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| | HB2506 Engrossed | | LRB100 08314 MJP 18421 b |
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| 1 | | AN ACT concerning health.
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| 2 | | Be it enacted by the People of the State of Illinois,
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| 3 | | represented in the General Assembly:
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| 4 | | Section 5. The Health Maintenance Organization Act is |
| 5 | | amended by changing Section 2-2 as follows:
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| 6 | | (215 ILCS 125/2-2) (from Ch. 111 1/2, par. 1404)
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| 7 | | Sec. 2-2. Determination by Director; Health Maintenance |
| 8 | | Advisory Board.
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| 9 | | (a) Upon receipt of an application for issuance of a |
| 10 | | certificate of
authority, the Director shall transmit copies of |
| 11 | | such application and
accompanying documents to the Director of |
| 12 | | the Illinois Department of Public
Health. The Director of the |
| 13 | | Department of Public Health shall then
determine whether the |
| 14 | | applicant for certificate of authority, with respect
to health |
| 15 | | care services to be furnished: (1) has demonstrated the
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| 16 | | willingness and potential ability to assure that such health |
| 17 | | care service
will be provided in a manner to insure both |
| 18 | | availability and accessibility
of adequate personnel and |
| 19 | | facilities and in a manner enhancing
availability, |
| 20 | | accessibility, and continuity of service; and (2) has
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| 21 | | arrangements, established in accordance with regulations |
| 22 | | promulgated by the
Department of Public Health for an ongoing |
| 23 | | quality of health care assurance
program concerning health care |
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| 1 | | processes and outcomes. Upon investigation,
the Director of the |
| 2 | | Department of Public Health shall certify to the
Director |
| 3 | | whether the proposed Health Maintenance Organization meets the
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| 4 | | requirements of this subsection (a). If the Director of the |
| 5 | | Department of
Public Health certifies that the Health |
| 6 | | Maintenance Organization does not
meet such requirements, he |
| 7 | | shall specify in what respect it is deficient.
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| 8 | | There is created in the Department of Public Health a |
| 9 | | Health Maintenance
Advisory Board composed of 11 members. Nine |
| 10 | | members shall have practiced in the health
field, 4 of which |
| 11 | | shall have been or are currently affiliated with a
Health |
| 12 | | Maintenance Organization. Two of the members shall be members |
| 13 | | of the
general public, one of whom is over 50 years of age. |
| 14 | | Each member shall be
appointed by the
Director of the |
| 15 | | Department of Public Health and serve at the pleasure of
that |
| 16 | | Director and shall receive no compensation for services |
| 17 | | rendered other
than reimbursement for expenses. Six members of |
| 18 | | the Board shall
constitute
a quorum. A vacancy in the |
| 19 | | membership of the Advisory Board shall not
impair the right of |
| 20 | | a quorum to exercise all rights and perform all duties
of the |
| 21 | | Board. The Health Maintenance Advisory Board has the power to |
| 22 | | review
and comment on proposed rules and regulations to be |
| 23 | | promulgated by the
Director of the Department of Public Health |
| 24 | | within 30 days after those
proposed rules and regulations have |
| 25 | | been submitted to the Advisory Board.
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| 26 | | (b) Issuance of a certificate of authority shall be granted |
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| 1 | | if the
following conditions are met:
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| 2 | | (1) the requirements of subsection (c) of
Section 2-1 |
| 3 | | have been fulfilled;
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| 4 | | (2) the persons responsible for the conduct
of the |
| 5 | | affairs of the applicant are competent, trustworthy, and |
| 6 | | possess
good reputations, and have had appropriate |
| 7 | | experience, training or
education;
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| 8 | | (3) the Director of the Department of Public Health
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| 9 | | certifies that the Health Maintenance Organization's |
| 10 | | proposed plan of
operation meets the requirements of this |
| 11 | | Act;
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| 12 | | (4) the Health Care Plan
furnishes basic health care |
| 13 | | services on a prepaid basis, through insurance
or |
| 14 | | otherwise, except to the extent of reasonable requirements |
| 15 | | for
co-payments or deductibles as authorized by this Act;
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| 16 | | (5) the Health
Maintenance Organization is financially |
| 17 | | responsible and may reasonably be
expected to meet its |
| 18 | | obligations to enrollees and prospective enrollees; in
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| 19 | | making this determination, the Director shall consider:
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| 20 | | (A) the financial soundness of the applicant's |
| 21 | | arrangements for health
services and the minimum |
| 22 | | standard rates, co-payments and other patient
charges |
| 23 | | used in connection therewith;
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| 24 | | (B) the adequacy of working capital, other sources |
| 25 | | of funding, and
provisions for contingencies; and
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| 26 | | (C) that no certificate of authority shall be |
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| 1 | | issued if the initial
minimum net worth of the |
| 2 | | applicant is less than $2,000,000. The initial net
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| 3 | | worth shall be provided in cash and securities in |
| 4 | | combination and form
acceptable to the Director;
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| 5 | | (6) the agreements with providers for the provision of |
| 6 | | health services
contain the provisions required by Section |
| 7 | | 2-8 of this Act; and
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| 8 | | (7) any deficiencies identified by the Director have |
| 9 | | been corrected.
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| 10 | | (Source: P.A. 91-617, eff. 1-1-00.)
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| 11 | | Section 99. Effective date. This Act takes effect upon |
| 12 | | becoming law.
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