102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3559

 

Introduced 2/22/2021, by Rep. Dan Ugaste

 

SYNOPSIS AS INTRODUCED:
 
820 ILCS 305/8.2

    Amends the Workers' Compensation Act. Makes existing medical fee schedules inoperative after August 31, 2022. Provides that the Illinois Workers' Compensation Commission shall establish new medical fee schedules applicable on and after September 1, 2022 in accordance with specified criteria. Provides for 4 non-hospital fee schedules and 14 hospital fee schedules applicable to different geographic areas of the State. Sets forth a procedure for petitioning the Commission if a maximum fee causes a significant limitation on access to quality health care in either a specific field of health care services or a specific geographic limitation on access to health care. Effective immediately.


LRB102 10871 JLS 16201 b

 

 

A BILL FOR

 

HB3559LRB102 10871 JLS 16201 b

1    AN ACT concerning employment.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Workers' Compensation Act is amended by
5changing Section 8.2 as follows:
 
6    (820 ILCS 305/8.2)
7    Sec. 8.2. Fee schedule.
8    (a) Except as provided for in subsection (c), for
9procedures, treatments, or services covered under this Act and
10rendered or to be rendered on and after February 1, 2006, the
11maximum allowable payment shall be 90% of the 80th percentile
12of charges and fees as determined by the Commission utilizing
13information provided by employers' and insurers' national
14databases, with a minimum of 12,000,000 Illinois line item
15charges and fees comprised of health care provider and
16hospital charges and fees as of August 1, 2004 but not earlier
17than August 1, 2002. These charges and fees are provider
18billed amounts and shall not include discounted charges. The
1980th percentile is the point on an ordered data set from low to
20high such that 80% of the cases are below or equal to that
21point and at most 20% are above or equal to that point. The
22Commission shall adjust these historical charges and fees as
23of August 1, 2004 by the Consumer Price Index-U for the period

 

 

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1August 1, 2004 through September 30, 2005. The Commission
2shall establish fee schedules for procedures, treatments, or
3services for hospital inpatient, hospital outpatient,
4emergency room and trauma, ambulatory surgical treatment
5centers, and professional services. These charges and fees
6shall be designated by geozip or any smaller geographic unit.
7The data shall in no way identify or tend to identify any
8patient, employer, or health care provider. As used in this
9Section, "geozip" means a three-digit zip code based on data
10similarities, geographical similarities, and frequencies. A
11geozip does not cross state boundaries. As used in this
12Section, "three-digit zip code" means a geographic area in
13which all zip codes have the same first 3 digits. If a geozip
14does not have the necessary number of charges and fees to
15calculate a valid percentile for a specific procedure,
16treatment, or service, the Commission may combine data from
17the geozip with up to 4 other geozips that are demographically
18and economically similar and exhibit similarities in data and
19frequencies until the Commission reaches 9 charges or fees for
20that specific procedure, treatment, or service. In cases where
21the compiled data contains less than 9 charges or fees for a
22procedure, treatment, or service, reimbursement shall occur at
2376% of charges and fees as determined by the Commission in a
24manner consistent with the provisions of this paragraph.
25Providers of out-of-state procedures, treatments, services,
26products, or supplies shall be reimbursed at the lesser of

 

 

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1that state's fee schedule amount or the fee schedule amount
2for the region in which the employee resides. If no fee
3schedule exists in that state, the provider shall be
4reimbursed at the lesser of the actual charge or the fee
5schedule amount for the region in which the employee resides.
6Not later than September 30 in 2006 and each year thereafter,
7the Commission shall automatically increase or decrease the
8maximum allowable payment for a procedure, treatment, or
9service established and in effect on January 1 of that year by
10the percentage change in the Consumer Price Index-U for the 12
11month period ending August 31 of that year. The increase or
12decrease shall become effective on January 1 of the following
13year. As used in this Section, "Consumer Price Index-U" means
14the index published by the Bureau of Labor Statistics of the
15U.S. Department of Labor, that measures the average change in
16prices of all goods and services purchased by all urban
17consumers, U.S. city average, all items, 1982-84=100.
18    The provisions of this subsection (a), other than this
19sentence, are inoperative after August 31, 2022.
20    (a-1) Notwithstanding the provisions of subsection (a) and
21unless otherwise indicated, the following provisions shall
22apply to the medical fee schedule starting on September 1,
232011:
24        (1) The Commission shall establish and maintain fee
25    schedules for procedures, treatments, products, services,
26    or supplies for hospital inpatient, hospital outpatient,

