Rep. Gregory Harris
Filed: 4/9/2019
 
 


 




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1
AMENDMENT TO HOUSE BILL 465




2 AMENDMENT NO. ______. Amend House Bill 465, AS AMENDED, by 
3replacing everything after the enacting clause with the 
4following:


5 "Section 1. The Freedom of Information Act is amended by 
6changing Sections 7 and 7.5 as follows:

7 (5 ILCS 140/7) (from Ch. 116, par. 207)
8 Sec. 7. Exemptions.

9 (1) When a request is made to inspect or copy a public 
10record that contains information that is exempt from disclosure 
11under this Section, but also contains information that is not 
12exempt from disclosure, the public body may elect to redact the 
13information that is exempt. The public body shall make the 
14remaining information available for inspection and copying. 
15Subject to this requirement, the following shall be exempt from 
16inspection and copying:


 
 
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1  (a) Information specifically prohibited from 
2 disclosure by federal or
State law or rules and regulations 
3 implementing federal or State law.


4  (b) Private information, unless disclosure is required 
5 by another provision of this Act, a State or federal law or 
6 a court order. 
7  (b-5) Files, documents, and other data or databases 
8 maintained by one or more law enforcement agencies and 
9 specifically designed to provide information to one or more 
10 law enforcement agencies regarding the physical or mental 
11 status of one or more individual subjects. 
12  (c) Personal information contained within public 
13 records, the disclosure of which would constitute a clearly

14 unwarranted invasion of personal privacy, unless the 
15 disclosure is
consented to in writing by the individual 
16 subjects of the information. "Unwarranted invasion of 
17 personal privacy" means the disclosure of information that 
18 is highly personal or objectionable to a reasonable person 
19 and in which the subject's right to privacy outweighs any 
20 legitimate public interest in obtaining the information. 
21 The
disclosure of information that bears on the public 
22 duties of public
employees and officials shall not be 
23 considered an invasion of personal
privacy.


24  (d) Records in the possession of any public body 
25 created in the course of administrative enforcement

26 proceedings, and any law enforcement or correctional 
 
 
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1 agency for
law enforcement purposes,
but only to the extent 
2 that disclosure would:


3   (i) interfere with pending or actually and 
4 reasonably contemplated
law enforcement proceedings 
5 conducted by any law enforcement or correctional

6 agency that is the recipient of the request;


7   (ii) interfere with active administrative 
8 enforcement proceedings
conducted by the public body 
9 that is the recipient of the request;


10   (iii) create a substantial likelihood that a 
11 person will be deprived of a fair trial or an impartial 
12 hearing;


13   (iv) unavoidably disclose the identity of a 
14 confidential source, confidential information 
15 furnished only by the confidential source, or persons 
16 who file complaints with or provide information to 
17 administrative, investigative, law enforcement, or 
18 penal agencies; except that the identities of 
19 witnesses to traffic accidents, traffic accident 
20 reports, and rescue reports shall be provided by 
21 agencies of local government, except when disclosure 
22 would interfere with an active criminal investigation 
23 conducted by the agency that is the recipient of the 
24 request;


25   (v) disclose unique or specialized investigative 
26 techniques other than
those generally used and known or 
 
 
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1 disclose internal documents of
correctional agencies 
2 related to detection, observation or investigation of

3 incidents of crime or misconduct, and disclosure would 
4 result in demonstrable harm to the agency or public 
5 body that is the recipient of the request;


6   (vi) endanger the life or physical safety of law 
7 enforcement personnel
or any other person; or


8   (vii) obstruct an ongoing criminal investigation 
9 by the agency that is the recipient of the request.


10  (d-5) A law enforcement record created for law 
11 enforcement purposes and contained in a shared electronic 
12 record management system if the law enforcement agency that 
13 is the recipient of the request did not create the record, 
14 did not participate in or have a role in any of the events 
15 which are the subject of the record, and only has access to 
16 the record through the shared electronic record management 
17 system. 
18  (e) Records that relate to or affect the security of 
19 correctional
institutions and detention facilities.


20  (e-5) Records requested by persons committed to the 
21 Department of Corrections, Department of Human Services 
22 Division of Mental Health, or a county jail if those 
23 materials are available in the library of the correctional 
24 institution or facility or jail where the inmate is 
25 confined. 
26  (e-6) Records requested by persons committed to the 
 
 
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1 Department of Corrections, Department of Human Services 
2 Division of Mental Health, or a county jail if those 
3 materials include records from staff members' personnel 
4 files, staff rosters, or other staffing assignment 
5 information. 
6  (e-7) Records requested by persons committed to the 
7 Department of Corrections or Department of Human Services 
8 Division of Mental Health if those materials are available 
9 through an administrative request to the Department of 
10 Corrections or Department of Human Services Division of 
11 Mental Health. 
12  (e-8) Records requested by a person committed to the 
13 Department of Corrections, Department of Human Services 
14 Division of Mental Health, or a county jail, the disclosure 
15 of which would result in the risk of harm to any person or 
16 the risk of an escape from a jail or correctional 
17 institution or facility.
18  (e-9) Records requested by a person in a county jail or 
19 committed to the Department of Corrections or Department of 
20 Human Services Division of Mental Health, containing 
21 personal information pertaining to the person's victim or 
22 the victim's family, including, but not limited to, a 
23 victim's home address, home telephone number, work or 
24 school address, work telephone number, social security 
25 number, or any other identifying information, except as may 
26 be relevant to a requester's current or potential case or 
 
 
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1 claim. 
2  (e-10) Law enforcement records of other persons 
3 requested by a person committed to the Department of 
4 Corrections, Department of Human Services Division of 
5 Mental Health, or a county jail, including, but not limited 
6 to, arrest and booking records, mug shots, and crime scene 
7 photographs, except as these records may be relevant to the 
8 requester's current or potential case or claim. 
9  (f) Preliminary drafts, notes, recommendations, 
10 memoranda and other
records in which opinions are 
11 expressed, or policies or actions are
formulated, except 
12 that a specific record or relevant portion of a
record 
13 shall not be exempt when the record is publicly cited
and 
14 identified by the head of the public body. The exemption 
15 provided in
this paragraph (f) extends to all those records 
16 of officers and agencies
of the General Assembly that 
17 pertain to the preparation of legislative
documents.


18  (g) Trade secrets and commercial or financial 
19 information obtained from
a person or business where the 
20 trade secrets or commercial or financial information are 
21 furnished under a claim that they are
proprietary, 
22 privileged or confidential, and that disclosure of the 
23 trade
secrets or commercial or financial information would 
24 cause competitive harm to the person or business, and only 
25 insofar as the claim directly applies to the records 
26 requested.
 
 
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1  The information included under this exemption includes 
2 all trade secrets and commercial or financial information 
3 obtained by a public body, including a public pension fund, 
4 from a private equity fund or a privately held company 
5 within the investment portfolio of a private equity fund as 
6 a result of either investing or evaluating a potential 
7 investment of public funds in a private equity fund. The 
8 exemption contained in this item does not apply to the 
9 aggregate financial performance information of a private 
10 equity fund, nor to the identity of the fund's managers or 
11 general partners. The exemption contained in this item does 
12 not apply to the identity of a privately held company 
13 within the investment portfolio of a private equity fund, 
14 unless the disclosure of the identity of a privately held 
15 company may cause competitive harm.
16  Nothing contained in this
paragraph (g) shall be 
17 construed to prevent a person or business from
consenting 
18 to disclosure.


19  (h) Proposals and bids for any contract, grant, or 
20 agreement, including
information which if it were 
21 disclosed would frustrate procurement or give
an advantage 
22 to any person proposing to enter into a contractor 
23 agreement
with the body, until an award or final selection 
24 is made. Information
prepared by or for the body in 
25 preparation of a bid solicitation shall be
exempt until an 
26 award or final selection is made.


