Date	Chamber	Action
1/13/2009	Senate	Session Sine Die

Statutes Amended In Order of Appearance

215 ILCS 125/1-1

from Ch. 111 1/2, par. 1401

Synopsis As Introduced
Amends the Health Maintenance Organization Act. Makes a technical change in a Section concerning the short title.

Senate Floor Amendment No. 2

	Deletes reference to:
	215 ILCS 125/1-1

	Adds reference to:
	5 ILCS 375/6.11

55 ILCS 5/5-1069.3

65 ILCS 5/10-4-2.3

105 ILCS 5/10-22.3f

215 ILCS 5/356f.1 new

215 ILCS 130/4003

from Ch. 73, par. 1504-3

215 ILCS 165/10

from Ch. 32, par. 604

Deletes everything after the enacting clause. Amends the State Employees Group Insurance Act of 1971, Counties Code, Illinois Municipal Code, School Code, Limited Health Service Organization Act, Voluntary Health Services Plans Act, and the Illinois Insurance Code. Adds a provision concerning external review appeals processes. Provides that a policy of accident or health insurance or managed care plan shall maintain an external review appeals process for member or member representatives' requests to reverse or modify adverse determinations made by the insurer or managed care plan. Adds a definition for "adverse determination". Sets forth guidelines for compliance to the provisions concerning external review appeals processes. Provides that the Director of the Division of Insurance of the Department of Financial and Professional Regulation, in consultation with the Director of the Department of Public Health, may certify alternative external review standards of national accreditation organizations or entities. Provides that the Division of Insurance may issue a corrective action plan where an external review program is not in compliance with the provisions concerning external review appeals processes and a subsequent cease and desist order where an external review program does not come into compliance. Makes other changes.

House Amendment No. 1

	Adds reference to:
	215 ILCS 125/5-3	from Ch. 111 1/2, par. 1411.2

Deletes everything after the enacting clause. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act. Provides that a policy of accident or health insurance or managed care plan shall establish and maintain an appeals procedure related to the denial of health care benefits. Sets forth guidelines for maintaining an appeals procedure, including an expedited process for an enrollee with (1) an ongoing course of treatment ordered by a health care provider, the denial of which could significantly increase the risk to an enrollee's health, or (2) a treatment referral, service, procedure, or other health care service, the denial of which could significantly increase the risk to an enrollee's health. Provides that if an initial appeal is denied by the policy or plan, an enrollee is entitled to seek external independent review of the decision made by the policy or plan. Sets forth guidelines and requirements for the external independent review process. Provides that nothing in the provision shall be construed to require a policy or plan to pay for a health care service not covered under the enrollee's certificate of coverage or policy. Provides that a policy or plan shall provide each enrollee, prospective enrollee, and enrollee representative with written notification of the policy's or plan's appeal processes. Provides that rulemaking authority to implement this amendatory Act of the 95th General Assembly, if any, is conditioned on the rules being adopted in accordance with all provisions of the Illinois Administrative Procedure Act and all rules and procedures of the Joint Committee on Administrative Rules; any purported rule not so adopted, for whatever reason, is unauthorized. Makes other changes.