 

 

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1    emergency room, ambulatory surgical treatment centers,
2    accredited ambulatory surgical treatment facilities,
3    prescriptions filled and dispensed outside of a licensed
4    pharmacy, dental services, and professional services. This
5    fee schedule shall be based on the fee schedule amounts
6    already established by the Commission pursuant to
7    subsection (a) of this Section. However, starting on
8    January 1, 2012, these fee schedule amounts shall be
9    grouped into geographic regions in the following manner:
10            (A) Four regions for non-hospital fee schedule
11        amounts shall be utilized:
12                (i) Cook County;
13                (ii) DuPage, Kane, Lake, and Will Counties;
14                (iii) Bond, Calhoun, Clinton, Jersey,
15            Macoupin, Madison, Monroe, Montgomery, Randolph,
16            St. Clair, and Washington Counties; and
17                (iv) All other counties of the State.
18            (B) Fourteen regions for hospital fee schedule
19        amounts shall be utilized:
20                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
21            Kendall, and Grundy Counties;
22                (ii) Kankakee County;
23                (iii) Madison, St. Clair, Macoupin, Clinton,
24            Monroe, Jersey, Bond, and Calhoun Counties;
25                (iv) Winnebago and Boone Counties;
26                (v) Peoria, Tazewell, Woodford, Marshall, and

 

 

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1            Stark Counties;
2                (vi) Champaign, Piatt, and Ford Counties;
3                (vii) Rock Island, Henry, and Mercer Counties;
4                (viii) Sangamon and Menard Counties;
5                (ix) McLean County;
6                (x) Lake County;
7                (xi) Macon County;
8                (xii) Vermilion County;
9                (xiii) Alexander County; and
10                (xiv) All other counties of the State.
11        (2) If a geozip, as defined in subsection (a) of this
12    Section, overlaps into one or more of the regions set
13    forth in this Section, then the Commission shall average
14    or repeat the charges and fees in a geozip in order to
15    designate charges and fees for each region.
16        (3) In cases where the compiled data contains less
17    than 9 charges or fees for a procedure, treatment,
18    product, supply, or service or where the fee schedule
19    amount cannot be determined by the non-discounted charge
20    data, non-Medicare relative values and conversion factors
21    derived from established fee schedule amounts, coding
22    crosswalks, or other data as determined by the Commission,
23    reimbursement shall occur at 76% of charges and fees until
24    September 1, 2011 and 53.2% of charges and fees thereafter
25    as determined by the Commission in a manner consistent
26    with the provisions of this paragraph.

 

 

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1        (4) To establish additional fee schedule amounts, the
2    Commission shall utilize provider non-discounted charge
3    data, non-Medicare relative values and conversion factors
4    derived from established fee schedule amounts, and coding
5    crosswalks. The Commission may establish additional fee
6    schedule amounts based on either the charge or cost of the
7    procedure, treatment, product, supply, or service.
8        (5) Implants shall be reimbursed at 25% above the net
9    manufacturer's invoice price less rebates, plus actual
10    reasonable and customary shipping charges whether or not
11    the implant charge is submitted by a provider in
12    conjunction with a bill for all other services associated
13    with the implant, submitted by a provider on a separate
14    claim form, submitted by a distributor, or submitted by
15    the manufacturer of the implant. "Implants" include the
16    following codes or any substantially similar updated code
17    as determined by the Commission: 0274
18    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
19    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
20    (investigational devices); and 0636 (drugs requiring
21    detailed coding). Non-implantable devices or supplies
22    within these codes shall be reimbursed at 65% of actual
23    charge, which is the provider's normal rates under its
24    standard chargemaster. A standard chargemaster is the
25    provider's list of charges for procedures, treatments,
26    products, supplies, or services used to bill payers in a

 

 