 
 
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1  (i) Valuable formulae,
computer geographic systems,

2 designs, drawings and research data obtained or
produced by 
3 any public body when disclosure could reasonably be 
4 expected to
produce private gain or public loss.
The 
5 exemption for "computer geographic systems" provided in 
6 this paragraph
(i) does not extend to requests made by news 
7 media as defined in Section 2 of
this Act when the 
8 requested information is not otherwise exempt and the only

9 purpose of the request is to access and disseminate 
10 information regarding the
health, safety, welfare, or 
11 legal rights of the general public.


12  (j) The following information pertaining to 
13 educational matters:
14   (i) test questions, scoring keys and other 
15 examination data used to
administer an academic 
16 examination;


17   (ii) information received by a primary or 
18 secondary school, college, or university under its 
19 procedures for the evaluation of faculty members by 
20 their academic peers; 
21   (iii) information concerning a school or 
22 university's adjudication of student disciplinary 
23 cases, but only to the extent that disclosure would 
24 unavoidably reveal the identity of the student; and
25   (iv) course materials or research materials used 
26 by faculty members. 
 
 
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1  (k) Architects' plans, engineers' technical 
2 submissions, and
other
construction related technical 
3 documents for
projects not constructed or developed in 
4 whole or in part with public funds
and the same for 
5 projects constructed or developed with public funds, 
6 including but not limited to power generating and 
7 distribution stations and other transmission and 
8 distribution facilities, water treatment facilities, 
9 airport facilities, sport stadiums, convention centers, 
10 and all government owned, operated, or occupied buildings, 
11 but
only to the extent
that disclosure would compromise 
12 security.


13  (l) Minutes of meetings of public bodies closed to the

14 public as provided in the Open Meetings Act until the 
15 public body
makes the minutes available to the public under 
16 Section 2.06 of the Open
Meetings Act.


17  (m) Communications between a public body and an 
18 attorney or auditor
representing the public body that would 
19 not be subject to discovery in
litigation, and materials 
20 prepared or compiled by or for a public body in

21 anticipation of a criminal, civil or administrative 
22 proceeding upon the
request of an attorney advising the 
23 public body, and materials prepared or
compiled with 
24 respect to internal audits of public bodies.


25  (n) Records relating to a public body's adjudication of 
26 employee grievances or disciplinary cases; however, this 
 
 
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1 exemption shall not extend to the final outcome of cases in 
2 which discipline is imposed.


3  (o) Administrative or technical information associated 
4 with automated
data processing operations, including but 
5 not limited to software,
operating protocols, computer 
6 program abstracts, file layouts, source
listings, object 
7 modules, load modules, user guides, documentation

8 pertaining to all logical and physical design of 
9 computerized systems,
employee manuals, and any other 
10 information that, if disclosed, would
jeopardize the 
11 security of the system or its data or the security of

12 materials exempt under this Section.


13  (p) Records relating to collective negotiating matters

14 between public bodies and their employees or 
15 representatives, except that
any final contract or 
16 agreement shall be subject to inspection and copying.


17  (q) Test questions, scoring keys, and other 
18 examination data used to determine the qualifications of an 
19 applicant for a license or employment.


20  (r) The records, documents, and information relating 
21 to real estate
purchase negotiations until those 
22 negotiations have been completed or
otherwise terminated. 
23 With regard to a parcel involved in a pending or
actually 
24 and reasonably contemplated eminent domain proceeding 
25 under the Eminent Domain Act, records, documents and

26 information relating to that parcel shall be exempt except 
 
 
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1 as may be
allowed under discovery rules adopted by the 
2 Illinois Supreme Court. The
records, documents and 
3 information relating to a real estate sale shall be
exempt 
4 until a sale is consummated.


5  (s) Any and all proprietary information and records 
6 related to the
operation of an intergovernmental risk 
7 management association or
self-insurance pool or jointly 
8 self-administered health and accident
cooperative or pool.

9 Insurance or self insurance (including any 
10 intergovernmental risk management association or self 
11 insurance pool) claims, loss or risk management 
12 information, records, data, advice or communications. 

13  (t) Information contained in or related to 
14 examination, operating, or
condition reports prepared by, 
15 on behalf of, or for the use of a public
body responsible 
16 for the regulation or supervision of financial

17 institutions, or insurance companies, or pharmacy benefit 
18 managers, unless disclosure is otherwise
required by State 
19 law.


20  (u) Information that would disclose
or might lead to 
21 the disclosure of
secret or confidential information, 
22 codes, algorithms, programs, or private
keys intended to be 
23 used to create electronic or digital signatures under the

24 Electronic Commerce Security Act.


25  (v) Vulnerability assessments, security measures, and 
26 response policies
or plans that are designed to identify, 
 
 
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1 prevent, or respond to potential
attacks upon a community's 
2 population or systems, facilities, or installations,
the 
3 destruction or contamination of which would constitute a 
4 clear and present
danger to the health or safety of the 
5 community, but only to the extent that
disclosure could 
6 reasonably be expected to jeopardize the effectiveness of 
7 the
measures or the safety of the personnel who implement 
8 them or the public.
Information exempt under this item may 
9 include such things as details
pertaining to the 
10 mobilization or deployment of personnel or equipment, to 
11 the
operation of communication systems or protocols, or to 
12 tactical operations.


13  (w) (Blank). 
14  (x) Maps and other records regarding the location or 
15 security of generation, transmission, distribution, 
16 storage, gathering,
treatment, or switching facilities 
17 owned by a utility, by a power generator, or by the 
18 Illinois Power Agency.


19  (y) Information contained in or related to proposals, 
20 bids, or negotiations related to electric power 
21 procurement under Section 1-75 of the Illinois Power Agency 
22 Act and Section 16-111.5 of the Public Utilities Act that 
23 is determined to be confidential and proprietary by the 
24 Illinois Power Agency or by the Illinois Commerce 
25 Commission.

26  (z) Information about students exempted from 
 
 
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1 disclosure under Sections 10-20.38 or 34-18.29 of the 
2 School Code, and information about undergraduate students 
3 enrolled at an institution of higher education exempted 
4 from disclosure under Section 25 of the Illinois Credit 
5 Card Marketing Act of 2009. 
6  (aa) Information the disclosure of which is
exempted 
7 under the Viatical Settlements Act of 2009.

8  (bb) Records and information provided to a mortality 
9 review team and records maintained by a mortality review 
10 team appointed under the Department of Juvenile Justice 
11 Mortality Review Team Act. 
12  (cc) Information regarding interments, entombments, or 
13 inurnments of human remains that are submitted to the 
14 Cemetery Oversight Database under the Cemetery Care Act or 
15 the Cemetery Oversight Act, whichever is applicable.
16  (dd) Correspondence and records (i) that may not be 
17 disclosed under Section 11-9 of the Illinois Public Aid 
18 Code or (ii) that pertain to appeals under Section 11-8 of 
19 the Illinois Public Aid Code. 
20  (ee) The names, addresses, or other personal 
21 information of persons who are minors and are also 
22 participants and registrants in programs of park 
23 districts, forest preserve districts, conservation 
24 districts, recreation agencies, and special recreation 
25 associations.
26  (ff) The names, addresses, or other personal 
 
 
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1 information of participants and registrants in programs of 
2 park districts, forest preserve districts, conservation 
3 districts, recreation agencies, and special recreation 
4 associations where such programs are targeted primarily to 
5 minors.
6  (gg) Confidential information described in Section 
7 1-100 of the Illinois Independent Tax Tribunal Act of 2012. 
8  (hh) The report submitted to the State Board of 
9 Education by the School Security and Standards Task Force 
10 under item (8) of subsection (d) of Section 2-3.160 of the 
11 School Code and any information contained in that report. 
12  (ii) Records requested by persons committed to or 
13 detained by the Department of Human Services under the 
14 Sexually Violent Persons Commitment Act or committed to the 
15 Department of Corrections under the Sexually Dangerous 
16 Persons Act if those materials: (i) are available in the 
17 library of the facility where the individual is confined; 
18 (ii) include records from staff members' personnel files, 
19 staff rosters, or other staffing assignment information; 
20 or (iii) are available through an administrative request to 
21 the Department of Human Services or the Department of 
22 Corrections.
23  (jj) Confidential information described in Section 
24 5-535 of the Civil Administrative Code of Illinois. 
25 (1.5) Any information exempt from disclosure under the 
26Judicial Privacy Act shall be redacted from public records 
 
 
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1prior to disclosure under this Act. 
2 (2) A public record that is not in the possession of a 
3public body but is in the possession of a party with whom the 
4agency has contracted to perform a governmental function on 
5behalf of the public body, and that directly relates to the 
6governmental function and is not otherwise exempt under this 
7Act, shall be considered a public record of the public body, 
8for purposes of this Act. 
9 (3) This Section does not authorize withholding of 
10information or limit the
availability of records to the public, 
11except as stated in this Section or
otherwise provided in this 
12Act.


