HEALTH CARRIER EXTERNAL REVIEW House SponsorsRep. Mary E. Flowers-Monique D. Davis-Linda Chapa LaVia and Camille Y. Lilly Senate Sponsors(Sen. Heather A. Steans-Jacqueline Y. Collins-Michael Noland) 8/26/2011HousePublic Act . . . . . . . . . 97-0574 215 ILCS 180/35 Amends the Health Carrier External Review Act in the provision concerning standard external review. Provides that whenever a request is eligible for external review (1) the health carrier shall, within 2 (instead of 5) business days, request the Director of Insurance to assign an independent review organization (now, from the list of approved independent review organizations compiled and maintained by the Director) and (2) within 3 business days after receiving the health carrier's request, the Director shall assign, on a rotating basis, an independent review organization from the list of approved independent review organizations compiled and maintained by the Director. Includes the health carrier among those to be notified in writing by the Director of the request's eligibility and acceptance for external review. Effective immediately.House Floor Amendment No. 1 Adds reference to:New Act215 ILCS 134/10215 ILCS 134/45215 ILCS 134/85215 ILCS 180/10215 ILCS 180/20215 ILCS 180/25215 ILCS 180/30215 ILCS 180/40215 ILCS 180/42 new215 ILCS 180/55215 ILCS 180/65215 ILCS 180/72215 ILCS 180/80 newReplaces everything after the enacting clause with the bill as introduced and the following changes. Creates the Utilization Review and Benefit Determination Law. Provides that the Law establishes standards and criteria for the structure and operation of utilization review and benefit determination processes designed to facilitate ongoing assessment and management of health care services. Sets forth provisions concerning definitions, applicability and scope, the corporate oversight of utilization review programs, contracting, the scope and content of utilization review programs, operational requirements, procedures for standard utilization review and benefit determinations, procedures for expedited utilization review and benefit determinations, emergency services, confidentiality requirements, disclosure requirements, and administration and enforcement. Changes the short title of the Health Carrier Grievance Procedure Act and references thereof to the Health Carrier Grievance Procedure Law. Makes changes in the provision of the Managed Care Reform and Patient Rights Act concerning utilization review program registration. Makes changes in the provision of the Health Carrier External Review Act concerning notice of right to external review and standard external review. Makes other changes. Effective immediately.Fiscal Note, House Floor Amendment No. 1 (Department of Insurance) As a result of the requirements brought about by this legislation, the Department would need to add, at a minimum, three (3) full time staff. Though no immediate need, additional legal staff may be required in the near future. The three (3) employees would work with the Consumer Division at a total cost to the Department of Insurance of approximately $283,000 for personal services and related expenses. The cost associated with these responsibilities is expected to be covered by Federal grant monies.State Mandates Fiscal Note, House Floor Amendment No. 1 (Dept. of Commerce & Economic Opportunity) HB 224 (H-AM 1) does not create a State mandate.Senate Floor Amendment No. 3 Replaces everything after the enacting clause with the engrossed bill and the following changes. Deletes the provisions concerning the Utilization Review and Benefit Determination Law and the Health Carrier Grievance Procedure Law. Further amends the Health Carrier External Review Act. Makes changes in the provision concerning definitions. Deletes references to the Utilization Review and Benefit Determination Law and the Health Carrier Grievance Procedure Law. Makes a change in the provision concerning the exhaustion of internal appeal process. Deletes the provision repealing the Section of the Managed Care Reform and Patient Rights Act concerning Administrative complaints and Departmental review. Changes the effective date from immediate to July 1, 2011. 