093_HB2772ham001

 










                                     LRB093 07796 JLS 12979 a

 1                    AMENDMENT TO HOUSE BILL 2772

 2        AMENDMENT NO.     .  Amend House Bill 2772  by  replacing
 3    the title with the following:

 4        "AN ACT concerning insurance." and

 5    by  replacing  everything  after the enacting clause with the
 6    following:

 7        "Section 5.  The Illinois Insurance Code  is  amended  by
 8    adding Section 368c as follows:

 9        (215 ILCS 5/368c new)
10        Sec. 368c.  Payments.
11        (a)  After  the  effective date of this amendatory Act of
12    the 93rd  General  Assembly,  health  care  professionals  or
13    health  care providers offered a contract for signature by an
14    insurer,   health   maintenance   organization,   independent
15    practice association, or physician hospital  organization  to
16    be paid on a service by service basis shall, upon request, be
17    provided  copies  of  the fee schedule or payment arrangement
18    and amounts for each health care service to be provided under
19    the contract prior to signing the  contract.  If  the  health
20    care  professional  or  health care provider is not paid on a
21    service by service basis, the amounts payable  and  terms  of
 
                            -2-      LRB093 07796 JLS 12979 a
 1    payment  under  that  alternative  payment  system  shall  be
 2    provided upon request.
 3        (b)  Payments   under  a  contract  with  a  health  care
 4    professional or health care provider  shall  not  be  changed
 5    based upon rates agreed to by the professional or provider in
 6    another   contract   with   an  insurer,  health  maintenance
 7    organization, independent practice association, or  physician
 8    hospital  organization.  Nothing  in  this  Section  shall be
 9    construed  to  prevent   an   insurer,   health   maintenance
10    organization,  independent practice association, or physician
11    hospital organization from renegotiating its payments under a
12    contract with a  health  care  professional  or  health  care
13    provider.
14        (c)  A  payment  statement shall be furnished to a health
15    care professional or health care provider paid on  a  service
16    by  service  basis  for  services provided under the contract
17    that identifies the  disposition  of  each  claim,  including
18    services  billed,  the  patient  responsibility,  if any, the
19    actual payment, if any, for the services  billed  by  CPT  or
20    other  appropriate  code,  and  the  reason  for  any payment
21    reduction to the claim submitted,  including  any  withholds,
22    and  the  reason  for  denial  of  any claim. Nothing in this
23    Section requires that a health care  professional  or  health
24    care provider be paid on a service by service basis. Payments
25    may   be   made   based   on  capitation  and  other  payment
26    arrangements.  Health  care  professionals  and  health  care
27    providers  shall   be   allowed   to   collect   co-payments,
28    co-insurance,   deductibles,   and  payment  for  non-covered
29    services directly from patients except as otherwise  provided
30    by   law.   An   insurer,  health  maintenance  organization,
31    independent  practice  association,  or  physician   hospital
32    organization may pay for covered services either to a patient
33    directly  or  a non-participating health care professional or
34    health care provider.
 
                            -3-      LRB093 07796 JLS 12979 a
 1        (d)  When  a  person  presents  a  health  care   service
 2    benefits  information  card,  a  health  care professional or
 3    health care provider shall inform the person if he or she  is
 4    not   participating  with  the  insurer,  health  maintenance
 5    organization, independent practice organization, or physician
 6    hospital organization issuing the card.

 7        Section 99.  Effective date. This  Act  takes  effect  on
 8    December 1, 2003.".