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Rep. Mary E. Flowers
Filed: 5/21/2008
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09500HB2286ham002 |
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| AMENDMENT TO HOUSE BILL 2286
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| AMENDMENT NO. ______. Amend House Bill 2286 by replacing |
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| everything after the enacting clause with the following:
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| "Section 5. The State Employees Group Insurance Act of 1971 |
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| is amended by changing Section 6.11 as follows:
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| (5 ILCS 375/6.11)
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| Sec. 6.11. Required health benefits; Illinois Insurance |
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| Code
requirements. The program of health
benefits shall provide |
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| the post-mastectomy care benefits required to be covered
by a |
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| policy of accident and health insurance under Section 356t of |
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| the Illinois
Insurance Code. The program of health benefits |
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| shall provide the coverage
required under Sections 356f.1, |
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| 356g.5,
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, |
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| and 356z.10
356z.9 of the
Illinois Insurance Code.
The program |
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| of health benefits must comply with Section 155.37 of the
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| Illinois Insurance Code.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; |
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| 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 10. The Counties Code is amended by changing |
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| Section 5-1069.3 as follows: |
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| (55 ILCS 5/5-1069.3)
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| Sec. 5-1069.3. Required health benefits. If a county, |
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| including a home
rule
county, is a self-insurer for purposes of |
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| providing health insurance coverage
for its employees, the |
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| coverage shall include coverage for the post-mastectomy
care |
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| benefits required to be covered by a policy of accident and |
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| health
insurance under Section 356t and the coverage required |
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| under Sections 356f.1, 356g.5, 356u,
356w, 356x, 356z.6, and |
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| 356z.9, and 356z.10
356z.9 of
the Illinois Insurance Code. The |
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| requirement that health benefits be covered
as provided in this |
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| Section is an
exclusive power and function of the State and is |
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| a denial and limitation under
Article VII, Section 6, |
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| subsection (h) of the Illinois Constitution. A home
rule county |
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| to which this Section applies must comply with every provision |
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| of
this Section.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; |
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| 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 15. The Illinois Municipal Code is amended by |
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| changing Section 10-4-2.3 as follows: |
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| (65 ILCS 5/10-4-2.3)
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| Sec. 10-4-2.3. Required health benefits. If a |
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| municipality, including a
home rule municipality, is a |
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| self-insurer for purposes of providing health
insurance |
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| coverage for its employees, the coverage shall include coverage |
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| for
the post-mastectomy care benefits required to be covered by |
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| a policy of
accident and health insurance under Section 356t |
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| and the coverage required
under Sections 356f.1, 356g.5, 356u, |
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| 356w, 356x, 356z.6, and 356z.9, and 356z.10
356z.9 of the |
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| Illinois
Insurance
Code. The requirement that health
benefits |
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| be covered as provided in this is an exclusive power and |
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| function of
the State and is a denial and limitation under |
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| Article VII, Section 6,
subsection (h) of the Illinois |
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| Constitution. A home rule municipality to which
this Section |
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| applies must comply with every provision of this Section.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; |
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| 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 20. The School Code is amended by changing Section |
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| 10-22.3f as follows: |
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| (105 ILCS 5/10-22.3f)
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| Sec. 10-22.3f. Required health benefits. Insurance |
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| protection and
benefits
for employees shall provide the |
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| post-mastectomy care benefits required to be
covered by a |
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| policy of accident and health insurance under Section 356t and |
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| the
coverage required under Sections 356f.1, 356g.5, 356u, |
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| 356w, 356x,
356z.6, and 356z.9 of
the
Illinois Insurance Code.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; |
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| revised 12-4-07.)
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| Section 25. The Illinois Insurance Code is amended by |
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| adding Section 356f.1 as follows: |
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| (215 ILCS 5/356f.1 new) |
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| Sec. 356f.1. Third-party review. |
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| (a) Definitions. For purposes of this Section, the |
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| following definitions shall apply: |
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| "Authorized representative" means: |
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| (1) a person to whom a covered person has given express |
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| written consent to represent the covered person in a |
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| third-party review; |
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| (2) a person authorized by law to provide substituted |
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| consent for a covered person; or |
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| (3) a family member of the covered person or the |
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| covered person's treating health care professional only |
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| when the covered person is unable to provide consent. |
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| "Director" means the Director of the Division of Insurance |
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| of the Department of Financial and Professional Regulation. |
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| "Covered person" means an individual whose coverage under |
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| an individual health insurance plan has been rescinded. |
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| "Division" means the Division of Insurance of the |
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| Department of Financial and Professional Regulation. |
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| "Disclose" means to release, transfer, or otherwise |
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| divulge protected health information to any person other than |
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| the individual who is the subject of the protected health |
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| information. |
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| "Health insurance plan" means a policy, contract, |
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| certificate, or agreement issued by a
health carrier to |
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| provide, deliver, arrange for, pay, or reimburse any of the |
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| costs of health
care services. For the purposes of this |
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| definition, "health insurance plan" does not include one or |
