310-345. Breast cancer and cervical cancer; written
9 summary regarding early detection and treatment.
10     (a) From funds made available for this purpose, the
11 Department shall publish, in layman's language, a standardized
12 written summary outlining methods for the early detection and
13 diagnosis of breast cancer and cervical cancer. The summary
14 shall include recommended guidelines for screening and
15 detection of breast cancer through the use of techniques that
16 shall include but not be limited to self-examination and
17 diagnostic radiology. The summary shall also include
18 recommended guidelines for screening and detection of cervical
19 cancer.
20     (b) The summary shall also suggest (i) that women seek
21 mammography services from facilities that are certified to
22 perform mammography as required by the federal Mammography
23 Quality Standards Act of 1992 and (ii) that women seek an
24 annual cervical smear or Pap test and a human papillomavirus
25 (HPV) test as diagnostic tools for cervical cancer.
26     (c) The summary shall also include the medically viable
27 alternative methods for the treatment of breast cancer and
28 cervical cancer, including, but not limited to, hormonal,
29 radiological, chemotherapeutic, or surgical treatments or
30 combinations thereof. The summary shall contain information on
31 breast reconstructive surgery, including, but not limited to,
32 the use of breast implants and their side effects. The summary

 

 

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1 shall inform the patient of the advantages, disadvantages,
2 risks, and dangers of the various procedures. The summary shall
3 include (i) a statement that mammography is the most accurate
4 method for making an early detection of breast cancer, however,
5 no diagnostic tool is 100% effective and (ii) instructions for
6 instructions for performing breast self-examination and a
7 statement that it is important to perform a breast
8 self-examination monthly. The summary shall also include a
9 statement that the combination of a Pap test and an HPV test
10 detects virtually 100% of all high-grade cervical disease and
11 cervical cancer.
12     (d) In developing the summary, the Department shall consult
13 with the Advisory Board of Cancer Control, the Illinois State
14 Medical Society and consumer groups. The summary shall be
15 updated by the Department every 2 years.
16     (e) The summaries shall additionally be translated into
17 Spanish, and the Department shall conduct a public information
18 campaign to distribute the summaries to the Hispanic women of
19 this State in order to inform them of the importance of (i)
20 early detection of breast cancer and mammograms (ii) early
21 detection of cervical cancer and Pap and HPV tests.
22     (f) The Department shall distribute the summary to
23 hospitals, public health centers, and physicians who are likely
24 to perform or order diagnostic tests for breast disease or
25 cervical disease or treat breast cancer or cervical cancer by
26 surgical or other medical methods. Those hospitals, public
27 health centers, and physicians shall make the summaries
28 available to the public. The Department shall also distribute
29 the summaries to any person, organization, or other interested
30 parties upon request. The summaries may be duplicated by any
31 person, provided the copies are identical to the current
32 summary prepared by the Department.
33     (g) The summary shall display, on the inside of its cover,
34 printed in capital letters, in bold face type, the following
35 paragraph:
36     "The information contained in this brochure regarding

 

 

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1 recommendations for early detection and diagnosis of breast
2 disease and cervical disease and alternative breast disease and
3 cervical disease treatments is only for the purpose of
4 assisting you, the patient, in understanding the medical
5 information and advice offered by your physician. This brochure
6 cannot serve as a substitute for the sound professional advice
7 of your physician. The availability of this brochure or the
8 information contained within is not intended to alter, in any
9 way, the existing physician-patient relationship, nor the
10 existing professional obligations of your physician in the
11 delivery of medical services to you, the patient."
12     (h) The summary shall be updated when necessary.
13 (Source: P.A. 91-239, eff. 1-1-00.)
 
14     Section 10. The Illinois Insurance Code is amended by
15 changing Section 356u as follows:
 
16     (215 ILCS 5/356u)
17     Sec. 356u. Pap tests, HPV tests, and prostate-specific
18 antigen tests.
19     (a) A group or individual policy of accident and health
20 insurance or managed care plan must provide that provides
21 coverage for hospital or medical treatment or services for
22 illness on an expense-incurred basis and is amended, delivered,
23 issued, or renewed after the effective date of this amendatory
24 Act of 1997 shall provide coverage for all of the following:
25         (1) An annual cervical smear or Pap smear test and a
26     human papillomavirus (HPV) test for female insureds.
27         (2) An annual digital rectal examination and a
28     prostate-specific antigen test, for male insureds upon the
29     recommendation of a physician licensed to practice
30     medicine in all its branches for:
31             (A) asymptomatic men age 50 and over;
32             (B) African-American men age 40 and over; and
33             (C) men age 40 and over with a family history of
34         prostate cancer.

 

 

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1     (b) This Section shall not apply to agreements, contracts,
2 or policies that provide coverage for a specified disease or
3 other limited benefit coverage.
4     (c) The changes made to this Section by this amendatory Act
5 of the 93rd General Assembly apply to policies amended,
6 delivered, issued, or renewed after the effective date of this
7 amendatory Act of the 93rd General Assembly.
8 (Source: P.A. 90-7, eff. 6-10-97.)
 
9     Section 15. The Comprehensive Health Insurance Plan Act is
10 amended by changing Section 8 as follows:
 
11     (215 ILCS 105/8)  (from Ch. 73, par. 1308)
12     Sec. 8. Minimum benefits.
13     a. Availability. The Plan shall offer in an annually
14 renewable policy major medical expense coverage to every
15 eligible person who is not eligible for Medicare. Major medical
16 expense coverage offered by the Plan shall pay an eligible
17 person's covered expenses, subject to limit on the deductible
18 and coinsurance payments authorized under paragraph (4) of
19 subsection d of this Section, up to a lifetime benefit limit of
20 $1,000,000 per covered individual. The maximum limit under this
21 subsection shall not be altered by the Board, and no actuarial
22 equivalent benefit may be substituted by the Board. Any person
23 who otherwise would qualify for coverage under the Plan, but is
24 excluded because he or she is eligible for Medicare, shall be
25 eligible for any separate Medicare supplement policy or
26 policies which the Board may offer.
27     b. Outline of benefits. Covered expenses shall be limited
28 to the usual and customary charge, including negotiated fees,
29 in the locality for the following services and articles when
30 prescribed by a physician and determined by the Plan to be
31 medically necessary for the following areas of services,
32 subject to such separate deductibles, co-payments, exclusions,
33 and other limitations on benefits as the Board shall establish
34 and approve, and the other provisions of this Section:

