Bill Amendment: IL HB0465 | 2019-2020 | 101st General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: REGULATION-TECH
Status: 2019-08-23 - Public Act . . . . . . . . . 101-0452 [HB0465 Detail]
Download: Illinois-2019-HB0465-House_Amendment_002.html
Bill Title: REGULATION-TECH
Status: 2019-08-23 - Public Act . . . . . . . . . 101-0452 [HB0465 Detail]
Download: Illinois-2019-HB0465-House_Amendment_002.html
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1 | AMENDMENT TO HOUSE BILL 465
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2 | AMENDMENT NO. ______. Amend House Bill 465, AS AMENDED, by | ||||||
3 | replacing everything after the enacting clause with the | ||||||
4 | following:
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5 | "Section 1. The Freedom of Information Act is amended by | ||||||
6 | changing Sections 7 and 7.5 as follows:
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7 | (5 ILCS 140/7) (from Ch. 116, par. 207) | ||||||
8 | Sec. 7. Exemptions.
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9 | (1) When a request is made to inspect or copy a public | ||||||
10 | record that contains information that is exempt from disclosure | ||||||
11 | under this Section, but also contains information that is not | ||||||
12 | exempt from disclosure, the public body may elect to redact the | ||||||
13 | information that is exempt. The public body shall make the | ||||||
14 | remaining information available for inspection and copying. | ||||||
15 | Subject to this requirement, the following shall be exempt from | ||||||
16 | inspection 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.
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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
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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.
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24 | (d) Records in the possession of any public body | ||||||
25 | created in the course of administrative enforcement
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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:
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3 | (i) interfere with pending or actually and | ||||||
4 | reasonably contemplated
law enforcement proceedings | ||||||
5 | conducted by any law enforcement or correctional
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6 | agency that is the recipient of the request;
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7 | (ii) interfere with active administrative | ||||||
8 | enforcement proceedings
conducted by the public body | ||||||
9 | that is the recipient of the request;
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10 | (iii) create a substantial likelihood that a | ||||||
11 | person will be deprived of a fair trial or an impartial | ||||||
12 | hearing;
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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;
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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
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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;
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6 | (vi) endanger the life or physical safety of law | ||||||
7 | enforcement personnel
or any other person; or
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8 | (vii) obstruct an ongoing criminal investigation | ||||||
9 | by the agency that is the recipient of the request.
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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.
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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.
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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.
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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,
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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
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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.
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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;
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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.
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13 | (l) Minutes of meetings of public bodies closed to the
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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.
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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
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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.
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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.
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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
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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
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12 | materials exempt under this Section.
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13 | (p) Records relating to collective negotiating matters
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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.
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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.
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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
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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.
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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.
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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.
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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
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17 | institutions , or insurance companies, or pharmacy benefit | ||||||
18 | managers, unless disclosure is otherwise
required by State | ||||||
19 | law.
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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
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24 | Electronic Commerce Security Act.
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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.
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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.
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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.
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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.
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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 | ||||||
26 | Judicial Privacy Act shall be redacted from public records |
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1 | prior to disclosure under this Act. | ||||||
2 | (2) A public record that is not in the possession of a | ||||||
3 | public body but is in the possession of a party with whom the | ||||||
4 | agency has contracted to perform a governmental function on | ||||||
5 | behalf of the public body, and that directly relates to the | ||||||
6 | governmental function and is not otherwise exempt under this | ||||||
7 | Act, shall be considered a public record of the public body, | ||||||
8 | for purposes of this Act. | ||||||
9 | (3) This Section does not authorize withholding of | ||||||
10 | information or limit the
availability of records to the public, | ||||||
11 | except as stated in this Section or
otherwise provided in this | ||||||
12 | Act.
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13 | (Source: P.A. 99-298, eff. 8-6-15; 99-346, eff. 1-1-16; 99-642, | ||||||
14 | eff. 7-28-16; 100-26, eff. 8-4-17; 100-201, eff. 8-18-17; | ||||||
15 | 100-732, eff. 8-3-18.)
