| ||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||
1 | AN ACT concerning pharmacists.
| |||||||||||||||||||||||||||||||
2 | Be it enacted by the People of the State of Illinois,
| |||||||||||||||||||||||||||||||
3 | represented in the General Assembly:
| |||||||||||||||||||||||||||||||
4 | Section 5. The Care of Students with Diabetes Act is | |||||||||||||||||||||||||||||||
5 | amended by changing Section 10 as follows:
| |||||||||||||||||||||||||||||||
6 | (105 ILCS 145/10)
| |||||||||||||||||||||||||||||||
7 | Sec. 10. Definitions. As used in this Act:
| |||||||||||||||||||||||||||||||
8 | "Delegated care aide" means a school employee who has | |||||||||||||||||||||||||||||||
9 | agreed to receive training in diabetes care and to assist | |||||||||||||||||||||||||||||||
10 | students in implementing their diabetes care plan and has | |||||||||||||||||||||||||||||||
11 | entered into an agreement with a parent or guardian and the | |||||||||||||||||||||||||||||||
12 | school district or private school.
| |||||||||||||||||||||||||||||||
13 | "Diabetes care plan" means a document that specifies the | |||||||||||||||||||||||||||||||
14 | diabetes-related services needed by a student at school and at | |||||||||||||||||||||||||||||||
15 | school-sponsored activities and identifies the appropriate | |||||||||||||||||||||||||||||||
16 | staff to provide and supervise these services.
| |||||||||||||||||||||||||||||||
17 | "Health care provider" means a physician licensed to | |||||||||||||||||||||||||||||||
18 | practice medicine in all of its branches, advanced practice | |||||||||||||||||||||||||||||||
19 | nurse who has a written agreement with a collaborating | |||||||||||||||||||||||||||||||
20 | physician who authorizes the provision of diabetes care, or a | |||||||||||||||||||||||||||||||
21 | physician assistant who has a written supervision agreement | |||||||||||||||||||||||||||||||
22 | with a supervising physician who authorizes the provision of | |||||||||||||||||||||||||||||||
23 | diabetes care , or a pharmacist licensed to practice pharmacy . |
| |||||||
| |||||||
1 | "Principal" means the principal of the school.
| ||||||
2 | "School" means any primary or secondary public, charter, or | ||||||
3 | private school located in this State.
| ||||||
4 | "School employee" means a person who is employed by a | ||||||
5 | public school district or private school, a person who is | ||||||
6 | employed by a local health department and assigned to a school, | ||||||
7 | or a person who contracts with a school or school district to | ||||||
8 | perform services in connection with a student's diabetes care | ||||||
9 | plan.
This definition must not be interpreted as requiring a | ||||||
10 | school district or private school to hire additional personnel | ||||||
11 | for the sole purpose of serving as a designated care aide.
| ||||||
12 | (Source: P.A. 96-1485, eff. 12-1-10.)
| ||||||
13 | Section 10. The Health Maintenance Organization Act is | ||||||
14 | amended by changing Section 1-2 as follows:
| ||||||
15 | (215 ILCS 125/1-2) (from Ch. 111 1/2, par. 1402)
| ||||||
16 | Sec. 1-2. Definitions. As used in this Act, unless the | ||||||
17 | context otherwise
requires, the following terms shall have the | ||||||
18 | meanings ascribed to them:
| ||||||
19 | (1) "Advertisement" means any printed or published | ||||||
20 | material,
audiovisual material and descriptive literature of | ||||||
21 | the health care plan
used in direct mail, newspapers, | ||||||
22 | magazines, radio scripts, television
scripts, billboards and | ||||||
23 | similar displays; and any descriptive literature or
sales aids | ||||||
24 | of all kinds disseminated by a representative of the health |
| |||||||
| |||||||
1 | care
plan for presentation to the public including, but not | ||||||
2 | limited to, circulars,
leaflets, booklets, depictions, | ||||||
3 | illustrations, form letters and prepared
sales presentations.
| ||||||
4 | (2) "Director" means the Director of Insurance.