 

 

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1         (1) Hospital services, except that any services
2     provided by a hospital that is located more than 75 miles
3     outside the State of Illinois shall be covered only for a
4     maximum of 45 days in any calendar year. With respect to
5     covered expenses incurred during any calendar year ending
6     on or after December 31, 1999, inpatient hospitalization of
7     an eligible person for the treatment of mental illness at a
8     hospital located within the State of Illinois shall be
9     subject to the same terms and conditions as for any other
10     illness.
11         (2) Professional services for the diagnosis or
12     treatment of injuries, illnesses or conditions, other than
13     dental and mental and nervous disorders as described in
14     paragraph (17), which are rendered by a physician, or by
15     other licensed professionals at the physician's direction.
16     This includes reconstruction of the breast on which a
17     mastectomy was performed; surgery and reconstruction of
18     the other breast to produce a symmetrical appearance; and
19     prostheses and treatment of physical complications at all
20     stages of the mastectomy, including lymphedemas.
21         (2.5) Professional services provided by a physician to
22     children under the age of 16 years for physical
23     examinations and age appropriate immunizations ordered by
24     a physician licensed to practice medicine in all its
25     branches.
26         (3) (Blank).
27         (4) Outpatient prescription drugs that by law require a
28     prescription written by a physician licensed to practice
29     medicine in all its branches subject to such separate
30     deductible, copayment, and other limitations or
31     restrictions as the Board shall approve, including the use
32     of a prescription drug card or any other program, or both.
33         (5) Skilled nursing services of a licensed skilled
34     nursing facility for not more than 120 days during a policy
35     year.
36         (6) Services of a home health agency in accord with a

 

 

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1     home health care plan, up to a maximum of 270 visits per
2     year.
3         (7) Services of a licensed hospice for not more than
4     180 days during a policy year.
5         (8) Use of radium or other radioactive materials.
6         (9) Oxygen.
7         (10) Anesthetics.
8         (11) Orthoses and prostheses other than dental.
9         (12) Rental or purchase in accordance with Board
10     policies or procedures of durable medical equipment, other
11     than eyeglasses or hearing aids, for which there is no
12     personal use in the absence of the condition for which it
13     is prescribed.
14         (13) Diagnostic x-rays and laboratory tests.
15         (14) Oral surgery (i) for excision of partially or
16     completely unerupted impacted teeth when not performed in
17     connection with the routine extraction or repair of teeth;
18     (ii) for excision of tumors or cysts of the jaws, cheeks,
19     lips, tongue, and roof and floor of the mouth; (iii)
20     required for correction of cleft lip and palate and other
21     craniofacial and maxillofacial birth defects; or (iv) for
22     treatment of injuries to natural teeth or a fractured jaw
23     due to an accident.
24         (15) Physical, speech, and functional occupational
25     therapy as medically necessary and provided by appropriate
26     licensed professionals.
27         (16) Emergency and other medically necessary
28     transportation provided by a licensed ambulance service to
29     the nearest health care facility qualified to treat a
30     covered illness, injury, or condition, subject to the
31     provisions of the Emergency Medical Systems (EMS) Act.
32         (17) Outpatient services for diagnosis and treatment
33     of mental and nervous disorders provided that a covered
34     person shall be required to make a copayment not to exceed
35     50% and that the Plan's payment shall not exceed such
36     amounts as are established by the Board.

 

 

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1         (18) Human organ or tissue transplants specified by the
2     Board that are performed at a hospital designated by the
3     Board as a participating transplant center for that
4     specific organ or tissue transplant.
5         (19) Naprapathic services, as appropriate, provided by
6     a licensed naprapathic practitioner.
7         (20) Coverage for hospital or medical treatment or
8     services for illness on an expense-incurred basis and
9     coverage for (A) an annual cervical smear or Pap smear test
10     and a human papillomavirus (HPV) test for women and (B) an
11     annual digital rectal examination and a prostate-specific
12     antigen test for men upon the recommendation of a physician
13     licensed to practice medicine in all its branches for: (i)
14     asymptomatic men age 50 and over; (ii) African-American men
15     age 40 and over; and (iii) men age 40 and over with a
16     family history of prostate cancer.
17     c. Exclusions. Covered expenses of the Plan shall not
18 include the following:
19         (1) Any charge for treatment for cosmetic purposes
20     other than for reconstructive surgery when the service is
21     incidental to or follows surgery resulting from injury,
22     sickness or other diseases of the involved part or surgery
23     for the repair or treatment of a congenital bodily defect
24     to restore normal bodily functions.
25         (2) Any charge for care that is primarily for rest,
26     custodial, educational, or domiciliary purposes.
27         (3) Any charge for services in a private room to the
28     extent it is in excess of the institution's charge for its
29     most common semiprivate room, unless a private room is
30     prescribed as medically necessary by a physician.
31         (4) That part of any charge for room and board or for
32     services rendered or articles prescribed by a physician,
33     dentist, or other health care personnel that exceeds the
34     reasonable and customary charge in the locality or for any
35     services or supplies not medically necessary for the
36     diagnosed injury or illness.