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16 | (5 ILCS 140/7.5) | ||||||
17 | Sec. 7.5. Statutory exemptions. To the extent provided for | ||||||
18 | by the statutes referenced below, the following shall be exempt | ||||||
19 | from 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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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. |
| |||||||
| |||||||
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, | ||||||
25 | eff. 1-1-16; 99-642, eff. 7-28-16; 99-776, eff. 8-12-16; | ||||||
26 | 99-863, eff. 8-19-16; 100-20, eff. 7-1-17; 100-22, eff. 1-1-18; |
| |||||||
| |||||||
1 | 100-201, eff. 8-18-17; 100-373, eff. 1-1-18; 100-464, eff. | ||||||
2 | 8-28-17; 100-465, eff. 8-31-17; 100-512, eff. 7-1-18; 100-517, | ||||||
3 | eff. 6-1-18; 100-646, eff. 7-27-18; 100-690, eff. 1-1-19; | ||||||
4 | 100-863, eff. 8-14-18; 100-887, eff. 8-14-18; revised | ||||||
5 | 10-12-18.)
| ||||||
6 | Section 5. The State Employees Group Insurance Act of 1971 | ||||||
7 | is 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 | ||||||
11 | Code
requirements. The program of health
benefits shall provide | ||||||
12 | the post-mastectomy care benefits required to be covered
by a | ||||||
13 | policy of accident and health insurance under Section 356t of | ||||||
14 | the Illinois
Insurance Code. The program of health benefits | ||||||
15 | shall provide the coverage
required under Sections 356g, | ||||||
16 | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | ||||||
17 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
18 | 356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
19 | and 356z.32 of the
Illinois Insurance Code.
The program of | ||||||
20 | health benefits must comply with Sections 155.22a, 155.37, | ||||||
21 | 355b, 356z.19, 370c, and 370c.1 , and Article XXXIIB of the
| ||||||
22 | Illinois Insurance Code. The Department of Insurance shall | ||||||
23 | enforce the requirements of this Section with respect to | ||||||
24 | Sections 370c and 370c.1 of the Illinois Insurance Code; all |
| |||||||
| |||||||
1 | other requirements of this Section shall be enforced by the | ||||||
2 | Department of Central Management Services.
| ||||||
3 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
4 | any, is conditioned on the rules being adopted in accordance | ||||||
5 | with all provisions of the Illinois Administrative Procedure | ||||||
6 | Act and all rules and procedures of the Joint Committee on | ||||||
7 | Administrative Rules; any purported rule not so adopted, for | ||||||
8 | whatever reason, is unauthorized. | ||||||
9 | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | ||||||
10 | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. | ||||||
11 | 1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; | ||||||
12 | 100-1170, eff. 6-1-19.)
| ||||||
13 | Section 10. The Illinois Insurance Code is amended by | ||||||
14 | adding 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 | ||||||
21 | in Section 19.5 of the Pharmacy Practice Act. | ||||||
22 | "Maximum allowable cost" means the maximum amount that a | ||||||
23 | pharmacy benefit manager will reimburse a pharmacy for the cost |
| |||||||
| |||||||
1 | of a drug. | ||||||
2 | "Maximum allowable cost list" means a list of drugs for | ||||||
3 | which a maximum allowable cost has been established by a | ||||||
4 | pharmacy benefit manager. | ||||||
5 | "Pharmacy benefit manager" means a person, business, or | ||||||
6 | entity, including a wholly or partially owned or controlled | ||||||
7 | subsidiary of a pharmacy benefit manager, that provides claims | ||||||
8 | processing services or other prescription drug or device | ||||||
9 | services, or both, for health benefit plans. | ||||||
10 | "Retail price" means the price an individual without | ||||||
11 | prescription drug coverage would pay at a retail pharmacy, not | ||||||
12 | including a pharmacist dispensing fee. | ||||||
13 | (b) A contract between a health insurer and a pharmacy | ||||||
14 | benefit 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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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. |
| |||||||
| |||||||
1 | (c) In order to place a particular prescription drug on a | ||||||
2 | maximum allowable cost list, the pharmacy benefit manager must, | ||||||
3 | at 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 | ||||||
16 | a pharmacist's ability to disclose whether the cost-sharing | ||||||
17 | obligation exceeds the retail price for a covered prescription | ||||||
18 | drug, and the availability of a more affordable alternative | ||||||
19 | drug, if one is available in accordance with Section 42 of the | ||||||
20 | Pharmacy Practice Act. | ||||||
21 | (e) A health insurer or pharmacy benefit manager shall not | ||||||
22 | require an insured to make a payment for a prescription drug at | ||||||
23 | the 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. |
| |||||||
| |||||||
1 | (f) This Section applies to contracts entered into or | ||||||
2 | renewed on or after July 1, 2020. | ||||||
3 | (g) This Section applies to any group or individual policy | ||||||
4 | of accident and health insurance or managed care plan that | ||||||
5 | provides coverage for prescription drugs and that is amended, | ||||||
6 | delivered, 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 | ||||||
10 | State, a pharmacy benefit manager must register with the | ||||||
11 | Director. To initially register or renew a registration, a | ||||||
12 | pharmacy 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 | ||||||
22 | required under this Section to the Director in writing within | ||||||
23 | 60 days after the change occurs. | ||||||
24 | (c) Upon receipt of a completed registration form, the | ||||||
25 | required documents, and the registration fee, the Director |
| |||||||
| |||||||
1 | shall issue a registration certificate. The certificate may be | ||||||
2 | in paper or electronic form, and shall clearly indicate the | ||||||
3 | expiration date of the registration. Registration certificates | ||||||
4 | are nontransferable. | ||||||
5 | (d) A registration certificate is valid for 2 years after | ||||||
6 | its date of issue. The Director shall adopt by rule an initial | ||||||
7 | registration fee not to exceed $500 and a registration renewal | ||||||
8 | fee not to exceed $500, both of which shall be nonrefundable. | ||||||
9 | Total fees may not exceed the cost of administering this | ||||||
10 | Section. | ||||||
11 | (e) The Department shall adopt any rules necessary to | ||||||
12 | implement this Section.
