§ 4-18 — Retirement facility residents

With respect to an enrollee who is a resident of a retirement facility consisting of a long-term care facility, as defined in the Nursing Home Care Act, and residential apartments, a contract or evidence of coverage issued, amended, delivered, or renewed after the effective date of this amendatory Act of 1997 shall provide that the enrollee's primary care physician must refer the enrollee to the retirement facility's long-term care facility for Medicare covered skilled nursing services if the primary care physician finds that: (1) it is in the best interests of the patient; (2) the facility, if not a participating provider in the specific health maintenance organization, agrees during the preauthorization period to a negotiated rate for skilled nursing services covered in that organization's health care plan; and (3) the facility meets all the requirements of a participating provider for skilled nursing services as defined and covered under the health maintenance organization's health care plan. Both the facility and the health maintenance organization must fully disclose all pertinent information to consumers to assure that their decisions are based upon full knowledge of the implications of their decision making.

Legislative History

(Source: P.A. 90-408, eff. 1-1-98; 90-655, eff. 7-30-98.)