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| more, or any combination of, the following: coverage only for |
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| accident or disability income insurance; coverage issued as
a |
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| supplement to liability insurance; liability insurance, |
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| including general liability
insurance and automobile liability |
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| insurance; workers' compensation or similar
insurance; |
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| automobile medical payment insurance; credit-only insurance; |
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| coverage for
on-site medical clinics; coverage similar to the |
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| foregoing as specified in federal
regulations issued pursuant |
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| to Public Law 104-191, under which benefits for medical
care |
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| are secondary or incidental to other insurance benefits; dental |
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| or vision benefits;
benefits for long-term care, nursing home |
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| care, home health care, or community-based
care; specified |
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| disease or illness coverage, hospital indemnity or other fixed |
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| indemnity
insurance, or such other similar, limited benefits as |
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| are specified in rules; Medicare
supplemental health insurance |
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| as defined under Section 1882(g)(1) of the Social Security
Act; |
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| coverage supplemental to the coverage provided under Chapter 55 |
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| of Title 10 of the
United States Code; or other similar limited |
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| benefit supplemental coverages. |
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| "Health care professional" means a physician or other |
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| health care practitioner licensed,
accredited, or certified in |
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| any state to perform specified health care services. |
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| "Health care services" means services for the diagnosis, |
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| prevention, treatment, or cure of a health condition, illness, |
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| injury, or disease. |
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| "Health carrier" means an entity subject to the insurance |
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| laws and rules of this State or subject to the jurisdiction of |
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| the Division that issues individual health insurance plans |
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| covering one or more residents of this State, including a |
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| sickness and accident insurance
company, a health maintenance |
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| organization, a nonprofit hospital and health corporation, or |
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| any other entity providing or issuing an individual health |
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| insurance plan. |
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| "Health maintenance organization" means an organization |
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| licensed under the Health Maintenance Organization Act. |
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| "Medicare" means coverage under both Parts A and B of Title |
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| XVIII of the Social Security Act. |
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| "Person" means an individual, a corporation, a |
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| partnership, an association, a joint venture, a joint stock |
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| company, a trust, an unincorporated organization, any similar |
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| entity, or any combination of the foregoing. |
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| "Protected health information" means health information |
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| that identifies an individual who is the subject of the |
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| information or with respect to which there is a reasonable |
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| basis to believe that the information could be used to identify |
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| the individual. |
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| "Rescission" means the process of voiding an individual |
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| health insurance plan, from its
inception, on the grounds of |
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| material misrepresentation or omission on the application for
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| insurance that would have resulted in a different decision by |
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| the health carrier with respect to
issuing coverage. |
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| "Review criteria" means the written screening procedures, |
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| decision abstracts, clinical protocols, the health carrier's |
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| underwriting manual, and practice guidelines used by a health |
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| carrier in making its rescission determination. |
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| "Third-party review organization" means an entity that |
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| conducts independent third-party reviews of rescission |
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| decisions made by health carriers that are based on medical |
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| issues for health insurance plan coverage. |
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| (b) Purpose, applicability, and scope. The purpose of this |
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| Section is to provide uniform standards for the establishment |
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| and maintenance of third-party review procedures to ensure that |
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| covered persons have the opportunity for an independent review |
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| of medical issues related to health carrier rescission |
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| decisions. This Section shall apply to rescission decisions |
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| made by health carriers that are based on medical issues for |
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| health insurance plan coverage. This Section does not extend to |
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| allegations related to agent conduct or decisions not based on |
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| medical issues, such as residency and marital status. |
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| (c) Notice of right to third-party review. A health carrier |
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| shall notify the covered person in writing of the covered |
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| person's right to request a third-party review to be conducted |
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| pursuant to subsection (f) of this Section and include the |
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| appropriate statements and information set forth in this |
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| subsection (c) at the same time the health carrier sends |
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| written notice of the rescission of the individual health |
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| insurance plan. As part of the written notice required under |
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| this subsection (c), a health carrier shall include the |
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| following, or substantially equivalent, language: |
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| "We have rescinded your coverage with us based on a |
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| material
misrepresentation contained in your application. |
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| After you have followed the
procedures for our internal |
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| grievance process for this rescission decision (if
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| applicable), you may have the right to have our decision |
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| reviewed by health care and
legal professionals who have no |
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| association with us if our decision was based on a
medical |
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| issue by submitting a request for third-party review to the |
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| Director at
the following address: (insert address where |
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| covered persons are to submit requests
for third-party |
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| review)." |
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| The health carrier shall include the following information |