| ||||||
13 | (215 ILCS 5/513b3 new) | ||||||
14 | Sec. 513b3. Examination. | ||||||
15 | (a) The Director, or his or her designee, may examine a | ||||||
16 | registered pharmacy benefit manager. | ||||||
17 | (b) Any pharmacy benefit manager being examined shall | ||||||
18 | provide to the Director, or his or her designee, convenient and | ||||||
19 | free access to all books, records, documents, and other papers | ||||||
20 | relating to such pharmacy benefit manager's business affairs at | ||||||
21 | all reasonable hours at its offices. | ||||||
22 | (c) The Director, or his or her designee, may administer | ||||||
23 | oaths and thereafter examine the pharmacy benefit manager's | ||||||
24 | designee, representative, or any officer or senior manager as | ||||||
25 | listed on the license or registration certificate about the |
| |||||||
| |||||||
1 | business of the pharmacy benefit manager. | ||||||
2 | (d) The examiners designated by the Director under this | ||||||
3 | Section may make reports to the Director. Any report alleging | ||||||
4 | substantive violations of this Article, any applicable | ||||||
5 | provisions of this Code, or any applicable Part of Title 50 of | ||||||
6 | the Illinois Administrative Code shall be in writing and be | ||||||
7 | based upon facts obtained by the examiners. The report shall be | ||||||
8 | verified by the examiners. | ||||||
9 | (e) If a report is made, the Director shall either deliver | ||||||
10 | a duplicate report to the pharmacy benefit manager being | ||||||
11 | examined or send such duplicate by certified or registered mail | ||||||
12 | to the pharmacy benefit manager's address specified in the | ||||||
13 | records of the Department. The Director shall afford the | ||||||
14 | pharmacy benefit manager an opportunity to request a hearing to | ||||||
15 | object to the report. The pharmacy benefit manager may request | ||||||
16 | a hearing within 30 days after receipt of the duplicate report | ||||||
17 | by giving the Director written notice of such request together | ||||||
18 | with written objections to the report. Any hearing shall be | ||||||
19 | conducted in accordance with Sections 402 and 403 of this Code. | ||||||
20 | The right to a hearing is waived if the delivery of the report | ||||||
21 | is refused or the report is otherwise undeliverable or the | ||||||
22 | pharmacy benefit manager does not timely request a hearing. | ||||||
23 | After the hearing or upon expiration of the time period during | ||||||
24 | which a pharmacy benefit manager may request a hearing, if the | ||||||
25 | examination reveals that the pharmacy benefit manager is | ||||||
26 | operating in violation of any applicable provision of this |
| |||||||
| |||||||
1 | Code, any applicable Part of Title 50 of the Illinois | ||||||
2 | Administrative Code, a provision of this Article, or prior | ||||||
3 | order, the Director, in the written order, may require the | ||||||
4 | pharmacy benefit manager to take any action the Director | ||||||
5 | considers necessary or appropriate in accordance with the | ||||||
6 | report or examination hearing. If the Director issues an order, | ||||||
7 | it shall be issued within 90 days after the report is filed, or | ||||||
8 | if there is a hearing, within 90 days after the conclusion of | ||||||
9 | the hearing. The order is subject to review under the | ||||||
10 | Administrative Review Law.
