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Public Act 094-0866
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| HB5339 Enrolled |
LRB094 16810 LJB 52086 b |
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AN ACT concerning insurance.
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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 |
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
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 |