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| in or attached to the notice required under this subsection |
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| (c): |
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| (1) a description of the standard and expedited |
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| third-party review procedures required under this Section, |
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| highlighting the provisions that give the covered person or |
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| the covered person's authorized representative the right |
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| to file a request for an expedited third-party review if |
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| the covered person has a medical condition where the |
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| timeframe for completion of an expedited review of the |
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| grievance or a standard third-party review under this |
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| Section would seriously jeopardize the life or health of |
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| the covered person or would jeopardize the covered person's |
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| ability to regain maximum function; and |
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| (2) an authorization form or other document approved by |
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| the Director that complies with the requirements of 45 |
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| C.F.R. 164.508 by which the covered person, for purposes of |
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| conducting a third-party review under this Section, |
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| authorizes the health carrier and the covered person's |
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| treating provider to disclose protected health |
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| information, including medical records, concerning the |
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| covered person that are pertinent to the third-party |
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| review, as provided under State medical record privacy laws |
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| and Article XL of this Code. |
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| (d) Third-party review requests. All requests for |
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| third-party review shall be made in writing to the Director. |
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| An expedited third-party review process shall be made |
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| available for the
review of health carrier rescission |
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| decisions. For expedited third-party review of a rescission |
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| decision, a covered person or the covered person's authorized |
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| representative may file a written request for an expedited |
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| third-party review with the Director after the exhaustion of |
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| the health carrier's internal grievance process in accordance |
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| with the requirements of
subsection (e) of this Section or |
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| after the receipt of the written notice of the right to |
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| third-party review pursuant to subsection (c) of this Section, |
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| whichever is later. |
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| (e) Exhaustion of internal grievance process. A |
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| third-party review cannot commence until the covered person has |
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| exhausted the health carrier's internal grievance process in |
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| accordance with the requirements of this subsection (e). |
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| For rescission decisions, a covered person shall be |
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| considered to have exhausted the health
carrier's internal |
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| grievance process for purposes of this Section if: |
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| (1) the health carrier has an internal grievance |
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| process for rescission decisions and the covered
person or |
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| the covered person's authorized representative has |
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| complied with all of the
steps required in the health |
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| carrier's internal grievance process that is established
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| pursuant to this Section and, except to the extent
the |
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| covered person or the covered person's authorized |
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| representative requested or agreed
to a delay, has not |
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| received a written decision on the grievance from the |
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| health carrier
within 30 days after the date the covered |
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| person or the covered person's
authorized representative |
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| filed the grievance with the health carrier or the date the |
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| health
carrier receives any requested information, |
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| whichever is later; |
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| (2) the grievance concerns a rescission decision and |
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| the covered person (i) is subject to procedures, |
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| treatments, or an ongoing course of treatment ordered by a |
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| health care provider, the suspension or termination of |
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| which could significantly increase the risk to the person's |
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| health or (ii) has received a treatment referral for a |
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| service, procedure, or other health care service, the |
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| denial of which could significantly increase the risk to |
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| the person's health, the policy or plan must allow for the |
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| filing of an expedited internal grievance either orally or |
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| in writing; upon submission of the expedited internal |
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| grievance, a policy or plan must notify the party filing |
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| the expedited internal grievance as soon as possible, but |
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| in no event more than 24 hours after the submission of the |
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| expedited internal grievance, of all information that the |
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| plan requires to evaluate the expedited internal |
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| grievance; the policy or plan shall render a decision on |
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| the expedited internal grievance within 24 hours after |
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| receipt of the required information; the policy or plan |
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| shall notify the party filing the expedited internal |
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| grievance and the person, the person's primary care |
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| physician, and any health care provider who recommended the |
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| health care service involved in the expedited internal |
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| grievance of its decision orally followed by a written |
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| notice of the determination; or |
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| (3) the health carrier waives the exhaustion |
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| requirement in writing. |
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| (f) Third-party review process - standard and expedited. |
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| Immediately following receipt of a request for an expedited |
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| third-party review, or within one business day after the date |
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| of receipt of a request for a standard third-party review, the |
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| Director shall do the following: |
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| (1) send a copy of the request to the health carrier; |
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| and |
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| (2) send written notice to the covered person or the |
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| covered person's authorized
representative informing him |
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| or her of the right to submit additional information to the