Actions 

Date	Chamber	Action
2/8/2007	Senate	Filed with Secretary by Sen. William R. Haine
2/8/2007	Senate	Chief Co-Sponsor Sen. Emil Jones, Jr.
2/8/2007	Senate	First Reading
2/8/2007	Senate	Referred to Rules
3/7/2007	Senate	Assigned to Executive
3/15/2007	Senate	Do Pass Executive; 007-005-000
3/15/2007	Senate	Placed on Calendar Order of 2nd Reading March 20, 2007
3/22/2007	Senate	Second Reading
3/22/2007	Senate	Placed on Calendar Order of 3rd Reading March 27, 2007
3/30/2007	Senate	Rule 2-10 Third Reading Deadline Established As May 31, 2007
5/31/2007	Senate	Rule 2-10 Third Reading Deadline Established As December 31, 2007
12/3/2007	Senate	Pursuant to Senate Rule 3-9(b) / Referred to Rules
5/21/2008	Senate	Approved for Consideration Rules
5/21/2008	Senate	Placed on Calendar Order of 3rd Reading May 22, 2008
5/21/2008	Senate	Senate Floor Amendment No. 1 Filed with Secretary by Sen. Jacqueline Y. Collins
5/21/2008	Senate	Senate Floor Amendment No. 1 Referred to Rules
5/21/2008	Senate	Senate Floor Amendment No. 1 Rules Refers to Insurance
5/22/2008	Senate	Senate Floor Amendment No. 1 Held in Insurance
5/22/2008	Senate	Chief Sponsor Changed to Sen. Jacqueline Y. Collins
5/22/2008	Senate	Added as Chief Co-Sponsor Sen. M. Maggie Crotty
5/22/2008	Senate	Rule 2-10 Third Reading Deadline Established As May 31, 2008
5/29/2008	Senate	Senate Floor Amendment No. 2 Filed with Secretary by Sen. Jacqueline Y. Collins
5/29/2008	Senate	Senate Floor Amendment No. 2 Referred to Rules
5/29/2008	Senate	Senate Floor Amendment No. 2 Rules Refers to Insurance
5/30/2008	Senate	Senate Floor Amendment No. 2 Recommend Do Adopt Insurance; 006-000-000
5/30/2008	Senate	Fiscal Note Requested by Sen. Dale A. Righter
5/30/2008	Senate	Recalled to Second Reading
5/30/2008	Senate	Senate Floor Amendment No. 2 Adopted; Collins
5/30/2008	Senate	Placed on Calendar Order of 3rd Reading
5/30/2008	Senate	Third Reading - Passed; 053-000-000
5/30/2008	Senate	Senate Floor Amendment No. 1 Tabled Pursuant to Rule 5-4(a)
5/30/2008	House	Arrived in House
5/30/2008	House	Placed on Calendar Order of First Reading
5/30/2008	House	Chief House Sponsor Rep. Mary E. Flowers
5/30/2008	House	First Reading
5/30/2008	House	Referred to Rules Committee
11/6/2008	House	Final Action Deadline Extended-9(b) November 30, 2008
11/6/2008	House	Assigned to Health Care Availability and Access Committee
11/19/2008	House	House Amendment No. 1 Filed with Clerk by Health Care Availability and Access Committee
11/19/2008	House	House Amendment No. 1 Adopted in Health Care Availability and Access Committee; by Voice Vote
11/19/2008	House	Do Pass as Amended / Short Debate Health Care Availability and Access Committee; 010-000-000
11/19/2008	House	Placed on Calendar 2nd Reading - Short Debate
11/19/2008	House	Second Reading - Short Debate
11/19/2008	House	Placed on Calendar Order of 3rd Reading - Short Debate
11/19/2008	House	Added Alternate Chief Co-Sponsor Rep. Fred Crespo
11/19/2008	House	Added Alternate Chief Co-Sponsor Rep. Lisa M. Dugan
11/19/2008	House	Added Alternate Chief Co-Sponsor Rep. Karen May
11/19/2008	House	Added Alternate Chief Co-Sponsor Rep. Esther Golar
11/19/2008	House	Alternate Chief Co-Sponsor Removed Rep. Esther Golar
11/19/2008	House	Added Alternate Chief Co-Sponsor Rep. Jack McGuire
11/19/2008	House	Added Alternate Co-Sponsor Rep. Esther Golar
11/20/2008	House	Added Alternate Co-Sponsor Rep. Careen M Gordon
11/20/2008	House	Added Alternate Co-Sponsor Rep. Monique D. Davis
11/20/2008	House	Added Alternate Co-Sponsor Rep. Naomi D. Jakobsson
11/20/2008	House	Added Alternate Co-Sponsor Rep. Kathleen A. Ryg
11/20/2008	House	Third Reading - Short Debate - Passed 088-021-000
11/20/2008	Senate	Secretary's Desk - Concurrence House Amendment(s) 01
11/20/2008	Senate	Placed on Calendar Order of Concurrence House Amendment(s) December 15, 2008; 01
11/20/2008	House	Added Alternate Co-Sponsor Rep. Joseph M. Lyons
1/12/2009	Senate	House Amendment No. 1 Motion to Concur Filed with Secretary Sen. Jacqueline Y. Collins
1/12/2009	Senate	House Amendment No. 1 Motion to Concur Referred to Rules
1/13/2009	Senate	Session Sine Die

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