 

 

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1         (5) Any charge for services or articles the provision
2     of which is not within the scope of licensure of the
3     institution or individual providing the services or
4     articles.
5         (6) Any expense incurred prior to the effective date of
6     coverage by the Plan for the person on whose behalf the
7     expense is incurred.
8         (7) Dental care, dental surgery, dental treatment, any
9     other dental procedure involving the teeth or
10     periodontium, or any dental appliances, including crowns,
11     bridges, implants, or partial or complete dentures, except
12     as specifically provided in paragraph (14) of subsection b
13     of this Section.
14         (8) Eyeglasses, contact lenses, hearing aids or their
15     fitting.
16         (9) Illness or injury due to acts of war.
17         (10) Services of blood donors and any fee for failure
18     to replace the first 3 pints of blood provided to a covered
19     person each policy year.
20         (11) Personal supplies or services provided by a
21     hospital or nursing home, or any other nonmedical or
22     nonprescribed supply or service.
23         (12) Routine maternity charges for a pregnancy, except
24     where added as optional coverage with payment of an
25     additional premium for pregnancy resulting from conception
26     occurring after the effective date of the optional
27     coverage.
28         (13) (Blank).
29         (14) Any expense or charge for services, drugs, or
30     supplies that are: (i) not provided in accord with
31     generally accepted standards of current medical practice;
32     (ii) for procedures, treatments, equipment, transplants,
33     or implants, any of which are investigational,
34     experimental, or for research purposes; (iii)
35     investigative and not proven safe and effective; or (iv)
36     for, or resulting from, a gender transformation operation.

 

 

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1         (15) Any expense or charge for routine physical
2     examinations or tests except as provided in item (2.5) of
3     subsection b of this Section.
4         (16) Any expense for which a charge is not made in the
5     absence of insurance or for which there is no legal
6     obligation on the part of the patient to pay.
7         (17) Any expense incurred for benefits provided under
8     the laws of the United States and this State, including
9     Medicare, Medicaid, and other medical assistance, maternal
10     and child health services and any other program that is
11     administered or funded by the Department of Human Services,
12     Department of Public Aid, or Department of Public Health,
13     military service-connected disability payments, medical
14     services provided for members of the armed forces and their
15     dependents or employees of the armed forces of the United
16     States, and medical services financed on behalf of all
17     citizens by the United States.
18         (18) Any expense or charge for in vitro fertilization,
19     artificial insemination, or any other artificial means
20     used to cause pregnancy.
21         (19) Any expense or charge for oral contraceptives used
22     for birth control or any other temporary birth control
23     measures.
24         (20) Any expense or charge for sterilization or
25     sterilization reversals.
26         (21) Any expense or charge for weight loss programs,
27     exercise equipment, or treatment of obesity, except when
28     certified by a physician as morbid obesity (at least 2
29     times normal body weight).
30         (22) Any expense or charge for acupuncture treatment
31     unless used as an anesthetic agent for a covered surgery.
32         (23) Any expense or charge for or related to organ or
33     tissue transplants other than those performed at a hospital
34     with a Board approved organ transplant program that has
35     been designated by the Board as a preferred or exclusive
36     provider organization for that specific organ or tissue

 

 

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1     transplant.
2         (24) Any expense or charge for procedures, treatments,
3     equipment, or services that are provided in special
4     settings for research purposes or in a controlled
5     environment, are being studied for safety, efficiency, and
6     effectiveness, and are awaiting endorsement by the
7     appropriate national medical speciality college for
8     general use within the medical community.
9     d. Deductibles and coinsurance.
10     The Plan coverage defined in Section 6 shall provide for a
11 choice of deductibles per individual as authorized by the
12 Board. If 2 individual members of the same family household,
13 who are both covered persons under the Plan, satisfy the same
14 applicable deductibles, no other member of that family who is
15 also a covered person under the Plan shall be required to meet
16 any deductibles for the balance of that calendar year. The
17 deductibles must be applied first to the authorized amount of
18 covered expenses incurred by the covered person. A mandatory
19 coinsurance requirement shall be imposed at the rate authorized
20 by the Board in excess of the mandatory deductible, the
21 coinsurance in the aggregate not to exceed such amounts as are
22 authorized by the Board per annum. At its discretion the Board
23 may, however, offer catastrophic coverages or other policies
24 that provide for larger deductibles with or without coinsurance
25 requirements. The deductibles and coinsurance factors may be
26 adjusted annually according to the Medical Component of the
27 Consumer Price Index.
28     e. Scope of coverage.
29         (1) In approving any of the benefit plans to be offered
30     by the Plan, the Board shall establish such benefit levels,
31     deductibles, coinsurance factors, exclusions, and
32     limitations as it may deem appropriate and that it believes
33     to be generally reflective of and commensurate with health
34     insurance coverage that is provided in the individual
35     market in this State.
36         (2) The benefit plans approved by the Board may also

 

 

HB6975 - 11 - LRB093 16063 SAS 41689 b

1     provide for and employ various cost containment measures
2     and other requirements including, but not limited to,
3     preadmission certification, prior approval, second
4     surgical opinions, concurrent utilization review programs,
5     individual case management, preferred provider
6     organizations, health maintenance organizations, and other
7     cost effective arrangements for paying for covered
8     expenses.
9     f. Preexisting conditions.
10         (1) Except for federally eligible individuals
11     qualifying for Plan coverage under Section 15 of this Act
12     or eligible persons who qualify for the waiver authorized
13     in paragraph (3) of this subsection, plan coverage shall
14     exclude charges or expenses incurred during the first 6
15     months following the effective date of coverage as to any
16     condition for which medical advice, care or treatment was
17     recommended or received during the 6 month period
18     immediately preceding the effective date of coverage.
19         (2) (Blank).
20         (3) Waiver: The preexisting condition exclusions as
21     set forth in paragraph (1) of this subsection shall be
22     waived to the extent to which the eligible person (a) has
23     satisfied similar exclusions under any prior individual
24     health insurance policy that was involuntarily terminated
25     because of the insolvency of the issuer of the policy and
26     (b) has applied for Plan coverage within 90 days following
27     the involuntary termination of that individual health
28     insurance coverage.
29     g. Other sources primary; nonduplication of benefits.
30         (1) The Plan shall be the last payor of benefits
31     whenever any other benefit or source of third party payment
32     is available. Subject to the provisions of subsection e of
33     Section 7, benefits otherwise payable under Plan coverage
34     shall be reduced by all amounts paid or payable by Medicare
35     or any other government program or through any health
36     insurance coverage or group health plan, whether by