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| Director that the covered person or the covered person's |
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| authorized
representative would like considered by the |
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| health carrier. These materials must
be submitted to the |
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| Director within 3 business days after receipt of
the |
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| Director's written notice provided under this subsection |
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| (f). |
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| Within one business day after receipt of any information |
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| submitted by the covered
person or the covered person's |
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| authorized representative pursuant to this subsection
(f), the |
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| Director shall forward the information to the health carrier. |
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| Upon receipt of the information, if any, required to be |
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| forwarded pursuant to this subsection (f), the health carrier |
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| may reconsider its determination that is the subject of the |
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| third-party review. Reconsideration by the health carrier of |
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| its determination pursuant to this subsection (f) shall not |
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| delay or terminate the third-party review. The third-party |
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| review may only be terminated if the health carrier decides, |
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| upon completion of its reconsideration, to reverse its
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| determination and provide coverage for the health care service |
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| or reinstate the health insurance plan. Within one business day |
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| after making the decision to reverse its determination
pursuant |
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| to this subsection (f), the health carrier shall notify the |
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| covered person, the covered person's authorized |
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| representative, the assigned third-party review organization, |
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| and the Director in writing of its decision. The assigned |
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| third-party review organization shall terminate the |
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| third-party review upon receipt of the notice from the health |
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| carrier sent pursuant to this subsection (f). |
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| Immediately following receipt of a request for an expedited |
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| third-party review or within 5 business days after the date of |
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| receipt of a standard third-party review request, the Director |
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| shall complete a preliminary review of the request to determine |
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| the following concerning rescission third-party reviews: |
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| (i) the individual's coverage under an individual |
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| health insurance plan has been rescinded; |
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| (ii) the rescission decision made by the health carrier |
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| is based on a medical issue; |
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| (iii) if the health carrier has an internal grievance |
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| process for rescission decisions, the
covered person has |
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| exhausted the health carrier's internal grievance process |
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| as set
forth in this Section, unless the covered
person is |
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| exempt under subsection (e) of this Section; and |
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| (iv) the covered person has provided all the |
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| information and forms required to proceed
with the |
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| third-party review. |
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| The Director shall notify the covered person, the covered |
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| person's authorized
representative, and the health carrier in |
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| writing whether the request is complete and
eligible for |
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| third-party review immediately after completion of the |
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| preliminary review under this subsection (f) for an expedited |
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| third-party review request or within one business day after |
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| completion of the preliminary review under this subsection (f) |
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| for a standard third-party review request. If the request is |
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| not complete, the Director shall include a statement in the |
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| notice required under this subsection (f) informing the covered |
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| person, the covered person's
authorized representative, and |
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| the health carrier in writing and include in the notice what
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| information or materials are needed to make the request |
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| complete. If the request is not eligible for third-party |
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| review, the Director shall include a statement in the notice |
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| required under this subsection (f) informing the covered |
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| person, the covered person's authorized representative, and |
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| the health carrier in writing and include in the notice the |
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| reasons for its ineligibility. If the request is complete and |
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| eligible for third-party review, the Director shall
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| immediately randomly assign a third-party review organization |
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| from the list of approved
third-party review organizations |
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| compiled and maintained pursuant to subsection (j) of this |
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| Section to conduct the third-party review and shall notify the |
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| third-party review organization and the health carrier of the |
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| assignment. |
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| The health carrier shall provide to the assigned |
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| third-party review organization the
documents and any |
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| information considered in making its determination within one |
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| business day after the date of receipt of the notice provided |
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| pursuant to this subsection (f) for expedited third-party |
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| review or within 5 business days after the date of receipt of |
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| the notice provided
pursuant to this subsection (f) for |
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| standard third-party reviews. Failure by the health carrier to |
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| provide the documents and information within the time specified |
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| in this subsection (f) shall not delay the conduct of the |
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| third-party review. If the health carrier fails to provide the |
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| documents and information within the time specified in this |
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| subsection (f), the assigned third-party review organization |
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| may terminate the third-party review and make a decision to |
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| reverse the health carrier's determination. Within one |
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| business day after making the decision under this subsection |
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| (f), the third-party review organization shall notify the |
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| covered person,
the covered person's authorized |
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| representative, if applicable, the health carrier,
and the |