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1    consistent manner.
2        (6) The Commission shall automatically update all
3    codes and associated rules with the version of the codes
4    and rules valid on January 1 of that year.
5    The provisions of this subsection (a-1), other than this
6sentence, are inoperative after August 31, 2022.
7    (a-1.5) The following provisions apply to procedures,
8treatments, services, products, and supplies covered under
9this Act and rendered or to be rendered on or after September
101, 2022:
11        (1) In this Section:
12        "CPT code" means each Current Procedural Terminology
13    code, for each geographic region specified in subsection
14    (b) of this Section, included on the most recent medical
15    fee schedule established by the Commission pursuant to
16    this Section.
17        "DRG code" means each current diagnosis related group
18    code, for each geographic region specified in subsection
19    (b) of this Section, included on the most recent medical
20    fee schedule established by the Commission pursuant to
21    this Section.
22        "Geozip" means a three-digit zip code based on data
23    similarities, geographical similarities, and frequencies.
24        "Health care services" means those CPT and DRG codes
25    for procedures, treatments, products, services or supplies
26    for hospital inpatient, hospital outpatient, emergency

 

 

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1    room, ambulatory surgical treatment centers, accredited
2    ambulatory surgical treatment facilities, and professional
3    services. It does not include codes classified as
4    healthcare common procedure coding systems or dental.
5        "Medicare maximum fee" means, for each CPT and DRG
6    code, the current maximum fee for that CPT or DRG code
7    allowed to be charged by the Centers for Medicare and
8    Medicaid Services for Medicare patients in that geographic
9    region. The Medicare maximum fee shall be the greater of
10    (i) the current maximum fee allowed to be charged by the
11    Centers for Medicare and Medicaid Services for Medicare
12    patients in the geographic region or (ii) the maximum fee
13    charged by the Centers for Medicare and Medicaid Services
14    for Medicare patients in the geographic region on January
15    1, 2022.
16        "Medicare percentage amount" means, for each CPT and
17    DRG code, the workers' compensation maximum fee as a
18    percentage of the Medicare maximum fee.
19        "Workers' compensation maximum fee" means, for each
20    CPT and DRG code, the current maximum fee allowed to be
21    charged under the medical fee schedule established by the
22    Commission for that CPT or DRG code in that geographic
23    region.
24        (2) The Commission shall establish and maintain fee
25    schedules for procedures, treatments, products, services,
26    or supplies for hospital inpatient, hospital outpatient,

 

 

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1    emergency room, ambulatory surgical treatment centers,
2    accredited ambulatory surgical treatment facilities,
3    prescriptions filled and dispensed outside of a licensed
4    pharmacy, dental services, and professional services.
5    These fee schedule amounts shall be grouped into
6    geographic regions in the following manner:
7            (A) Four regions for non-hospital fee schedule
8        amounts shall be utilized:
9                (i) Cook County;
10                (ii) DuPage, Kane, Lake, and Will Counties;
11                (iii) Bond, Calhoun, Clinton, Jersey,
12            Macoupin, Madison, Monroe, Montgomery, Randolph,
13            St. Clair, and Washington Counties; and
14                (iv) All other counties of the State.
15            (B) Fourteen regions for hospital fee schedule
16        amounts shall be utilized:
17                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
18            Kendall, and Grundy Counties;
19                (ii) Kankakee County;
20                (iii) Madison, St. Clair, Macoupin, Clinton,
21            Monroe, Jersey, Bond, and Calhoun Counties;
22                (iv) Winnebago and Boone Counties;
23                (v) Peoria, Tazewell, Woodford, Marshall, and
24            Stark Counties;
25                (vi) Champaign, Piatt, and Ford Counties;
26                (vii) Rock Island, Henry, and Mercer Counties;

 

 

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1                (viii) Sangamon and Menard Counties;
2                (ix) McLean County;
3                (x) Lake County;
4                (xi) Macon County;
5                (xii) Vermilion County;
6                (xiii) Alexander County; and
7                (xiv) All other counties of the State.
8        If a geozip overlaps into one or more of the regions
9    set forth in this Section, then the Commission shall
10    average or repeat the charges and fees in a geozip in order
11    to designate charges and fees for each region.
12        (3) The initial workers' compensation maximum fee for
13    each CPT and DRG code as of September 1, 2022 shall be
14    determined as follows:
15            (A) Within 45 days after the effective date of
16        this amendatory Act of the 102nd General Assembly, the
17        Commission shall determine the Medicare percentage
18        amount for each CPT and DRG code using the most recent
19        data available.
20            CPT or DRG codes which have a value, but are not
21        covered expenses under Medicare, are still compensable
22        under the medical fee schedule according to the rate
23        described in Section (B).
24            (B) Within 30 days after the Commission makes the
25        determinations required by subdivision (3)(A) of this
26        subsection (a-1.5), the Commission shall determine an

 

 