 

 

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1     insurance, reimbursement, or otherwise, or through any
2     third party liability, settlement, judgment, or award,
3     regardless of the date of the settlement, judgment, or
4     award, whether the settlement, judgment, or award is in the
5     form of a contract, agreement, or trust on behalf of a
6     minor or otherwise and whether the settlement, judgment, or
7     award is payable to the covered person, his or her
8     dependent, estate, personal representative, or guardian in
9     a lump sum or over time, and by all hospital or medical
10     expense benefits paid or payable under any worker's
11     compensation coverage, automobile medical payment, or
12     liability insurance, whether provided on the basis of fault
13     or nonfault, and by any hospital or medical benefits paid
14     or payable under or provided pursuant to any State or
15     federal law or program.
16         (2) The Plan shall have a cause of action against any
17     covered person or any other person or entity for the
18     recovery of any amount paid to the extent the amount was
19     for treatment, services, or supplies not covered in this
20     Section or in excess of benefits as set forth in this
21     Section.
22         (3) Whenever benefits are due from the Plan because of
23     sickness or an injury to a covered person resulting from a
24     third party's wrongful act or negligence and the covered
25     person has recovered or may recover damages from a third
26     party or its insurer, the Plan shall have the right to
27     reduce benefits or to refuse to pay benefits that otherwise
28     may be payable by the amount of damages that the covered
29     person has recovered or may recover regardless of the date
30     of the sickness or injury or the date of any settlement,
31     judgment, or award resulting from that sickness or injury.
32         During the pendency of any action or claim that is
33     brought by or on behalf of a covered person against a third
34     party or its insurer, any benefits that would otherwise be
35     payable except for the provisions of this paragraph (3)
36     shall be paid if payment by or for the third party has not

 

 

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1     yet been made and the covered person or, if incapable, that
2     person's legal representative agrees in writing to pay back
3     promptly the benefits paid as a result of the sickness or
4     injury to the extent of any future payments made by or for
5     the third party for the sickness or injury. This agreement
6     is to apply whether or not liability for the payments is
7     established or admitted by the third party or whether those
8     payments are itemized.
9         Any amounts due the plan to repay benefits may be
10     deducted from other benefits payable by the Plan after
11     payments by or for the third party are made.
12         (4) Benefits due from the Plan may be reduced or
13     refused as an offset against any amount otherwise
14     recoverable under this Section.
15     h. Right of subrogation; recoveries.
16         (1) Whenever the Plan has paid benefits because of
17     sickness or an injury to any covered person resulting from
18     a third party's wrongful act or negligence, or for which an
19     insurer is liable in accordance with the provisions of any
20     policy of insurance, and the covered person has recovered
21     or may recover damages from a third party that is liable
22     for the damages, the Plan shall have the right to recover
23     the benefits it paid from any amounts that the covered
24     person has received or may receive regardless of the date
25     of the sickness or injury or the date of any settlement,
26     judgment, or award resulting from that sickness or injury.
27     The Plan shall be subrogated to any right of recovery the
28     covered person may have under the terms of any private or
29     public health care coverage or liability coverage,
30     including coverage under the Workers' Compensation Act or
31     the Workers' Occupational Diseases Act, without the
32     necessity of assignment of claim or other authorization to
33     secure the right of recovery. To enforce its subrogation
34     right, the Plan may (i) intervene or join in an action or
35     proceeding brought by the covered person or his personal
36     representative, including his guardian, conservator,

 

 

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1     estate, dependents, or survivors, against any third party
2     or the third party's insurer that may be liable or (ii)
3     institute and prosecute legal proceedings against any
4     third party or the third party's insurer that may be liable
5     for the sickness or injury in an appropriate court either
6     in the name of the Plan or in the name of the covered
7     person or his personal representative, including his
8     guardian, conservator, estate, dependents, or survivors.
9         (2) If any action or claim is brought by or on behalf
10     of a covered person against a third party or the third
11     party's insurer, the covered person or his personal
12     representative, including his guardian, conservator,
13     estate, dependents, or survivors, shall notify the Plan by
14     personal service or registered mail of the action or claim
15     and of the name of the court in which the action or claim
16     is brought, filing proof thereof in the action or claim.
17     The Plan may, at any time thereafter, join in the action or
18     claim upon its motion so that all orders of court after
19     hearing and judgment shall be made for its protection. No
20     release or settlement of a claim for damages and no
21     satisfaction of judgment in the action shall be valid
22     without the written consent of the Plan to the extent of
23     its interest in the settlement or judgment and of the
24     covered person or his personal representative.
25         (3) In the event that the covered person or his
26     personal representative fails to institute a proceeding
27     against any appropriate third party before the fifth month
28     before the action would be barred, the Plan may, in its own
29     name or in the name of the covered person or personal
30     representative, commence a proceeding against any
31     appropriate third party for the recovery of damages on
32     account of any sickness, injury, or death to the covered
33     person. The covered person shall cooperate in doing what is
34     reasonably necessary to assist the Plan in any recovery and
35     shall not take any action that would prejudice the Plan's
36     right to recovery. The Plan shall pay to the covered person

 

 

HB6975 - 15 - LRB093 16063 SAS 41689 b

1     or his personal representative all sums collected from any
2     third party by judgment or otherwise in excess of amounts
3     paid in benefits under the Plan and amounts paid or to be
4     paid as costs, attorneys fees, and reasonable expenses
5     incurred by the Plan in making the collection or enforcing
6     the judgment.
7         (4) In the event that a covered person or his personal
8     representative, including his guardian, conservator,
9     estate, dependents, or survivors, recovers damages from a
10     third party for sickness or injury caused to the covered
11     person, the covered person or the personal representative
12     shall pay to the Plan from the damages recovered the amount
13     of benefits paid or to be paid on behalf of the covered
14     person.
15         (5) When the action or claim is brought by the covered
16     person alone and the covered person incurs a personal
17     liability to pay attorney's fees and costs of litigation,
18     the Plan's claim for reimbursement of the benefits provided
19     to the covered person shall be the full amount of benefits
20     paid to or on behalf of the covered person under this Act
21     less a pro rata share that represents the Plan's reasonable
22     share of attorney's fees paid by the covered person and
23     that portion of the cost of litigation expenses determined
24     by multiplying by the ratio of the full amount of the
25     expenditures to the full amount of the judgement, award, or
26     settlement.
27         (6) In the event of judgment or award in a suit or
28     claim against a third party or insurer, the court shall
29     first order paid from any judgement or award the reasonable
30     litigation expenses incurred in preparation and
31     prosecution of the action or claim, together with
32     reasonable attorney's fees. After payment of those
33     expenses and attorney's fees, the court shall apply out of
34     the balance of the judgment or award an amount sufficient
35     to reimburse the Plan the full amount of benefits paid on
36     behalf of the covered person under this Act, provided the