| ||||||
5 | (3) "Basic health care services" means emergency care, and | ||||||
6 | inpatient
hospital and physician care, outpatient medical | ||||||
7 | services, mental
health services and care for alcohol and drug | ||||||
8 | abuse, including any
reasonable deductibles and co-payments, | ||||||
9 | all of which are subject to the
limitations described in | ||||||
10 | Section 4-20 of this Act and as determined by the Director | ||||||
11 | pursuant to rule.
| ||||||
12 | (4) "Enrollee" means an individual who has been enrolled in | ||||||
13 | a health
care plan.
| ||||||
14 | (5) "Evidence of coverage" means any certificate, | ||||||
15 | agreement,
or contract issued to an enrollee setting out the | ||||||
16 | coverage to which he is
entitled in exchange for a per capita | ||||||
17 | prepaid sum.
| ||||||
18 | (6) "Group contract" means a contract for health care | ||||||
19 | services which
by its terms limits eligibility to members of a | ||||||
20 | specified group.
| ||||||
21 | (7) "Health care plan" means any arrangement whereby any | ||||||
22 | organization
undertakes to provide or arrange for and pay for | ||||||
23 | or reimburse the
cost of basic health care services, excluding | ||||||
24 | any reasonable deductibles and copayments, from providers | ||||||
25 | selected by
the Health Maintenance Organization and such | ||||||
26 | arrangement
consists of arranging for or the provision of such |
| |||||||
| |||||||
1 | health care services, as
distinguished from mere | ||||||
2 | indemnification against the cost of such services,
except as | ||||||
3 | otherwise authorized by Section 2-3 of this Act,
on a per | ||||||
4 | capita prepaid basis, through insurance or otherwise. A "health
| ||||||
5 | care plan" also includes any arrangement whereby an | ||||||
6 | organization undertakes to
provide or arrange for or pay for or | ||||||
7 | reimburse the cost of any health care
service for persons who | ||||||
8 | are enrolled under Article V of the Illinois Public Aid
Code or | ||||||
9 | under the Children's Health Insurance Program Act through
| ||||||
10 | providers selected by the organization and the arrangement | ||||||
11 | consists of making
provision for the delivery of health care | ||||||
12 | services, as distinguished from mere
indemnification. A | ||||||
13 | "health care plan" also includes any arrangement pursuant
to | ||||||
14 | Section 4-17. Nothing in this definition, however, affects the | ||||||
15 | total
medical services available to persons eligible for | ||||||
16 | medical assistance under the
Illinois Public Aid Code.
| ||||||
17 | (8) "Health care services" means any services included in | ||||||
18 | the furnishing
to any individual of medical , or dental , or | ||||||
19 | pharmacy care, or the hospitalization or
incident to the | ||||||
20 | furnishing of such care or hospitalization as well as the
| ||||||
21 | furnishing to any person of any and all other services for the | ||||||
22 | purpose of
preventing, alleviating, curing or healing human | ||||||
23 | illness or injury.
| ||||||
24 | (9) "Health Maintenance Organization" means any | ||||||
25 | organization formed
under the laws of this or another state to | ||||||
26 | provide or arrange for one or
more health care plans under a |
| |||||||
| |||||||
1 | system which causes any part of the risk of
health care | ||||||
2 | delivery to be borne by the organization or its providers.
| ||||||
3 | (10) "Net worth" means admitted assets, as defined in | ||||||
4 | Section 1-3 of
this Act, minus liabilities.
| ||||||
5 | (11) "Organization" means any insurance company, a | ||||||
6 | nonprofit
corporation authorized under the Dental
Service Plan | ||||||
7 | Act or the Voluntary
Health Services Plans Act,
or a | ||||||
8 | corporation organized under the laws of this or another state | ||||||
9 | for the
purpose of operating one or more health care plans and | ||||||
10 | doing no business other
than that of a Health Maintenance | ||||||
11 | Organization or an insurance company.
