102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB4941

 

Introduced 1/27/2022, by Rep. Theresa Mah

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/368b

    Amends the Accident and Health Insurance Article of the Illinois Insurance Code. In provisions concerning contracting procedures, replaces language concerning changes to the fee schedule with language providing that an insurer, health maintenance organization, independent practice association, or physician hospital organization shall provide all contracted health care professionals or health care providers with notice of any changes to the fee schedule at least 90 days before the effective date of the change, that the right to advance notice of changes to the fee schedule cannot be waived by the health care professional or provider, and that changes to the fee schedule cannot be applied retroactively from the effective date of the changes. Provides that if the changes to the fee schedule include a reduction in fees greater than 3% of the Medicare rate established for the current calendar year, the health care professional or health care provider may propose alternative changes to the fee schedule. Provides that any changes to the fee schedule must be final at least 30 days before the effective date of the changes. Provides that fee schedule information must be provided directly to the contracted health care professional or health care provider (rather than may be made available) by mail, e-mail, or telephone, and that this information may also be provided by newsletter, website listing, or other reasonable method.


LRB102 22842 BMS 34494 b

 

 

A BILL FOR

 

HB4941LRB102 22842 BMS 34494 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
12of this 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
15and attachments that the contract indicates are to be
16attached. Within 35 days after a written request, the health
17care professional or health care provider offered a contract
18shall be given the opportunity to review and obtain a copy of
19the following: a specialty-specific fee schedule sample based
20on a minimum of the 50 highest volume fee schedule codes with
21the rates applicable to the health care professional or health
22care provider to whom the contract is offered, the network
23provider administration manual, and a summary capitation

 

 

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1schedule, if payment is made on a capitation basis. If 50 codes
2do not exist for a particular specialty, the health care
3professional or health care provider offered a contract shall
4be given the opportunity to review or obtain a copy of a fee
5schedule sample with the codes applicable to that particular
6specialty. This information may be provided electronically. An
7insurer, health maintenance organization, independent practice
8association, or physician hospital organization may substitute
9the fee schedule sample with a document providing reference to
10the information 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
25enter into the contract or keep the contract in force. Any
26person or entity receiving or reviewing such protected

 

 

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1information pursuant to this Section shall not disclose the
2information to any other person, organization, or entity,
3unless the disclosure is requested pursuant to a valid court
4order or required by a state or federal government agency.
5Individuals or entities receiving such information from a
6health care professional or health care provider as delineated
7in this subsection are subject to the provisions of the
8Illinois Trade Secrets 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.
13The 30-day review period begins upon receipt of the health
14care professional or health care provider services contract,
15unless the information available upon request in subsection
16(a) is not included. If information is not included in the
17professional services contract and is requested pursuant to
18subsection (a), the 30-day review period begins on the date of
19receipt of the information. Nothing in this subsection shall
20prohibit a health care professional or health care provider
21from signing a contract prior to the expiration of the 30-day
22review period.
23    (d) The insurer, health maintenance organization,
24independent practice association, or physician hospital
25organization shall provide all contracted health care
26professionals or health care providers with notice of any

 

 

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1changes to the fee schedule provided under subsection (a) at
2least 90 days before the effective date of the changes. The
3right to advance notice of changes to the fee schedule cannot
4be waived by the health care professional or provider. Changes
5to the fee schedule cannot be applied retroactively from the
6effective date of the changes. If the changes to the fee
7schedule include a reduction in fees greater than 3% of the
8Medicare rate established for the current calendar year, the
9health care professional or health care provider may propose
10alternative changes to the fee schedule to the insurer, health
11maintenance organization, independent practice association, or
12physician hospital organization. Any changes to the fee
13schedule must be final at least 30 days before the effective
14date of the changes. The insurer, health maintenance
15organization, independent practice association, or physician
16hospital organization shall provide all contracted health care
17professionals or health care providers with any changes to the
18fee schedule provided under subsection (a) not later than 35
19days after the effective date of the changes, unless such
20changes are specified in the contract and the health care
21professional or health care provider is able to calculate the
22changed rates based on information in the contract and
23information available to the public at no charge.
24    For the purposes of this subsection, "changes" means an
25increase or decrease in the fee schedule referred to in
26subsection (a). This information must be provided directly to

 

 

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1the contracted health care professional or health care
2provider may be made available by mail, e-mail, or telephone.
3In addition to communicating directly with the contracted
4health care professional or health care provider, this
5information may also be provided by newsletter, website
6listing, or other reasonable method. Upon request, a health
7care professional or health care provider may request an
8updated copy of the fee schedule referred to in subsection (a)
9every calendar quarter.
10    (e) Upon termination of a contract with an insurer, health
11maintenance organization, independent practice association, or
12physician hospital organization and at the request of the
13patient, a health care professional or health care provider
14shall transfer copies of the patient's medical records. Any
15other provision of law notwithstanding, the costs for copying
16and transferring copies of medical records shall be assigned
17per the arrangements agreed upon, if any, in the health care
18professional or health care provider services contract.
19(Source: P.A. 93-261, eff. 1-1-04.)