| ||||||
11 | (215 ILCS 5/513b4 new) | ||||||
12 | Sec. 513b4. Denial, revocation, or suspension of | ||||||
13 | registration; administrative fines. | ||||||
14 | (a) Denial of an application or suspension or revocation of | ||||||
15 | a registration in accordance with this Section shall be by | ||||||
16 | written order sent to the applicant or registrant by certified | ||||||
17 | or registered mail at the address specified in the records of | ||||||
18 | the Department. The written order shall state the grounds, | ||||||
19 | charges, or conduct on which denial, suspension, or revocation | ||||||
20 | is based. The applicant or registrant may in writing request a | ||||||
21 | hearing within 30 days from the date of mailing. Upon receipt | ||||||
22 | of a written request, the Director shall issue an order | ||||||
23 | setting: (i) a specific time for the hearing, which may not be | ||||||
24 | less than 20 nor more than 30 days after receipt of the | ||||||
25 | request; and (ii) a specific place for the hearing, which may |
| |||||||
| |||||||
1 | be in either the city of Springfield or in the county in | ||||||
2 | Illinois where the applicant's or registrant's principal place | ||||||
3 | of business is located. If no written request is received by | ||||||
4 | the Director, such order shall be final upon the expiration of | ||||||
5 | said 30 days. | ||||||
6 | (b) If the Director finds that one or more grounds exist | ||||||
7 | for the revocation or suspension of a registration issued under | ||||||
8 | this Article, the Director may, in lieu of or in addition to | ||||||
9 | such suspension or revocation, impose a fine upon the pharmacy | ||||||
10 | benefit manager as provided under subsection (c). | ||||||
11 | (c) With respect to any knowing and willful violation of a | ||||||
12 | lawful order of the Director, any applicable portion of this | ||||||
13 | Code, Part of Title 50 of the Illinois Administrative Code, or | ||||||
14 | provision of this Article, the Director may impose a fine upon | ||||||
15 | the pharmacy benefit manager in an amount not to exceed $50,000 | ||||||
16 | for each violation.
| ||||||
17 | (215 ILCS 5/513b5 new) | ||||||
18 | Sec. 513b5. Failure to register. Any pharmacy benefit | ||||||
19 | manager that operates without a registration or fails to | ||||||
20 | register with the Director and pay the fee prescribed by this | ||||||
21 | Article is an unauthorized insurer as defined in Article VII of | ||||||
22 | this Code and shall be subject to all penalties provided for | ||||||
23 | therein.
| ||||||
24 | (215 ILCS 5/513b6 new) |
| |||||||
| |||||||
1 | Sec. 513b6. Insurance Producer Administration Fund. All | ||||||
2 | fees and fines paid to and collected by the Director under this | ||||||
3 | Article shall be paid promptly after receipt thereof, together | ||||||
4 | with a detailed statement of such fees, into the Insurance | ||||||
5 | Producer Administration Fund. The moneys deposited into the | ||||||
6 | Insurance Producer Administration Fund may be transferred to | ||||||
7 | the Professions Indirect Cost Fund, as authorized under Section | ||||||
8 | 2105-300 of the Department of Professional Regulation Law of | ||||||
9 | the Civil Administrative Code of Illinois.
| ||||||
10 | Section 15. The Health Maintenance Organization Act is | ||||||
11 | amended 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 | ||||||
15 | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
| ||||||
16 | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | ||||||
17 | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | ||||||
18 | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | ||||||
19 | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | ||||||
20 | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | ||||||
21 | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 364, | ||||||
22 | 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, | ||||||
23 | 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, 408.2, 409, 412, | ||||||
24 | 444,
and
444.1,
paragraph (c) of subsection (2) of Section 367, |
| |||||||
| |||||||
1 | and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, | ||||||
2 | and XXVI , and XXXIIB of the Illinois Insurance Code.
| ||||||
3 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
4 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
5 | Maintenance Organizations in
the following categories are | ||||||
6 | deemed 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 | ||||||
18 | acquisition of
control of a Health Maintenance Organization | ||||||
19 | pursuant 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 |
| |||||||
| |||||||
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 | ||||||
25 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
26 | any health maintenance
organization of greater than 10% of its
|
| |||||||
| |||||||
1 | enrollee population (including without limitation the health | ||||||
2 | maintenance
organization's right, title, and interest in and to | ||||||
3 | its health care
certificates).
| ||||||
4 | (e) In considering any management contract or service | ||||||
5 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
6 | Code, the Director (i) shall, in
addition to the criteria | ||||||
7 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
8 | into account the effect of the management contract or
service | ||||||
9 | agreement on the continuation of benefits to enrollees and the
| ||||||
10 | financial condition of the health maintenance organization to | ||||||
11 | be managed or
serviced, and (ii) need not take into account the | ||||||
12 | effect of the management
contract or service agreement on | ||||||
13 | competition.
