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96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
SB0683
Introduced 2/6/2009, by Sen. John J. Cullerton SYNOPSIS AS INTRODUCED:
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215 ILCS 125/4-10 |
from Ch. 111 1/2, par. 1409.3 |
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Amends the Health Maintenance Organization Act. Makes a technical change in a
Section concerning medical necessity determinations.
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A BILL FOR
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SB0683 |
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LRB096 06747 RPM 16831 b |
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| AN ACT concerning regulation.
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| Be it enacted by the People of the State of Illinois, |
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| represented in the General Assembly:
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| Section 5. The Health Maintenance Organization Act is |
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| amended by changing Section 4-10 as follows:
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| (215 ILCS 125/4-10) (from Ch. 111 1/2, par. 1409.3)
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| Sec. 4-10.
(a) Medical Necessity - Dispute |
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| Resolution-Independent
Second Opinion. Each Health Maintenance |
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| Organization shall provide a mechanism
for the
the timely |
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| review by a physician holding the same class of license as
the |
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| primary care physician, who is unaffiliated with the Health |
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| Maintenance
Organization, jointly selected by the patient (or |
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| the patient's next of
kin or legal representative if the |
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| patient is unable to act for himself),
primary care physician |
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| and the Health Maintenance Organization in the event
of a |
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| dispute between the primary care physician and the Health |
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| Maintenance
Organization regarding the medical necessity of a |
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| covered service proposed
by a primary care physician. In the |
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| event that the reviewing physician
determines the covered |
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| service to be medically necessary, the Health
Maintenance |
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| Organization shall provide the covered service. Future
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| contractual or employment action by the Health Maintenance |
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| Organization
regarding the primary care physician shall not be |