Full Text of HB4433 102nd General Assembly
HB4433enr 102ND GENERAL ASSEMBLY |
| | HB4433 Enrolled | | LRB102 23892 BMS 33089 b |
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| 1 | | AN ACT concerning regulation.
| 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, | 13 | | prospective 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 | 20 | | Act.
| 21 | | (c) No health care plan or its subcontractors may by | 22 | | contract, written
policy, procedure, or otherwise mandate or | 23 | | require an enrollee
to substitute his or her participating |
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| 1 | | primary care physician
under the plan during inpatient | 2 | | hospitalization, such as with a hospitalist physician licensed | 3 | | to practice medicine in all its branches,
without the | 4 | | agreement of that enrollee's
participating primary care | 5 | | physician. "Participating primary care
physician" for health | 6 | | care plans and subcontractors that do not require
coordination | 7 | | of care by a primary care physician means the participating
| 8 | | physician treating the patient. All health care plans shall | 9 | | inform enrollees
of any policies, recommendations, or | 10 | | guidelines concerning the
substitution of the enrollee's | 11 | | primary care physician when hospitalization is
necessary in | 12 | | the manner set forth in subsections (d) and (e) of Section 15.
| 13 | | (d) A health care plan shall apply any third-party | 14 | | payments, financial assistance, discount, product vouchers, or | 15 | | any other reduction in out-of-pocket expenses made by or on | 16 | | behalf of such insured for prescription drugs toward a covered | 17 | | individual's deductible, copay, or cost-sharing | 18 | | responsibility, or out-of-pocket maximum associated with the | 19 | | individual's health insurance. If, under federal law, | 20 | | application of this requirement would result in health savings | 21 | | account ineligibility under Section 223 of the Internal | 22 | | Revenue Code, this requirement applies to health savings | 23 | | account-qualified high deductible health plans with respect to | 24 | | the deductible of such a plan after the enrollee has satisfied | 25 | | the minimum deductible under Section 223, except with respect | 26 | | to items or services that are preventive care pursuant to |
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| 1 | | Section 223(c)(2)(C) of the Internal Revenue Code, in which | 2 | | case the requirement of this subsection applies regardless of | 3 | | whether the minimum deductible under Section 223 has been | 4 | | satisfied. | 5 | | (e) Any violation of this Section shall be subject to the
| 6 | | penalties under this Act.
| 7 | | (Source: P.A. 101-452, eff. 1-1-20 .)
| 8 | | Section 99. Effective date. This Act takes effect upon | 9 | | becoming law.
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