| ||||||
14 | (f) Except for small employer groups as defined in the | ||||||
15 | Small Employer
Rating, Renewability and Portability Health | ||||||
16 | Insurance Act and except for
medicare supplement policies as | ||||||
17 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
18 | Maintenance Organization may by contract agree with a
group or | ||||||
19 | other enrollment unit to effect refunds or charge additional | ||||||
20 | premiums
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
|
| |||||||
| |||||||
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 | ||||||
17 | statement in the
evidence of coverage issued to each enrollee | ||||||
18 | describing the possibility of a
refund or additional premium, | ||||||
19 | and upon request of any group or enrollment unit,
provide to | ||||||
20 | the group or enrollment unit a description of the method used | ||||||
21 | to
calculate (1) the Health Maintenance Organization's | ||||||
22 | profitable experience with
respect to the group or enrollment | ||||||
23 | unit and the resulting refund to the group
or enrollment unit | ||||||
24 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
25 | experience with respect to the group or enrollment unit and the | ||||||
26 | resulting
additional premium to be paid by the group or |
| |||||||
| |||||||
1 | enrollment unit.
| ||||||
2 | In no event shall the Illinois Health Maintenance | ||||||
3 | Organization
Guaranty Association be liable to pay any | ||||||
4 | contractual obligation of an
insolvent organization to pay any | ||||||
5 | refund authorized under this Section.
| ||||||
6 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
7 | if any, is conditioned on the rules being adopted in accordance | ||||||
8 | with all provisions of the Illinois Administrative Procedure | ||||||
9 | Act and all rules and procedures of the Joint Committee on | ||||||
10 | Administrative Rules; any purported rule not so adopted, for | ||||||
11 | whatever reason, is unauthorized. | ||||||
12 | (Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17; | ||||||
13 | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff. | ||||||
14 | 8-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | ||||||
15 | 10-4-18.)
| ||||||
16 | Section 20. The Managed Care Reform and Patient Rights Act | ||||||
17 | is 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 | ||||||
21 | care plan under
Section 45 or by a utilization review program | ||||||
22 | under Section
85 that
a health care service is not medically | ||||||
23 | necessary.
| ||||||
24 | "Clinical peer" means a health care professional who is in |
| |||||||
| |||||||
1 | the same
profession and the same or similar specialty as the | ||||||
2 | health care provider who
typically manages the medical | ||||||
3 | condition, procedures, or treatment under
review.
| ||||||
4 | "Department" means the Department of Insurance.
| ||||||
5 | "Emergency medical condition" means a medical condition | ||||||
6 | manifesting itself by
acute symptoms of sufficient severity , | ||||||
7 | regardless of the final diagnosis given, (including, but not | ||||||
8 | limited to, severe
pain) such that a prudent
layperson, who | ||||||
9 | possesses an average knowledge of health and medicine, could
| ||||||
10 | reasonably expect the absence of immediate medical attention to | ||||||
11 | result 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 | ||||||
26 | screening
examination and
evaluation by a physician licensed to |
| |||||||
| |||||||
1 | practice medicine in all its branches, or
to the extent | ||||||
2 | permitted
by applicable laws, by other appropriately licensed | ||||||
3 | personnel under the
supervision of or in
collaboration with a | ||||||
4 | physician licensed to practice medicine in all its
branches to | ||||||
5 | determine whether
the need for emergency services exists.
| ||||||
6 | "Emergency services" means, with respect to an enrollee of | ||||||
7 | a health care
plan,
transportation services, including but not | ||||||
8 | limited to ambulance services, and
covered inpatient and | ||||||
9 | outpatient hospital services
furnished by a provider
qualified | ||||||
10 | to furnish those services that are needed to evaluate or | ||||||
11 | stabilize an
emergency medical condition. "Emergency services" | ||||||
12 | does not
refer to post-stabilization medical services.
| ||||||
13 | "Enrollee" means any person and his or her dependents | ||||||
14 | enrolled in or covered
by a health care plan.
| ||||||
15 | "Health care plan" means a plan, including, but not limited | ||||||
16 | to, a health maintenance organization, a managed care community | ||||||
17 | network as defined in the Illinois Public Aid Code, or an | ||||||
18 | accountable care entity as defined in the Illinois Public Aid | ||||||
19 | Code that receives capitated payments to cover medical services | ||||||
20 | from the Department of Healthcare and Family Services, that | ||||||
21 | establishes, operates, or maintains a
network of health care | ||||||
22 | providers that has entered into an agreement with the
plan to | ||||||
23 | provide health care services to enrollees to whom the plan has | ||||||
24 | the
ultimate obligation to arrange for the provision of or | ||||||
25 | payment for services
through organizational arrangements for | ||||||
26 | ongoing quality assurance,
utilization review programs, or |
| |||||||
| |||||||
1 | dispute resolution.
