102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB5590

 

Introduced 1/31/2022, by Rep. Mark Batinick

 

SYNOPSIS AS INTRODUCED:
 
New Act
215 ILCS 5/5.5

    Creates the Health Care Billing Equity Act. Provides that the Department of Public Health shall research, accept information on, and maintain a database of any and all billing information, billing codes, and CPT codes used to bill health care plans, providers of policies of health insurance, and individual patients for health care procedures carried out in this State. Provides that, effective on January 1, 2024, any health care bill that contains any element in which the charge upon an individual who has received care billed by health care plans or providers of policies of health insurance that exceeds the bill for the same element of health care when billed to individual patients is prohibited. Provides that the Department of Insurance and the Department of Healthcare and Family Services shall cooperate with the Department of Public Health to further the implementation of the Act. Creates the Health Care Billing Equity Act Disciplinary Committee to study the implementation of the Act and to submit a report to the Governor and the General Assembly, no later than March 31, 2023, on ways and means to discipline health care licensees who fail to comply with the requirements of the Act. Contains other provisions. Amends the Illinois Insurance Code. Provides that a company authorized to do business in this State or accredited by the State to issue policies of health insurance must disclose to the Department of Healthcare and Family Services any and all CPT codes and billing codes used by health care providers to bill insurers for health care services rendered. Effective immediately.


LRB102 23124 CPF 32283 b

 

 

A BILL FOR

 

HB5590LRB102 23124 CPF 32283 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 1. Short title. This Act may be cited as the Health
5Care Billing Equity Act.
 
6    Section 5. Purpose. The purpose of this Act is to ensure
7that, notwithstanding any other law, any medical procedure
8carried out in Illinois that is prepaid or paid for within 30
9days of service directly by the patient will be charged the
10lowest negotiated rate that that provider has as a contract
11rate with any health care plan or policy of health insurance
12during the time frame under which the medical procedure was
13carried out.
 
14    Section 10. Definitions.
15    "Billing code" means a CPT code, as that term is defined in
16subsection (a) of Section 368g of the Illinois Insurance Code.
17    "Department" means the Department of Public Health.
18    "Health care plan" has the same meaning as defined in
19Section 10 of the Managed Care Reform and Patient Rights Act.
20    "Health care procedure" means any service provided by a
21health care provider.
22    "Health care provider" has the same meaning as defined in

 

 

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1Section 2.03 of the Medical Patient Rights Act.
2    "Policy of health insurance" includes, but is not limited
3to, self-insured plans, group health plans (as defined in
4Section 607(1) of the federal Employee Retirement Income
5Security Act of 1974), service benefit plans, managed care
6organizations, pharmacy benefit managers, or other parties
7that are by statute, contract, or agreement legally
8responsible for payment of a claim for a health care item or
9service as a condition of doing business in the State.
 
10    Section 15. Implementation.
11    (a) The Department shall research, accept information on,
12and maintain a database of any and all billing information,
13billing codes, and CPT codes used to bill health care plans or
14providers of policies of health insurance for health care
15procedures carried out in this State.
16    (b) The Department shall research, accept information on,
17and maintain a database of any and all billing information,
18billing codes, and CPT codes used to bill individual patients
19for health care procedures carried out in this State.
20    (c) Effective on January 1, 2024, any health care bill
21that contains any element in which the charge upon an
22individual who has received care billed as described under
23subsection (b) that exceeds the bill for the same element of
24health care when billed as described under subsection (a) is
25prohibited.
 

 

 

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1    Section 20. Intergovernmental cooperation. The Department
2of Insurance shall, upon request of the Department, cooperate
3with the Department in any way requested by the Department to
4further the implementation of this Act. The Department of
5Healthcare and Family Services shall, upon request of the
6Department, cooperate with the Department in any way requested
7by the Department to further the implementation of this Act.
 
8    Section 25. Administrative rules. The Department shall, in
9compliance with the Illinois Administrative Procedure Act,
10adopt rules to provide for the implementation of this Act.
 
11    Section 30. Health Care Billing Equity Act Disciplinary
12Committee.
13    (a) The Health Care Billing Equity Act Disciplinary
14Committee is created to study the implementation of this Act.
15The Commission shall consist of 5 members to be appointed on or
16before September 30, 2022 as follows:
17        (1) One member appointed by the Governor.
18        (2) One member appointed by the President of the
19    Senate.
20        (3) One member appointed by the Minority Leader of the
21    Senate.
22        (4) One member appointed by the Speaker of the House
23    of Representatives.

