Bill Status of HB 5473   96th General Assembly

Short Description:  INS CD-MED NECESSARY APPEALS

House Sponsors
Rep. Mary E. Flowers, Michael K. Smith and Jehan A. Gordon

Last Action  View All Actions

DateChamber Action
  1/11/2011HouseSession Sine Die

Statutes Amended In Order of Appearance
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356f.1 new
215 ILCS 125/5-3from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003from Ch. 73, par. 1504-3
215 ILCS 165/10from Ch. 32, par. 604

Synopsis As Introduced
Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act. Provides that a policy of accident or health insurance or managed care plan shall establish and maintain an appeals procedure related to the denial of health care benefits. Sets forth guidelines for maintaining an appeals procedure, including an expedited process for an enrollee with (1) an ongoing course of treatment ordered by a health care provider, the denial of which could significantly increase the risk to an enrollee's health or (2) a treatment referral, service, or procedure, the denial of which could significantly increase the risk to an enrollee's health. Provides that if an initial appeal is denied by the policy or plan, an enrollee is entitled to seek external independent review of the decision made by the policy or plan. Sets forth guidelines and requirements for the external independent review process. Provides that nothing in the provision shall be construed to require a policy or plan to pay for a health care service not covered under the enrollee's certificate of coverage or policy. Provides that a policy or plan shall provide each enrollee, prospective enrollee, and enrollee representative with written notification of the policy's or plan's appeal processes. Contains a nonacceleration clause. Makes other changes.

 Fiscal Note (Department of Insurance)
 HB 5473 has no projected fiscal impact to the Illinois Department of Insurance.

 State Mandates Fiscal Note (Dept. of Commerce & Economic Opportunity)
 This bill does not create a State mandate.

Actions 
DateChamber Action
  2/4/2010HouseFiled with the Clerk by Rep. Mary E. Flowers
  2/5/2010HouseFirst Reading
  2/5/2010HouseReferred to Rules Committee
  2/16/2010HouseAssigned to Health Care Availability and Accessibility Committee
  3/12/2010HouseDo Pass / Standard Debate Health Care Availability and Accessibility Committee; 007-005-000
  3/12/2010HousePlaced on Calendar 2nd Reading - Standard Debate
  3/15/2010HouseFiscal Note Requested by Rep. Ron Stephens
  3/15/2010HouseState Mandates Fiscal Note Requested by Rep. Ron Stephens
  3/19/2010HouseFiscal Note Filed
  3/23/2010HouseState Mandates Fiscal Note Filed
  3/23/2010HouseAdded Co-Sponsor Rep. Michael K. Smith
  3/23/2010HouseAdded Co-Sponsor Rep. Jehan A. Gordon
  3/25/2010HouseSecond Reading - Standard Debate
  3/25/2010HouseHeld on Calendar Order of Second Reading - Standard Debate
  3/26/2010HouseRule 19(a) / Re-referred to Rules Committee
  1/11/2011HouseSession Sine Die

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