HB4941 EngrossedLRB102 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) As used in this subsection:
24    "Change" means an increase or decrease in the fee schedule
25referred to in subsection (a).
26    "Nonroutine change" means any proposed change to the fee

 

 

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1schedule except a change that is otherwise required by law,
2regulation, or an applicable regulatory authority or that is
3required as a result of changes in fee schedules,
4reimbursement methodology, or payment policies established by
5a government agency or by the American Medical Association's
6current procedural terminology codes, reporting guidelines,
7and conventions, or a change that is expressly provided for
8under the terms of the contract by the inclusion of or
9reference to a specific fee or fee schedule, reimbursement
10methodology, or payment policy indexing mechanism.
11    The insurer, health maintenance organization, independent
12practice association, or physician hospital organization shall
13provide all contracted health care professionals or health
14care providers with any changes to the fee schedule provided
15under subsection (a) not later than 35 days after the
16effective date of the changes, unless such changes are
17specified in the contract and the health care professional or
18health care provider is able to calculate the changed rates
19based on information in the contract and information available
20to the public at no charge. Beginning January 1, 2023, with
21respect to nonroutine changes to the fee schedule, the
22insurer, health maintenance organization, independent practice
23association, or physician hospital organization shall provide
24all contracted health care professionals or health care
25providers impacted by the nonroutine change with notice of the
26change at least 60 days before the effective date of the

 

 

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1change. The right to advance notice of nonroutine changes to
2the fee schedule may not be waived by the health care
3professional or health care provider.
4    For the purposes of this subsection, "changes" means an
5increase or decrease in the fee schedule referred to in
6subsection (a). This information may be made available by
7mail, e-mail, newsletter, website listing, or other reasonable
8method. For nonroutine changes, the information directing the
9health care professional or health care provider to the
10information provided by newsletter, website listing, or other
11reasonable method shall be provided by email or, if requested
12by the health care professional or health care provider, by
13mail. Upon request, a health care professional or health care
14provider may request an updated copy of the fee schedule
15referred to in subsection (a) every calendar quarter.
16    (e) Upon termination of a contract with an insurer, health
17maintenance organization, independent practice association, or
18physician hospital organization and at the request of the
19patient, a health care professional or health care provider
20shall transfer copies of the patient's medical records. Any
21other provision of law notwithstanding, the costs for copying
22and transferring copies of medical records shall be assigned
23per the arrangements agreed upon, if any, in the health care
24professional or health care provider services contract.
25(Source: P.A. 93-261, eff. 1-1-04.)