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Public Act 102-0704
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| HB4433 Enrolled | LRB102 23892 BMS 33089 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 Managed Care Reform and Patient Rights Act |
is amended by changing Section 30 as follows:
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(215 ILCS 134/30)
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Sec. 30. Prohibitions.
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(a) No health care plan or its subcontractors may prohibit |
or discourage
health care providers
by contract or policy from
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discussing any health care services and health care providers, |
utilization
review and quality assurance policies, terms and |
conditions of plans and plan
policy with enrollees, |
prospective enrollees, providers, or the public.
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(b) No health care plan by contract, written policy, or |
procedure may
permit or allow an individual or entity to |
dispense a different
drug in place of the drug or brand of drug |
ordered or prescribed without the
express permission of the |
person ordering or prescribing the drug, except as
provided |
under Section 3.14 of the Illinois Food, Drug and Cosmetic |
Act.
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(c) No health care plan or its subcontractors may by |
contract, written
policy, procedure, or otherwise mandate or |
require an enrollee
to substitute his or her participating |
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primary care physician
under the plan during inpatient |
hospitalization, such as with a hospitalist physician licensed |
to practice medicine in all its branches,
without the |
agreement of that enrollee's
participating primary care |
physician. "Participating primary care
physician" for health |
care plans and subcontractors that do not require
coordination |
of care by a primary care physician means the participating
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physician treating the patient. All health care plans shall |
inform enrollees
of any policies, recommendations, or |
guidelines concerning the
substitution of the enrollee's |
primary care physician when hospitalization is
necessary in |
the manner set forth in subsections (d) and (e) of Section 15.
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(d) A health care plan shall apply any third-party |
payments, financial assistance, discount, product vouchers, or |
any other reduction in out-of-pocket expenses made by or on |
behalf of such insured for prescription drugs toward a covered |
individual's deductible, copay, or cost-sharing |
responsibility, or out-of-pocket maximum associated with the |
individual's health insurance. If, under federal law, |
application of this requirement would result in health savings |
account ineligibility under Section 223 of the Internal |
Revenue Code, this requirement applies to health savings |
account-qualified high deductible health plans with respect to |
the deductible of such a plan after the enrollee has satisfied |
the minimum deductible under Section 223, except with respect |
to items or services that are preventive care pursuant to |