"Organization" shall | ||||||
12 | also mean the University of Illinois Hospital as
defined in the | ||||||
13 | University of Illinois Hospital Act or a unit of local | ||||||
14 | government health system operating within a county with a | ||||||
15 | population of 3,000,000 or more.
| ||||||
16 | (12) "Provider" means any physician, hospital facility,
| ||||||
17 | facility licensed under the Nursing Home Care Act, pharmacist, | ||||||
18 | or facility or long-term care facility as those terms are | ||||||
19 | defined in the Nursing Home Care Act or other person which is | ||||||
20 | licensed or otherwise authorized
to furnish health care | ||||||
21 | services and also includes any other entity that
arranges for | ||||||
22 | the delivery or furnishing of health care service.
| ||||||
23 | (13) "Producer" means a person directly or indirectly | ||||||
24 | associated with a
health care plan who engages in solicitation | ||||||
25 | or enrollment.
| ||||||
26 | (14) "Per capita prepaid" means a basis of prepayment by |
| |||||||
| |||||||
1 | which a fixed
amount of money is prepaid per individual or any | ||||||
2 | other enrollment unit to
the Health Maintenance Organization or | ||||||
3 | for health care services which are
provided during a definite | ||||||
4 | time period regardless of the frequency or
extent of the | ||||||
5 | services rendered
by the Health Maintenance Organization, | ||||||
6 | except for copayments and deductibles
and except as provided in | ||||||
7 | subsection (f) of Section 5-3 of this Act.
| ||||||
8 | (15) "Subscriber" means a person who has entered into a | ||||||
9 | contractual
relationship with the Health Maintenance | ||||||
10 | Organization for the provision of
or arrangement of at least | ||||||
11 | basic health care services to the beneficiaries
of such | ||||||
12 | contract.
| ||||||
13 | (Source: P.A. 97-1148, eff. 1-24-13; 98-651, eff. 6-16-14; | ||||||
14 | 98-841, eff. 8-1-14; revised 10-24-14.)
| ||||||
15 | Section 15. The Limited Health Service Organization Act is | ||||||
16 | amended by changing Section 1002 as follows:
| ||||||
17 | (215 ILCS 130/1002) (from Ch. 73, par. 1501-2)
| ||||||
18 | Sec. 1002. Definitions. As used in this Act, unless the | ||||||
19 | context
otherwise requires, the following terms shall have the | ||||||
20 | meanings ascribed
to them:
| ||||||
21 | "Advertisement" means any printed or published material,
| ||||||
22 | audiovisual material and descriptive literature of the limited | ||||||
23 | health care
plan used in direct mail, newspapers, magazines, | ||||||
24 | radio scripts, television
scripts, billboards and similar |
| |||||||
| |||||||
1 | displays; and any descriptive literature or
sales aids of all | ||||||
2 | kinds disseminated by a representative of the limited
health | ||||||
3 | care plan for presentation to the public including, but not | ||||||
4 | limited
to, circulars, leaflets, booklets, depictions, | ||||||
5 | illustrations, form letters
and prepared sales presentations.
| ||||||
6 | "Copayment" means the amount that an enrollee must pay in | ||||||
7 | order to
receive a specific service that is not fully prepaid.
| ||||||
8 | "Director" means the Director of Insurance.
| ||||||
9 | "Enrollee" means an individual who has been enrolled in a | ||||||
10 | limited health care plan.
| ||||||
11 | "Evidence of coverage" means any certificate, agreement or
| ||||||
12 | contract issued to an enrollee setting out the coverage to | ||||||
13 | which that
enrollee is entitled in exchange for a per capita | ||||||
14 | prepaid sum.
| ||||||
15 | "Group contract" means a contract for limited health | ||||||
16 | services
which by its terms limits eligibility to members of a | ||||||
17 | specified group.
| ||||||
18 | "In-plan covered services" means covered limited health | ||||||
19 | services
obtained from providers who are employed by, under | ||||||
20 | contract with, referred
by, or otherwise affiliated with the | ||||||
21 | LHSO and emergency services.
| ||||||
22 | "Limited health care plan" means any arrangement whereby an
| ||||||
23 | organization undertakes to provide or arrange for and, pay for | ||||||
24 | or reimburse
the cost of any limited health services from | ||||||
25 | providers selected by the
limited health service organization | ||||||
26 | and such arrangement consists of
arranging for or the provision |
| |||||||
| |||||||
1 | of such limited health services on a per
capita prepaid basis, | ||||||
2 | as distinguished from mere indemnification against
the cost of | ||||||
3 | such limited services on a per capita prepaid basis through
| ||||||
4 | insurance except as otherwise provided under Section 3009.
| ||||||
5 | "Limited health service" means ambulance care services, | ||||||
6 | dental care
services, vision care services, pharmaceutical | ||||||
7 | services, pharmacist-provided services, clinical laboratory
| ||||||
8 | services, and podiatric care services. Limited health service | ||||||
9 | shall not
include hospital, medical, surgical or emergency | ||||||
10 | services except when those
services are essential to the | ||||||
11 | delivery of the limited health service.
