Bill Text: IL SB0683 | 2009-2010 | 96th General Assembly | Introduced
Bill Title: Amends the Health Maintenance Organization Act. Makes a technical change in a Section concerning medical necessity determinations.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2009-08-15 - Pursuant to Senate Rule 3-9(b) / Referred to Assignments [SB0683 Detail]
Download: Illinois-2009-SB0683-Introduced.html
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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois, | |||||||||||||||||||
3 | represented in the General Assembly:
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4 | Section 5. The Health Maintenance Organization Act is | |||||||||||||||||||
5 | amended by changing Section 4-10 as follows:
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6 | (215 ILCS 125/4-10) (from Ch. 111 1/2, par. 1409.3)
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7 | Sec. 4-10.
(a) Medical Necessity - Dispute | |||||||||||||||||||
8 | Resolution-Independent
Second Opinion. Each Health Maintenance | |||||||||||||||||||
9 | Organization shall provide a mechanism
for the
the timely | |||||||||||||||||||
10 | review by a physician holding the same class of license as
the | |||||||||||||||||||
11 | primary care physician, who is unaffiliated with the Health | |||||||||||||||||||
12 | Maintenance
Organization, jointly selected by the patient (or | |||||||||||||||||||
13 | the patient's next of
kin or legal representative if the | |||||||||||||||||||
14 | patient is unable to act for himself),
primary care physician | |||||||||||||||||||
15 | and the Health Maintenance Organization in the event
of a | |||||||||||||||||||
16 | dispute between the primary care physician and the Health | |||||||||||||||||||
17 | Maintenance
Organization regarding the medical necessity of a | |||||||||||||||||||
18 | covered service proposed
by a primary care physician. In the | |||||||||||||||||||
19 | event that the reviewing physician
determines the covered | |||||||||||||||||||
20 | service to be medically necessary, the Health
Maintenance | |||||||||||||||||||
21 | Organization shall provide the covered service. Future
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22 | contractual or employment action by the Health Maintenance | |||||||||||||||||||
23 | Organization
regarding the primary care physician shall not be |
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1 | based solely on the
physician's
participation in this | ||||||
2 | procedure. | ||||||
3 | (Source: P.A. 85-20; 85-850 .)
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