Bill Text: IL SB0688 | 2009-2010 | 96th General Assembly | Introduced

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Bill Title: Amends the Managed Care Reform and Patient Rights Act. Makes a technical change in a Section concerning emergency services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2009-08-15 - Pursuant to Senate Rule 3-9(b) / Referred to Assignments [SB0688 Detail]

Download: Illinois-2009-SB0688-Introduced.html

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96TH GENERAL ASSEMBLY State of Illinois 2009 and 2010 SB0688 Introduced 2/6/2009, by Sen. John J. Cullerton SYNOPSIS AS INTRODUCED:
215 ILCS 134/65
Amends the Managed Care Reform and Patient Rights Act. Makes a technical change in a Section concerning emergency services.
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A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Managed Care Reform and Patient Rights Act
is amended by changing Section 65 as follows:
(215 ILCS 134/65)
Sec. 65. Emergency services prior to stabilization.
(a) A health care plan that that provides or that is
required by law to provide coverage for emergency services
shall provide coverage such that payment under this coverage is
not dependent upon whether the services are performed by a plan
or non-plan health care provider and without regard to prior
authorization. This coverage shall be at the same benefit level
as if the services or treatment had been rendered by the health
care plan physician licensed to practice medicine in all its
branches or health care provider.
(b) Prior authorization or approval by the plan shall not
be required for emergency services.
(c) Coverage and payment shall only be retrospectively
denied under the following circumstances:
(1) upon reasonable determination that the emergency
services claimed were never performed;
(2) upon timely determination that the emergency

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evaluation and treatment were rendered to an enrollee who
sought emergency services and whose circumstance did not
meet the definition of emergency medical condition;
(3) upon determination that the patient receiving such
services was not an enrollee of the health care plan; or
(4) upon material misrepresentation by the enrollee or
health care provider; "material" means a fact or situation
that is not merely technical in nature and results or could
result in a substantial change in the situation.
(d) When an enrollee presents to a hospital seeking
emergency services, the determination as to whether the need
for those services exists shall be made for purposes of
treatment by a physician licensed to practice medicine in all
its branches or, to the extent permitted by applicable law, by
other appropriately licensed personnel under the supervision
of or in collaboration with a physician licensed to practice
medicine in all its branches. The physician or other
appropriate personnel shall indicate in the patient's chart the
results of the emergency medical screening examination.
(e) The appropriate use of the 911 emergency telephone
system or its local equivalent shall not be discouraged or
penalized by the health care plan when an emergency medical
condition exists. This provision shall not imply that the use
of 911 or its local equivalent is a factor in determining the
existence of an emergency medical condition.
(f) The medical director's or his or her designee's

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determination of whether the enrollee meets the standard of an
emergency medical condition shall be based solely upon the
presenting symptoms documented in the medical record at the
time care was sought. Only a clinical peer may make an adverse
determination.
(g) Nothing in this Section shall prohibit the imposition
of deductibles, copayments, and co-insurance. Nothing in this
Section alters the prohibition on billing enrollees contained
in the Health Maintenance Organization Act.
(Source: P.A. 91-617, eff. 1-1-00.)