Essential hospital, | ||||||
12 | medical, surgical, or emergency services shall be covered
| ||||||
13 | unless specifically excluded.
| ||||||
14 | "Limited health service organization" (LHSO) means any | ||||||
15 | organization
formed under the laws of this or another state to | ||||||
16 | provide or arrange for
one or more limited health care plans | ||||||
17 | under a system which causes any part
of the risk of limited | ||||||
18 | health care delivery to be borne by the organization
or its | ||||||
19 | providers.
| ||||||
20 | "Net worth" means admitted assets, as defined in Section | ||||||
21 | 1003 of
this Act, minus liabilities.
| ||||||
22 | "Organization" means any insurance company or other | ||||||
23 | corporation
organized under the laws of this or another state | ||||||
24 | for the purpose of
operating one or more limited health care | ||||||
25 | plans and doing no business other
than that of a health | ||||||
26 | maintenance organization or a limited health service
|
| |||||||
| |||||||
1 | organization or an insurance company. Organization does not | ||||||
2 | include (1)
any entity otherwise authorized on the effective | ||||||
3 | date of this Act pursuant
to the laws of this State either to | ||||||
4 | provide any limited health service on a
prepayment basis or to | ||||||
5 | indemnity for any limited health service; nor does
it include | ||||||
6 | (2) any provider or other entity when providing or arranging | ||||||
7 | for
the provision of limited health services pursuant to a | ||||||
8 | contract with a
limited health service organization or with any | ||||||
9 | entity described in (1) of
this definition.
| ||||||
10 | "Out-of-plan covered services" means non-emergency, | ||||||
11 | self-referred
covered limited health services obtained from | ||||||
12 | providers who are not
otherwise employed by, under contract | ||||||
13 | with, or otherwise affiliated with
the LHSO or services | ||||||
14 | obtained without a referral from providers who have
contracted | ||||||
15 | to provide limited health services to the enrollee on behalf of
| ||||||
16 | the limited health care plan.
| ||||||
17 | "Point-of-service product" (POS) means a group contract | ||||||
18 | that includes
both in-plan covered services and out-of-plan | ||||||
19 | covered services as well as a
POS contract in which the risk | ||||||
20 | for out-of-plan covered services is borne
through reinsurance. | ||||||
21 | This term does not apply to indemnity benefits
offered through | ||||||
22 | an LHSO that are underwritten in whole by a licensed
insurance | ||||||
23 | carrier and offered in conjunction with the LHSO benefit | ||||||
24 | package.
| ||||||
25 | "Provider" means any physician, dentist, pharmacist, | ||||||
26 | health facility, or
other person or institution which is duly |
| |||||||
| |||||||
1 | licensed or otherwise authorized
to deliver or furnish limited | ||||||
2 | health services and also includes any other
entity that | ||||||
3 | arranges for the delivery or furnishing of limited health | ||||||
4 | service.
| ||||||
5 | "Per capita prepaid" means a basis of payment by which a | ||||||
6 | fixed
amount of money is prepaid per individual or any other | ||||||
7 | enrollment unit to
the limited health service organization or | ||||||
8 | for limited health services
which are provided during a | ||||||
9 | definite time period regardless of the
frequency or extent of | ||||||
10 | the services rendered, except for copayments of a
fixed amount | ||||||
11 | by the limited health service organization.
| ||||||
12 | "Subscriber" means the person whose employment or other | ||||||
13 | status,
except for family dependency, is the basis for | ||||||
14 | entitlement to limited
health services pursuant to a contract | ||||||
15 | with an organization authorized to
provide or arrange for such | ||||||
16 | services under this Act.
| ||||||
17 | "Uncovered expense" means the cost of limited health | ||||||
18 | services that
are the obligation of a limited health service | ||||||
19 | organization for which an
enrollee may be liable in the event | ||||||
20 | of the insolvency of the organization.
