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90_HB0919
5 ILCS 375/6.9 new
30 ILCS 805/8.21 new
55 ILCS 5/5-1069.3 new
65 ILCS 5/10-4-2.3 new
105 ILCS 5/10-22.3f new
215 ILCS 5/356t new
215 ILCS 105/8.7 new
215 ILCS 125/4-6.5 new
215 ILCS 130/4002.2 new
215 ILCS 165/10 from Ch. 32, par. 604
305 ILCS 5/5-16.8 new
Amends the State Employees Group Insurance Act of 1971,
Counties Code, Illinois Municipal Code, School Code, Illinois
Insurance Code, Health Maintenance Organization Act,
Comprehensive Health Insurance Plan Act, Limited Health
Service Organization Act, Voluntary Health Services Plans
Act, and Illinois Public Aid Code. Provides persons with a
disability covered under a group or individual policy of
accident and health insurance or a managed care plan must be
permitted to designate a specialist to whom the person has
access without referral or prior approval. Effective
immediately.
LRB9001953JScc
LRB9001953JScc
1 AN ACT concerning access to health care providers,
2 amending named Acts.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The State Employees Group Insurance Act of
6 1971 is amended by adding Section 6.9 as follows:
7 (5 ILCS 375/6.9 new)
8 Sec. 6.9. Person with a disability; specialist. The
9 program of health benefits is subject to the provisions of
10 Section 356t of the Illinois Insurance Code.
11 Section 10. The State Mandates Act is amended by adding
12 Section 8.21 as follows:
13 (30 ILCS 805/8.21 new)
14 Sec. 8.21. Exempt mandate. Notwithstanding Sections 6
15 and 8 of this Act, no reimbursement by the State is required
16 for the implementation of any mandate created by this
17 amendatory Act of 1997.
18 Section 15. The Counties Code is amended by adding
19 Section 5-1069.3 as follows:
20 (55 ILCS 5/5-1069.3 new)
21 Sec. 5-1069.3. Person with a disability; specialist.
22 All counties, including home rule counties, are subject to
23 the provisions of Section 356t of the Illinois Insurance
24 Code. The requirement under this Section that health care
25 benefits provided by counties comply with Section 356t of the
26 Illinois Insurance Code is an exclusive power and function of
27 the State and is a denial and limitation of home rule county
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1 powers under Article VII, Section 6, subsection (h) of the
2 Illinois Constitution.
3 Section 20. The Illinois Municipal Code is amended by
4 adding 10-4-2.3 as follows:
5 (65 ILCS 5/10-4-2.3 new)
6 Sec. 10-4-2.3. Person with a disability; specialist.
7 The corporate authorities of all municipalities are subject
8 to the provisions of Section 356t of the Illinois Insurance
9 Code. The requirement under this Section that health care
10 benefits provided by municipalities comply with Section 356t
11 of the Illinois Insurance Code is an exclusive power and
12 function of the State and is a denial and limitation of home
13 rule municipality powers under Article VII, Section 6,
14 subsection (h) of the Illinois Constitution.
15 Section 25. The School Code is amended by adding Section
16 10-22.3f as follows:
17 (105 ILCS 5/10-22.3f new)
18 Sec. 10-22.3f. Person with a disability; specialist.
19 Insurance protection and benefits for employees are subject
20 to the provisions of Section 356t of the Illinois Insurance
21 Code.
22 Section 30. The Illinois Insurance Code is amended by
23 adding Section 356t as follows:
24 (215 ILCS 5/356t new)
25 Sec. 356t. Person with a disability; specialist.
26 (a) An individual or group policy of accident and health
27 insurance or a managed care plan amended, delivered, issued,
28 or renewed in this State after the effective date of this
-3- LRB9001953JScc
1 amendatory Act of 1997 that requires an insured or enrollee
2 to designate an individual to coordinate care or to control
3 access to health care services shall also permit an insured
4 or enrollee with a disability to designate a participating
5 provider who is a specialist.
6 (b) If an insured or enrollee with a disability has
7 designated a specialist, then the insured or enrollee must be
8 given direct access to the specialist for services covered by
9 the policy or plan without the need for a referral or prior
10 approval. Nothing shall prohibit the insurer or managed care
11 plan from requiring prior authorization or approval from
12 either a primary care provider or the specialist for
13 referrals for additional care or services.
14 (c) For the purposes of this Section the following terms
15 are defined:
16 (1) "Disability" means a permanent physical or
17 mental impairment resulting from disease, injury,
18 functional disorder, or congenital condition.
19 (2 "Specialist" means a physician licensed to
20 practice medicine in all of its branches who has
21 specialized training and meets professional standards for
22 diagnosing and treating a disabling condition of an
23 individual with a disability.
24 (3) The terms "managed care entity", "managed care
25 plan", and "participating provider", have the meaning
26 given to those terms in Section 356r of this Code.
27 Section 35. The Comprehensive Health Insurance Plan Act
28 is amended by adding Section 8.7 as follows:
29 (215 ILCS 105/8.7 new)
30 Sec. 8.7. Person with a disability; specialist. The
31 plan shall be subject to the provisions of Section 356t of
32 the Illinois Insurance Code.
-4- LRB9001953JScc
1 Section 40. The Health Maintenance Organization Act is
2 amended by adding Section 4.6.5 as follows:
3 (215 ILCS 125/4-6.5 new)
4 Sec. 4-6.5. Person with a disability; specialist.
5 Health maintenance organizations are subject to the
6 provisions of Section 356t of the Illinois Insurance Code.
7 Section 45. The Limited Health Services Organization Act
8 is amended by adding Section 4002.2 as follows:
9 (215 ILCS 130/4002.2 new)
10 Sec. 4002.2. Person with a disability; specialist.
11 Limited health service organizations are subject to the
12 provisions of Section 356t of the Illinois Insurance Code.
13 Section 50. The Voluntary Health Services Plans Act is
14 amended by changing Section 10 as follows:
15 (215 ILCS 165/10) (from Ch. 32, par. 604)
16 Sec. 10. Application of Insurance Code provisions.
17 Health services plan corporations and all persons interested
18 therein or dealing therewith shall be subject to the
19 provisions of Article XII 1/2 and Sections 3.1, 133, 140,
20 143, 143c, 149, 354, 355.2, 356r, 356t, 367.2, 401, 401.1,
21 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and
22 (15) of Section 367 of the Illinois Insurance Code.
23 (Source: P.A. 89-514, eff. 7-17-96.)
24 Section 55. The Illinois Public Aid Code is amended by
25 adding Section 5-16.8 as follows:
26 (305 ILCS 5/5-16.8 new)
27 Sec. 5-16.8. Person with a disability; specialist. The
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1 medical assistance program is subject to the provisions of
2 Section 356t of the Illinois Insurance Code. The Illinois
3 Department shall adopt rules to implement the requirements of
4 Section 356t of the Illinois Insurance Code in the medical
5 assistance program including managed care components defined
6 in Section 5-16.3.
7 Section 99. Effective date. This Act takes effect upon
8 becoming law.