HB7033 93RD GENERAL ASSEMBLY

LRB093 15407 SAS 41010 b

93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB7033

Introduced 02/09/04, by Kenneth Dunkin

SYNOPSIS AS INTRODUCED:

215 ILCS 5/368f new

Amends the Illinois Insurance Code. Provides that accident and health insurers and health care professionals and health care providers shall have the ability to accept and submit claims electronically in accordance with federal standards. Provides for the Department of Insurance to establish a timetable for compliance. Establishes an exemption for long term care facilities and community-integrated living arrangements. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning provider billing.

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

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

(215 ILCS 5/368f new)

Sec. 368f. Requirement to enable electronic exchange of information.

(a) An accident and health insurer licensed in Illinois shall have the ability to accept health claims or equivalent encounter information, referral certification, authorization, and eligibility transactions electronically and shall utilize the federal standards for these electronic transactions established by the Department of Health and Human Services pursuant to Section 262 of Pub.L. 104-191 (42 U.S.C. 1320d et seq.) and Part 162 of Title 45, Code of Federal Regulations.

A health care professional or health care facility that is licensed to provide health care services in Illinois and that accepts patients who are enrolled in an individual health plan or a group health plan, including a health insurance issuer offering coverage through the group health plan, Medicaid, or the State employee health plan shall submit health claims or equivalent encounter information, referral certification, authorization, and eligibility transactions electronically and shall utilize the federal standards for these electronic transactions established by the Department of Health and Human Services pursuant to Section 262 of Pub.L. 104-191 (42 U.S.C. 1320d et seq.) and Part 162 of Title 45, Code of Federal Regulations.

(b) The Department shall establish a timetable for implementation of the electronic transmission of health care transactions. The timetable shall not require implementation prior to the compliance date set forth by the U.S. Department of Health and Human Services for federal standards for electronic health care transactions pursuant to Section 262 of Pub.L. 104-191 (42 U.S.C. 1320d et seq.) and Part 162 of Title 45, Code of Federal Regulations or any extension granted by the Secretary of Health and Human Services to comply with the federal standards.

(c) The Director may temporarily waive the application of this Section in cases in which:

(1) there is no method available for the submission of claims in an electronic form; or

(2) the entity submitting the claim is a small health care professional or health care facility with fewer than 10 full-time equivalent employees that has demonstrated that compliance with this Act will result in an undue hardship or other special circumstance on the health care professional or health care facility.

(d) The Department shall establish an application and review process for health care professionals and health care facilities with identified special circumstances no later than 6 months prior to the effective date of implementation as determined under subsection (b).

(e) The Department shall report to the Governor and the General Assembly within one year after establishing the timetable pursuant to this Section, and at least annually thereafter, on the number of extensions or temporary waivers of the implementation requirement that it has granted pursuant to subsection (c), the reasons therefor, and recommendations to overcome obstacles to full compliance by affected health care professionals and health care facilities.

(f) Beginning January 1, 2005, an individual health plan or a group health plan, including a health insurance issuer offering coverage through the group health plan, or a state agency administering a government health plan, may not deduct more than a $2 per claim service fee for adjudication of any paper health claims.

(g) This Section does not apply to long-term care facilities licensed under the Nursing Home Care Act or to community-integrated living arrangements operated under the Community-Integrated Living Arrangements Licensure and Certification Act.

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