Costs incurred by a | ||||||
21 | provider who has agreed in writing not to bill
enrollees, | ||||||
22 | except for permissible supplemental charges, shall be | ||||||
23 | considered
covered expenses.
| ||||||
24 | (Source: P.A. 87-1079; 88-568, eff. 8-5-94; 88-667, eff. | ||||||
25 | 9-16-94.)
|
| |||||||
| |||||||
1 | Section 20. The Managed Care Reform and Patient Rights Act | ||||||
2 | is amended by changing Section 10 as follows:
| ||||||
3 | (215 ILCS 134/10)
| ||||||
4 | Sec. 10. Definitions . :
| ||||||
5 | "Adverse determination" means a determination by a health | ||||||
6 | care plan under
Section 45 or by a utilization review program | ||||||
7 | under Section
85 that
a health care service is not medically | ||||||
8 | necessary.
| ||||||
9 | "Clinical peer" means a health care professional who is in | ||||||
10 | the same
profession and the same or similar specialty as the | ||||||
11 | health care provider who
typically manages the medical | ||||||
12 | condition, procedures, or treatment under
review.
| ||||||
13 | "Department" means the Department of Insurance.
| ||||||
14 | "Emergency medical condition" means a medical condition | ||||||
15 | manifesting itself by
acute symptoms of sufficient severity | ||||||
16 | (including, but not limited to, severe
pain) such that a | ||||||
17 | prudent
layperson, who possesses an average knowledge of health | ||||||
18 | and medicine, could
reasonably expect the absence of immediate | ||||||
19 | medical attention to result in:
| ||||||
20 | (1) placing the health of the individual (or, with | ||||||
21 | respect to a pregnant
woman, the
health of the woman or her | ||||||
22 | unborn child) in serious jeopardy;
| ||||||
23 | (2) serious
impairment to bodily functions; or
| ||||||
24 | (3) serious dysfunction of any bodily organ
or part.
| ||||||
25 | "Emergency medical screening examination" means a medical |
| |||||||
| |||||||
1 | screening
examination and
evaluation by a physician licensed to | ||||||
2 | practice medicine in all its branches, or
to the extent | ||||||
3 | permitted
by applicable laws, by other appropriately licensed | ||||||
4 | personnel under the
supervision of or in
collaboration with a | ||||||
5 | physician licensed to practice medicine in all its
branches to | ||||||
6 | determine whether
the need for emergency services exists.
| ||||||
7 | "Emergency services" means, with respect to an enrollee of | ||||||
8 | a health care
plan,
transportation services, including but not | ||||||
9 | limited to ambulance services, and
covered inpatient and | ||||||
10 | outpatient hospital services
furnished by a provider
qualified | ||||||
11 | to furnish those services that are needed to evaluate or | ||||||
12 | stabilize an
emergency medical condition. "Emergency services" | ||||||
13 | does not
refer to post-stabilization medical services.
| ||||||
14 | "Enrollee" means any person and his or her dependents | ||||||
15 | enrolled in or covered
by a health care plan.
| ||||||
16 | "Health care plan" means a plan, including, but not limited | ||||||
17 | to, a health maintenance organization, a managed care community | ||||||
18 | network as defined in the Illinois Public Aid Code, or an | ||||||
19 | accountable care entity as defined in the Illinois Public Aid | ||||||
20 | Code that receives capitated payments to cover medical services | ||||||
21 | from the Department of Healthcare and Family Services, that | ||||||
22 | establishes, operates, or maintains a
network of health care | ||||||
23 | providers that has entered into an agreement with the
plan to | ||||||
24 | provide health care services to enrollees to whom the plan has | ||||||
25 | the
ultimate obligation to arrange for the provision of or | ||||||
26 | payment for services
through organizational arrangements for |
| |||||||
| |||||||
1 | ongoing quality assurance,
utilization review programs, or | ||||||
2 | dispute resolution.