13(Source: P.A. 99-298, eff. 8-6-15; 99-346, eff. 1-1-16; 99-642, 
14eff. 7-28-16; 100-26, eff. 8-4-17; 100-201, eff. 8-18-17; 
15100-732, eff. 8-3-18.)

16 (5 ILCS 140/7.5)
17 Sec. 7.5. Statutory exemptions. To the extent provided for 
18by the statutes referenced below, the following shall be exempt 
19from inspection and copying:
20  (a) All information determined to be confidential 
21 under Section 4002 of the Technology Advancement and 
22 Development Act.
23  (b) Library circulation and order records identifying 
24 library users with specific materials under the Library 
25 Records Confidentiality Act.
 
 
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1  (c) Applications, related documents, and medical 
2 records received by the Experimental Organ Transplantation 
3 Procedures Board and any and all documents or other records 
4 prepared by the Experimental Organ Transplantation 
5 Procedures Board or its staff relating to applications it 
6 has received.
7  (d) Information and records held by the Department of 
8 Public Health and its authorized representatives relating 
9 to known or suspected cases of sexually transmissible 
10 disease or any information the disclosure of which is 
11 restricted under the Illinois Sexually Transmissible 
12 Disease Control Act.
13  (e) Information the disclosure of which is exempted 
14 under Section 30 of the Radon Industry Licensing Act.
15  (f) Firm performance evaluations under Section 55 of 
16 the Architectural, Engineering, and Land Surveying 
17 Qualifications Based Selection Act.
18  (g) Information the disclosure of which is restricted 
19 and exempted under Section 50 of the Illinois Prepaid 
20 Tuition Act.
21  (h) Information the disclosure of which is exempted 
22 under the State Officials and Employees Ethics Act, and 
23 records of any lawfully created State or local inspector 
24 general's office that would be exempt if created or 
25 obtained by an Executive Inspector General's office under 
26 that Act.
 
 
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1  (i) Information contained in a local emergency energy 
2 plan submitted to a municipality in accordance with a local 
3 emergency energy plan ordinance that is adopted under 
4 Section 11-21.5-5 of the Illinois Municipal Code.
5  (j) Information and data concerning the distribution 
6 of surcharge moneys collected and remitted by carriers 
7 under the Emergency Telephone System Act.
8  (k) Law enforcement officer identification information 
9 or driver identification information compiled by a law 
10 enforcement agency or the Department of Transportation 
11 under Section 11-212 of the Illinois Vehicle Code.
12  (l) Records and information provided to a residential 
13 health care facility resident sexual assault and death 
14 review team or the Executive Council under the Abuse 
15 Prevention Review Team Act.
16  (m) Information provided to the predatory lending 
17 database created pursuant to Article 3 of the Residential 
18 Real Property Disclosure Act, except to the extent 
19 authorized under that Article.
20  (n) Defense budgets and petitions for certification of 
21 compensation and expenses for court appointed trial 
22 counsel as provided under Sections 10 and 15 of the Capital 
23 Crimes Litigation Act. This subsection (n) shall apply 
24 until the conclusion of the trial of the case, even if the 
25 prosecution chooses not to pursue the death penalty prior 
26 to trial or sentencing.
 
 
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1  (o) Information that is prohibited from being 
2 disclosed under Section 4 of the Illinois Health and 
3 Hazardous Substances Registry Act.
4  (p) Security portions of system safety program plans, 
5 investigation reports, surveys, schedules, lists, data, or 
6 information compiled, collected, or prepared by or for the 
7 Regional Transportation Authority under Section 2.11 of 
8 the Regional Transportation Authority Act or the St. Clair 
9 County Transit District under the Bi-State Transit Safety 
10 Act. 
11  (q) Information prohibited from being disclosed by the 
12 Personnel Record Records Review Act. 
13  (r) Information prohibited from being disclosed by the 
14 Illinois School Student Records Act. 
15  (s) Information the disclosure of which is restricted 
16 under Section 5-108 of the Public Utilities Act. 

17  (t) All identified or deidentified health information 
18 in the form of health data or medical records contained in, 
19 stored in, submitted to, transferred by, or released from 
20 the Illinois Health Information Exchange, and identified 
21 or deidentified health information in the form of health 
22 data and medical records of the Illinois Health Information 
23 Exchange in the possession of the Illinois Health 
24 Information Exchange Authority due to its administration 
25 of the Illinois Health Information Exchange. The terms 
26 "identified" and "deidentified" shall be given the same 
 
 
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1 meaning as in the Health Insurance Portability and 
2 Accountability Act of 1996, Public Law 104-191, or any 
3 subsequent amendments thereto, and any regulations 
4 promulgated thereunder. 
5  (u) Records and information provided to an independent 
6 team of experts under the Developmental Disability and 
7 Mental Health Safety Act (also known as Brian's Law). 
8  (v) Names and information of people who have applied 
9 for or received Firearm Owner's Identification Cards under 
10 the Firearm Owners Identification Card Act or applied for 
11 or received a concealed carry license under the Firearm 
12 Concealed Carry Act, unless otherwise authorized by the 
13 Firearm Concealed Carry Act; and databases under the 
14 Firearm Concealed Carry Act, records of the Concealed Carry 
15 Licensing Review Board under the Firearm Concealed Carry 
16 Act, and law enforcement agency objections under the 
17 Firearm Concealed Carry Act. 
18  (w) Personally identifiable information which is 
19 exempted from disclosure under subsection (g) of Section 
20 19.1 of the Toll Highway Act.
21  (x) Information which is exempted from disclosure 
22 under Section 5-1014.3 of the Counties Code or Section 
23 8-11-21 of the Illinois Municipal Code. 
24  (y) Confidential information under the Adult 
25 Protective Services Act and its predecessor enabling 
26 statute, the Elder Abuse and Neglect Act, including 
 
 
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1 information about the identity and administrative finding 
2 against any caregiver of a verified and substantiated 
3 decision of abuse, neglect, or financial exploitation of an 
4 eligible adult maintained in the Registry established 
5 under Section 7.5 of the Adult Protective Services Act. 
6  (z) Records and information provided to a fatality 
7 review team or the Illinois Fatality Review Team Advisory 
8 Council under Section 15 of the Adult Protective Services 
9 Act. 
10  (aa) Information which is exempted from disclosure 
11 under Section 2.37 of the Wildlife Code. 
12  (bb) Information which is or was prohibited from 
13 disclosure by the Juvenile Court Act of 1987. 
14  (cc) Recordings made under the Law Enforcement 
15 Officer-Worn Body Camera Act, except to the extent 
16 authorized under that Act.
17  (dd) Information that is prohibited from being 
18 disclosed under Section 45 of the Condominium and Common 
19 Interest Community Ombudsperson Act. 
20  (ee) Information that is exempted from disclosure 
21 under Section 30.1 of the Pharmacy Practice Act. 
22  (ff) Information that is exempted from disclosure 
23 under the Revised Uniform Unclaimed Property Act. 
24  (gg) Information that is prohibited from being 
25 disclosed under Section 7-603.5 of the Illinois Vehicle 
26 Code. 
 