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| Director. |
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| (g) Third-party review process - health care review panel. |
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| The assigned third-party review organization shall select a |
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| panel of health care professional reviewers and legal reviewers |
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| to conduct the third-party review in accordance with subsection |
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| (f) of this Section immediately after being assigned by the |
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| Director to conduct an expedited
third-party review or within |
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| one business day after being assigned by the Director to |
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| conduct
a standard third-party review. |
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| For third-party reviews of rescission decisions, the panel |
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| shall consist of one health care professional reviewer and 2 |
12 |
| legal reviewers and must include individuals with expertise and |
13 |
| knowledge of the individual health insurance market, including |
14 |
| the underwriting process. In selecting the third-party review |
15 |
| panel, the assigned third-party review
organization shall |
16 |
| select physicians, health care professionals, and attorneys |
17 |
| who
meet the minimum qualifications described in subsections |
18 |
| (k) and (l) of this Section. Neither the covered person, the |
19 |
| covered person's authorized representative, the health |
20 |
| carrier, nor the Director shall choose or control the choice of |
21 |
| the physicians, health care professionals, or attorneys |
22 |
| selected to conduct the third-party review. |
23 |
| The third-party review panel shall provide an opinion to |
24 |
| the assigned third-party review
organization on whether the |
25 |
| medical condition should be covered or whether the health
|
26 |
| insurance plan should be reinstated as expeditiously as the |
|
|
|
09500HB2286ham002 |
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1 |
| covered person's medical condition or circumstances require, |
2 |
| but in no event more than 2 business days after being selected |
3 |
| to conduct the expedited third-party review or within 20 days |
4 |
| after being selected to conduct the standard third-party |
5 |
| review. |
6 |
| Each third-party review panel opinion shall be in writing |
7 |
| and include the following information: |
8 |
| (1) a description of the covered person's medical |
9 |
| condition; |
10 |
| (2) a description of the relevant information from the |
11 |
| individual's application; |
12 |
| (3) a description and analysis of any medical or |
13 |
| scientific evidence considered in
reaching the opinion; |
14 |
| (4) a description and analysis of any applicable legal |
15 |
| standard or requirement; |
16 |
| (5) an identification of the applicable terms of the |
17 |
| health insurance plan; and |
18 |
| (6) an explanation of the panel's rationale for the |
19 |
| opinion. |
20 |
| In rendering its decision, neither the third-party review |
21 |
| panel nor the third-party review
organization is bound by any |
22 |
| decisions or conclusions reached during the health carrier's
|
23 |
| initial determination or the health carrier's internal |
24 |
| grievance process, if applicable, as set
forth in this Section; |
25 |
| however, the third-party review panel and the third-party |
26 |
| review organization must use the health carrier's underwriting |
|
|
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09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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1 |
| guidelines that were in effect at the time the person was first |
2 |
| issued the health insurance plan. |
3 |
| The assigned third-party review organization shall make a |
4 |
| decision and provide written
notice of the decision, in |
5 |
| accordance with this subsection (g), to the covered person, the |
6 |
| covered person's authorized representative, the health |
7 |
| carrier, and the Director immediately upon receipt of the |
8 |
| third-party review panel opinion, but in no event
more than 3 |
9 |
| business days after being selected to conduct the expedited |
10 |
| third-party review or within 20 days after receipt of the |
11 |
| third-party review panel opinion, but in no event more than 45 |
12 |
| days after being selected to conduct the standard third-party |
13 |
| review. |
14 |
| The third-party review organization shall include the |
15 |
| following information in the notice
sent pursuant to this |
16 |
| subsection (g): |
17 |
| (i) a general description of the reason for the request |
18 |
| for third-party review; |
19 |
| (ii) the date the third-party review organization |
20 |
| received the assignment to conduct
the third-party review; |
21 |
| (iii) the written opinion of the third-party review |
22 |
| panel, including the recommendation
of the panel as to |
23 |
| whether the medical condition should be covered or the |
24 |
| health
insurance plan reinstated; |
25 |
| (iv) the date the third-party review was conducted, if |
26 |
| appropriate; |
|
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09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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1 |
| (v) the date of its decision; |
2 |
| (vi) the principal reason or reasons for its decision; |
3 |
| (vii) the rationale for its decision; and |
4 |
| (viii) references to the evidence or documentation |
5 |
| considered in reaching its decision,
including the |
6 |
| relevant portions of the covered person's application, the |
7 |
| terms of
the health insurance plan, any medical and |
8 |
| scientific evidence, and the applicable
legal |
9 |
| requirements. |
10 |
| Upon receipt of a notice of the third-party review |
11 |
| organization's decision pursuant to this subsection (g) that |
12 |
| reverses the health carrier's determination, the health |
13 |
| carrier immediately shall reinstate the health insurance plan |
14 |
| that was the subject of the third-party review. |
15 |
| (h) Binding nature of third-party review decision. A |
16 |
| third-party review decision is binding on the health carrier |
17 |
| except to the extent the health carrier has other remedies |
18 |
| available under applicable federal or State law. |
19 |
| A covered person or the covered person's authorized |
20 |
| representative may not file a subsequent request for |
21 |
| third-party review involving the same medical condition that |
22 |
| was the subject of the rescission decision or health carrier |
23 |
| determination for which the covered person has already received |
24 |
| a third-party review decision pursuant to this Section. |
25 |
| (i) Exhaustion of third-party review process. A covered |
26 |
| person or the covered person's authorized representative may |
|
|
|
09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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|
1 |
| not pursue litigation of a health carrier's decisions based on |
2 |
| medical issues involved in a denial of a claim based on the |
3 |
| determination to rescind a policy until the covered person has |
4 |
| exhausted the third-party review process as set forth in this |
5 |
| Section. |
6 |
| (j) Approval of third-party review organizations. The |
7 |
| Director shall approve third-party review organizations |
8 |
| eligible to be assigned to conduct third-party reviews under |
9 |
| this Section. In order to be eligible for approval by the |
10 |
| Director under this Section to conduct third-party reviews |
11 |
| under this Section, a third-party review organization shall |
12 |
| submit an application for approval pursuant to this subsection |
13 |
| (j). The Director shall develop an application form for |
14 |
| initially approving and for re-approving third-party review |
15 |
| organizations to conduct third-party reviews. |
16 |
| Any third-party review organization wishing to be approved |
17 |
| to conduct third-party
reviews under this Section shall submit |
18 |
| the application form and include with the form all
|
19 |
| documentation and information necessary for the Director to |
20 |
| determine if the third-party review organization satisfies the |
21 |
| minimum qualifications established under subsections (k) and |
22 |
| (l) of this Section. The Director may charge an application fee |
23 |
| that third-party review organizations
shall submit to the |
24 |
| Director with an application for approval or re-approval. A |
25 |
| third-party review organization shall be deemed approved 90 |
26 |
| days after the date of receipt of a complete application |
|
|
|
09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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|
1 |
| submitted under this subsection (j), unless the Director |
2 |
| disapproves the application within that period or the Director |
3 |
| extends the timeframe for an additional 90 days. If the |
4 |
| Director extends the timeframe for an additional 90 days, the |
5 |
| third-party review organization shall be deemed approved at the |
6 |
| end of that additional period, unless the Director disapproves
|
7 |
| the application within the extended 90-day period. |
8 |
| An approval is effective for 2 years, unless the Director |
9 |
| determines before its expiration that the third-party review |
10 |
| organization is not satisfying the minimum qualifications |
11 |
| established under subsections (k) and (l) of this Section. |
12 |
| Whenever the Director determines that a third-party review |
13 |
| organization no longer satisfies the minimum requirements |
14 |
| established under subsections (k) and (l) of this Section, the |
15 |
| Director shall terminate the approval of the third-party review |
16 |
| organization and remove the third-party review organization |
17 |
| from the list of third-party review organizations approved to |
