99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB3509

 

Introduced , by Rep. Greg Harris

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/368b

    Amends the Illinois Insurance Code. Provides that contracts between insurers and health care professionals or providers for the provision of health care to the insured shall not contain terms allowing the plan to change a material term of the contract or a term affecting reimbursement rates established in the contract unless the term has been negotiated and agreed to or the change is necessary to comply with State or federal law or regulations or accreditation requirements. Effective immediately.


LRB099 09196 MLM 29399 b

 

 

A BILL FOR

 

HB3509LRB099 09196 MLM 29399 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 368b as follows:
 
6    (215 ILCS 5/368b)
7    Sec. 368b. Contracting procedures.
8    (a) A health care professional or health care provider
9offered a contract by an insurer, health maintenance
10organization, independent practice association, or physician
11hospital organization for signature after the effective date of
12this amendatory Act of the 93rd General Assembly shall be
13provided with a proposed health care professional or health
14care provider services contract including, if any, exhibits and
15attachments that the contract indicates are to be attached.
16Within 35 days after a written request, the health care
17professional or health care provider offered a contract shall
18be given the opportunity to review and obtain a copy of the
19following: a specialty-specific fee schedule sample based on a
20minimum of the 50 highest volume fee schedule codes with the
21rates applicable to the health care professional or health care
22provider to whom the contract is offered, the network provider
23administration manual, and a summary capitation schedule, if

 

 

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1payment is made on a capitation basis. If 50 codes do not exist
2for a particular specialty, the health care professional or
3health care provider offered a contract shall be given the
4opportunity to review or obtain a copy of a fee schedule sample
5with the codes applicable to that particular specialty. This
6information may be provided electronically. An insurer, health
7maintenance organization, independent practice association, or
8physician hospital organization may substitute the fee
9schedule sample with a document providing reference to the
10information needed to calculate the fee schedule that is
11available to the public at no charge and the percentage or
12conversion factor at which the insurer, health maintenance
13organization, preferred provider organization, independent
14practice association, or physician hospital organization sets
15its rates.
16    (b) The fee schedule, the capitation schedule, and the
17network provider administration manual constitute
18confidential, proprietary, and trade secret information and
19are subject to the provisions of the Illinois Trade Secrets
20Act. The health care professional or health care provider
21receiving such protected information may disclose the
22information on a need to know basis and only to individuals and
23entities that provide services directly related to the health
24care professional's or health care provider's decision to enter
25into the contract or keep the contract in force. Any person or
26entity receiving or reviewing such protected information

 

 

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1pursuant to this Section shall not disclose the information to
2any other person, organization, or entity, unless the
3disclosure is requested pursuant to a valid court order or
4required by a state or federal government agency. Individuals
5or entities receiving such information from a health care
6professional or health care provider as delineated in this
7subsection are subject to the provisions of the Illinois Trade
8Secrets Act.
9    (c) The health care professional or health care provider
10shall be allowed at least 30 days to review the health care
11professional or health care provider services contract,
12including exhibits and attachments, if any, before signing. The
1330-day review period begins upon receipt of the health care
14professional or health care provider services contract, unless
15the information available upon request in subsection (a) is not
16included. If information is not included in the professional
17services contract and is requested pursuant to subsection (a),
18the 30-day review period begins on the date of receipt of the
19information. Nothing in this subsection shall prohibit a health
20care professional or health care provider from signing a
21contract prior to the expiration of the 30-day review period.
22    (d) The insurer, health maintenance organization,
23independent practice association, or physician hospital
24organization shall provide all contracted health care
25professionals or health care providers with any changes to the
26fee schedule provided under subsection (a) not later than 35

 

 

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1days after the effective date of the changes, unless such
2changes are specified in the contract and the health care
3professional or health care provider is able to calculate the
4changed rates based on information in the contract and
5information available to the public at no charge. For the
6purposes of this subsection, "changes" means an increase or
7decrease in the fee schedule referred to in subsection (a).
8This information may be made available by mail, e-mail,
9newsletter, website listing, or other reasonable method. Upon
10request, a health care professional or health care provider may
11request an updated copy of the fee schedule referred to in
12subsection (a) every calendar quarter.
13    (e) Upon termination of a contract with an insurer, health
14maintenance organization, independent practice association, or
15physician hospital organization and at the request of the
16patient, a health care professional or health care provider
17shall transfer copies of the patient's medical records. Any
18other provision of law notwithstanding, the costs for copying
19and transferring copies of medical records shall be assigned
20per the arrangements agreed upon, if any, in the health care
21professional or health care provider services contract.
22    (f) No contract between an insurer, health maintenance
23organization, managed care plan, health care plan, preferred
24provider organization, third party administrator, independent
25practice association, or physician-hospital organization and a
26health care provider or health care professional for the

 

 

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1provision of health care services to an insured, enrollee,
2beneficiary, or subscriber shall contain terms allowing the
3plan to change a material term of the contract or a term
4affecting reimbursement rates established in the contract,
5including changes made by amending a manual, policy, procedure
6document, or other document referenced in the contract, unless
7the change has first been negotiated and agreed to by the
8provider or professional and the plan or the change is
9necessary to comply with State or federal law or regulations or
10any accreditation requirements of a private sector
11accreditation organization.
12(Source: P.A. 93-261, eff. 1-1-04.)
 
13    Section 99. Effective date. This Act takes effect upon
14becoming law.