Rep. Gregory Harris

Filed: 3/29/2017





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2    AMENDMENT NO. ______. Amend House Bill 311, AS AMENDED,
3with reference to page and line numbers of House Amendment No.
41, on page 1, immediately below line 5, by inserting the
6    "Section 3. Applicability of Act. This Act applies to an
7individual or group policy of accident and health insurance
8with a network plan amended, delivered, issued, or renewed in
9this State on or after January 1, 2019."; and
10on page 1, immediately below line 6, by inserting the
12    ""Authorized representative" means a person to whom a
13beneficiary has given express written consent to represent the
14beneficiary; a person authorized by law to provide substituted
15consent for a beneficiary; or the beneficiary's treating



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1provider only when the beneficiary or his or her family member
2is unable to provide consent."; and
3on page 3, line 20, by replacing "256z.22 of the Insurance
4Code" with "356z.22 of the Illinois Insurance Code"; and
5on page 5, by replacing lines 1 and 2 with the following:
6    "(b) Insurers must file for review a description of the
7services"; and
8on page 5, line 25, by deleting "full-time equivalent"; and
9on page 6, line 22, by replacing "apply to" with "apply to:
10(A)"; and
11on page 6, line 25, by replacing "providers." with "providers,
12or (B) a beneficiary enrolled in a health maintenance
13organization."; and
14on page 7, by replacing lines 17 and 18 with the following:
15    "(c) The network plan shall demonstrate to the Director a
16minimum ratio of"; and
17on page 7, line 20, by deleting "full-time equivalent"; and



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1on page 7, line 25, by deleting "concerning exchange plans or
2Medicare Advantage Plans"; and
3on page 9, lines 6 and 22, by deleting "annual" each time it
4appears; and
5on page 9, lines 9 and 10, by deleting ", prior to approval,";
7on page 9, by replacing lines 14 and 15 with "and Medicaid
8Services. These standards shall consist of the maximum"; and
9on page 9, line 26, by replacing "These" with "Except for
10network plans solely offered as a group health plan, these";
12by replacing line 15 on page 11 through line 1 on page 12 with
13the following:
14    "Section 15. Notice of renewal or termination.
15    (a) A network plan must give at least 60 days' notice of
16nonrenewal or termination of a provider to the provider and to
17the beneficiaries served by the provider. The notice shall
18include a name and address to which a beneficiary or provider
19may direct comments and concerns regarding the nonrenewal or



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1termination and the telephone number maintained by the
2Department for consumer complaints. Immediate written notice
3may be provided without 60 days' notice when a provider's
4license has been disciplined by a State licensing board or when
5the network plan reasonably believes direct imminent physical
6harm to patients under the providers care may occur.
7    (b) Primary care providers must notify active affected
8patients of nonrenewal or termination of the provider from the
9network plan, except in the case of incapacitation."; and
10on page 14, by replacing line 9 with the following:
11        "(2) If a beneficiary, or a beneficiary's authorized
12    representative, elects in writing to continue to receive
13    care"; and
14on page 16, line 8, by deleting "annually"; and
15on page 16, line 9, after "Director", by inserting "upon
16request"; and
17on page 20, immediately below line 23, by inserting the
19    "Section 30. Facility nonparticipating provider
20transparency. Prior to providing a non-emergency outpatient



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1procedure to a beneficiary in an in-network facility or during
2the admission or as soon as practicable thereafter, the
3hospital must provide an insured patient with written notice
5        (1) the patient may receive separate bills for services
6    provided by health care professionals affiliated with the
7    hospital;
8        (2) if applicable, some hospital staff members may not
9    be participating providers in the same insurance plans and
10    networks as the hospital;
11        (3) if applicable, the patient may have a greater
12    financial responsibility for services provided by health
13    care professionals at the hospital who are not under
14    contract with the patient's health care plan; and
15        (4) questions about coverage or benefit levels should
16    be directed to the patient's health care plan and the
17    patient's certificate of coverage."; and
18on page 20, line 24, by replacing "30" with "35"; and
19on page 21, by replacing lines 12 through 16 with "pursuant to
20the enforcement powers granted to it by law."; and
21on page 21, by replacing lines 19 and 20 with the following:
22    "Section 99. Effective date. This Act takes effect upon



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1becoming law.".