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90_HB3265
215 ILCS 125/5-10 new
215 ILCS 125/5-11 new
215 ILCS 125/5-12 new
215 ILCS 125/5-13 new
Amends the Health Maintenance Organization Act.
Establishes the office of health care consumer assistance,
advocacy, and information within the Department of Insurance.
Provides for an executive director appointed by the Governor
to a 3-year term. Directs the office to assist health care
consumers on a statewide basis in asserting their contractual
and legal rights, resolving consumer complaints, and
obtaining appropriate referrals. Requires the executive
director to make quarterly reports to the Director of
Insurance and the Governor. Requires an annual report to the
General Assembly including recommendations for improving the
health care consumer assistance and complaint resolution
process. Effective immediately.
LRB9009287JSgcA
LRB9009287JSgcA
1 AN ACT to amend the Health Maintenance Organization Act
2 by adding Sections 5-10, 5-11, 5-12, and 5-13.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Health Maintenance Organization Act is
6 amended by adding Sections 5-10, 5-11, 5-12, and 5-13 as
7 follows:
8 (215 ILCS 125/5-10 new)
9 Sec. 5-10. Office of consumer assistance.
10 (a) The office of health care consumer assistance,
11 advocacy, and information is established within the
12 Department of Insurance to provide assistance, advocacy, and
13 information to all health care consumers within the State.
14 The office shall have no regulatory power or authority and
15 shall not provide legal representation in a court of law.
16 (b) An executive director shall be appointed by the
17 governor for a 3-year term and may be removed only for just
18 cause.
19 (c) The executive director must:
20 (1) be selected without regard to political
21 affiliation;
22 (2) have knowledge and experience concerning the
23 needs and rights of health care consumers; and
24 (3) be qualified to analyze questions of law,
25 administrative functions, and public policy.
26 (d) No person may serve as executive director while
27 holding another public office.
28 (e) The Department shall provide office space, equipment
29 and supplies, and technical support to the office of health
30 care consumer assistance, advocacy, and information.
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1 (215 ILCS 125/5-11 new)
2 Sec. 5-11. Duties and powers of the office of health
3 care consumer assistance, advocacy, and information.
4 (a) Within the appropriation allocated, the executive
5 director shall provide information and assistance to all
6 health care consumers by:
7 (1) assisting patients and enrollees in
8 understanding and asserting their contractual and legal
9 rights, including the rights under an alternative dispute
10 resolution process; this assistance may include advocacy
11 for enrollees in administrative proceedings or other
12 formal or informal dispute resolution processes;
13 (2) assisting enrollees in obtaining appropriate
14 health care referrals under their health plan company,
15 health insurance, or health coverage plan;
16 (3) assisting patients and enrollees in accessing
17 the services of governmental agencies or regulatory
18 boards or other State consumer assistance programs, or
19 advocacy services whenever appropriate so that the
20 patient or enrollee can take full advantage of existing
21 mechanisms for resolving complaints;
22 (4) referring patients and enrollees to
23 governmental agencies and regulatory boards for the
24 investigation of health care complaints and for
25 enforcement action;
26 (5) educating and training enrollees about their
27 health plan company, health insurance, or health coverage
28 plan to enable them to assert their rights and to
29 understand their responsibilities;
30 (6) assisting enrollees in receiving a timely
31 resolution of their complaints;
32 (7) monitoring health care consumer complaints
33 addressed by the office of health care consumer
34 assistance, advocacy, and information to identify
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1 specific complaint patterns or areas of potential
2 improvement;
3 (8) collecting public information on consumer
4 satisfaction and outcomes data on health plan company and
5 health care provider performances from organizations
6 conducting surveys; and
7 (9) recommending to health plan companies ways to
8 identify and remove any barriers that might delay or
9 impede the health plan company's effort to resolve
10 consumer complaints.
11 (215 ILCS 125/5-12 new)
12 Sec. 5-12. Reports by executive director.
13 (a) Beginning March 1, 1999, the executive director shall
14 report, on at least a quarterly basis, any patterns
15 identified from the consumer complaints addressed by the
16 office to the Director and the Governor.
17 (b) Beginning January 1, 2000, the executive director
18 shall make an annual written report to the General Assembly
19 regarding activities of the office, including recommendations
20 on improving health care consumer assistance and complaint
21 resolution processes. Before any recommendations are made to
22 the General Assembly, the executive director must consult
23 with the Public Service Division and other interested
24 parties.
25 (215 ILCS 125/5-13 new)
26 Sec. 5-13. Retaliation. A health plan company or health
27 care provider may not retaliate or take adverse action
28 against an enrollee or patient who, in good faith, makes a
29 complaint against a health plan company or health care
30 provider.
31 Section 99. Effective date. This Act takes effect upon
-4- LRB9009287JSgcA
1 becoming law.