Full Text of SB3490 97th General Assembly
SB3490 97TH GENERAL ASSEMBLY |
| | 97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012 SB3490 Introduced 2/8/2012, by Sen. M. Maggie Crotty SYNOPSIS AS INTRODUCED: |
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Amends the Managed Care Reform and Patient Rights Act to provide that no health care plan or its subcontractors may, by contract, written policy, procedure, or any other means, mandate or require an optometrist or ophthalmologist to participate in and accept payment from a vision plan as a condition for participation in a health care plan. Effective immediately.
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| | A BILL FOR |
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| | | SB3490 | | LRB097 17747 RPM 62962 b |
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| 1 | | AN ACT concerning insurance.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Managed Care Reform and Patient Rights Act | 5 | | is 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 | 9 | | or discourage
health care providers
by contract or policy from
| 10 | | discussing any health care services and health care providers, | 11 | | utilization
review and quality assurance policies, terms and | 12 | | conditions of plans and plan
policy with enrollees, prospective | 13 | | enrollees, providers, or the public.
| 14 | | (b) No health care plan by contract, written policy, or | 15 | | procedure may
permit or allow an individual or entity to | 16 | | dispense a different
drug in place of the drug or brand of drug | 17 | | ordered or prescribed without the
express permission of the | 18 | | person ordering or prescribing the drug, except as
provided | 19 | | under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.
| 20 | | (c) No health care plan or its subcontractors may by | 21 | | contract, written
policy, procedure, or otherwise mandate or | 22 | | require an enrollee
to substitute his or her participating | 23 | | primary care physician
under the plan during inpatient |
| | | SB3490 | - 2 - | LRB097 17747 RPM 62962 b |
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| 1 | | hospitalization, such as with a hospitalist physician licensed | 2 | | to practice medicine in all its branches,
without the agreement | 3 | | of that enrollee's
participating primary care physician. | 4 | | "Participating primary care
physician" for health care plans | 5 | | and subcontractors that do not require
coordination of care by | 6 | | a primary care physician means the participating
physician | 7 | | treating the patient. All health care plans shall inform | 8 | | enrollees
of any policies, recommendations, or guidelines | 9 | | concerning the
substitution of the enrollee's primary care | 10 | | physician when hospitalization is
necessary in the manner set | 11 | | forth in subsections (d) and (e) of Section 15.
| 12 | | (c-5) No health care plan or its subcontractors may, by | 13 | | contract, written policy, procedure, or any other means, | 14 | | mandate or require an optometrist or ophthalmologist to | 15 | | participate in and accept payment from a vision plan as a | 16 | | condition for participation in a health care plan. | 17 | | (d) Any violation of this Section shall be subject to the
| 18 | | penalties under this Act.
| 19 | | (Source: P.A. 94-866, eff. 6-16-06.)
| 20 | | Section 99. Effective date. This Act takes effect upon | 21 | | becoming law.
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