Nothing in this definition shall be | ||||||
2 | construed to mean that an independent
practice association or a | ||||||
3 | physician hospital organization that subcontracts
with
a | ||||||
4 | health care plan is, for purposes of that subcontract, a health | ||||||
5 | care plan.
| ||||||
6 | For purposes of this definition, "health care plan" shall | ||||||
7 | not 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 | ||||||
26 | professional
nurse,
or other individual appropriately licensed |
| |||||||
| |||||||
1 | or registered
to provide health care services.
| ||||||
2 | "Health care provider" means any physician, hospital | ||||||
3 | facility, facility licensed under the Nursing Home Care Act, | ||||||
4 | long-term care facility as defined in Section 1-113 of the | ||||||
5 | Nursing Home Care Act, or other
person that is licensed or | ||||||
6 | otherwise authorized to deliver health care
services. Nothing | ||||||
7 | in this
Act shall be construed to define Independent Practice | ||||||
8 | Associations or
Physician-Hospital Organizations as health | ||||||
9 | care providers.
| ||||||
10 | "Health care services" means any services included in the | ||||||
11 | furnishing to any
individual of medical care, or the
| ||||||
12 | hospitalization incident to the furnishing of such care, as | ||||||
13 | well as the
furnishing to any person of
any and all other | ||||||
14 | services for the purpose of preventing,
alleviating, curing, or | ||||||
15 | healing human illness or injury including home health
and | ||||||
16 | pharmaceutical services and products.
| ||||||
17 | "Medical director" means a physician licensed in any state | ||||||
18 | to practice
medicine in all its
branches appointed by a health | ||||||
19 | care plan.
| ||||||
20 | "Person" means a corporation, association, partnership,
| ||||||
21 | limited liability company, sole proprietorship, or any other | ||||||
22 | legal entity.
| ||||||
23 | "Physician" means a person licensed under the Medical
| ||||||
24 | Practice Act of 1987.
| ||||||
25 | "Post-stabilization medical services" means health care | ||||||
26 | services
provided to an enrollee that are furnished in a |
| |||||||
| |||||||
1 | licensed hospital by a provider
that is qualified to furnish | ||||||
2 | such services, and determined to be medically
necessary and | ||||||
3 | directly related to the emergency medical condition following
| ||||||
4 | stabilization.
| ||||||
5 | "Stabilization" means, with respect to an emergency | ||||||
6 | medical condition, to
provide such medical treatment of the | ||||||
7 | condition as may be necessary to assure,
within reasonable | ||||||
8 | medical probability, that no material deterioration
of the | ||||||
9 | condition is likely to result.
| ||||||
10 | "Utilization review" means the evaluation of the medical | ||||||
11 | necessity,
appropriateness, and efficiency of the use of health | ||||||
12 | care services, procedures,
and facilities.
| ||||||
13 | "Utilization review program" means a program established | ||||||
14 | by a person to
perform utilization review.
| ||||||
15 | (Source: P.A. 98-651, eff. 6-16-14; 98-841, eff. 8-1-14; 99-78, | ||||||
16 | eff. 7-20-15.)
| ||||||
17 | (215 ILCS 134/30)
| ||||||
18 | Sec. 30. Prohibitions.
| ||||||
19 | (a) No health care plan or its subcontractors may prohibit | ||||||
20 | or discourage
health care providers
by contract or policy from
| ||||||
21 | discussing any health care services and health care providers, | ||||||
22 | utilization
review and quality assurance policies, terms and | ||||||
23 | conditions of plans and plan
policy with enrollees, prospective | ||||||
24 | enrollees, providers, or the public.
| ||||||
25 | (b) No health care plan by contract, written policy, or |
| |||||||
| |||||||
1 | procedure may
permit or allow an individual or entity to | ||||||
2 | dispense a different
drug in place of the drug or brand of drug | ||||||
3 | ordered or prescribed without the
express permission of the | ||||||
4 | person ordering or prescribing the drug, except as
provided | ||||||
5 | under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.