 
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1  (hh) Records that are exempt from disclosure under 
2 Section 1A-16.7 of the Election Code. 
3  (ii) Information which is exempted from disclosure 
4 under Section 2505-800 of the Department of Revenue Law of 
5 the Civil Administrative Code of Illinois. 
6  (jj) Information and reports that are required to be 
7 submitted to the Department of Labor by registering day and 
8 temporary labor service agencies but are exempt from 
9 disclosure under subsection (a-1) of Section 45 of the Day 
10 and Temporary Labor Services Act. 
11  (kk) Information prohibited from disclosure under the 
12 Seizure and Forfeiture Reporting Act. 
13  (ll) Information the disclosure of which is restricted 
14 and exempted under Section 5-30.8 of the Illinois Public 
15 Aid Code. 
16  (mm) (ll) Records that are exempt from disclosure under 
17 Section 4.2 of the Crime Victims Compensation Act. 
18  (nn) (ll) Information that is exempt from disclosure 
19 under Section 70 of the Higher Education Student Assistance 
20 Act. 
21  (oo) Information that is exempt from disclosure under 
22 subsections (f) and (j) of Section 5-36 of the Illinois 
23 Public Aid Code. 
24(Source: P.A. 99-78, eff. 7-20-15; 99-298, eff. 8-6-15; 99-352, 
25eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16; 
2699-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; 
 
 
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1100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. 
28-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517, 
3eff. 6-1-18; 100-646, eff. 7-27-18; 100-690, eff. 1-1-19; 
4100-863, eff. 8-14-18; 100-887, eff. 8-14-18; revised 
510-12-18.)

6 Section 5. The State Employees Group Insurance Act of 1971 
7is amended by changing Section 6.11 as follows:



8 (5 ILCS 375/6.11)

9 (Text of Section after amendment by P.A. 100-1170)
10 Sec. 6.11. Required health benefits; Illinois Insurance 
11Code
requirements. The program of health
benefits shall provide 
12the post-mastectomy care benefits required to be covered
by a 
13policy of accident and health insurance under Section 356t of 
14the Illinois
Insurance Code. The program of health benefits 
15shall provide the coverage
required under Sections 356g, 
16356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, 
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 
18356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 
19and 356z.32 of the
Illinois Insurance Code.
The program of 
20health benefits must comply with Sections 155.22a, 155.37, 
21355b, 356z.19, 370c, and 370c.1, and Article XXXIIB of the

22Illinois Insurance Code. The Department of Insurance shall 
23enforce the requirements of this Section with respect to 
24Sections 370c and 370c.1 of the Illinois Insurance Code; all 
 
 
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1other requirements of this Section shall be enforced by the 
2Department of Central Management Services.

3 Rulemaking authority to implement Public Act 95-1045, if 
4any, is conditioned on the rules being adopted in accordance 
5with all provisions of the Illinois Administrative Procedure 
6Act and all rules and procedures of the Joint Committee on 
7Administrative Rules; any purported rule not so adopted, for 
8whatever reason, is unauthorized. 
9(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; 
10100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. 
111-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 
12100-1170, eff. 6-1-19.)

13 Section 10. The Illinois Insurance Code is amended by 
14adding Article XXXIIB as follows:

15 (215 ILCS 5/Art. XXXIIB heading new)
16
ARTICLE XXXIIB.  PHARMACY BENEFIT MANAGERS


17 (215 ILCS 5/513b1 new)
18 Sec. 513b1. Pharmacy benefit manager contracts.
19 (a) As used in this Section: 
20 "Biological product" has the meaning ascribed to that term 
21in Section 19.5 of the Pharmacy Practice Act. 
22 "Maximum allowable cost" means the maximum amount that a 
23pharmacy benefit manager will reimburse a pharmacy for the cost 
 
 
10100HB0465ham002- 24 -LRB101 03398 KTG 59484 a


1of a drug. 
2 "Maximum allowable cost list" means a list of drugs for 
3which a maximum allowable cost has been established by a 
4pharmacy benefit manager. 
5 "Pharmacy benefit manager" means a person, business, or 
6entity, including a wholly or partially owned or controlled 
7subsidiary of a pharmacy benefit manager, that provides claims 
8processing services or other prescription drug or device 
9services, or both, for health benefit plans. 
10 "Retail price" means the price an individual without 
11prescription drug coverage would pay at a retail pharmacy, not 
12including a pharmacist dispensing fee. 
13 (b) A contract between a health insurer and a pharmacy 
14benefit manager must require that the pharmacy benefit manager: 
15  (1) Update maximum allowable cost pricing information 
16 at least every 7 calendar days. 
17  (2) Maintain a process that will, in a timely manner, 
18 eliminate drugs from maximum allowable cost lists or modify 
19 drug prices to remain consistent with changes in pricing 
20 data used in formulating maximum allowable cost prices and 
21 product availability. 
22  (3) Provide access to its maximum allowable cost list 
23 to each pharmacy or pharmacy services administrative 
24 organization subject to the maximum allowable cost list. 
25 Access may include a real-time pharmacy website portal to 
26 be able to view the maximum allowable cost list. As used in 
 
 
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1 this Section, "pharmacy services administrative 
2 organization" means an entity operating within the State 
3 that contracts with independent pharmacies to conduct 
4 business on their behalf with third-party payers. A 
5 pharmacy services administrative organization may provide 
6 administrative services to pharmacies and negotiate and 
7 enter into contracts with third-party payers or pharmacy 
8 benefit managers on behalf of pharmacies. 
9  (4) Provide a process by which a contracted pharmacy 
10 can appeal the provider's reimbursement for a drug subject 
11 to maximum allowable cost pricing. The appeals process 
12 must, at a minimum, include the following: 
13   (A) A requirement that a contracted pharmacy has 14 
14 calendar days after the applicable fill date to appeal 
15 a maximum allowable cost if the reimbursement for the 
16 drug is less than the net amount that the network 
17 provider paid to the supplier of the drug. 
18   (B) A requirement that a pharmacy benefit manager 
19 must respond to a challenge within 14 calendar days of 
20 the contracted pharmacy making the claim for which the 
21 appeal has been submitted.
22   (C) A telephone number and e-mail address or 
23 website to network providers, at which the provider can 
24 contact the pharmacy benefit manager to process and 
25 submit an appeal.
26   (D) A requirement that, if an appeal is denied, the 
 
 
10100HB0465ham002- 26 -LRB101 03398 KTG 59484 a


1 pharmacy benefit manager must provide the reason for 
2 the denial and the name and the national drug code 
3 number from national or regional wholesalers.
4   (E) A requirement that, if an appeal is sustained, 
5 the pharmacy benefit manager must make an adjustment in 
6 the drug price effective the date the challenge is 
7 resolved and make the adjustment applicable to all 
8 similarly situated network pharmacy providers, as 
9 determined by the managed care organization or 
10 pharmacy benefit manager. 
11  (5) Allow a plan sponsor contracting with a pharmacy 
12 benefit manager an annual right to audit compliance with 
13 the terms of the contract by the pharmacy benefit manager, 
14 including, but not limited to, full disclosure of any and 
15 all rebate amounts secured, whether product specific or 
16 generalized rebates, that were provided to the pharmacy 
17 benefit manager by a pharmaceutical manufacturer.
18  (6) Allow a plan sponsor contracting with a pharmacy 
19 benefit manager to request that the pharmacy benefit 
20 manager disclose the actual amounts paid by the pharmacy 
21 benefit manager to the pharmacy.
22  (7) Provide notice to the party contracting with the 
23 pharmacy benefit manager of any consideration that the 
24 pharmacy benefit manager receives from the manufacturer 
25 for dispense as written prescriptions once a generic or 
26 biologically similar product becomes available. 
 