 

 

HB6975 - 16 - LRB093 16063 SAS 41689 b

1     court may reduce and apportion the Plan's portion of the
2     judgement proportionate to the recovery of the covered
3     person. The burden of producing evidence sufficient to
4     support the exercise by the court of its discretion to
5     reduce the amount of a proven charge sought to be enforced
6     against the recovery shall rest with the party seeking the
7     reduction. The court may consider the nature and extent of
8     the injury, economic and non-economic loss, settlement
9     offers, comparative negligence as it applies to the case at
10     hand, hospital costs, physician costs, and all other
11     appropriate costs. The Plan shall pay its pro rata share of
12     the attorney fees based on the Plan's recovery as it
13     compares to the total judgment. Any reimbursement rights of
14     the Plan shall take priority over all other liens and
15     charges existing under the laws of this State with the
16     exception of any attorney liens filed under the Attorneys
17     Lien Act.
18         (7) The Plan may compromise or settle and release any
19     claim for benefits provided under this Act or waive any
20     claims for benefits, in whole or in part, for the
21     convenience of the Plan or if the Plan determines that
22     collection would result in undue hardship upon the covered
23     person.
24 (Source: P.A. 91-639, eff. 8-20-99; 91-735, eff. 6-2-00; 92-2,
25 eff. 5-1-01; 92-630, eff. 7-11-02.)
 
26     Section 20. The Health Maintenance Organization Act is
27 amended by changing Section 5-3 as follows:
 
28     (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
29     Sec. 5-3. Insurance Code provisions.
30     (a) Health Maintenance Organizations shall be subject to
31 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
32 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
33 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356u, 356v, 356w,
34 356x, 356y, 356z.2, 356z.4, 356z.5, 367.2, 367.2-5, 367i, 368a,

 

 

HB6975 - 17 - LRB093 16063 SAS 41689 b

1 368b, 368c, 368d, 368e, 401, 401.1, 402, 403, 403A, 408, 408.2,
2 409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
3 Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
4 XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
5     (b) For purposes of the Illinois Insurance Code, except for
6 Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
7 Maintenance Organizations in the following categories are
8 deemed to be "domestic companies":
9         (1) a corporation authorized under the Dental Service
10     Plan Act or the Voluntary Health Services Plans Act;
11         (2) a corporation organized under the laws of this
12     State; or
13         (3) a corporation organized under the laws of another
14     state, 30% or more of the enrollees of which are residents
15     of this State, except a corporation subject to
16     substantially the same requirements in its state of
17     organization as is a "domestic company" under Article VIII
18     1/2 of the Illinois Insurance Code.
19     (c) In considering the merger, consolidation, or other
20 acquisition of control of a Health Maintenance Organization
21 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
22         (1) the Director shall give primary consideration to
23     the continuation of benefits to enrollees and the financial
24     conditions of the acquired Health Maintenance Organization
25     after the merger, consolidation, or other acquisition of
26     control takes effect;
27         (2)(i) the criteria specified in subsection (1)(b) of
28     Section 131.8 of the Illinois Insurance Code shall not
29     apply and (ii) the Director, in making his determination
30     with respect to the merger, consolidation, or other
31     acquisition of control, need not take into account the
32     effect on competition of the merger, consolidation, or
33     other acquisition of control;
34         (3) the Director shall have the power to require the
35     following information:
36             (A) certification by an independent actuary of the

 

 

HB6975 - 18 - LRB093 16063 SAS 41689 b

1         adequacy of the reserves of the Health Maintenance
2         Organization sought to be acquired;
3             (B) pro forma financial statements reflecting the
4         combined balance sheets of the acquiring company and
5         the Health Maintenance Organization sought to be
6         acquired as of the end of the preceding year and as of
7         a date 90 days prior to the acquisition, as well as pro
8         forma financial statements reflecting projected
9         combined operation for a period of 2 years;
10             (C) a pro forma business plan detailing an
11         acquiring party's plans with respect to the operation
12         of the Health Maintenance Organization sought to be
13         acquired for a period of not less than 3 years; and
14             (D) such other information as the Director shall
15         require.
16     (d) The provisions of Article VIII 1/2 of the Illinois
17 Insurance Code and this Section 5-3 shall apply to the sale by
18 any health maintenance organization of greater than 10% of its
19 enrollee population (including without limitation the health
20 maintenance organization's right, title, and interest in and to
21 its health care certificates).
22     (e) In considering any management contract or service
23 agreement subject to Section 141.1 of the Illinois Insurance
24 Code, the Director (i) shall, in addition to the criteria
25 specified in Section 141.2 of the Illinois Insurance Code, take
26 into account the effect of the management contract or service
27 agreement on the continuation of benefits to enrollees and the
28 financial condition of the health maintenance organization to
29 be managed or serviced, and (ii) need not take into account the
30 effect of the management contract or service agreement on
31 competition.
32     (f) Except for small employer groups as defined in the
33 Small Employer Rating, Renewability and Portability Health
34 Insurance Act and except for medicare supplement policies as
35 defined in Section 363 of the Illinois Insurance Code, a Health
36 Maintenance Organization may by contract agree with a group or

 

 