| ||||||
6 | (c) No health care plan or its subcontractors may by | ||||||
7 | contract, written
policy, procedure, or otherwise mandate or | ||||||
8 | require an enrollee
to substitute his or her participating | ||||||
9 | primary care physician
under the plan during inpatient | ||||||
10 | hospitalization, such as with a hospitalist physician licensed | ||||||
11 | to practice medicine in all its branches,
without the agreement | ||||||
12 | of that enrollee's
participating primary care physician. | ||||||
13 | "Participating primary care
physician" for health care plans | ||||||
14 | and subcontractors that do not require
coordination of care by | ||||||
15 | a primary care physician means the participating
physician | ||||||
16 | treating the patient. All health care plans shall inform | ||||||
17 | enrollees
of any policies, recommendations, or guidelines | ||||||
18 | concerning the
substitution of the enrollee's primary care | ||||||
19 | physician when hospitalization is
necessary in the manner set | ||||||
20 | forth in subsections (d) and (e) of Section 15.
| ||||||
21 | (d) A health care plan shall apply any third-party | ||||||
22 | payments, financial assistance, discount, product vouchers, or | ||||||
23 | any other reduction in out-of-pocket expenses made by or on | ||||||
24 | behalf of such insured for prescription drugs toward a covered | ||||||
25 | individual's deductible, copay, or cost-sharing | ||||||
26 | responsibility, or out-of-pocket maximum associated with the |
| |||||||
| |||||||
1 | individual's health insurance. | ||||||
2 | (e) (d) Any violation of this Section shall be subject to | ||||||
3 | the
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 | ||||||
6 | Section 42 as follows:
| ||||||
7 | (225 ILCS 85/42 new) | ||||||
8 | Sec. 42. Information disclosure. A pharmacist or her or his | ||||||
9 | authorized employee must inform customers of a less expensive, | ||||||
10 | generically equivalent drug product for her or his prescription | ||||||
11 | and whether the cost-sharing obligation to the customer exceeds | ||||||
12 | the retail price of the prescription in the absence of | ||||||
13 | prescription drug coverage.
| ||||||
14 | Section 30. The Illinois Public Aid Code is amended by | ||||||
15 | adding 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 | ||||||
19 | third party on a fee-for-service reimbursement model for the | ||||||
20 | purpose of administering pharmacy benefits as provided in this | ||||||
21 | Section for members not enrolled in a Medicaid managed care | ||||||
22 | organization; however, these services shall be approved by the |
| |||||||
| |||||||
1 | Department. The Department shall ensure coordination of care | ||||||
2 | between the third-party administrator and managed care | ||||||
3 | organizations as a consideration in any contracts established | ||||||
4 | in accordance with this Section. Any managed care techniques, | ||||||
5 | principles, or administration of benefits utilized in | ||||||
6 | accordance with this subsection shall comply with State law. | ||||||
7 | (2) The following shall apply to contracts between entities | ||||||
8 | contracting relating to the Department's third-party | ||||||
9 | administrators 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 | ||||||
21 | outpatient pharmacy services provided by a health care facility | ||||||
22 | registered as a covered entity pursuant to 42 U.S.C. 256b or | ||||||
23 | any pharmacy owned by or contracted with the covered entity. A | ||||||
24 | Medicaid managed care organization shall, either directly or | ||||||
25 | through a pharmacy benefit manager, administer and reimburse | ||||||
26 | outpatient pharmacy claims submitted by a health care facility |
| |||||||
| |||||||
1 | registered as a covered entity pursuant to 42 U.S.C. 256b, its | ||||||
2 | owned pharmacies, and contracted pharmacies in accordance with | ||||||
3 | the contractual agreements the Medicaid managed care | ||||||
4 | organization or its pharmacy benefit manager has with such | ||||||
5 | facilities and pharmacies. Any pharmacy benefit manager that | ||||||
6 | contracts with a Medicaid managed care organization to | ||||||
7 | administer and reimburse pharmacy claims as provided in this | ||||||
8 | Section must be registered with the Director of Insurance in | ||||||
9 | accordance with Section 513b2 of the Illinois Insurance Code. | ||||||
10 | (c) On at least an annual basis, the Director of the | ||||||
11 | Department of Healthcare and Family Services shall submit a | ||||||
12 | report beginning no later than one year after the effective | ||||||
13 | date of this amendatory Act of the 101st General Assembly that | ||||||
14 | provides an update on any contract, contract issues, formulary, | ||||||
15 | dispensing fees, and maximum allowable cost concerns regarding | ||||||
16 | a third-party administrator and managed care. The requirement | ||||||