18 |
| conduct third-party reviews under this Section that is |
19 |
| maintained by the Director. The Director shall maintain and |
20 |
| periodically update a list of approved third-party review |
21 |
| organizations. |
22 |
| (k) Minimum qualifications for third-party review |
23 |
| organizations' written policies and procedures. To be approved |
24 |
| under subsection (j) of this Section to conduct third-party |
25 |
| reviews, a third-party review organization shall have and |
26 |
| maintain written policies and procedures that govern all |
|
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|
09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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|
1 |
| aspects of both the standard third-party review process and the |
2 |
| expedited third-party review process set forth in this Section, |
3 |
| which include, at a minimum, the following: |
4 |
| (1) a quality assurance mechanism in place that |
5 |
| ensures: |
6 |
| (A) that third-party reviews are conducted within |
7 |
| the specified time frames and required notices are |
8 |
| provided in a timely manner; |
9 |
| (B) the selection of qualified and impartial |
10 |
| health care professional reviewers and legal reviewers |
11 |
| with expertise and knowledge about the individual |
12 |
| health insurance market, including the underwriting |
13 |
| process, to conduct each third-party review on behalf |
14 |
| of the third-party review organization, suitable |
15 |
| matching of reviewers to specific cases, and that the |
16 |
| third-party review organization employs or contracts |
17 |
| with an adequate number of health care professional |
18 |
| reviewers and legal reviewers to meet this objective; |
19 |
| (C) the confidentiality of medical and treatment |
20 |
| records and review criteria; and |
21 |
| (D) that any person employed by or under contract |
22 |
| with the third-party review organization adheres to |
23 |
| the requirements of this Section; |
24 |
| (2) a toll-free telephone service to receive |
25 |
| information on a 24-hour-a-day, 7-day-a-week basis related |
26 |
| to third-party reviews that is capable of accepting, |
|
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09500HB2286ham002 |
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1 |
| recording, or providing appropriate instruction to |
2 |
| incoming telephone callers during other than normal |
3 |
| business hours; and |
4 |
| (3) agreement to maintain and provide to the Director |
5 |
| the information set out in subsection (n) of this Section. |
6 |
| (l) Minimum qualifications for third-party review |
7 |
| organizations. All legal reviewers assigned by a third-party |
8 |
| review organization to conduct third-party reviews shall be |
9 |
| licensed attorneys who meet the following minimum |
10 |
| qualifications: |
11 |
| (1) possess demonstrated expertise in contract and |
12 |
| insurance law with knowledge of the
individual health |
13 |
| insurance market, including the underwriting process; |
14 |
| (2) hold a non-restricted license to practice law in |
15 |
| any state or the District of
Columbia; and |
16 |
| (3) have no history of disciplinary actions or |
17 |
| sanctions that have been taken or are
pending by any state |
18 |
| bar association, regulatory body, or court of law that |
19 |
| raise a
substantial question as to the legal reviewer's |
20 |
| physical, mental, or professional
competence or moral |
21 |
| character. |
22 |
| All health care professional reviewers assigned by a |
23 |
| third-party review organization to
conduct third-party reviews |
24 |
| shall be physicians or other appropriate health care providers
|
25 |
| who meet the following minimum qualifications: |
26 |
| (A) be knowledgeable about the relevant health care |
|
|
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09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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1 |
| service or treatment through
recent or current actual |
2 |
| clinical experience treating patients with the same or
|
3 |
| similar medical condition of the covered person; |
4 |
| (B) hold a non-restricted license in any state or the |
5 |
| District of Columbia and, for
physicians, a current |
6 |
| certification by a recognized American medical specialty
|
7 |
| board in the area or areas appropriate to the subject of |
8 |
| the third-party review; and |
9 |
| (C) have no history of disciplinary actions or |
10 |
| sanctions, including loss of staff
privileges or |
11 |
| participation restrictions, that have been taken or are |
12 |
| pending by any
hospital, governmental agency or unit, or |
13 |
| regulatory body that raise a substantial
question as to the |
14 |
| health care professional reviewer's physical, mental, or
|
15 |
| professional competence or moral character. |
16 |
| In addition to the requirements set forth in subsection (k) |
17 |
| of this Section, the third-party review organization selected |
18 |
| to conduct the third-party review and any health care |
19 |
| professional reviewer or legal reviewer assigned by the |
20 |
| third-party review organization to conduct the third-party |
21 |
| review may not own or control, be a subsidiary of, or in any |
22 |
| way be owned or controlled by or exercise control with a health |
23 |
| carrier; a national, state, or local trade association of |
24 |
| health carriers; or a national, state, or local trade |
25 |
| association of health care
providers. The third-party review |
26 |
| organization shall be unbiased. A third-party review |
|
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09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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1 |
| organization shall establish and maintain written procedures |
2 |
| to ensure that it is unbiased in addition to any other |
3 |
| procedures required under this Section. |
4 |
| In addition to the requirements set forth in this |
5 |
| subsection and subsection (k) of this Section, to be approved |
6 |
| pursuant to subsection (j) of this Section to conduct a |
7 |
| third-party review of a specified case, neither the third-party |
8 |
| review organization selected to conduct the third-party review |
9 |
| nor any health care professional reviewer or legal reviewer |
10 |
| assigned by the third-party review organization to conduct the |
11 |
| third-party review may have a material professional, familial, |
12 |
| or financial conflict of interest with any of the following: |
13 |
| (i) the health carrier that is the subject of the |
14 |
| third-party review; |
15 |
| (ii) the covered person whose treatment is the subject |
16 |
| of the third-party review or the
covered person's |
17 |
| authorized representative; |
18 |
| (iii) any officer, director, or management employee of |
19 |
| the health carrier that is the
subject of the third-party |
20 |
| review; |
21 |
| (iv) the health care provider or the health care |
22 |
| provider's medical group or
independent practice |
23 |
| association recommending the health care service or
|
24 |
| treatment that is the subject of the third-party review; |
25 |
| (v) the facility at which the recommended health care |
26 |
| service or treatment would be
provided; or |
|
|
|
09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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1 |
| (vi) the developer or manufacturer of the principal |
2 |
| drug, device, procedure, or other
therapy being |
3 |
| recommended for the covered person whose treatment is the |
4 |
| subject
of the third-party review. |
5 |
| In determining whether a material professional, familial, or |
6 |
| financial conflict of interest
exists for purposes of this |
7 |
| subsection (l), the Director shall take into consideration
|
8 |
| situations where the third-party review organization, the |
9 |
| health care professional
reviewer, or legal reviewer may have |
10 |
| an apparent professional, familial, or financial
relationship |
11 |
| or connection with a person described in this subsection (l), |
12 |
| but the
characteristics of that relationship or connection are |
13 |
| such that they do not create a
material professional, familial, |
14 |
| or financial conflict of interest. |
15 |
| (m) Hold harmless for third-party review organizations. No |
16 |
| third-party review organization; health care professional |
17 |
| reviewer or legal reviewer working on behalf of a third-party |
18 |
| review organization; or an employee, agent, or contractor of a |
19 |
| third-party review organization shall be liable in damages to |
20 |
| any person for any opinions rendered or acts or omissions |
21 |
| performed within the scope of the organization's or person's |
22 |
| duties under the law during or upon completion of a third-party |
23 |
| review conducted pursuant to this Section, unless the opinion |
24 |
| was rendered or act or omission performed in bad faith or |
25 |
| involved gross negligence. |
26 |
| (n) Third-party review reporting requirements. A |
|
|
|
09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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| third-party review organization assigned to conduct a |
2 |
| third-party review shall maintain written records in the |
3 |
| aggregate, by state, and by health carrier on all requests for |
4 |
| which it received a request to conduct a third-party review |
5 |
| during a calendar year. The third-party review organization |
6 |
| shall retain the written records required pursuant to this |
7 |
| subsection (n) for at least 3 years. |
8 |
| Each third-party review organization shall submit to the |
9 |
| Director, upon request, a report in the format specified by the |
10 |
| Director. The report shall include, at a minimum, the following |
11 |
| information in the aggregate, by state, and for each health |
12 |
| carrier: |
13 |
| (1) the total number of assigned third-party review |
14 |
| requests; |
15 |
| (2) the number of third-party review requests resolved |
16 |
| by the third-party review
organization and, of those |
17 |
