95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008
HB5315


 
Introduced , by Rep. William Davis
 
SYNOPSIS AS INTRODUCED:
 		













215 ILCS 5/370e.1 new










    Amends the Illinois Insurance Code. Provides that no contract between a health care service plan and a physician, physician group, or other licensed health care practitioner shall contain any incentive plan that includes a specific payment made directly, in any type or form, to a physician, physician group, or other licensed health care practitioner as an inducement to prescribe a specific medication or type of medication or to deny, reduce, limit, or delay specific, medically necessary and appropriate services provided with respect to a specific enrollee or groups of enrollees with similar medical conditions. Provides that nothing in the provision shall be construed to prohibit contracts that contain incentive plans that involve general payments, such as capitation payments or shared-risk arrangements that are not tied to specific medical decisions involving specific enrollees or groups of enrollees with similar medical conditions.  Provides that the payments rendered or to be rendered to physicians, physician groups, or other licensed health care practitioners under these arrangements shall be deemed confidential.
















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A BILL FOR









 











HB5315

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    AN ACT concerning regulation.

 
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    Be it enacted by the People of the State of Illinois,
 
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represented in the General Assembly:


 
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    Section 5. The Illinois Insurance Code is amended  by adding 
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Section 370e.1 as follows:
 
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    (215 ILCS 5/370e.1 new)

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    Sec. 370e.1. Incentives prohibited. No contract between a 
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health care service plan and a physician, physician group, or 
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other licensed health care practitioner shall contain any 
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incentive plan that includes a specific payment made directly, 
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in any type or form, to a physician, physician group, or other 
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licensed health care practitioner as an inducement to prescribe 
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a specific medication or type of medication or deny, reduce, 
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limit, or delay specific, medically necessary and appropriate 
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services provided with respect to a specific enrollee or groups 
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of enrollees with similar medical conditions.  Nothing in this 
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Section shall be construed to prohibit contracts that contain 
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incentive plans that involve general payments, such as 
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capitation payments or shared-risk arrangements that are not 
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tied to specific medical decisions involving specific 
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enrollees or groups of enrollees with similar medical 
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conditions.  The payments rendered or to be rendered to 
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physicians, physician groups, or other licensed health care 
 


 






HB5315
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practitioners under these arrangements shall be deemed 
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confidential.