17 | for reporting to the General Assembly shall be satisfied by | ||||||
18 | filing copies of the report with the Speaker, the Minority | ||||||
19 | Leader, and the Clerk of the House of Representatives and with | ||||||
20 | the President, the Minority leader, and the Secretary of the | ||||||
21 | Senate. The Department shall take care that no proprietary | ||||||
22 | information is included in the report required under this | ||||||
23 | Section. | ||||||
24 | (d) A pharmacy benefit manager shall notify the Department | ||||||
25 | in writing of any activity, policy, or practice of the pharmacy | ||||||
26 | benefit manager that directly or indirectly presents a conflict |
| |||||||
| |||||||
1 | of interest that interferes with the discharge of the pharmacy | ||||||
2 | benefit manager's duty to a managed care organization to | ||||||
3 | exercise its contractual duties. "Conflict of interest" shall | ||||||
4 | be defined by rule by the Department. | ||||||
5 | (e) A pharmacy benefit manager shall, upon request, | ||||||
6 | disclose 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 |
| |||||||
| |||||||
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 | ||||||
6 | include all retail, mail order, specialty, and compounded | ||||||
7 | prescription products. All information made
available to the | ||||||
8 | Department under subsection (e) is confidential and not subject | ||||||
9 | to disclosure under the Freedom of Information Act. All | ||||||
10 | information made available to the Department under subsection | ||||||
11 | (e) shall not be reported or distributed in any way that | ||||||
12 | compromises its competitive, proprietary, or financial value. | ||||||
13 | The information shall only be used by the Department to assess | ||||||
14 | the contract, agreement, or other arrangements made between a | ||||||
15 | pharmacy benefit manager and a pharmacy provider, | ||||||
16 | pharmaceutical manufacturer or labeler, managed care | ||||||
17 | organization, or other entity, as applicable. | ||||||
18 | (g) A pharmacy benefit manager shall disclose directly in | ||||||
19 | writing to a pharmacy provider or pharmacy services | ||||||
20 | administrative organization contracting with the pharmacy | ||||||
21 | benefit manager of any material change to a contract provision | ||||||
22 | that affects the terms of the reimbursement, the process for | ||||||
23 | verifying benefits and eligibility, dispute resolution, | ||||||
24 | procedures for verifying drugs included on the formulary, and | ||||||
25 | contract termination at least 30 days prior to the date of the | ||||||
26 | change to the provision. The terms of this subsection shall be |
| |||||||
| |||||||
1 | deemed met if the pharmacy benefit manager posts the | ||||||
2 | information on a website, viewable by the public. A pharmacy | ||||||
3 | service administration organization shall notify all contract | ||||||
4 | pharmacies of any material change, as described in this | ||||||
5 | subsection, within 2 days of notification. As used in this | ||||||
6 | Section, "pharmacy services administrative organization" means | ||||||
7 | an entity operating within the State that contracts with | ||||||
8 | independent pharmacies to conduct business on their behalf with | ||||||
9 | third-party payers. A pharmacy services administrative | ||||||
10 | organization may provide administrative services to pharmacies | ||||||
11 | and negotiate and enter into contracts with third-party payers | ||||||
12 | or pharmacy benefit managers on behalf of pharmacies. | ||||||
13 | (h) A pharmacy benefit manager shall not include the | ||||||
14 | following 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 | ||||||
2 | a pharmacy benefit manager from requiring the same | ||||||
3 | reimbursement and terms and conditions for a pharmacy provider | ||||||
4 | as for a pharmacy owned, controlled, or otherwise associated | ||||||
5 | with the pharmacy benefit manager. | ||||||
6 | (j) A pharmacy benefit manager shall establish and | ||||||
7 | implement a process for the resolution of disputes arising out | ||||||
8 | of this Section, which shall be approved by the Department. | ||||||
9 | (k) The Department shall adopt rules establishing | ||||||
10 | reasonable dispensing fees for fee-for-service payments in | ||||||
11 | accordance with guidance or guidelines from the federal Centers | ||||||
12 | for Medicare and Medicaid Services.
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13 | Section 97. Severability. If any provision of this Act or | ||||||
14 | the application of this Act to any person or circumstance is | ||||||
15 | held invalid, the invalidity shall not affect other provisions | ||||||
16 | or applications of this Act which can be given effect without | ||||||
17 | the invalid provision or application, and to this end, the | ||||||
18 | provisions of this Act are declared severable.".
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