Nothing in this definition shall be | ||||||
3 | construed to mean that an independent
practice association or a | ||||||
4 | physician hospital organization that subcontracts
with
a | ||||||
5 | health care plan is, for purposes of that subcontract, a health | ||||||
6 | care plan.
| ||||||
7 | For purposes of this definition, "health care plan" shall | ||||||
8 | not include the
following:
| ||||||
9 | (1) indemnity health insurance policies including | ||||||
10 | those using a contracted
provider network;
| ||||||
11 | (2) health care plans that offer only dental or only | ||||||
12 | vision coverage;
| ||||||
13 | (3) preferred provider administrators, as defined in | ||||||
14 | Section 370g(g) of
the
Illinois Insurance Code;
| ||||||
15 | (4) employee or employer self-insured health benefit | ||||||
16 | plans under the
federal Employee Retirement Income | ||||||
17 | Security Act of 1974;
| ||||||
18 | (5) health care provided pursuant to the Workers' | ||||||
19 | Compensation Act or the
Workers' Occupational Diseases | ||||||
20 | Act; and
| ||||||
21 | (6) not-for-profit voluntary health services plans | ||||||
22 | with health maintenance
organization
authority in | ||||||
23 | existence as of January 1, 1999 that are affiliated with a | ||||||
24 | union
and that
only extend coverage to union members and | ||||||
25 | their dependents.
| ||||||
26 | "Health care professional" means a physician, a registered |
| |||||||
| |||||||
1 | professional
nurse,
a pharmacist, or other individual | ||||||
2 | appropriately licensed or registered
to provide health care | ||||||
3 | services.
| ||||||
4 | "Health care provider" means any physician, pharmacist, | ||||||
5 | hospital facility, facility licensed under the Nursing Home | ||||||
6 | Care Act, long-term care facility as defined in Section 1-113 | ||||||
7 | of the Nursing Home Care Act, or other
person that is licensed | ||||||
8 | or otherwise authorized to deliver health care
services. | ||||||
9 | Nothing in this
Act shall be construed to define Independent | ||||||
10 | Practice Associations or
Physician-Hospital Organizations as | ||||||
11 | health care providers.
| ||||||
12 | "Health care services" means any services included in the | ||||||
13 | furnishing to any
individual of medical or pharmacist care, or | ||||||
14 | the
hospitalization incident to the furnishing of such care, as | ||||||
15 | well as the
furnishing to any person of
any and all other | ||||||
16 | services for the purpose of preventing,
alleviating, curing, or | ||||||
17 | healing human illness or injury including home health
and | ||||||
18 | pharmaceutical services and products.
| ||||||
19 | "Medical director" means a physician licensed in any state | ||||||
20 | to practice
medicine in all its
branches appointed by a health | ||||||
21 | care plan.
| ||||||
22 | "Person" means a corporation, association, partnership,
| ||||||
23 | limited liability company, sole proprietorship, or any other | ||||||
24 | legal entity.
| ||||||
25 | "Pharmacist" has the same meaning as set forth in the | ||||||
26 | Pharmacy Practice Act. |
| |||||||
| |||||||
1 | "Physician" means a person licensed under the Medical
| ||||||
2 | Practice Act of 1987.
| ||||||
3 | "Post-stabilization medical services" means health care | ||||||
4 | services
provided to an enrollee that are furnished in a | ||||||
5 | licensed hospital by a provider
that is qualified to furnish | ||||||
6 | such services, and determined to be medically
necessary and | ||||||
7 | directly related to the emergency medical condition following
| ||||||
8 | stabilization.
| ||||||
9 | "Stabilization" means, with respect to an emergency | ||||||
10 | medical condition, to
provide such medical treatment of the | ||||||
11 | condition as may be necessary to assure,
within reasonable | ||||||
12 | medical probability, that no material deterioration
of the | ||||||
13 | condition is likely to result.
| ||||||
14 | "Utilization review" means the evaluation of the medical | ||||||
15 | necessity,
appropriateness, and efficiency of the use of health | ||||||
16 | care services, procedures,
and facilities.
| ||||||
17 | "Utilization review program" means a program established | ||||||
18 | by a person to
perform utilization review.
| ||||||
19 | (Source: P.A. 98-651, eff. 6-16-14; 98-841, eff. 8-1-14; | ||||||
20 | revised 10-24-14.)