 
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1 (c) In order to place a particular prescription drug on a 
2maximum allowable cost list, the pharmacy benefit manager must, 
3at a minimum, ensure that: 
4  (1) if the drug is a generically equivalent drug, it is 
5 listed as therapeutically equivalent and pharmaceutically 
6 equivalent "A" or "B" rated in the United States Food and 
7 Drug Administration's most recent version of the "Orange 
8 Book" or have an NR or NA rating by Medi-Span, Gold 
9 Standard, or a similar rating by a nationally recognized 
10 reference; 
11  (2) the drug is available for purchase by each pharmacy 
12 in the State from national or regional wholesalers 
13 operating in Illinois; and 
14  (3) the drug is not obsolete. 
15 (d) A pharmacy benefit manager is prohibited from limiting 
16a pharmacist's ability to disclose whether the cost-sharing 
17obligation exceeds the retail price for a covered prescription 
18drug, and the availability of a more affordable alternative 
19drug, if one is available in accordance with Section 42 of the 
20Pharmacy Practice Act. 
21 (e) A health insurer or pharmacy benefit manager shall not 
22require an insured to make a payment for a prescription drug at 
23the point of sale in an amount that exceeds the lesser of: 
24  (1) the applicable cost-sharing amount; or
25  (2) the retail price of the drug in the absence of 
26 prescription drug coverage. 
 
 
10100HB0465ham002- 28 -LRB101 03398 KTG 59484 a


1 (f) This Section applies to contracts entered into or 
2renewed on or after July 1, 2020. 
3 (g) This Section applies to any group or individual policy 
4of accident and health insurance or managed care plan that 
5provides coverage for prescription drugs and that is amended, 
6delivered, issued, or renewed on or after July 1, 2020. 

7 (215 ILCS 5/513b2 new)
8 Sec. 513b2. Licensure requirements.
9 (a) Beginning on July 1, 2020, to conduct business in this 
10State, a pharmacy benefit manager must register with the 
11Director. To initially register or renew a registration, a 
12pharmacy benefit manager shall submit: 
13  (1) A nonrefundable fee not to exceed $500. 
14  (2) A copy of the registrant's corporate charter, 
15 articles of incorporation, or other charter document. 
16  (3) A completed registration form adopted by the 
17 Director containing: 
18   (A) The name and address of the registrant. 
19   (B) The name, address, and official position of 
20 each officer and director of the registrant. 
21 (b) The registrant shall report any change in information 
22required under this Section to the Director in writing within 
2360 days after the change occurs. 
24 (c) Upon receipt of a completed registration form, the 
25required documents, and the registration fee, the Director 
 
 
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1shall issue a registration certificate. The certificate may be 
2in paper or electronic form, and shall clearly indicate the 
3expiration date of the registration. Registration certificates 
4are nontransferable. 
5 (d) A registration certificate is valid for 2 years after 
6its date of issue. The Director shall adopt by rule an initial 
7registration fee not to exceed $500 and a registration renewal 
8fee not to exceed $500, both of which shall be nonrefundable. 
9Total fees may not exceed the cost of administering this 
10Section. 
11 (e) The Department shall adopt any rules necessary to 
12implement this Section. 

13 (215 ILCS 5/513b3 new)
14 Sec. 513b3. Examination.
15 (a) The Director, or his or her designee, may examine a 
16registered pharmacy benefit manager.
17 (b) Any pharmacy benefit manager being examined shall 
18provide to the Director, or his or her designee, convenient and 
19free access to all books, records, documents, and other papers 
20relating to such pharmacy benefit manager's business affairs at 
21all reasonable hours at its offices.
22 (c) The Director, or his or her designee, may administer 
23oaths and thereafter examine the pharmacy benefit manager's 
24designee, representative, or any officer or senior manager as 
25listed on the license or registration certificate about the 
 
 
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1business of the pharmacy benefit manager.
2 (d) The examiners designated by the Director under this 
3Section may make reports to the Director. Any report alleging 
4substantive violations of this Article, any applicable 
5provisions of this Code, or any applicable Part of Title 50 of 
6the Illinois Administrative Code shall be in writing and be 
7based upon facts obtained by the examiners. The report shall be 
8verified by the examiners.
9 (e) If a report is made, the Director shall either deliver 
10a duplicate report to the pharmacy benefit manager being 
11examined or send such duplicate by certified or registered mail 
12to the pharmacy benefit manager's address specified in the 
13records of the Department. The Director shall afford the 
14pharmacy benefit manager an opportunity to request a hearing to 
15object to the report. The pharmacy benefit manager may request 
16a hearing within 30 days after receipt of the duplicate report 
17by giving the Director written notice of such request together 
18with written objections to the report. Any hearing shall be 
19conducted in accordance with Sections 402 and 403 of this Code. 
20The right to a hearing is waived if the delivery of the report 
21is refused or the report is otherwise undeliverable or the 
22pharmacy benefit manager does not timely request a hearing. 
23After the hearing or upon expiration of the time period during 
24which a pharmacy benefit manager may request a hearing, if the 
25examination reveals that the pharmacy benefit manager is 
26operating in violation of any applicable provision of this 
 
 
10100HB0465ham002- 31 -LRB101 03398 KTG 59484 a


1Code, any applicable Part of Title 50 of the Illinois 
2Administrative Code, a provision of this Article, or prior 
3order, the Director, in the written order, may require the 
4pharmacy benefit manager to take any action the Director 
5considers necessary or appropriate in accordance with the 
6report or examination hearing. If the Director issues an order, 
7it shall be issued within 90 days after the report is filed, or 
8if there is a hearing, within 90 days after the conclusion of 
9the hearing. The order is subject to review under the 
10Administrative Review Law.

11 (215 ILCS 5/513b4 new)
12 Sec. 513b4. Denial, revocation, or suspension of 
13registration; administrative fines.
14 (a) Denial of an application or suspension or revocation of 
15a registration in accordance with this Section shall be by 
16written order sent to the applicant or registrant by certified 
17or registered mail at the address specified in the records of 
18the Department. The written order shall state the grounds, 
19charges, or conduct on which denial, suspension, or revocation 
20is based. The applicant or registrant may in writing request a 
21hearing within 30 days from the date of mailing. Upon receipt 
22of a written request, the Director shall issue an order 
23setting: (i) a specific time for the hearing, which may not be 
24less than 20 nor more than 30 days after receipt of the 
25request; and (ii) a specific place for the hearing, which may 
 
 
10100HB0465ham002- 32 -LRB101 03398 KTG 59484 a


1be in either the city of Springfield or in the county in 
2Illinois where the applicant's or registrant's principal place 
3of business is located. If no written request is received by 
4the Director, such order shall be final upon the expiration of 
5said 30 days. 
6 (b) If the Director finds that one or more grounds exist 
7for the revocation or suspension of a registration issued under 
8this Article, the Director may, in lieu of or in addition to 
9such suspension or revocation, impose a fine upon the pharmacy 
10benefit manager as provided under subsection (c).
11 (c) With respect to any knowing and willful violation of a 
12lawful order of the Director, any applicable portion of this 
13Code, Part of Title 50 of the Illinois Administrative Code, or 
14provision of this Article, the Director may impose a fine upon 
15the pharmacy benefit manager in an amount not to exceed $50,000 
16for each violation.

17 (215 ILCS 5/513b5 new)
18 Sec. 513b5. Failure to register. Any pharmacy benefit 
19manager that operates without a registration or fails to 
20register with the Director and pay the fee prescribed by this 
21Article is an unauthorized insurer as defined in Article VII of 
22this Code and shall be subject to all penalties provided for 
23therein.

