Full Text of HB3018 98th General Assembly
HB3018 98TH GENERAL ASSEMBLY |
| | 98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014 HB3018 Introduced , by Rep. David Reis SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Insurance Code. With regard to a health care professional or health care provider offered a contract by
an
insurer, health maintenance organization,
independent practice association, or physician
hospital organization, provides that the insurer, health maintenance organization, independent practice association, physician hospital organization, or preferred provider organization shall provide health care professional applicants who are denied participation in any panel of in-network health care professionals with a specific reason for the denial. Provides that any participating health care professional must be provided 60 days' notice and an opportunity to initiate corrective action prior to the initiation of any attempts to terminate or otherwise remove the health care professional from a panel of in-network health care professionals and that the required notice shall include specific reasons for the proposed termination or removal. Provides that any participating health care professional terminated or removed from an in-network panel by his or her own written request must be provided an opportunity to appeal the decision. Provides that immediate written notice may be provided without 60 days' notice when a health care professional's license has been disciplined by a State licensing or disciplinary board.
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| | A BILL FOR |
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| 1 | | AN ACT concerning insurance.
| 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 | | changing Section 368b as follows:
| 6 | | (215 ILCS 5/368b)
| 7 | | Sec. 368b. Contracting procedures.
| 8 | | (a) A health care professional or health care provider | 9 | | offered a contract by
an
insurer, health maintenance | 10 | | organization,
independent practice association, or physician
| 11 | | hospital organization for signature after the effective date of | 12 | | this amendatory
Act of the
93rd General Assembly shall be | 13 | | provided with a proposed health care
professional or
health | 14 | | care provider
services contract including, if any, exhibits and | 15 | | attachments that the contract
indicates are
to be attached. | 16 | | Within 35 days after a written request, the health care
| 17 | | professional or health
care provider offered a contract shall | 18 | | be given the opportunity to review and
obtain a
copy of the | 19 | | following: a specialty-specific fee schedule sample based on a
| 20 | | minimum of
the 50 highest volume fee schedule codes with the | 21 | | rates applicable to the
health care
professional or health care | 22 | | provider to whom the contract is offered, the
network
provider
| 23 | | administration manual, and a summary capitation schedule, if |
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| 1 | | payment is made on
a
capitation basis. If 50 codes do not exist | 2 | | for a particular specialty, the
health care
professional or | 3 | | health care provider offered a contract shall be given the
| 4 | | opportunity to
review or obtain a copy of a fee schedule sample | 5 | | with the codes applicable to
that
particular specialty. This | 6 | | information may be provided electronically. An
insurer, health
| 7 | | maintenance organization, independent practice
association, or | 8 | | physician hospital
organization may substitute the fee | 9 | | schedule sample with a document providing
reference
to the | 10 | | information needed to calculate the fee schedule that is | 11 | | available to
the public at no
charge and the percentage or | 12 | | conversion factor at which the insurer, health
maintenance
| 13 | | organization, preferred provider organization, independent | 14 | | practice
association, or physician hospital organization sets | 15 | | its rates.
| 16 | | (b) The fee schedule, the capitation schedule, and
the | 17 | | network provider
administration manual constitute | 18 | | confidential, proprietary, and trade secret
information and | 19 | | are subject to the provisions of the Illinois Trade Secrets
| 20 | | Act.
The health
care professional or health care provider | 21 | | receiving such protected information
may disclose
the | 22 | | information on a need to know basis and only to individuals and | 23 | | entities
that provide
services directly related to the health | 24 | | care professional's or health care
provider's decision
to enter | 25 | | into the contract or keep the contract in force. Any person or | 26 | | entity
receiving or
reviewing such protected information |
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| 1 | | pursuant to this Section shall not
disclose
the
information to | 2 | | any other person, organization, or entity, unless the | 3 | | disclosure
is requested
pursuant to a valid court order or | 4 | | required by a state or federal government
agency.
Individuals | 5 | | or entities receiving such information from a health care
| 6 | | professional
or health care provider as delineated in this | 7 | | subsection are subject to the
provisions of the
Illinois Trade | 8 | | Secrets Act.
| 9 | | (c) The health care professional or health care provider | 10 | | shall be allowed at
least
30 days to review the health care | 11 | | professional or health care provider services
contract, | 12 | | including
exhibits and
attachments, if any, before signing. The | 13 | | 30-day review period begins upon
receipt of the
health care
| 14 | | professional or health care provider services contract, unless | 15 | | the information
available
upon request
in subsection (a) is not | 16 | | included. If information is not included in the
professional
| 17 | | services contract and is requested pursuant to subsection (a), | 18 | | the 30-day
review period
begins on the date of receipt of the | 19 | | information. Nothing in this subsection
shall prohibit
a health | 20 | | care professional or health care provider from signing a | 21 | | contract
prior to the
expiration of the 30-day review period.
| 22 | | (d) The insurer, health maintenance organization,
| 23 | | independent practice
association, or physician hospital | 24 | | organization shall provide all contracted
health care
| 25 | | professionals or health care providers with any changes to the | 26 | | fee schedule
provided
under subsection (a) not later than 35 |
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| 1 | | days after the effective date of the
changes,
unless such
| 2 | | changes are specified in the contract and the health care | 3 | | professional or
health care
provider is able to calculate the | 4 | | changed rates based on information in the
contract and
| 5 | | information available to the public at no charge. For the | 6 | | purposes of this
subsection,
"changes" means an increase or | 7 | | decrease in the fee schedule referred to in
subsection (a).
| 8 | | This information may be made available by mail, e-mail, | 9 | | newsletter, website
listing, or
other reasonable method. Upon | 10 | | request, a health care professional or health
care provider
may | 11 | | request an updated copy of the fee schedule referred to in | 12 | | subsection (a)
every
calendar quarter.
| 13 | | (d-5) The insurer, health maintenance organization, | 14 | | independent practice association, physician hospital | 15 | | organization, or preferred provider organization shall provide | 16 | | health care professional applicants who are denied | 17 | | participation in any panel of in-network health care | 18 | | professionals with a specific reason for the denial. In | 19 | | addition, any participating health care professional must be | 20 | | provided 60 days' notice and an opportunity to initiate | 21 | | corrective action prior to the initiation of any attempts to | 22 | | terminate or otherwise remove the health care professional from | 23 | | a panel of in-network health care professionals. The required | 24 | | notice shall include specific reasons for the proposed | 25 | | termination or removal. Any participating health care | 26 | | professional terminated or removed from an in-network panel by |
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| 1 | | his or her own written request must be provided an opportunity | 2 | | to appeal the decision. Immediate written notice may be | 3 | | provided without 60 days' notice when a health care | 4 | | professional's license has been disciplined by a State | 5 | | licensing or disciplinary board. | 6 | | (e) Upon termination of a contract with an insurer, health | 7 | | maintenance
organization, independent practice
association, or | 8 | | physician hospital
organization and at
the request of the | 9 | | patient, a health care professional or health care provider
| 10 | | shall transfer
copies of the patient's medical records. Any | 11 | | other provision of law
notwithstanding, the
costs for copying | 12 | | and transferring copies of medical records shall be assigned
| 13 | | per the
arrangements agreed upon, if any, in the health care | 14 | | professional or health
care provider services
contract.
| 15 | | (Source: P.A. 93-261, eff. 1-1-04.)
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