| ||||||
21 | Section 25. The Voluntary Health Services Plans Act is | ||||||
22 | amended by changing Sections 2 and 7 as follows:
| ||||||
23 | (215 ILCS 165/2) (from Ch. 32, par. 596)
| ||||||
24 | Sec. 2. For the purposes of this Act, the following terms |
| |||||||
| |||||||
1 | have the respective
meanings set forth in this section, unless | ||||||
2 | different meanings are plainly
indicated by the context:
| ||||||
3 | (a) "Health Services Plan Corporation" means a corporation | ||||||
4 | organized under
the terms of this Act for the purpose of | ||||||
5 | establishing and operating a voluntary
health services plan and | ||||||
6 | providing other medically related services.
| ||||||
7 | (b) "Voluntary health services plan" means either a plan or | ||||||
8 | system under which
medical, hospital, nursing and relating | ||||||
9 | health services may
be rendered to a subscriber or beneficiary | ||||||
10 | at the expense of a health
services plan corporation, or any | ||||||
11 | contractual arrangement to provide,
either directly or through | ||||||
12 | arrangements with others, dental care services
to subscribers | ||||||
13 | and beneficiaries.
| ||||||
14 | (c) "Subscriber" means a natural person to whom a | ||||||
15 | subscription certificate
has been issued by a health services | ||||||
16 | plan corporation. Persons eligible
under Section 5-2 of the | ||||||
17 | Illinois Public Aid Code may be subscribers if
a written | ||||||
18 | agreement exists, as specified in Section 25 of this Act, | ||||||
19 | between
the Health Services Plan Corporation and the Department | ||||||
20 | of Healthcare and Family Services.
A subscription certificate | ||||||
21 | may be issued to such persons at no cost.
| ||||||
22 | (d) "Beneficiary" means a person designated in a | ||||||
23 | subscription certificate
as one entitled to receive health | ||||||
24 | services.
| ||||||
25 | (e) "Health services" means those services ordinarily | ||||||
26 | rendered by physicians
licensed in Illinois to practice |
| |||||||
| |||||||
1 | medicine in all of its branches, by podiatric physicians
| ||||||
2 | licensed in Illinois to practice podiatric medicine, by | ||||||
3 | dentists and dental
surgeons licensed to practice in Illinois, | ||||||
4 | by nurses registered in Illinois,
by dental hygienists licensed | ||||||
5 | to practice in Illinois, by pharmacists licensed in Illinois to | ||||||
6 | practice pharmacy, and by assistants
and technicians acting | ||||||
7 | under professional supervision; it likewise means
hospital | ||||||
8 | services as usually and customarily rendered in Illinois, and | ||||||
9 | the
compounding and dispensing of drugs and medicines by | ||||||
10 | pharmacists and assistant
pharmacists registered in Illinois.
| ||||||
11 | (f) "Subscription certificate" means a certificate issued | ||||||
12 | to a subscriber
by a health services plan corporation, setting | ||||||
13 | forth the terms and conditions
upon which health services shall | ||||||
14 | be rendered to a subscriber or a beneficiary.
| ||||||
15 | (g) "Physician rendering service for a plan" means a | ||||||
16 | physician licensed
in Illinois to practice medicine in all of | ||||||
17 | its branches who has undertaken
or agreed, upon terms and | ||||||
18 | conditions acceptable both to himself and to the
health | ||||||
19 | services plan corporation involved, to furnish medical service | ||||||
20 | to
the plan's subscribers and beneficiaries.
| ||||||
21 | (h) "Dentist or dental surgeon rendering service for a | ||||||
22 | plan" means a dentist
or dental surgeon licensed in Illinois to | ||||||
23 | practice dentistry or dental surgery
who has undertaken or | ||||||
24 | agreed, upon terms and conditions acceptable both
to himself | ||||||
25 | and to the health services plan corporation involved, to | ||||||
26 | furnish
dental or dental surgical services to the plan's |
| |||||||
| |||||||
1 | subscribers and beneficiaries.
| ||||||
2 | (i) "Director" means the Director of Insurance of the State | ||||||
3 | of Illinois.
| ||||||
4 | (j) "Person" means any of the following: a natural person, | ||||||
5 | corporation,
partnership or unincorporated association.