24 (215 ILCS 5/513b6 new)
 
 
10100HB0465ham002- 33 -LRB101 03398 KTG 59484 a


1 Sec. 513b6. Insurance Producer Administration Fund.  All 
2fees and fines paid to and collected by the Director under this 
3Article shall be paid promptly after receipt thereof, together 
4with a detailed statement of such fees, into the Insurance 
5Producer Administration Fund. The moneys deposited into the 
6Insurance Producer Administration Fund may be transferred to 
7the Professions Indirect Cost Fund, as authorized under Section 
82105-300 of the Department of Professional Regulation Law of 
9the Civil Administrative Code of Illinois.

10 Section 15. The Health Maintenance Organization Act is 
11amended by changing Section 5-3 as follows:



12 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)


13 Sec. 5-3. Insurance Code provisions. 

14 (a) Health Maintenance Organizations
shall be subject to 
15the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,

16141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 
17154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, 
18355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, 
19356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 
20356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 
21356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 364, 
22364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 
23370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 
24444,
and
444.1,
paragraph (c) of subsection (2) of Section 367, 
 
 
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1and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, 
2and XXVI, and XXXIIB of the Illinois Insurance Code.

3 (b) For purposes of the Illinois Insurance Code, except for 
4Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health 
5Maintenance Organizations in
the following categories are 
6deemed to be "domestic companies":

7  (1) a corporation authorized under the
Dental Service 
8 Plan Act or the Voluntary Health Services Plans Act;

9  (2) a corporation organized under the laws of this 
10 State; or

11  (3) a corporation organized under the laws of another 
12 state, 30% or more
of the enrollees of which are residents 
13 of this State, except a
corporation subject to 
14 substantially the same requirements in its state of

15 organization as is a "domestic company" under Article VIII 
16 1/2 of the
Illinois Insurance Code.

17 (c) In considering the merger, consolidation, or other 
18acquisition of
control of a Health Maintenance Organization 
19pursuant to Article VIII 1/2
of the Illinois Insurance Code,

20  (1) the Director shall give primary consideration to 
21 the continuation of
benefits to enrollees and the financial 
22 conditions of the acquired Health
Maintenance Organization 
23 after the merger, consolidation, or other
acquisition of 
24 control takes effect;

25  (2)(i) the criteria specified in subsection (1)(b) of 
26 Section 131.8 of
the Illinois Insurance Code shall not 
 
 
10100HB0465ham002- 35 -LRB101 03398 KTG 59484 a


1 apply and (ii) the Director, in making
his determination 
2 with respect to the merger, consolidation, or other

3 acquisition of control, need not take into account the 
4 effect on
competition of the merger, consolidation, or 
5 other acquisition of control;

6  (3) the Director shall have the power to require the 
7 following
information:

8   (A) certification by an independent actuary of the 
9 adequacy
of the reserves of the Health Maintenance 
10 Organization sought to be acquired;

11   (B) pro forma financial statements reflecting the 
12 combined balance
sheets of the acquiring company and 
13 the Health Maintenance Organization sought
to be 
14 acquired as of the end of the preceding year and as of 
15 a date 90 days
prior to the acquisition, as well as pro 
16 forma financial statements
reflecting projected 
17 combined operation for a period of 2 years;

18   (C) a pro forma business plan detailing an 
19 acquiring party's plans with
respect to the operation 
20 of the Health Maintenance Organization sought to
be 
21 acquired for a period of not less than 3 years; and

22   (D) such other information as the Director shall 
23 require.

24 (d) The provisions of Article VIII 1/2 of the Illinois 
25Insurance Code
and this Section 5-3 shall apply to the sale by 
26any health maintenance
organization of greater than 10% of its

 
 
10100HB0465ham002- 36 -LRB101 03398 KTG 59484 a


1enrollee population (including without limitation the health 
2maintenance
organization's right, title, and interest in and to 
3its health care
certificates).

4 (e) In considering any management contract or service 
5agreement subject
to Section 141.1 of the Illinois Insurance 
6Code, the Director (i) shall, in
addition to the criteria 
7specified in Section 141.2 of the Illinois
Insurance Code, take 
8into account the effect of the management contract or
service 
9agreement on the continuation of benefits to enrollees and the

10financial condition of the health maintenance organization to 
11be managed or
serviced, and (ii) need not take into account the 
12effect of the management
contract or service agreement on 
13competition.

14 (f) Except for small employer groups as defined in the 
15Small Employer
Rating, Renewability and Portability Health 
16Insurance Act and except for
medicare supplement policies as 
17defined in Section 363 of the Illinois
Insurance Code, a Health 
18Maintenance Organization may by contract agree with a
group or 
19other enrollment unit to effect refunds or charge additional 
20premiums
under the following terms and conditions:

21  (i) the amount of, and other terms and conditions with 
22 respect to, the
refund or additional premium are set forth 
23 in the group or enrollment unit
contract agreed in advance 
24 of the period for which a refund is to be paid or

25 additional premium is to be charged (which period shall not 
26 be less than one
year); and

 
 
10100HB0465ham002- 37 -LRB101 03398 KTG 59484 a


1  (ii) the amount of the refund or additional premium 
2 shall not exceed 20%
of the Health Maintenance 
3 Organization's profitable or unprofitable experience
with 
4 respect to the group or other enrollment unit for the 
5 period (and, for
purposes of a refund or additional 
6 premium, the profitable or unprofitable
experience shall 
7 be calculated taking into account a pro rata share of the

8 Health Maintenance Organization's administrative and 
9 marketing expenses, but
shall not include any refund to be 
10 made or additional premium to be paid
pursuant to this 
11 subsection (f)). The Health Maintenance Organization and 
12 the
group or enrollment unit may agree that the profitable 
13 or unprofitable
experience may be calculated taking into 
14 account the refund period and the
immediately preceding 2 
15 plan years.

16 The Health Maintenance Organization shall include a 
17statement in the
evidence of coverage issued to each enrollee 
18describing the possibility of a
refund or additional premium, 
19and upon request of any group or enrollment unit,
provide to 
20the group or enrollment unit a description of the method used 
21to
calculate (1) the Health Maintenance Organization's 
22profitable experience with
respect to the group or enrollment 
23unit and the resulting refund to the group
or enrollment unit 
24or (2) the Health Maintenance Organization's unprofitable

25experience with respect to the group or enrollment unit and the 
26resulting
additional premium to be paid by the group or 
 
 
10100HB0465ham002- 38 -LRB101 03398 KTG 59484 a


1enrollment unit.

2 In no event shall the Illinois Health Maintenance 
3Organization
Guaranty Association be liable to pay any 
4contractual obligation of an
insolvent organization to pay any 
5refund authorized under this Section.

6 (g) Rulemaking authority to implement Public Act 95-1045, 
7if any, is conditioned on the rules being adopted in accordance 
8with all provisions of the Illinois Administrative Procedure 
9Act and all rules and procedures of the Joint Committee on 
10Administrative Rules; any purported rule not so adopted, for 
11whatever reason, is unauthorized. 
12(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17; 
13100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff. 
148-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised 
1510-4-18.)

16 Section 20. The Managed Care Reform and Patient Rights Act 
17is amended by changing Sections 10 and 30 as follows:




18 (215 ILCS 134/10)



19 Sec. 10. Definitions. 

20 "Adverse determination" means a determination by a health 
21care plan under
Section 45 or by a utilization review program 
22under Section
85 that
a health care service is not medically 
23necessary.

24 "Clinical peer" means a health care professional who is in 
 
 
10100HB0465ham002- 39 -LRB101 03398 KTG 59484 a


1the same
profession and the same or similar specialty as the 
2health care provider who
typically manages the medical 
3condition, procedures, or treatment under
review.

4 "Department" means the Department of Insurance.

