Public Act 93-0540

HB0081 Enrolled                      LRB093 03479 AMC 03507 b

    AN ACT concerning health care.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  5.   The  Department of Public Health Powers and
Duties Law of the Civil Administrative Code  of  Illinois  is
amended by adding Section 2310-543 as follows:

    (20 ILCS 2310/2310-543 new)
    Sec.   2310-543.  Information   regarding   health   care
services.   With  funds  made available for this purpose, the
Department  may,  in  conjunction  with  other  programs   or
activities  related  to  accessing  medical care, develop and
provide to the public and health  care  patients  information
regarding  the  categories  or  types of health care services
available  and  their  appropriate  use,  paying   particular
attention to seeking care in hospital emergency departments.

    Section  10.   The  Emergency  Medical  Treatment  Act is
amended by changing Section 2 as follows:

    (210 ILCS 70/2 new)
    Sec. 2.  Findings; prohibited terms.
    (a)  The Illinois  General  Assembly  makes  all  of  the
following findings:
         (1)  Hospital  emergency services are not always the
    most appropriate  level  of  care  for  patients  seeking
    unscheduled  medical care or for patients who do not have
    a regular physician who can treat a significant or  acute
    medical  condition not considered critical, debilitating,
    or life-threatening.
         (2)  Hospital emergency rooms are over-utilized  and
    too  often  over-burdened with many injuries or illnesses
    that could  be  managed  in  a  less  intensive  clinical
    setting or physician's office.
         (3)  Over-utilization    of    hospital    emergency
    departments  contributes  to  excess  medical  and health
    insurance costs.
         (4)  The use of the term "urgent" or "emergi-" or  a
    similar  term  in  a facility's posted or advertised name
    may confuse the public and prospective patients regarding
    the type of services offered relative to  those  provided
    by a hospital emergency department.  There is significant
    risk to the public health and safety if persons requiring
    treatment  for  a  critical or life-threatening condition
    inappropriately use such facilities.
         (5)  Many times patients are not  clearly  aware  of
    the  policies  and  procedures of their insurer or health
    plan that must be followed in the use of emergency  rooms
    versus  non-emergent  clinics  and  what rights they have
    under the law in regard to appropriately sought emergency
    care.
         (6)  There is a need  to  more  effectively  educate
    health   care   payers   and  consumers  about  the  most
    appropriate  use  of  the  various  available  levels  of
    medical  care  and  particularly  the  use  of   hospital
    emergency  rooms  and walk-in medical clinics that do not
    require appointments.
    (b)  After the effective date of this amendatory  Act  of
the  93rd  General  Assembly,  no person, facility, or entity
shall hold itself out to the public as an "urgent",  "urgi-",
"emergi-", or "emergent" care center or use any similar term,
as  defined  by  rule,  that  would  give the impression that
emergency medical treatment is  provided  by  the  person  or
entity  or  at  the  facility  unless  the  facility  is  the
emergency room of a facility licensed as a hospital under the
Hospital   Licensing   Act   or  a  facility  licensed  as  a
freestanding emergency center  under  the  Emergency  Medical
Services (EMS) Systems Act.
    (c)  Violation  of  this  Section  constitutes a business
offense with a minimum fine of $5,000 plus $1,000 per day for
a continuing violation, with a maximum of $25,000.
    (d)  The Director of Public Health in  the  name  of  the
people  of the State, through the Attorney General, may bring
an action for an injunction or to  restrain  a  violation  of
this Section or the rules adopted pursuant to this Section or
to enjoin the future operation or maintenance of any facility
in violation of this Section or the rules adopted pursuant to
this Section.
    (e)  The  Department  of  Public Health shall adopt rules
necessary for the implementation of this Section.

    Section 15.  The Managed Care Reform and  Patient  Rights
Act is amended by adding Section 43 as follows:

    (215 ILCS 134/43 new)
    Sec. 43.  Utilization of health care facilities.
    (a)  A health care plan must provide its enrollees with a
description of their rights and responsibilities in obtaining
referrals  to  and  making  appropriate  use  of  health care
facilities when access to their primary care physician is not
readily available.
    (b)  Nothing in this Section is intended  to  affect  the
rights  of  enrollees  or  relieve  a health care plan of its
responsibilities  with  respect  to  the  provision  of   and
coverage  of  emergency services or treatment of an emergency
medical condition, as those terms are defined  by  this  Act,
and  as  those  responsibilities  and  rights  are  otherwise
provided under this Act, especially Section 65 of this Act.

    Section  99.  Effective date.  This Act takes effect upon
becoming law.