 

 

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1        (5) One member appointed by the Minority Leader of the
2    House of Representatives.
3    (b) The Committee shall meet as it deems appropriate. The
4Committee shall submit a report to the Governor and the
5General Assembly, no later than March 31, 2023, on ways and
6means to discipline health care licensees who fail to comply
7with the requirements of this Act. No element of the report
8shall be approved for public report unless it has received the
9favorable vote of at least 4 members of the Committee. If the
10members of the Committee are not able to reach an agreement on
11items within the report, the report shall contain a public
12disclosure that no agreement could be reached.
13    (c) The Department shall provide staff support to the
14Committee. Committee members shall serve without compensation
15but may be reimbursed for expenses incurred in performing
16their duties.
17    (d) The Committee is dissolved, and this Section is
18repealed, on January 1, 2024.
 
19    Section 80. The Illinois Insurance Code is amended by
20changing Section 5.5 as follows:
 
21    (215 ILCS 5/5.5)
22    Sec. 5.5. Compliance with the Department of Healthcare and
23Family Services. A company authorized to do business in this
24State or accredited by the State to issue policies of health

 

 

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1insurance, including but not limited to, self-insured plans,
2group health plans (as defined in Section 607(1) of the
3Employee Retirement Income Security Act of 1974), service
4benefit plans, managed care organizations, pharmacy benefit
5managers, or other parties that are by statute, contract, or
6agreement legally responsible for payment of a claim for a
7health care item or service as a condition of doing business in
8the State must:
9        (1) provide to the Department of Healthcare and Family
10    Services, or any successor agency, on at least a quarterly
11    basis if so requested by the Department, information to
12    determine during what period any individual may be, or may
13    have been, covered by a health insurer and the nature of
14    the coverage that is or was provided by the health
15    insurer, including the name, address, and identifying
16    number of the plan;
17        (2) accept the State's right of recovery and the
18    assignment to the State of any right of an individual or
19    other entity to payment from the party for an item or
20    service for which payment has been made under the medical
21    programs of the Department of Healthcare and Family
22    Services, or any successor agency, under this Code or the
23    Illinois Public Aid Code;
24        (3) respond to any inquiry by the Department of
25    Healthcare and Family Services regarding a claim for
26    payment for any health care item or service that is

 

 

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1    submitted not later than 3 years after the date of the
2    provision of such health care item or service; and
3        (4) agree not to deny a claim submitted by the
4    Department of Healthcare and Family Services solely on the
5    basis of the date of submission of the claim, the type or
6    format of the claim form, or a failure to present proper
7    documentation at the point-of-sale that is the basis of
8    the claim if (i) the claim is submitted by the Department
9    of Healthcare and Family Services within the 3-year period
10    beginning on the date on which the item or service was
11    furnished and (ii) any action by the Department of
12    Healthcare and Family Services to enforce its rights with
13    respect to such claim is commenced within 6 years of its
14    submission of such claim; and .
15        (5) disclose to the Department of Healthcare and
16    Family Services any and all CPT codes and billing codes
17    used by health care providers to bill insurers for health
18    care services rendered; in this paragraph, "health care
19    provider" has the same meaning as defined in Section 10 of
20    the Health Care Billing Equity Act.
21    The Department of Healthcare and Family Services may
22impose an administrative penalty as provided under Section
2312-4.45 of the Illinois Public Aid Code on entities that have
24established a pattern of failure to provide the information
25required under this Section, or in cases in which the
26Department of Healthcare and Family Services has determined

 

 

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1that an entity that provides health insurance coverage has
2established a pattern of failure to provide the information
3required under this Section, and has subsequently certified
4that determination, along with supporting documentation, to
5the Director of the Department of Insurance, the Director of
6the Department of Insurance, based upon the certification of
7determination made by the Department of Healthcare and Family
8Services, may commence regulatory proceedings in accordance
9with all applicable provisions of the Illinois Insurance Code.
10(Source: P.A. 98-130, eff. 8-2-13.)
 
11    Section 99. Effective date. This Act takes effect upon
12becoming law.