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91_HB1410
LRB9104550JSmg
1 AN ACT to amend the Health Maintenance Organization Act
2 by changing Section 4-5.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Health Maintenance Organization Act is
6 amended by changing Section 4-5 as follows:
7 (215 ILCS 125/4-5) (from Ch. 111 1/2, par. 1408.5)
8 Sec. 4-5. Organ Transplants. No contract or evidence of
9 coverage issued by a health maintenance organization that
10 which provides coverage for health care services shall deny
11 reimbursement for an otherwise covered expense incurred for
12 any organ transplantation procedure solely on the basis that
13 such procedure is deemed experimental or investigational
14 unless supported by the determination of the Office of Health
15 Care Technology Assessment within the Agency for Health Care
16 Policy and Research within the federal Department of Health
17 and Human Services that such procedure is either experimental
18 or investigational or that there is insufficient data or
19 experience to determine whether an organ transplantation
20 procedure is clinically acceptable. If a health maintenance
21 organization has made written request, or had one made on its
22 behalf by a national organization, for determination by the
23 Office of Health Care Technology Assessment within the Agency
24 for Health Care Policy and Research within the federal
25 Department of Health and Human Services as to whether a
26 specific organ transplantation procedure is clinically
27 acceptable and said organization fails to respond to such a
28 request within a period of 90 days, the failure to act may be
29 deemed a determination that the procedure is deemed to be
30 experimental or investigational.
31 (Source: P.A. 87-218.)