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| 1 | AN ACT concerning regulation.
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| 2 | Be it enacted by the People of the State of Illinois,
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| 3 | represented in the General Assembly:
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| 4 | Section 5. The Illinois Insurance Code is amended by adding | ||||||
| 5 | Section 5.5 as follows: | ||||||
| 6 | (215 ILCS 5/5.5 new) | ||||||
| 7 | Sec. 5.5. Compliance with the Department of Healthcare and | ||||||
| 8 | Family Services. A company authorized to do business in this | ||||||
| 9 | State or accredited by the State to issue policies of health | ||||||
| 10 | insurance, including but not limited to, self-insured plans, | ||||||
| 11 | group health plans (as defined in Section 607(1) of the | ||||||
| 12 | Employee Retirement Income Security Act of 1974), service | ||||||
| 13 | benefit plans, managed care organizations, pharmacy benefit | ||||||
| 14 | managers, or other parties that are by statute, contract, or | ||||||
| 15 | agreement legally responsible for payment of a claim for a | ||||||
| 16 | health care item or service as a condition of doing business in | ||||||
| 17 | the State must: | ||||||
| 18 | (1) provide to the Department of Healthcare and Family | ||||||
| 19 | Services, or any successor agency, upon request | ||||||
| 20 | information to determine during what period any individual | ||||||
| 21 | may be, or may have been, covered by a health insurer and | ||||||
| 22 | the nature of the coverage that is or was provided by the | ||||||
| 23 | health insurer, including the name, address, and | ||||||
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| 1 | identifying number of the plan; | ||||||
| 2 | (2) accept the State's right of recovery and the | ||||||
| 3 | assignment to the State of any right of an individual or | ||||||
| 4 | other entity to payment from the party for an item or | ||||||
| 5 | service for which payment has been made under the medical | ||||||
| 6 | programs of the Department of Healthcare and Family | ||||||
| 7 | Services, or any successor agency, under this Code or the | ||||||
| 8 | Illinois Public Aid Code; | ||||||
| 9 | (3) respond to any inquiry by the Department of | ||||||
| 10 | Healthcare and Family Services regarding a claim for | ||||||
| 11 | payment for any health care item or service that is | ||||||
| 12 | submitted not later than 3 years after the date of the | ||||||
| 13 | provision of such health care item or service; and | ||||||
| 14 | (4) agree not to deny a claim submitted by the | ||||||
| 15 | Department of Healthcare and Family Services solely on the | ||||||
| 16 | basis of the date of submission of the claim, the type or | ||||||
| 17 | format of the claim form, or a failure to present proper | ||||||
| 18 | documentation at the point-of-sale that is the basis of the | ||||||
| 19 | claim if (i) the claim is submitted by the Department of | ||||||
| 20 | Healthcare and Family Services within the 3-year period | ||||||
| 21 | beginning on the date on which the item or service was | ||||||
| 22 | furnished and (ii) any action by the Department of | ||||||
| 23 | Healthcare and Family Services to enforce its rights with | ||||||
| 24 | respect to such claim is commenced within 6 years of its | ||||||
| 25 | submission of such claim.
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| 26 | Section 99. Effective date. This Act takes effect upon | ||||||
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| 1 | becoming law.
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