99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB0802

 

Introduced 2/5/2015, by Sen. William R. Haine

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 134/30

    Amends the Managed Care Reform and Patient Rights Act. Provides that no health care plan or its subcontractors may by contract, written policy, procedure, or otherwise (1) mandate or require an optometrist licensed under the Illinois Optometric Practice Act of 1987 to meet requirements not required of other eye care providers as a condition for participation in the health care plan or (2) reimburse the optometrist at a rate lower than other licensed providers based on class of licensure for equal services provided by the optometrist under the plan. Provides that all health care plans shall upon enrollment or renewal inform the plan participant that he or she has a right to choose an optometrist as his or her medical eye care provider.


LRB099 07540 MLM 27663 b

 

 

A BILL FOR

 

SB0802LRB099 07540 MLM 27663 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Managed Care Reform and Patient Rights Act
5is amended by changing Section 30 as follows:
 
6    (215 ILCS 134/30)
7    Sec. 30. Prohibitions.
8    (a) No health care plan or its subcontractors may prohibit
9or discourage health care providers by contract or policy from
10discussing any health care services and health care providers,
11utilization review and quality assurance policies, terms and
12conditions of plans and plan policy with enrollees, prospective
13enrollees, providers, or the public.
14    (b) No health care plan by contract, written policy, or
15procedure may permit or allow an individual or entity to
16dispense a different drug in place of the drug or brand of drug
17ordered or prescribed without the express permission of the
18person ordering or prescribing the drug, except as provided
19under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.
20    (c) No health care plan or its subcontractors may by
21contract, written policy, procedure, or otherwise mandate or
22require an enrollee to substitute his or her participating
23primary care physician under the plan during inpatient

 

 

SB0802- 2 -LRB099 07540 MLM 27663 b

1hospitalization, such as with a hospitalist physician licensed
2to practice medicine in all its branches, without the agreement
3of that enrollee's participating primary care physician.
4"Participating primary care physician" for health care plans
5and subcontractors that do not require coordination of care by
6a primary care physician means the participating physician
7treating the patient. All health care plans shall inform
8enrollees of any policies, recommendations, or guidelines
9concerning the substitution of the enrollee's primary care
10physician when hospitalization is necessary in the manner set
11forth in subsections (d) and (e) of Section 15.
12    (c-5) No health care plan or its subcontractors may by
13contract, written policy, procedure, or otherwise (1) mandate
14or require an optometrist licensed under the Illinois
15Optometric Practice Act of 1987 to meet requirements not
16required of other eye care providers as a condition for
17participation in the health care plan or (2) reimburse the
18optometrist at a rate lower than other licensed providers based
19on class of licensure for equal services provided by the
20optometrist under the plan. All health care plans shall, upon
21enrollment or renewal, inform the plan participant that he or
22she has a right to choose an optometrist as his or her medical
23eye care provider.
24    (d) Any violation of this Section shall be subject to the
25penalties under this Act.
26(Source: P.A. 94-866, eff. 6-16-06.)