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1        adjustment to be made to the workers' compensation
2        maximum fee for each CPT and DRG code as follows:
3                (i) If the Medicare percentage amount for that
4            CPT or DRG code is equal to or less than 125%, then
5            the workers' compensation maximum fee for that CPT
6            or DRG code shall be adjusted so that it equals
7            125% of the most recent Medicare maximum fee for
8            that CPT or DRG code.
9                (ii) If the Medicare percentage amount for
10            that CPT or DRG code is greater than 125% but less
11            than 150%, then the workers' compensation maximum
12            fee for that CPT or DRG code shall not be adjusted.
13                (iii) If the Medicare percentage amount for
14            that CPT or DRG code is greater than 150% but less
15            than or equal to 225%, then the workers'
16            compensation maximum fee for that CPT or DRG code
17            shall be adjusted so that it equals the greater of
18            (I) 150% of the most recent Medicare maximum fee
19            for that CPT or DRG code or (II) 85% of the most
20            recent workers' compensation maximum amount for
21            that CPT or DRG code.
22                (iv) If the Medicare percentage amount for
23            that CPT or DRG code is greater than 225% but less
24            than or equal to 428.57%, then the workers'
25            compensation maximum fee for that CPT or DRG code
26            shall be adjusted so that it equals the greater of

 

 

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1            (I) 191.25% of the most recent Medicare maximum
2            fee for that CPT or DRG code or (II) 70% of the
3            most recent workers' compensation maximum amount
4            for that CPT or DRG code.
5                (v) If the Medicare percentage amount for that
6            CPT or DRG code is greater than 428.57%, then the
7            workers' compensation maximum fee for that CPT or
8            DRG code shall be adjusted so that it equals 300%
9            of the most recent Medicare maximum fee for that
10            CPT or DRG code.
11            The Commission shall promptly publish the
12        adjustments determined pursuant to this subdivision
13        (3)(B) on its website.
14            (C) The initial workers' compensation maximum fee
15        for each CPT and DRG code as of September 1, 2022 shall
16        be equal to the workers' compensation maximum fee for
17        that code as determined and adjusted pursuant to
18        subdivision (3)(B) of this subsection, subject to any
19        further adjustments pursuant to subdivision (5) of
20        this subsection.
21        (4) The Commission, as of September 1, 2023 and
22    September 1 of each year thereafter, shall adjust the
23    workers' compensation maximum fee for each CPT or DRG code
24    to exactly half of the most recent annual increase in the
25    Consumer Price Index-U.
26        (5) A person who believes that the workers'

 

 

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1    compensation maximum fee for a CPT or DRG code, as
2    otherwise determined pursuant to this subsection, creates
3    or would create upon implementation a significant
4    limitation on access to quality health care in either a
5    specific field of health care services or a specific
6    geographic limitation on access to health care may
7    petition the Commission to modify the workers'
8    compensation maximum fee for that CPT or DRG code so as to
9    not create that significant limitation.
10        The petitioner bears the burden of demonstrating, by a
11    preponderance of the credible evidence, that the workers'
12    compensation maximum fee that would otherwise apply would
13    create a significant limitation on access to quality
14    health care in either a specific field of health care
15    services or a specific geographic limitation on access to
16    health care. Petitions shall be made publicly available.
17    Such credible evidence shall include empirical data
18    demonstrating a significant limitation on access to
19    quality health care. Other interested persons may file
20    comments or responses to a petition within 30 days of the
21    filing of a petition.
22        The Commission shall take final action on each
23    petition within 180 days of filing. The Commission may,
24    but is not required to, seek the recommendation of the
25    Medical Fee Advisory Board to assist with this
26    determination. If the Commission grants the petition, the

 

 

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1    Commission shall further increase the workers'
2    compensation maximum fee for that CPT or DRG code by the
3    amount minimally necessary to avoid creating a significant
4    limitation on access to quality health care in either a
5    specific field of health care services or a specific
6    geographic limitation on access to health care. The
7    increased workers' compensation maximum fee shall take
8    effect upon entry of the Commission's final action.
9    (a-2) For procedures, treatments, services, or supplies
10covered under this Act and rendered or to be rendered on or
11after September 1, 2011, the maximum allowable payment shall
12be 70% of the fee schedule amounts, which shall be adjusted
13yearly by the Consumer Price Index-U, as described in
14subsection (a) of this Section. The provisions of this
15subsection (a-2), other than this sentence, are inoperative
16after August 31, 2022.
17    (a-3) Prescriptions filled and dispensed outside of a
18licensed pharmacy shall be subject to a fee schedule that
19shall not exceed the Average Wholesale Price (AWP) plus a
20dispensing fee of $4.18. AWP or its equivalent as registered
21by the National Drug Code shall be set forth for that drug on
22that date as published in Medispan.
23    (b) Notwithstanding the provisions of subsection (a), if
24the Commission finds that there is a significant limitation on
25access to quality health care in either a specific field of
26health care services or a specific geographic limitation on

