093_HB2359

 
                                     LRB093 10692 JLS 11054 b

 1        AN ACT concerning provider billing.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  5.  The  Illinois  Insurance  Code is amended by
 5    adding Section 368b as follows:

 6        (215 ILCS 5/368b new)
 7        Sec. 368b.  Requirements to enable electronic exchange of
 8    information.
 9        (a)  An accident and health insurer licensed in  Illinois
10    shall  have the ability to accept health claims or equivalent
11    encounter information, referral certification, authorization,
12    and eligibility transactions electronically and shall utilize
13    the  federal  standards  for  these  electronic  transactions
14    established by the Department of Health  and  Human  Services
15    pursuant to Section 262 of Pub.L. 104-191 (42 U.S.C. 1320d et
16    seq.) and Part 162 of Title 45, Code of Federal Regulations.
17        A  health  care professional or health care facility that
18    is licensed to provide health care services in  Illinois  and
19    that  accepts  patients  who  are  enrolled  in an individual
20    health plan or  a  group  health  plan,  including  a  health
21    insurance  issuer  offering coverage through the group health
22    plan, Medicaid, or  the  State  employee  health  plan  shall
23    submit  health  claims  or  equivalent encounter information,
24    referral  certification,   authorization,   and   eligibility
25    transactions  electronically  and  shall  utilize the federal
26    standards for these electronic  transactions  established  by
27    the  Department  of  Health  and  Human  Services pursuant to
28    Section 262 of Pub.L. 104-191 (42 U.S.C. 1320d et  seq.)  and
29    Part 162 of Title 45, Code of Federal Regulations.
30        (b)  The  Department  shall  establish  a  timetable  for
31    implementation  of the electronic transmission of health care
 
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 1    transactions. The timetable shall not require  implementation
 2    prior to the compliance date set forth by the U.S. Department
 3    of  Health  and  Human  Services  for  federal  standards for
 4    electronic health care transactions pursuant to  Section  262
 5    of  Pub.L.  104-191 (42 U.S.C. 1320d et seq.) and Part 162 of
 6    Title 45,  Code  of  Federal  Regulations  or  any  extension
 7    granted  by  the  Secretary  of  Health and Human Services to
 8    comply with the federal standards.
 9        (c)  The Director may temporarily waive  the  application
10    of this Section in cases in which:
11             (1)  there is no method available for the submission
12        of claims in an electronic form; or
13             (2)  the  entity  submitting  the  claim  is a small
14        health care professional or  health  care  facility  with
15        fewer  than  10  full-time  equivalent employees that has
16        demonstrated that compliance with this Act will result in
17        an undue hardship or other special  circumstance  on  the
18        health care professional or health care facility.
19        (d)  The  Department  shall  establish an application and
20    review process for health care professionals and health  care
21    facilities  with  identified  special  circumstances no later
22    than 6 months prior to the effective date  of  implementation
23    as determined under subsection (b).
24        (e)  The  Department shall report to the Governor and the
25    General Assembly  within  one  year  after  establishing  the
26    timetable  pursuant  to  this  Section, and at least annually
27    thereafter, on the number of extensions or temporary  waivers
28    of   the  implementation  requirement  that  it  has  granted
29    pursuant  to  subsection  (c),  the  reasons  therefor,   and
30    recommendations  to  overcome obstacles to full compliance by
31    affected  health   care   professionals   and   health   care
32    facilities.
33        (f)  Beginning January 1, 2004, an individual health plan
34    or  a  group health plan, including a health insurance issuer
 
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 1    offering coverage through the group health plan, or  a  state
 2    agency administering a government health plan, may not deduct
 3    more  than a $2 per claim service fee for adjudication of any
 4    paper health claims.
 5        (g)  This  Section  does  not  apply  to  long-term  care
 6    facilities.

 7        Section 99.  Effective date.  This Act takes effect  upon
 8    becoming law.