| ||||||
6 | (k) "Podiatric physician or podiatric surgeon rendering | ||||||
7 | service for a plan" means
any podiatric physician or podiatric | ||||||
8 | surgeon licensed in Illinois to practice podiatry,
who has | ||||||
9 | undertaken or agreed, upon terms and conditions acceptable both
| ||||||
10 | to himself and to the health services plan corporation | ||||||
11 | involved, to furnish
podiatric or podiatric surgical services | ||||||
12 | to the plan's subscribers and beneficiaries.
| ||||||
13 | (l) "Pharmacist rendering service for a plan" means a | ||||||
14 | pharmacist licensed in Illinois to practice pharmacy who has | ||||||
15 | undertaken or agreed, upon terms and conditions acceptable both | ||||||
16 | to the pharmacist and to the health services plan corporation | ||||||
17 | involved, to furnish pharmacy and pharmacist-provided service | ||||||
18 | to the plan's subscribers and beneficiaries. | ||||||
19 | (Source: P.A. 98-214, eff. 8-9-13.)
| ||||||
20 | (215 ILCS 165/7) (from Ch. 32, par. 601)
| ||||||
21 | Sec. 7.
Every physician licensed in Illinois to practice | ||||||
22 | medicine in
all of its branches, every podiatric physician | ||||||
23 | licensed to practice podiatric medicine
in Illinois, every | ||||||
24 | pharmacist licensed to practice pharmacy in Illinois, and every | ||||||
25 | dentist and dental surgeon licensed to
practice in Illinois may |
| |||||||
| |||||||
1 | be eligible to render medical, podiatric , pharmacy, or dental
| ||||||
2 | services respectively, upon such terms and conditions as may be | ||||||
3 | mutually
acceptable to such physician, podiatric physician, | ||||||
4 | pharmacist, dentist or dental surgeon and to the
health | ||||||
5 | services plan corporation involved. Such a corporation shall
| ||||||
6 | impose no restrictions on the physicians, podiatric | ||||||
7 | physicians, pharmacist, dentists , or dental surgeons
who treat | ||||||
8 | its subscribers as to methods of diagnosis or treatment. The
| ||||||
9 | private physician-patient relationship shall be maintained, | ||||||
10 | and
subscribers shall at all times have free choice of any | ||||||
11 | physician, podiatric physician, dentist , pharmacist, or dental | ||||||
12 | surgeon who is rendering service on behalf of the
corporation. | ||||||
13 | All of the records, charts, files and other data of a
health | ||||||
14 | services plan corporation pertaining to the condition of health
| ||||||
15 | of its subscribers and beneficiaries shall be and remain | ||||||
16 | confidential,
and no disclosure of the contents thereof shall | ||||||
17 | be made by the
corporation to any person, except upon the prior | ||||||
18 | written authorization
of the particular subscriber or | ||||||
19 | beneficiary concerned.
| ||||||
20 | (Source: P.A. 98-214, eff. 8-9-13.)
| ||||||
21 | Section 30. The Health Care Services Lien Act is amended by | ||||||
22 | changing Section 5 as follows:
| ||||||
23 | (770 ILCS 23/5)
| ||||||
24 | Sec. 5. Definitions. In this Act:
|
| |||||||
| |||||||
1 | "Health care professional" means any individual in any of | ||||||
2 | the following
license
categories: licensed physician, licensed | ||||||
3 | dentist,
licensed optometrist, licensed naprapath, licensed
| ||||||
4 | clinical
psychologist, or licensed physical therapist , or | ||||||
5 | licensed pharmacist .
| ||||||
6 | "Health care provider" means any entity in any of the | ||||||
7 | following license
categories:
licensed hospital, licensed home | ||||||
8 | health
agency,
licensed ambulatory surgical treatment
center, | ||||||
9 | licensed long-term care facilities, or licensed
emergency | ||||||
10 | medical services personnel , or licensed pharmacy . | ||||||
11 | This amendatory Act of the 94th General Assembly applies to | ||||||
12 | causes of action accruing on or after its effective date.
| ||||||
13 | (Source: P.A. 93-51, eff. 7-1-03; 94-403, eff. 1-1-06.)
| ||||||
14 | Section 99. Effective date. This Act takes effect January | ||||||
15 | 1, 2016.
|