102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3327

 

Introduced 2/19/2021, by Rep. Jackie Haas

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/368a

    Amends the Illinois Insurance Code. In provisions concerning timely payment for health care services, provides that failure to make periodic payments within specified time periods shall entitle a health care professional, health care facility, independent practice association, physician-hospital organization, insurer, health maintenance organization, managed care plans health care plan, preferred provider organization, or third party administrator to interest at the rate of 9% semiannually (rather than 9% per year).


LRB102 14001 BMS 19353 b

 

 

A BILL FOR

 

HB3327LRB102 14001 BMS 19353 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 368a as follows:
 
6    (215 ILCS 5/368a)
7    Sec. 368a. Timely payment for health care services.
8    (a) This Section applies to insurers, health maintenance
9organizations, managed care plans, health care plans,
10preferred provider organizations, third party administrators,
11independent practice associations, and physician-hospital
12organizations (hereinafter referred to as "payors") that
13provide periodic payments, which are payments not requiring a
14claim, bill, capitation encounter data, or capitation
15reconciliation reports, such as prospective capitation
16payments, to health care professionals and health care
17facilities to provide medical or health care services for
18insureds or enrollees.
19        (1) A payor shall make periodic payments in accordance
20    with item (3). Failure to make periodic payments within
21    the period of time specified in item (3) shall entitle the
22    health care professional or health care facility to
23    interest at the rate of 9% semiannually per year from the

 

 

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1    date payment was required to be made to the date of the
2    late payment, provided that interest amounting to less
3    than $1 need not be paid. Any required interest payments
4    shall be made within 30 days after the payment.
5        (2) When a payor requires selection of a health care
6    professional or health care facility, the selection shall
7    be completed by the insured or enrollee no later than 30
8    days after enrollment. The payor shall provide written
9    notice of this requirement to all insureds and enrollees.
10    Nothing in this Section shall be construed to require a
11    payor to select a health care professional or health care
12    facility for an insured or enrollee.
13        (3) A payor shall provide the health care professional
14    or health care facility with notice of the selection as a
15    health care professional or health care facility by an
16    insured or enrollee and the effective date of the
17    selection within 60 calendar days after the selection. No
18    later than the 60th day following the date an insured or
19    enrollee has selected a health care professional or health
20    care facility or the date that selection becomes
21    effective, whichever is later, or in cases of
22    retrospective enrollment only, 30 days after notice by an
23    employer to the payor of the selection, a payor shall
24    begin periodic payment of the required amounts to the
25    insured's or enrollee's health care professional or health
26    care facility, or the designee of either, calculated from

 

 

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1    the date of selection or the date the selection becomes
2    effective, whichever is later. All subsequent payments
3    shall be made in accordance with a monthly periodic cycle.
4    (b) Notwithstanding any other provision of this Section,
5independent practice associations and physician-hospital
6organizations shall make periodic payment of the required
7amounts in accordance with a monthly periodic schedule after
8an insured or enrollee has selected a health care professional
9or health care facility or after that selection becomes
10effective, whichever is later.
11    Notwithstanding any other provision of this Section,
12independent practice associations and physician-hospital
13organizations shall make all other payments for health
14services within 30 days after receipt of due proof of loss.
15Independent practice associations and physician-hospital
16organizations shall notify the insured, insured's assignee,
17health care professional, or health care facility of any
18failure to provide sufficient documentation for a due proof of
19loss within 30 days after receipt of the claim for health
20services.
21    Failure to pay within the required time period shall
22entitle the payee to interest at the rate of 9% semiannually
23per year from the date the payment is due to the date of the
24late payment, provided that interest amounting to less than $1
25need not be paid. Any required interest payments shall be made
26within 30 days after the payment.

 

 

HB3327- 4 -LRB102 14001 BMS 19353 b

1    (c) All insurers, health maintenance organizations,
2managed care plans, health care plans, preferred provider
3organizations, and third party administrators shall ensure
4that all claims and indemnities concerning health care
5services other than for any periodic payment shall be paid
6within 30 days after receipt of due written proof of such loss.
7An insured, insured's assignee, health care professional, or
8health care facility shall be notified of any known failure to
9provide sufficient documentation for a due proof of loss
10within 30 days after receipt of the claim for health care
11services. Failure to pay within such period shall entitle the
12payee to interest at the rate of 9% semiannually per year from
13the 30th day after receipt of such proof of loss to the date of
14late payment, provided that interest amounting to less than
15one dollar need not be paid. Any required interest payments
16shall be made within 30 days after the payment.
17    (d) The Department shall enforce the provisions of this
18Section pursuant to the enforcement powers granted to it by
19law.
20    (e) The Department is hereby granted specific authority to
21issue a cease and desist order, fine, or otherwise penalize
22independent practice associations and physician-hospital
23organizations that violate this Section. The Department shall
24adopt reasonable rules to enforce compliance with this Section
25by independent practice associations and physician-hospital
26organizations.

 

 

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1(Source: P.A. 97-813, eff. 7-13-12.)