HB6975 - 19 - LRB093 16063 SAS 41689 b

1 other enrollment unit to effect refunds or charge additional
2 premiums under the following terms and conditions:
3         (i) the amount of, and other terms and conditions with
4     respect to, the refund or additional premium are set forth
5     in the group or enrollment unit contract agreed in advance
6     of the period for which a refund is to be paid or
7     additional premium is to be charged (which period shall not
8     be less than one year); and
9         (ii) the amount of the refund or additional premium
10     shall not exceed 20% of the Health Maintenance
11     Organization's profitable or unprofitable experience with
12     respect to the group or other enrollment unit for the
13     period (and, for purposes of a refund or additional
14     premium, the profitable or unprofitable experience shall
15     be calculated taking into account a pro rata share of the
16     Health Maintenance Organization's administrative and
17     marketing expenses, but shall not include any refund to be
18     made or additional premium to be paid pursuant to this
19     subsection (f)). The Health Maintenance Organization and
20     the group or enrollment unit may agree that the profitable
21     or unprofitable experience may be calculated taking into
22     account the refund period and the immediately preceding 2
23     plan years.
24     The Health Maintenance Organization shall include a
25 statement in the evidence of coverage issued to each enrollee
26 describing the possibility of a refund or additional premium,
27 and upon request of any group or enrollment unit, provide to
28 the group or enrollment unit a description of the method used
29 to calculate (1) the Health Maintenance Organization's
30 profitable experience with respect to the group or enrollment
31 unit and the resulting refund to the group or enrollment unit
32 or (2) the Health Maintenance Organization's unprofitable
33 experience with respect to the group or enrollment unit and the
34 resulting additional premium to be paid by the group or
35 enrollment unit.
36     In no event shall the Illinois Health Maintenance

 

 

HB6975 - 20 - LRB093 16063 SAS 41689 b

1 Organization Guaranty Association be liable to pay any
2 contractual obligation of an insolvent organization to pay any
3 refund authorized under this Section.
4 (Source: P.A. 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; 93-261,
5 eff. 1-1-04; 93-477, eff. 8-8-03; 93-529, eff. 8-14-03; revised
6 9-25-03.)
 
7     Section 25. The Illinois Public Aid Code is amended by
8 changing Section 5-5 as follows:
 
9     (305 ILCS 5/5-5)  (from Ch. 23, par. 5-5)
10     Sec. 5-5. Medical services. The Illinois Department, by
11 rule, shall determine the quantity and quality of and the rate
12 of reimbursement for the medical assistance for which payment
13 will be authorized, and the medical services to be provided,
14 which may include all or part of the following: (1) inpatient
15 hospital services; (2) outpatient hospital services; (3) other
16 laboratory and X-ray services; (4) skilled nursing home
17 services; (5) physicians' services whether furnished in the
18 office, the patient's home, a hospital, a skilled nursing home,
19 or elsewhere; (6) medical care, or any other type of remedial
20 care furnished by licensed practitioners; (7) home health care
21 services; (8) private duty nursing service; (9) clinic
22 services; (10) dental services; (11) physical therapy and
23 related services; (12) prescribed drugs, dentures, and
24 prosthetic devices; and eyeglasses prescribed by a physician
25 skilled in the diseases of the eye, or by an optometrist,
26 whichever the person may select; (13) other diagnostic,
27 screening, preventive, and rehabilitative services; (14)
28 transportation and such other expenses as may be necessary;
29 (15) medical treatment of sexual assault survivors, as defined
30 in Section 1a of the Sexual Assault Survivors Emergency
31 Treatment Act, for injuries sustained as a result of the sexual
32 assault, including examinations and laboratory tests to
33 discover evidence which may be used in criminal proceedings
34 arising from the sexual assault; (16) the diagnosis and

 

 

HB6975 - 21 - LRB093 16063 SAS 41689 b

1 treatment of sickle cell anemia; and (17) any other medical
2 care, and any other type of remedial care recognized under the
3 laws of this State, but not including abortions, or induced
4 miscarriages or premature births, unless, in the opinion of a
5 physician, such procedures are necessary for the preservation
6 of the life of the woman seeking such treatment, or except an
7 induced premature birth intended to produce a live viable child
8 and such procedure is necessary for the health of the mother or
9 her unborn child. The Illinois Department, by rule, shall
10 prohibit any physician from providing medical assistance to
11 anyone eligible therefor under this Code where such physician
12 has been found guilty of performing an abortion procedure in a
13 wilful and wanton manner upon a woman who was not pregnant at
14 the time such abortion procedure was performed. The term "any
15 other type of remedial care" shall include nursing care and
16 nursing home service for persons who rely on treatment by
17 spiritual means alone through prayer for healing.
18     Notwithstanding any other provision of this Section, a
19 comprehensive tobacco use cessation program that includes
20 purchasing prescription drugs or prescription medical devices
21 approved by the Food and Drug administration shall be covered
22 under the medical assistance program under this Article for
23 persons who are otherwise eligible for assistance under this
24 Article.
25     Notwithstanding any other provision of this Code, the
26 Illinois Department may not require, as a condition of payment
27 for any laboratory test authorized under this Article, that a
28 physician's handwritten signature appear on the laboratory
29 test order form. The Illinois Department may, however, impose
30 other appropriate requirements regarding laboratory test order
31 documentation.
32     The Illinois Department of Public Aid shall provide the
33 following services to persons eligible for assistance under
34 this Article who are participating in education, training or
35 employment programs operated by the Department of Human
36 Services as successor to the Department of Public Aid:

 

 

