Sen. William R. Haine
Filed: 4/11/2011
 
 

 

 

 
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1
AMENDMENT TO SENATE BILL 72




2    AMENDMENT NO. ______. Amend Senate Bill 72, AS AMENDED, by 
3replacing everything after the enacting clause with the 
4following:

 
5    "Section 5. The Illinois Insurance Code is amended  by 
6adding Section 356z.3b as follows:
 
7    (215 ILCS 5/356z.3b new)
8    Sec. 356z.3b. Facility-based physicians and providers.
9    (a)  All insurers and health plans with networks of 
10physicians and providers shall report the following 
11information to the Department of Insurance:
12        (1)  The reimbursement amounts per individual procedure 
13    or service for all out-of-network facility-based 
14    physicians and providers per hospital or ASTC.
15        (2)  The reimbursement amounts per individual procedure 
16    or service for all in-network facility-based physicians 
 
 
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1    and providers per hospital or ASTC.
2        (3)  The charges of all out-of-network facility-based 
3    physicians and providers per individual procedure or 
4    service per hospital or ASTC.
5        (4)  The charges of all in-network facility-based 
6    physicians and providers per individual procedure or 
7    service per hospital or ASTC.
8    The information required under this subsection (a) shall be 
9submitted based upon reimbursement amounts and charges as of 
10January 1, 2010 for services rendered from January 1, 2009 
11through December 31, 2010 and shall be submitted by October 1, 
122011. The charges are physician or provider billed amounts and 
13shall not include discounted charges. The data shall in no way 
14identify any physician or provider or patient. The Department 
15may request additional data necessary to comply with this 
16Section.
17    The Director shall compile the data required under this 
18subsection (a) and, no later than February 1, 2012, submit a 
19written recommendation to the General Assembly for a 
20reimbursement methodology for out-of-network facility-based 
21physicians or providers.
22    (b)  For purposes of this Section only "facility-based 
23physician or provider" means a physician or other provider who 
24provides radiology, anesthesiology, pathology, neonatology, or 
25emergency department services to insureds, beneficiaries, or 
26enrollees in a participating hospital or participating 
 
 
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1ambulatory surgical treatment center.

 
2    Section 10. "An Act concerning insurance", approved 
3February 14, 2011, Public Act 96-1523, is amended  by adding 
4Section 99 as follows:
 
5    (P.A. 96-1523, Sec. 99 new)
6    Sec. 99. Effective date. This Act takes effect July 1, 
72012.
 
 
8    Section 999. Effective date. This Section and Section 10 
9take effect upon becoming law.".