1/20/2011HouseFiled with the Clerk by Rep. Mary E. Flowers 1/21/2011HouseFirst Reading 1/21/2011HouseReferred to Rules Committee 2/8/2011HouseAssigned to Health Care Availability and Accessibility Committee 3/8/2011HouseDo Pass / Short Debate Health Care Availability and Accessibility Committee; 008-004-000 3/9/2011HousePlaced on Calendar 2nd Reading - Short Debate 3/10/2011HouseAdded Chief Co-Sponsor Rep. Monique D. Davis 4/4/2011HouseHouse Floor Amendment No. 1 Filed with Clerk by Rep. Mary E. Flowers 4/4/2011HouseHouse Floor Amendment No. 1 Referred to Rules Committee 4/6/2011HouseHouse Floor Amendment No. 1 Rules Refers to Health Care Availability and Accessibility Committee 4/6/2011HouseHouse Floor Amendment No. 1 Recommends Be Adopted Health Care Availability and Accessibility Committee; 010-002-000 4/7/2011HouseHouse Floor Amendment No. 1 Fiscal Note Requested as Amended by Rep. Dennis M. Reboletti 4/7/2011HouseHouse Floor Amendment No. 1 State Mandates Fiscal Note Requested as Amended by Rep. Dennis M. Reboletti 4/12/2011HouseHouse Floor Amendment No. 1 Fiscal Note Filed as Amended 4/12/2011HouseHouse Floor Amendment No. 1 State Mandates Fiscal Note Filed as Amended 4/12/2011HouseAdded Chief Co-Sponsor Rep. Linda Chapa LaVia 4/12/2011HouseSecond Reading - Short Debate 4/12/2011HouseHouse Floor Amendment No. 1 Adopted by Voice Vote 4/12/2011HousePlaced on Calendar Order of 3rd Reading - Short Debate 4/13/2011HouseThird Reading - Consideration Postponed 4/13/2011HousePlaced on Calendar - Consideration Postponed April 13, 2011 4/13/2011HouseThird Reading - Short Debate - Passed 071-045-000 4/14/2011SenateArrive in Senate 4/14/2011SenatePlaced on Calendar Order of First Reading April 15, 2011 4/14/2011SenateChief Senate Sponsor Sen. Heather A. Steans 4/14/2011SenateFirst Reading 4/14/2011SenateReferred to Assignments 4/27/2011SenateAssigned to Insurance 5/10/2011SenateSenate Committee Amendment No. 1 Filed with Secretary by Sen. Heather A. Steans 5/10/2011SenateSenate Committee Amendment No. 1 Referred to Assignments 5/12/2011SenateAdded as Alternate Chief Co-Sponsor Sen. Jacqueline Y. Collins 5/13/2011SenateRule 2-10 Committee Deadline Established As May 31, 2011 5/14/2011SenateSenate Committee Amendment No. 1 Pursuant to Senate Rule 3-8(c-1) - Referred to Insurance 5/16/2011SenateSenate Committee Amendment No. 1 Postponed - Insurance 5/16/2011SenateDo Pass Insurance; 009-000-000 5/16/2011SenatePlaced on Calendar Order of 2nd Reading May 17, 2011 5/18/2011SenateSecond Reading 5/18/2011SenatePlaced on Calendar Order of 3rd Reading May 19, 2011 5/19/2011SenateSenate Floor Amendment No. 2 Filed with Secretary by Sen. Heather A. Steans 5/19/2011SenateSenate Floor Amendment No. 2 Referred to Assignments 5/23/2011SenateSenate Floor Amendment No. 3 Filed with Secretary by Sen. Heather A. Steans 5/23/2011SenateSenate Floor Amendment No. 3 Referred to Assignments 5/24/2011SenateSenate Floor Amendment No. 2 Assignments Refers to Insurance 5/24/2011SenateSenate Floor Amendment No. 3 Assignments Refers to Insurance 5/24/2011SenateSenate Floor Amendment No. 2 Postponed - Insurance 5/24/2011SenateSenate Floor Amendment No. 3 Recommend Do Adopt Insurance; 007-001-000 5/25/2011SenateRecalled to Second Reading 5/25/2011SenateSenate Floor Amendment No. 3 Adopted; Steans 5/25/2011SenatePlaced on Calendar Order of 3rd Reading 5/25/2011SenateAdded as Alternate Chief Co-Sponsor Sen. Michael Noland 5/25/2011SenateThird Reading - Passed; 057-000-000 5/25/2011SenateSenate Committee Amendment No. 1 Tabled Pursuant to Rule 5-4(a) 5/25/2011SenateSenate Floor Amendment No. 2 Tabled Pursuant to Rule 5-4(a) 5/25/2011HouseArrived in House 5/25/2011HousePlaced on Calendar Order of Concurrence Senate Amendment(s) 3 5/25/2011HouseSenate Floor Amendment No. 3 Motion Filed Concur Rep. Mary E. Flowers 5/25/2011HouseSenate Floor Amendment No. 3 Motion to Concur Referred to Rules Committee 5/29/2011HouseSenate Floor Amendment No. 3 Motion to Concur Recommends Be Adopted Rules Committee; 004-000-000 5/29/2011HouseSenate Floor Amendment No. 3 House Concurs 087-025-000 5/29/2011HousePassed Both Houses 5/29/2011HouseAdded Co-Sponsor Rep. Camille Y. Lilly 6/27/2011HouseSent to the Governor 8/26/2011HouseGovernor Approved 8/26/2011HouseEffective Date August 26, 2011 8/26/2011HousePublic Act . . . . . . . . . 97-0574