HB6975 - 22 - LRB093 16063 SAS 41689 b

1         (1) dental services, which shall include but not be
2     limited to prosthodontics; and
3         (2) eyeglasses prescribed by a physician skilled in the
4     diseases of the eye, or by an optometrist, whichever the
5     person may select.
6     The Illinois Department, by rule, may distinguish and
7 classify the medical services to be provided only in accordance
8 with the classes of persons designated in Section 5-2.
9     The Illinois Department shall authorize the provision of,
10 and shall authorize payment for, screening by low-dose
11 mammography for the presence of occult breast cancer for women
12 35 years of age or older who are eligible for medical
13 assistance under this Article, as follows: a baseline mammogram
14 for women 35 to 39 years of age and an annual mammogram for
15 women 40 years of age or older. All screenings shall include a
16 physical breast exam, instruction on self-examination and
17 information regarding the frequency of self-examination and
18 its value as a preventative tool. As used in this Section,
19 "low-dose mammography" means the x-ray examination of the
20 breast using equipment dedicated specifically for mammography,
21 including the x-ray tube, filter, compression device, image
22 receptor, and cassettes, with an average radiation exposure
23 delivery of less than one rad mid-breast, with 2 views for each
24 breast.
25     The Illinois Department shall authorize the provision of
26 and payment for hospital or medical treatment or services for
27 illness on an expense-incurred basis and coverage for the
28 following medical tests: (A) an annual cervical smear or Pap
29 smear test and a human papillomavirus (HPV) test for women who
30 are eligible for medical assistance under this Article and (B)
31 an annual digital rectal examination and a prostate-specific
32 antigen test for men who are eligible for medical assistance
33 under this Article upon the recommendation of a physician
34 licensed to practice medicine in all its branches for: (i)
35 asymptomatic men age 50 and over; (ii) African-American men age
36 40 and over; and (iii) men age 40 and over with a family

 

 

HB6975 - 23 - LRB093 16063 SAS 41689 b

1 history of prostate cancer.
2     Any medical or health care provider shall immediately
3 recommend, to any pregnant woman who is being provided prenatal
4 services and is suspected of drug abuse or is addicted as
5 defined in the Alcoholism and Other Drug Abuse and Dependency
6 Act, referral to a local substance abuse treatment provider
7 licensed by the Department of Human Services or to a licensed
8 hospital which provides substance abuse treatment services.
9 The Department of Public Aid shall assure coverage for the cost
10 of treatment of the drug abuse or addiction for pregnant
11 recipients in accordance with the Illinois Medicaid Program in
12 conjunction with the Department of Human Services.
13     All medical providers providing medical assistance to
14 pregnant women under this Code shall receive information from
15 the Department on the availability of services under the Drug
16 Free Families with a Future or any comparable program providing
17 case management services for addicted women, including
18 information on appropriate referrals for other social services
19 that may be needed by addicted women in addition to treatment
20 for addiction.
21     The Illinois Department, in cooperation with the
22 Departments of Human Services (as successor to the Department
23 of Alcoholism and Substance Abuse) and Public Health, through a
24 public awareness campaign, may provide information concerning
25 treatment for alcoholism and drug abuse and addiction, prenatal
26 health care, and other pertinent programs directed at reducing
27 the number of drug-affected infants born to recipients of
28 medical assistance.
29     Neither the Illinois Department of Public Aid nor the
30 Department of Human Services shall sanction the recipient
31 solely on the basis of her substance abuse.
32     The Illinois Department shall establish such regulations
33 governing the dispensing of health services under this Article
34 as it shall deem appropriate. The Department should seek the
35 advice of formal professional advisory committees appointed by
36 the Director of the Illinois Department for the purpose of

 

 

HB6975 - 24 - LRB093 16063 SAS 41689 b

1 providing regular advice on policy and administrative matters,
2 information dissemination and educational activities for
3 medical and health care providers, and consistency in
4 procedures to the Illinois Department.
5     The Illinois Department may develop and contract with
6 Partnerships of medical providers to arrange medical services
7 for persons eligible under Section 5-2 of this Code.
8 Implementation of this Section may be by demonstration projects
9 in certain geographic areas. The Partnership shall be
10 represented by a sponsor organization. The Department, by rule,
11 shall develop qualifications for sponsors of Partnerships.
12 Nothing in this Section shall be construed to require that the
13 sponsor organization be a medical organization.
14     The sponsor must negotiate formal written contracts with
15 medical providers for physician services, inpatient and
16 outpatient hospital care, home health services, treatment for
17 alcoholism and substance abuse, and other services determined
18 necessary by the Illinois Department by rule for delivery by
19 Partnerships. Physician services must include prenatal and
20 obstetrical care. The Illinois Department shall reimburse
21 medical services delivered by Partnership providers to clients
22 in target areas according to provisions of this Article and the
23 Illinois Health Finance Reform Act, except that:
24         (1) Physicians participating in a Partnership and
25     providing certain services, which shall be determined by
26     the Illinois Department, to persons in areas covered by the
27     Partnership may receive an additional surcharge for such
28     services.
29         (2) The Department may elect to consider and negotiate
30     financial incentives to encourage the development of
31     Partnerships and the efficient delivery of medical care.
32         (3) Persons receiving medical services through
33     Partnerships may receive medical and case management
34     services above the level usually offered through the
35     medical assistance program.
36     Medical providers shall be required to meet certain

 

 

HB6975 - 25 - LRB093 16063 SAS 41689 b

1 qualifications to participate in Partnerships to ensure the
2 delivery of high quality medical services. These
3 qualifications shall be determined by rule of the Illinois
4 Department and may be higher than qualifications for
5 participation in the medical assistance program. Partnership
6 sponsors may prescribe reasonable additional qualifications
7 for participation by medical providers, only with the prior
8 written approval of the Illinois Department.
9     Nothing in this Section shall limit the free choice of
10 practitioners, hospitals, and other providers of medical
11 services by clients. In order to ensure patient freedom of
12 choice, the Illinois Department shall immediately promulgate
13 all rules and take all other necessary actions so that provided
14 services may be accessed from therapeutically certified
15 optometrists to the full extent of the Illinois Optometric
16 Practice Act of 1987 without discriminating between service
17 providers.
18     The Department shall apply for a waiver from the United
19 States Health Care Financing Administration to allow for the
20 implementation of Partnerships under this Section.
21     The Illinois Department shall require health care
22 providers to maintain records that document the medical care
23 and services provided to recipients of Medical Assistance under
24 this Article. The Illinois Department shall require health care
25 providers to make available, when authorized by the patient, in
26 writing, the medical records in a timely fashion to other
27 health care providers who are treating or serving persons
28 eligible for Medical Assistance under this Article. All
29 dispensers of medical services shall be required to maintain
30 and retain business and professional records sufficient to
31 fully and accurately document the nature, scope, details and
32 receipt of the health care provided to persons eligible for
33 medical assistance under this Code, in accordance with
34 regulations promulgated by the Illinois Department. The rules
35 and regulations shall require that proof of the receipt of
36 prescription drugs, dentures, prosthetic devices and