| resolved, the number resolved upholding the
health |
18 |
| carrier's determination and the number resolved reversing |
19 |
| the health
carrier's determination; |
20 |
| (3) the average length of time for resolution; |
21 |
| (4) a summary of the types of coverages or cases for |
22 |
| which a third-party review
was sought, as provided in the |
23 |
| format required by the Director; |
24 |
| (5) the number of third-party reviews that were |
25 |
| terminated as the result of a
reconsideration by the health |
26 |
| carrier of its determination after the receipt of
|
|
|
|
09500HB2286ham002 |
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|
1 |
| additional information from the covered person or the |
2 |
| covered person's
authorized representative pursuant to |
3 |
| subsection (f) of this Section; and |
4 |
| (6) any other information the Director may request or |
5 |
| require. |
6 |
| Each health carrier shall maintain written records in the |
7 |
| aggregate, by state, and for each
type of health insurance plan |
8 |
| offered by the health carrier for all third-party review |
9 |
| requests received by the health carrier pursuant to subsection |
10 |
| (f) of this Section. The health carrier
shall retain the |
11 |
| written records required pursuant to this subsection (n) for at |
12 |
| least 3 years. Each health carrier shall submit to the |
13 |
| Director, upon request, a report on all third-party review |
14 |
| requests received by the health carrier pursuant to subsection |
15 |
| (f) of this Section in the format specified by the Director. |
16 |
| The Director shall annually collect data on the third-party |
17 |
| reviews conducted in this State and issue a report that |
18 |
| includes the information reported by third-party review |
19 |
| organizations and health carriers under this subsection (n), |
20 |
| along with the total number of written third-party review |
21 |
| requests received by the Director. |
22 |
| (o) Funding of third-party review process. The health |
23 |
| carrier against which a third-party review request is filed |
24 |
| shall pay the reasonable and necessary costs associated with |
25 |
| the review process. The Director shall maintain active |
26 |
| management and oversight of the third-party review process, |
|
|
|
09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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|
1 |
| including, but not limited to, the administrative costs |
2 |
| associated with the process, and the fees associated with the |
3 |
| use of health care professional reviewers and legal reviewers. |
4 |
| The Director shall review and affirmatively endorse detailed |
5 |
| billings from the third-party review organization before the |
6 |
| detailed billings are sent to the health carrier. |
7 |
| (p) Health carrier disclosure requirements. Each health |
8 |
| carrier shall include a description of the third-party review |
9 |
| procedures in or attached to the policy, certificate, |
10 |
| membership booklet, outline of coverage, or other evidence of |
11 |
| coverage it provides to covered persons that includes, at a |
12 |
| minimum, the following information: |
13 |
| (1) a statement that informs the covered person of the |
14 |
| right to file a request for a third-party review of |
15 |
| rescission decisions made by the health carrier are based |
16 |
| on medical issues for health insurance plan coverage. The |
17 |
| statement shall explain that third-party review is only |
18 |
| available when the rescission decisions made by the health |
19 |
| carrier are based on medical issues for health insurance |
20 |
| plan coverage and include the telephone number and address |
21 |
| of the Director where the policy is issued and delivered; |
22 |
| and |
23 |
| (2) a statement that informs the covered person that, |
24 |
| when filing a request for a third-party review, the covered |
25 |
| person will be required to authorize the release of any
|
26 |
| medical records of the covered person that may be required |
|
|
|
09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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|
1 |
| to be reviewed for the
purpose of reaching a decision on |
2 |
| the third-party review. |
3 |
| The disclosure required by this subsection (p) shall be in |
4 |
| a format prescribed by the Director. |
5 |
| (q) Third-party review panel confidentiality. A |
6 |
| third-party review organization shall not disclose the |
7 |
| identity of the health care professional reviewers or legal |
8 |
| reviewers involved in the third-party review process, unless |
9 |
| otherwise directed to divulge this information by a federal or |
10 |
| State court of law. |
11 |
| (r) Notwithstanding any other rulemaking authority that |
12 |
| may exist, neither the Governor nor any agency or agency head |
13 |
| under the jurisdiction of the Governor has any authority to |
14 |
| make or promulgate rules to implement or enforce the provisions |
15 |
| of this amendatory Act of the 95th General Assembly. If, |
16 |
| however, the Governor believes that rules are necessary to |
17 |
| implement or enforce the provisions of this amendatory Act of |
18 |
| the 95th General Assembly, the Governor may suggest rules to |
19 |
| the General Assembly by filing them with the Clerk of the House |
20 |
| and the Secretary of the Senate and by requesting that the |
21 |
| General Assembly authorize such rulemaking by law, enact those |
22 |
| suggested rules into law, or take any other appropriate action |
23 |
| in the General Assembly's discretion. Nothing contained in this |
24 |
| amendatory Act of the 95th General Assembly shall be |
25 |
| interpreted to grant rulemaking authority under any other |
26 |
| Illinois statute where such authority is not otherwise |
|
|
|
09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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|
1 |
| explicitly given. For the purposes of this amendatory Act of |
2 |
| the 95th General Assembly, "rules" is given the meaning |
3 |
| contained in Section 1-70 of the Illinois Administrative |
4 |
| Procedure Act, and "agency" and "agency head" are given the |
5 |
| meanings contained in Sections 1-20 and 1-25 of the Illinois |
6 |
| Administrative Procedure Act to the extent that such |
7 |
| definitions apply to agencies or agency heads under the |
8 |
| jurisdiction of the Governor.
|
9 |
| Section 30. The Health Maintenance Organization Act is |
10 |
| amended by changing Section 5-3 as follows:
|
11 |
| (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
|
12 |
| Sec. 5-3. Insurance Code provisions.
|
13 |
| (a) Health Maintenance Organizations
shall be subject to |
14 |
| the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, |
15 |
| 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, |
16 |
| 154.6,
154.7, 154.8, 155.04, 355.2, 356f.1, 356m, 356v, 356w, |
17 |
| 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, |
18 |
| 356z.10
356z.9 , 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, |
19 |
| 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, 409, |
20 |
| 412, 444,
and
444.1,
paragraph (c) of subsection (2) of Section |
21 |
| 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, |
22 |
| XXV, and XXVI of the Illinois Insurance Code.
|
23 |
| (b) For purposes of the Illinois Insurance Code, except for |
24 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health |
|
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| Maintenance Organizations in
the following categories are |
2 |
| deemed to be "domestic companies":
|
3 |
| (1) a corporation authorized under the
Dental Service |
4 |
| Plan Act or the Voluntary Health Services Plans Act;
|
5 |
| (2) a corporation organized under the laws of this |
6 |
| State; or
|
7 |
| (3) a corporation organized under the laws of another |
8 |
| state, 30% or more
of the enrollees of which are residents |
9 |
| of this State, except a
corporation subject to |
10 |
| substantially the same requirements in its state of
|
11 |
| organization as is a "domestic company" under Article VIII |
12 |
| 1/2 of the
Illinois Insurance Code.
|
13 |
| (c) In considering the merger, consolidation, or other |
14 |
| acquisition of
control of a Health Maintenance Organization |
15 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
|
16 |
| (1) the Director shall give primary consideration to |
17 |
| the continuation of
benefits to enrollees and the financial |
18 |
| conditions of the acquired Health
Maintenance Organization |
19 |
| after the merger, consolidation, or other
acquisition of |
20 |
| control takes effect;
|
21 |
| (2)(i) the criteria specified in subsection (1)(b) of |
22 |
| Section 131.8 of
the Illinois Insurance Code shall not |
23 |
| apply and (ii) the Director, in making
his determination |
24 |
| with respect to the merger, consolidation, or other
|
25 |
| acquisition of control, need not take into account the |
26 |
| effect on
competition of the merger, consolidation, or |
|
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09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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| other acquisition of control;
|
2 |
| (3) the Director shall have the power to require the |
3 |
| following
information:
|
4 |
| (A) certification by an independent actuary of the |
5 |
| adequacy
of the reserves of the Health Maintenance |
6 |
| Organization sought to be acquired;
|
7 |
| (B) pro forma financial statements reflecting the |
8 |
| combined balance
sheets of the acquiring company and |
9 |
| the Health Maintenance Organization sought
to be |
10 |
| acquired as of the end of the preceding year and as of |
11 |
| a date 90 days
prior to the acquisition, as well as pro |
12 |
| forma financial statements
reflecting projected |
13 |
| combined operation for a period of 2 years;
|
14 |
| (C) a pro forma business plan detailing an |
15 |
| acquiring party's plans with
respect to the operation |
16 |
| of the Health Maintenance Organization sought to
be |
17 |
| acquired for a period of not less than 3 years; and
|
18 |
| (D) such other information as the Director shall |
19 |
| require.