 

 

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1access to health care, it may change the Consumer Price
2Index-U increase or decrease for that specific field or
3specific geographic limitation on access to health care to
4address that limitation.
5    (c) The Commission shall establish by rule a process to
6review those medical cases or outliers that involve
7extra-ordinary treatment to determine whether to make an
8additional adjustment to the maximum payment within a fee
9schedule for a procedure, treatment, or service.
10    (d) When a patient notifies a provider that the treatment,
11procedure, or service being sought is for a work-related
12illness or injury and furnishes the provider the name and
13address of the responsible employer, the provider shall bill
14the employer or its designee directly. The employer or its
15designee shall make payment for treatment in accordance with
16the provisions of this Section directly to the provider,
17except that, if a provider has designated a third-party
18billing entity to bill on its behalf, payment shall be made
19directly to the billing entity. Providers shall submit bills
20and records in accordance with the provisions of this Section.
21        (1) All payments to providers for treatment provided
22    pursuant to this Act shall be made within 30 days of
23    receipt of the bills as long as the bill contains
24    substantially all the required data elements necessary to
25    adjudicate the bill.
26        (2) If the bill does not contain substantially all the

 

 

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1    required data elements necessary to adjudicate the bill,
2    or the claim is denied for any other reason, in whole or in
3    part, the employer or insurer shall provide written
4    notification to the provider in the form of an explanation
5    of benefits explaining the basis for the denial and
6    describing any additional necessary data elements within
7    30 days of receipt of the bill. The Commission, with
8    assistance from the Medical Fee Advisory Board, shall
9    adopt rules detailing the requirements for the explanation
10    of benefits required under this subsection.
11        (3) In the case (i) of nonpayment to a provider within
12    30 days of receipt of the bill which contained
13    substantially all of the required data elements necessary
14    to adjudicate the bill, (ii) of nonpayment to a provider
15    of a portion of such a bill, or (iii) where the provider
16    has not been issued an explanation of benefits for a bill,
17    the bill, or portion of the bill up to the lesser of the
18    actual charge or the payment level set by the Commission
19    in the fee schedule established in this Section, shall
20    incur interest at a rate of 1% per month payable by the
21    employer to the provider. Any required interest payments
22    shall be made by the employer or its insurer to the
23    provider within 30 days after payment of the bill.
24        (4) If the employer or its insurer fails to pay
25    interest within 30 days after payment of the bill as
26    required pursuant to paragraph (3), the provider may bring

 

 

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1    an action in circuit court for the sole purpose of seeking
2    payment of interest pursuant to paragraph (3) against the
3    employer or its insurer responsible for insuring the
4    employer's liability pursuant to item (3) of subsection
5    (a) of Section 4. The circuit court's jurisdiction shall
6    be limited to enforcing payment of interest pursuant to
7    paragraph (3). Interest under paragraph (3) is only
8    payable to the provider. An employee is not responsible
9    for the payment of interest under this Section. The right
10    to interest under paragraph (3) shall not delay, diminish,
11    restrict, or alter in any way the benefits to which the
12    employee or his or her dependents are entitled under this
13    Act.
14    The changes made to this subsection (d) by this amendatory
15Act of the 100th General Assembly apply to procedures,
16treatments, and services rendered on and after the effective
17date of this amendatory Act of the 100th General Assembly.
18    (e) Except as provided in subsections (e-5), (e-10), and
19(e-15), a provider shall not hold an employee liable for costs
20related to a non-disputed procedure, treatment, or service
21rendered in connection with a compensable injury. The
22provisions of subsections (e-5), (e-10), (e-15), and (e-20)
23shall not apply if an employee provides information to the
24provider regarding participation in a group health plan. If
25the employee participates in a group health plan, the provider
26may submit a claim for services to the group health plan. If

 

 