 

 

HB6975 - 26 - LRB093 16063 SAS 41689 b

1 eyeglasses by eligible persons under this Section accompany
2 each claim for reimbursement submitted by the dispenser of such
3 medical services. No such claims for reimbursement shall be
4 approved for payment by the Illinois Department without such
5 proof of receipt, unless the Illinois Department shall have put
6 into effect and shall be operating a system of post-payment
7 audit and review which shall, on a sampling basis, be deemed
8 adequate by the Illinois Department to assure that such drugs,
9 dentures, prosthetic devices and eyeglasses for which payment
10 is being made are actually being received by eligible
11 recipients. Within 90 days after the effective date of this
12 amendatory Act of 1984, the Illinois Department shall establish
13 a current list of acquisition costs for all prosthetic devices
14 and any other items recognized as medical equipment and
15 supplies reimbursable under this Article and shall update such
16 list on a quarterly basis, except that the acquisition costs of
17 all prescription drugs shall be updated no less frequently than
18 every 30 days as required by Section 5-5.12.
19     The rules and regulations of the Illinois Department shall
20 require that a written statement including the required opinion
21 of a physician shall accompany any claim for reimbursement for
22 abortions, or induced miscarriages or premature births. This
23 statement shall indicate what procedures were used in providing
24 such medical services.
25     The Illinois Department shall require all dispensers of
26 medical services, other than an individual practitioner or
27 group of practitioners, desiring to participate in the Medical
28 Assistance program established under this Article to disclose
29 all financial, beneficial, ownership, equity, surety or other
30 interests in any and all firms, corporations, partnerships,
31 associations, business enterprises, joint ventures, agencies,
32 institutions or other legal entities providing any form of
33 health care services in this State under this Article.
34     The Illinois Department may require that all dispensers of
35 medical services desiring to participate in the medical
36 assistance program established under this Article disclose,

 

 

HB6975 - 27 - LRB093 16063 SAS 41689 b

1 under such terms and conditions as the Illinois Department may
2 by rule establish, all inquiries from clients and attorneys
3 regarding medical bills paid by the Illinois Department, which
4 inquiries could indicate potential existence of claims or liens
5 for the Illinois Department.
6     Enrollment of a vendor that provides non-emergency medical
7 transportation, defined by the Department by rule, shall be
8 conditional for 180 days. During that time, the Department of
9 Public Aid may terminate the vendor's eligibility to
10 participate in the medical assistance program without cause.
11 That termination of eligibility is not subject to the
12 Department's hearing process.
13     The Illinois Department shall establish policies,
14 procedures, standards and criteria by rule for the acquisition,
15 repair and replacement of orthotic and prosthetic devices and
16 durable medical equipment. Such rules shall provide, but not be
17 limited to, the following services: (1) immediate repair or
18 replacement of such devices by recipients without medical
19 authorization; and (2) rental, lease, purchase or
20 lease-purchase of durable medical equipment in a
21 cost-effective manner, taking into consideration the
22 recipient's medical prognosis, the extent of the recipient's
23 needs, and the requirements and costs for maintaining such
24 equipment. Such rules shall enable a recipient to temporarily
25 acquire and use alternative or substitute devices or equipment
26 pending repairs or replacements of any device or equipment
27 previously authorized for such recipient by the Department.
28 Rules under clause (2) above shall not provide for purchase or
29 lease-purchase of durable medical equipment or supplies used
30 for the purpose of oxygen delivery and respiratory care.
31     The Department shall execute, relative to the nursing home
32 prescreening project, written inter-agency agreements with the
33 Department of Human Services and the Department on Aging, to
34 effect the following: (i) intake procedures and common
35 eligibility criteria for those persons who are receiving
36 non-institutional services; and (ii) the establishment and

 

 

HB6975 - 28 - LRB093 16063 SAS 41689 b

1 development of non-institutional services in areas of the State
2 where they are not currently available or are undeveloped.
3     The Illinois Department shall develop and operate, in
4 cooperation with other State Departments and agencies and in
5 compliance with applicable federal laws and regulations,
6 appropriate and effective systems of health care evaluation and
7 programs for monitoring of utilization of health care services
8 and facilities, as it affects persons eligible for medical
9 assistance under this Code.
10     The Illinois Department shall report annually to the
11 General Assembly, no later than the second Friday in April of
12 1979 and each year thereafter, in regard to:
13         (a) actual statistics and trends in utilization of
14     medical services by public aid recipients;
15         (b) actual statistics and trends in the provision of
16     the various medical services by medical vendors;
17         (c) current rate structures and proposed changes in
18     those rate structures for the various medical vendors; and
19         (d) efforts at utilization review and control by the
20     Illinois Department.
21     The period covered by each report shall be the 3 years
22 ending on the June 30 prior to the report. The report shall
23 include suggested legislation for consideration by the General
24 Assembly. The filing of one copy of the report with the
25 Speaker, one copy with the Minority Leader and one copy with
26 the Clerk of the House of Representatives, one copy with the
27 President, one copy with the Minority Leader and one copy with
28 the Secretary of the Senate, one copy with the Legislative
29 Research Unit, and such additional copies with the State
30 Government Report Distribution Center for the General Assembly
31 as is required under paragraph (t) of Section 7 of the State
32 Library Act shall be deemed sufficient to comply with this
33 Section.
34 (Source: P.A. 92-16, eff. 6-28-01; 92-651, eff. 7-11-02;
35 92-789, eff. 8-6-02; 93-632, eff. 2-1-04.)