5 "Emergency medical condition" means a medical condition 
6manifesting itself by
acute symptoms of sufficient severity, 
7regardless of the final diagnosis given, (including, but not 
8limited to, severe
pain) such that a prudent
layperson, who 
9possesses an average knowledge of health and medicine, could

10reasonably expect the absence of immediate medical attention to 
11result in: 

12  (1) placing the health of the individual (or, with 
13 respect to a pregnant
woman, the
health of the woman or her 
14 unborn child) in serious jeopardy;

15  (2) serious
impairment to bodily functions; or

16  (3) serious dysfunction of any bodily organ
or part; .

17  (4) inadequately controlled pain; or 
18  (5) with respect to a pregnant woman who is having 
19 contractions: 
20   (A) inadequate time to complete a safe transfer to 
21 another hospital before delivery; or 
22   (B) a transfer to another hospital may pose a 
23 threat to the health or safety of the woman or unborn 
24 child. 
25 "Emergency medical screening examination" means a medical 
26screening
examination and
evaluation by a physician licensed to 
 
 
10100HB0465ham002- 40 -LRB101 03398 KTG 59484 a


1practice medicine in all its branches, or
to the extent 
2permitted
by applicable laws, by other appropriately licensed 
3personnel under the
supervision of or in
collaboration with a 
4physician licensed to practice medicine in all its
branches to 
5determine whether
the need for emergency services exists.

6 "Emergency services" means, with respect to an enrollee of 
7a health care
plan,
transportation services, including but not 
8limited to ambulance services, and
covered inpatient and 
9outpatient hospital services
furnished by a provider
qualified 
10to furnish those services that are needed to evaluate or 
11stabilize an
emergency medical condition. "Emergency services" 
12does not
refer to post-stabilization medical services.

13 "Enrollee" means any person and his or her dependents 
14enrolled in or covered
by a health care plan.

15 "Health care plan" means a plan, including, but not limited 
16to, a health maintenance organization, a managed care community 
17network as defined in the Illinois Public Aid Code, or an 
18accountable care entity as defined in the Illinois Public Aid 
19Code that receives capitated payments to cover medical services 
20from the Department of Healthcare and Family Services, that 
21establishes, operates, or maintains a
network of health care 
22providers that has entered into an agreement with the
plan to 
23provide health care services to enrollees to whom the plan has 
24the
ultimate obligation to arrange for the provision of or 
25payment for services
through organizational arrangements for 
26ongoing quality assurance,
utilization review programs, or 
 
 
10100HB0465ham002- 41 -LRB101 03398 KTG 59484 a


1dispute resolution.
Nothing in this definition shall be 
2construed to mean that an independent
practice association or a 
3physician hospital organization that subcontracts
with
a 
4health care plan is, for purposes of that subcontract, a health 
5care plan.

6 For purposes of this definition, "health care plan" shall 
7not include the
following:

8  (1) indemnity health insurance policies including 
9 those using a contracted
provider network;

10  (2) health care plans that offer only dental or only 
11 vision coverage;

12  (3) preferred provider administrators, as defined in 
13 Section 370g(g) of
the
Illinois Insurance Code;

14  (4) employee or employer self-insured health benefit 
15 plans under the
federal Employee Retirement Income 
16 Security Act of 1974;

17  (5) health care provided pursuant to the Workers' 
18 Compensation Act or the
Workers' Occupational Diseases 
19 Act; and

20  (6) not-for-profit voluntary health services plans 
21 with health maintenance
organization
authority in 
22 existence as of January 1, 1999 that are affiliated with a 
23 union
and that
only extend coverage to union members and 
24 their dependents.

25 "Health care professional" means a physician, a registered 
26professional
nurse,
or other individual appropriately licensed 
 
 
10100HB0465ham002- 42 -LRB101 03398 KTG 59484 a


1or registered
to provide health care services.

2 "Health care provider" means any physician, hospital 
3facility, facility licensed under the Nursing Home Care Act, 
4long-term care facility as defined in Section 1-113 of the 
5Nursing Home Care Act, or other
person that is licensed or 
6otherwise authorized to deliver health care
services. Nothing 
7in this
Act shall be construed to define Independent Practice 
8Associations or
Physician-Hospital Organizations as health 
9care providers.

10 "Health care services" means any services included in the 
11furnishing to any
individual of medical care, or the

12hospitalization incident to the furnishing of such care, as 
13well as the
furnishing to any person of
any and all other 
14services for the purpose of preventing,
alleviating, curing, or 
15healing human illness or injury including home health
and 
16pharmaceutical services and products.

17 "Medical director" means a physician licensed in any state 
18to practice
medicine in all its
branches appointed by a health 
19care plan.

20 "Person" means a corporation, association, partnership,

21limited liability company, sole proprietorship, or any other 
22legal entity.

23 "Physician" means a person licensed under the Medical

24Practice Act of 1987.

25 "Post-stabilization medical services" means health care 
26services
provided to an enrollee that are furnished in a 
 
 
10100HB0465ham002- 43 -LRB101 03398 KTG 59484 a


1licensed hospital by a provider
that is qualified to furnish 
2such services, and determined to be medically
necessary and 
3directly related to the emergency medical condition following

4stabilization.

5 "Stabilization" means, with respect to an emergency 
6medical condition, to
provide such medical treatment of the 
7condition as may be necessary to assure,
within reasonable 
8medical probability, that no material deterioration
of the 
9condition is likely to result.

10 "Utilization review" means the evaluation of the medical 
11necessity,
appropriateness, and efficiency of the use of health 
12care services, procedures,
and facilities.

13 "Utilization review program" means a program established 
14by a person to
perform utilization review.

15(Source: P.A. 98-651, eff. 6-16-14; 98-841, eff. 8-1-14; 99-78, 
16eff. 7-20-15.)





17 (215 ILCS 134/30)



18 Sec. 30. Prohibitions. 

19 (a) No health care plan or its subcontractors may prohibit 
20or discourage
health care providers
by contract or policy from

21discussing any health care services and health care providers, 
22utilization
review and quality assurance policies, terms and 
23conditions of plans and plan
policy with enrollees, prospective 
24enrollees, providers, or the public.

25 (b) No health care plan by contract, written policy, or 
 
 
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1procedure may
permit or allow an individual or entity to 
2dispense a different
drug in place of the drug or brand of drug 
3ordered or prescribed without the
express permission of the 
4person ordering or prescribing the drug, except as
provided 
5under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.

6 (c) No health care plan or its subcontractors may by 
7contract, written
policy, procedure, or otherwise mandate or 
8require an enrollee
to substitute his or her participating 
9primary care physician
under the plan during inpatient 
10hospitalization, such as with a hospitalist physician licensed 
11to practice medicine in all its branches,
without the agreement 
12of that enrollee's
participating primary care physician. 
13"Participating primary care
physician" for health care plans 
14and subcontractors that do not require
coordination of care by 
15a primary care physician means the participating
physician 
16treating the patient. All health care plans shall inform 
17enrollees
of any policies, recommendations, or guidelines 
18concerning the
substitution of the enrollee's primary care 
19physician when hospitalization is
necessary in the manner set 
20forth in subsections (d) and (e) of Section 15.

21 (d) A health care plan shall apply any third-party 
22payments, financial assistance, discount, product vouchers, or 
23any other reduction in out-of-pocket expenses made by or on 
24behalf of such insured for prescription drugs toward a covered 
25individual's deductible, copay, or cost-sharing 
26responsibility, or out-of-pocket maximum associated with the 
 
 
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1individual's health insurance. 
2 (e) (d) Any violation of this Section shall be subject to 
3the
penalties under this Act.

4(Source: P.A. 94-866, eff. 6-16-06.)


5 Section 25. The Pharmacy Practice Act is amended by adding 
6Section 42 as follows:

7 (225 ILCS 85/42 new)
8 Sec. 42. Information disclosure. A pharmacist or her or his 
9authorized employee must inform customers of a less expensive, 
10generically equivalent drug product for her or his prescription 
11and whether the cost-sharing obligation to the customer exceeds 
12the retail price of the prescription in the absence of 
13prescription drug coverage.