|
20 |
| (d) The provisions of Article VIII 1/2 of the Illinois |
21 |
| Insurance Code
and this Section 5-3 shall apply to the sale by |
22 |
| any health maintenance
organization of greater than 10% of its
|
23 |
| enrollee population (including without limitation the health |
24 |
| maintenance
organization's right, title, and interest in and to |
25 |
| its health care
certificates).
|
26 |
| (e) In considering any management contract or service |
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| agreement subject
to Section 141.1 of the Illinois Insurance |
2 |
| Code, the Director (i) shall, in
addition to the criteria |
3 |
| specified in Section 141.2 of the Illinois
Insurance Code, take |
4 |
| into account the effect of the management contract or
service |
5 |
| agreement on the continuation of benefits to enrollees and the
|
6 |
| financial condition of the health maintenance organization to |
7 |
| be managed or
serviced, and (ii) need not take into account the |
8 |
| effect of the management
contract or service agreement on |
9 |
| competition.
|
10 |
| (f) Except for small employer groups as defined in the |
11 |
| Small Employer
Rating, Renewability and Portability Health |
12 |
| Insurance Act and except for
medicare supplement policies as |
13 |
| defined in Section 363 of the Illinois
Insurance Code, a Health |
14 |
| Maintenance Organization may by contract agree with a
group or |
15 |
| other enrollment unit to effect refunds or charge additional |
16 |
| premiums
under the following terms and conditions:
|
17 |
| (i) the amount of, and other terms and conditions with |
18 |
| respect to, the
refund or additional premium are set forth |
19 |
| in the group or enrollment unit
contract agreed in advance |
20 |
| of the period for which a refund is to be paid or
|
21 |
| additional premium is to be charged (which period shall not |
22 |
| be less than one
year); and
|
23 |
| (ii) the amount of the refund or additional premium |
24 |
| shall not exceed 20%
of the Health Maintenance |
25 |
| Organization's profitable or unprofitable experience
with |
26 |
| respect to the group or other enrollment unit for the |
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09500HB2286ham002 |
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| period (and, for
purposes of a refund or additional |
2 |
| premium, the profitable or unprofitable
experience shall |
3 |
| be calculated taking into account a pro rata share of the
|
4 |
| Health Maintenance Organization's administrative and |
5 |
| marketing expenses, but
shall not include any refund to be |
6 |
| made or additional premium to be paid
pursuant to this |
7 |
| subsection (f)). The Health Maintenance Organization and |
8 |
| the
group or enrollment unit may agree that the profitable |
9 |
| or unprofitable
experience may be calculated taking into |
10 |
| account the refund period and the
immediately preceding 2 |
11 |
| plan years.
|
12 |
| The Health Maintenance Organization shall include a |
13 |
| statement in the
evidence of coverage issued to each enrollee |
14 |
| describing the possibility of a
refund or additional premium, |
15 |
| and upon request of any group or enrollment unit,
provide to |
16 |
| the group or enrollment unit a description of the method used |
17 |
| to
calculate (1) the Health Maintenance Organization's |
18 |
| profitable experience with
respect to the group or enrollment |
19 |
| unit and the resulting refund to the group
or enrollment unit |
20 |
| or (2) the Health Maintenance Organization's unprofitable
|
21 |
| experience with respect to the group or enrollment unit and the |
22 |
| resulting
additional premium to be paid by the group or |
23 |
| enrollment unit.
|
24 |
| In no event shall the Illinois Health Maintenance |
25 |
| Organization
Guaranty Association be liable to pay any |
26 |
| contractual obligation of an
insolvent organization to pay any |
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09500HB2286ham002 |
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|
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| refund authorized under this Section.
|
2 |
| (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; |
3 |
| 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
|
4 |
| Section 35. The Limited Health Service Organization Act is |
5 |
| amended by changing Section 4003 as follows:
|
6 |
| (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
|
7 |
| Sec. 4003. Illinois Insurance Code provisions. Limited |
8 |
| health service
organizations shall be subject to the provisions |
9 |
| of Sections 133, 134, 137,
140, 141.1, 141.2, 141.3, 143, 143c, |
10 |
| 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, 154.7, 154.8, |
11 |
| 155.04, 155.37, 355.2, 356f.1, 356v, 356z.10
356z.9 , 368a, 401, |
12 |
| 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and 444.1 and |
13 |
| Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and |
14 |
| XXVI of the Illinois Insurance Code. For purposes of the
|
15 |
| Illinois Insurance Code, except for Sections 444 and 444.1 and |
16 |
| Articles XIII
and XIII 1/2, limited health service |
17 |
| organizations in the following categories
are deemed to be |
18 |
| domestic companies:
|
19 |
| (1) a corporation under the laws of this State; or
|
20 |
| (2) a corporation organized under the laws of another |
21 |
| state, 30% of more
of the enrollees of which are residents |
22 |
| of this State, except a corporation
subject to |
23 |
| substantially the same requirements in its state of |
24 |
| organization as
is a domestic company under Article VIII |
|
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09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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|
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| 1/2 of the Illinois Insurance Code.
|
2 |
| (Source: P.A. 95-520, eff. 8-28-07; revised 12-5-07.)
|
3 |
| Section 40. The Voluntary Health Services Plans Act is |
4 |
| amended by changing Section 10 as follows:
|
5 |
| (215 ILCS 165/10) (from Ch. 32, par. 604)
|
6 |
| Sec. 10. Application of Insurance Code provisions. Health |
7 |
| services
plan corporations and all persons interested therein |
8 |
| or dealing therewith
shall be subject to the provisions of |
9 |
| Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, |
10 |
| 149, 155.37, 354, 355.2, 356f.1, 356g.5, 356r, 356t, 356u, |
11 |
| 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, |
12 |
| 356z.8, 356z.9,
356z.10
356z.9 , 364.01, 367.2, 368a, 401, |
13 |
| 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) |
14 |
| and (15) of Section 367 of the Illinois
Insurance Code.
|
15 |
| (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; |
16 |
| 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. |
17 |
| 8-28-07; revised 12-5-07.)".
|