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1the claim for service is covered by the group health plan, the
2employee's responsibility shall be limited to applicable
3deductibles, co-payments, or co-insurance. Except as provided
4under subsections (e-5), (e-10), (e-15), and (e-20), a
5provider shall not bill or otherwise attempt to recover from
6the employee the difference between the provider's charge and
7the amount paid by the employer or the insurer on a compensable
8injury, or for medical services or treatment determined by the
9Commission to be excessive or unnecessary.
10    (e-5) If an employer notifies a provider that the employer
11does not consider the illness or injury to be compensable
12under this Act, the provider may seek payment of the
13provider's actual charges from the employee for any procedure,
14treatment, or service rendered. Once an employee informs the
15provider that there is an application filed with the
16Commission to resolve a dispute over payment of such charges,
17the provider shall cease any and all efforts to collect
18payment for the services that are the subject of the dispute.
19Any statute of limitations or statute of repose applicable to
20the provider's efforts to collect payment from the employee
21shall be tolled from the date that the employee files the
22application with the Commission until the date that the
23provider is permitted to resume collection efforts under the
24provisions of this Section.
25    (e-10) If an employer notifies a provider that the
26employer will pay only a portion of a bill for any procedure,

 

 

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1treatment, or service rendered in connection with a
2compensable illness or disease, the provider may seek payment
3from the employee for the remainder of the amount of the bill
4up to the lesser of the actual charge, negotiated rate, if
5applicable, or the payment level set by the Commission in the
6fee schedule established in this Section. Once an employee
7informs the provider that there is an application filed with
8the Commission to resolve a dispute over payment of such
9charges, the provider shall cease any and all efforts to
10collect payment for the services that are the subject of the
11dispute. Any statute of limitations or statute of repose
12applicable to the provider's efforts to collect payment from
13the employee shall be tolled from the date that the employee
14files the application with the Commission until the date that
15the provider is permitted to resume collection efforts under
16the provisions of this Section.
17    (e-15) When there is a dispute over the compensability of
18or amount of payment for a procedure, treatment, or service,
19and a case is pending or proceeding before an Arbitrator or the
20Commission, the provider may mail the employee reminders that
21the employee will be responsible for payment of any procedure,
22treatment or service rendered by the provider. The reminders
23must state that they are not bills, to the extent practicable
24include itemized information, and state that the employee need
25not pay until such time as the provider is permitted to resume
26collection efforts under this Section. The reminders shall not

 

 

HB3559- 20 -LRB102 10871 JLS 16201 b

1be provided to any credit rating agency. The reminders may
2request that the employee furnish the provider with
3information about the proceeding under this Act, such as the
4file number, names of parties, and status of the case. If an
5employee fails to respond to such request for information or
6fails to furnish the information requested within 90 days of
7the date of the reminder, the provider is entitled to resume
8any and all efforts to collect payment from the employee for
9the services rendered to the employee and the employee shall
10be responsible for payment of any outstanding bills for a
11procedure, treatment, or service rendered by a provider.
12    (e-20) Upon a final award or judgment by an Arbitrator or
13the Commission, or a settlement agreed to by the employer and
14the employee, a provider may resume any and all efforts to
15collect payment from the employee for the services rendered to
16the employee and the employee shall be responsible for payment
17of any outstanding bills for a procedure, treatment, or
18service rendered by a provider as well as the interest awarded
19under subsection (d) of this Section. In the case of a
20procedure, treatment, or service deemed compensable, the
21provider shall not require a payment rate, excluding the
22interest provisions under subsection (d), greater than the
23lesser of the actual charge or the payment level set by the
24Commission in the fee schedule established in this Section.
25Payment for services deemed not covered or not compensable
26under this Act is the responsibility of the employee unless a

 

 

HB3559- 21 -LRB102 10871 JLS 16201 b

1provider and employee have agreed otherwise in writing.
2Services not covered or not compensable under this Act are not
3subject to the fee schedule in this Section.
4    (f) Nothing in this Act shall prohibit an employer or
5insurer from contracting with a health care provider or group
6of health care providers for reimbursement levels for benefits
7under this Act different from those provided in this Section.
8    (g) On or before January 1, 2010 the Commission shall
9provide to the Governor and General Assembly a report
10regarding the implementation of the medical fee schedule and
11the index used for annual adjustment to that schedule as
12described in this Section.
13(Source: P.A. 100-1117, eff. 11-27-18; 100-1175, eff.
141-11-19.)
 
15    Section 99. Effective date. This Act takes effect upon
16becoming law.