14 Section 30. The Illinois Public Aid Code is amended by 
15adding Section 5-36 as follows:

16 (305 ILCS 5/5-36 new)
17 Sec. 5-36. Pharmacy benefits. 
18 (a)(1) The Department may enter into a contract with a 
19third party on a fee-for-service reimbursement model for the 
20purpose of administering pharmacy benefits as provided in this 
21Section for members not enrolled in a Medicaid managed care 
22organization; however, these services shall be approved by the 
 
 
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1Department. The Department shall ensure coordination of care 
2between the third-party administrator and managed care 
3organizations as a consideration in any contracts established 
4in accordance with this Section. Any managed care techniques, 
5principles, or administration of benefits utilized in 
6accordance with this subsection shall comply with State law. 
7 (2) The following shall apply to contracts between entities 
8contracting relating to the Department's third-party 
9administrators and pharmacies: 
10  (A) the Department shall approve any contract between a 
11 third-party administrator and a pharmacy;
12  (B) the Department's third-party administrator shall 
13 not change the terms of a contract between a third-party 
14 administrator and a pharmacy without written approval by 
15 the Department; and
16  (C) the Department's third-party administrator shall 
17 not create, modify, implement, or indirectly establish any 
18 fee on a pharmacy, pharmacist, or a recipient of medical 
19 assistance without written approval by the Department. 
20 (b) The provisions of this Section shall not apply to 
21outpatient pharmacy services provided by a health care facility 
22registered as a covered entity pursuant to 42 U.S.C. 256b or 
23any pharmacy owned by or contracted with the covered entity. A 
24Medicaid managed care organization shall, either directly or 
25through a pharmacy benefit manager, administer and reimburse 
26outpatient pharmacy claims submitted by a health care facility 
 
 
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1registered as a covered entity pursuant to 42 U.S.C. 256b, its 
2owned pharmacies, and contracted pharmacies in accordance with 
3the contractual agreements the Medicaid managed care 
4organization or its pharmacy benefit manager has with such 
5facilities and pharmacies. Any pharmacy benefit manager that 
6contracts with a Medicaid managed care organization to 
7administer and reimburse pharmacy claims as provided in this 
8Section must be registered with the Director of Insurance in 
9accordance with Section 513b2 of the Illinois Insurance Code. 
10 (c) On at least an annual basis, the Director of the 
11Department of Healthcare and Family Services shall submit a 
12report beginning no later than one year after the effective 
13date of this amendatory Act of the 101st General Assembly that 
14provides an update on any contract, contract issues, formulary, 
15dispensing fees, and maximum allowable cost concerns regarding 
16a third-party administrator and managed care. The requirement 
17for reporting to the General Assembly shall be satisfied by 
18filing copies of the report with the Speaker, the Minority 
19Leader, and the Clerk of the House of Representatives and with 
20the President, the Minority leader, and the Secretary of the 
21Senate. The Department shall take care that no proprietary 
22information is included in the report required under this 
23Section. 
24 (d) A pharmacy benefit manager shall notify the Department 
25in writing of any activity, policy, or practice of the pharmacy 
26benefit manager that directly or indirectly presents a conflict 
 
 
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1of interest that interferes with the discharge of the pharmacy 
2benefit manager's duty to a managed care organization to 
3exercise its contractual duties. "Conflict of interest" shall 
4be defined by rule by the Department. 
5 (e) A pharmacy benefit manager shall, upon request, 
6disclose to the Department the following information: 
7  (1) whether the pharmacy benefit manager has a 
8 contract, agreement, or other arrangement with a 
9 pharmaceutical manufacturer to exclusively dispense or 
10 provide a drug to a managed care organization's enrollees, 
11 and the aggregate amounts of consideration of economic 
12 benefits collected or received pursuant to that 
13 arrangement; 
14  (2) the percentage of claims payments made by the 
15 pharmacy benefit manager to pharmacies owned, managed, or 
16 controlled by the pharmacy benefit manager or any of the 
17 pharmacy benefit manager's management companies, parent 
18 companies, subsidiary companies, or jointly held 
19 companies; 
20  (3) the aggregate amount of the fees or assessments 
21 imposed on, or collected from, pharmacy providers; and 
22  (4) the average annualized percentage of revenue 
23 collected by the pharmacy benefit manager as a result of 
24 each contract it has executed with a managed care 
25 organization contracted by the Department to provide 
26 medical assistance benefits which is not paid by the 
 
 
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1 pharmacy benefit manager to pharmacy providers and 
2 pharmaceutical manufacturers or labelers or in order to 
3 perform administrative functions pursuant to its contracts 
4 with managed care organizations. 
5 (f) The information disclosed under subsection (e) shall 
6include all retail, mail order, specialty, and compounded 
7prescription products. All information made
available to the 
8Department under subsection (e) is confidential and not subject 
9to disclosure under the Freedom of Information Act. All 
10information made available to the Department under subsection 
11(e) shall not be reported or distributed in any way that 
12compromises its competitive, proprietary, or financial value. 
13The information shall only be used by the Department to assess 
14the contract, agreement, or other arrangements made between a 
15pharmacy benefit manager and a pharmacy provider, 
16pharmaceutical manufacturer or labeler, managed care 
17organization, or other entity, as applicable. 
18 (g) A pharmacy benefit manager shall disclose directly in 
19writing to a pharmacy provider or pharmacy services 
20administrative organization contracting with the pharmacy 
21benefit manager of any material change to a contract provision 
22that affects the terms of the reimbursement, the process for 
23verifying benefits and eligibility, dispute resolution, 
24procedures for verifying drugs included on the formulary, and 
25contract termination at least 30 days prior to the date of the 
26change to the provision. The terms of this subsection shall be 
 
 
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1deemed met if the pharmacy benefit manager posts the 
2information on a website, viewable by the public. A pharmacy 
3service administration organization shall notify all contract 
4pharmacies of any material change, as described in this 
5subsection, within 2 days of notification. As used in this 
6Section, "pharmacy services administrative organization" means 
7an entity operating within the State that contracts with 
8independent pharmacies to conduct business on their behalf with 
9third-party payers. A pharmacy services administrative 
10organization may provide administrative services to pharmacies 
11and negotiate and enter into contracts with third-party payers 
12or pharmacy benefit managers on behalf of pharmacies. 
13 (h) A pharmacy benefit manager shall not include the 
14following in a contract with a pharmacy provider: 
15  (1) a provision prohibiting the provider from 
16 informing a patient of a less costly alternative to a 
17 prescribed medication; or 
18  (2) a provision that prohibits the provider from 
19 dispensing a particular amount of a prescribed medication, 
20 if the pharmacy benefit manager allows that amount to be 
21 dispensed through a pharmacy owned or controlled by the 
22 pharmacy benefit manager, unless the prescription drug is 
23 subject to restricted distribution by the United States 
24 Food and Drug Administration or requires special handling, 
25 provider coordination, or patient education that cannot be 
26 provided by a retail pharmacy. 
 
 
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1 (i) Nothing in this Section shall be construed to prohibit 
2a pharmacy benefit manager from requiring the same 
3reimbursement and terms and conditions for a pharmacy provider 
4as for a pharmacy owned, controlled, or otherwise associated 
5with the pharmacy benefit manager. 
6 (j) A pharmacy benefit manager shall establish and 
7implement a process for the resolution of disputes arising out 
8of this Section, which shall be approved by the Department. 
9 (k) The Department shall adopt rules establishing 
10reasonable dispensing fees for fee-for-service payments in 
11accordance with guidance or guidelines from the federal Centers 
12for Medicare and Medicaid Services.


13 Section 97. Severability. If any provision of this Act or 
14the application of this Act to any person or circumstance is 
15held invalid, the invalidity shall not affect other provisions 
16or applications of this Act which can be given effect without 
17the invalid provision or application, and to this end, the 
18provisions of this Act are declared severable.".