Illinois General Assembly - Full Text of HB0311
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Full Text of HB0311  100th General Assembly




State of Illinois
2017 and 2018


Introduced , by Rep. Gregory Harris


New Act

    Creates the Network Adequacy and Transparency Act. Provides that administrators and insurers, prior to going to market, must file with the Department of Insurance for review and approval a description of the services to be offered through a network plan, with certain criteria included in the description. Provides that the network plan shall demonstrate to the Department, prior to approval, a minimum ratio of full-time equivalent providers to plan beneficiaries and maximum travel and distance standards for plan beneficiaries, which shall be established annually by the Department based upon specified sources. Provides that the Department shall conduct quarterly audits of network plans to verify compliance with network adequacy standards. Establishes certain notice requirements. Provides that a network plan shall provide for continuity of care for its beneficiaries under certain circumstances and according to certain requirements. Provides that a network plan shall post electronically a current and accurate provider directory and make available in print, upon request, a provider directory subject to certain specifications. Provides that the Department is granted specific authority to issue a cease and desist order against, fine, or otherwise penalize any insurer or administrator for violations of any provision of the Act. Makes other changes. Effective January 1, 2018.

LRB100 05356 RPS 15367 b






HB0311LRB100 05356 RPS 15367 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
5Network Adequacy and Transparency Act.
6    Section 5. Definitions. In this Act:
7    "Administrator" means any person, partnership, or
8corporation, other than a risk-bearing entity, that arranges,
9contracts with, or administers contracts with a provider under
10which insureds or beneficiaries are provided an incentive to
11use the services of the provider. "Administrator" also includes
12(i) any person, partnership, or corporation, other than a
13risk-bearing entity, that enters into a contract with another
14administrator to enroll beneficiaries or insureds in a network
15plan marketed as an independently identifiable program based on
16marketing materials or member benefit identification cards and
17(ii) an employer.
18    "Beneficiary" means an individual, an enrollee, an
19insured, a participant, or any other person entitled to
20reimbursement for covered expenses of or the discounting of
21provider fees for health care services under a program in which
22the beneficiary has an incentive to utilize the services of a
23provider that has entered into an agreement or arrangement with



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1an administrator, as defined in subsection (g) of Section 370g
2of the Illinois Insurance Code.
3    "Department" means the Department of Insurance.
4    "Director" means the Director of Insurance.
5    "Insurer" means any entity that offers individual or group
6accident and health insurance, including, but not limited to,
7health maintenance organizations, preferred provider
8organizations, exclusive provider organizations, and other
9plan structures requiring network participation, excluding the
10medical assistance program under the Illinois Public Aid Code
11and the State employees group health insurance program.
12    "Material change" means a significant reduction in the
13number of providers available in a network plan, including, but
14not limited to, a reduction of 10% or more in a specific type
15of providers, the removal of a major health system that causes
16a network to be significantly different from the network when
17the beneficiary purchased the network plan, or any change that
18would cause the network to no longer satisfy the requirements
19of this Act or the Department's rules for network adequacy and
21    "Network" means the group or groups of preferred providers
22providing services to a network plan.
23    "Network plan" means an individual or group policy of
24accident and health insurance that either requires a covered
25person to use or creates incentives, including financial
26incentives, for a covered person to use providers managed,



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1owned, under contract with, or employed by the insurer.
2    "Ongoing course of treatment" means (1) treatment for a
3life-threatening condition, which is a disease or condition for
4which likelihood of death is probable unless the course of the
5disease or condition is interrupted; (2) treatment for a
6serious acute condition, defined as a disease or condition
7requiring complex ongoing care that the covered person is
8currently receiving, such as chemotherapy, radiation therapy,
9or post-operative visits; (3) a course of treatment for a
10health condition that a treating provider attests that
11discontinuing care by that provider would worsen the condition
12or interfere with anticipated outcomes; or (4) the third
13trimester of pregnancy through the post-partum period.
14    "Preferred provider" means any provider who has entered,
15either directly or indirectly, into an agreement with an
16administrator, employer, or risk-bearing entity relating to
17health care services that may be rendered to beneficiaries
18under a network plan.
19    "Providers" means physicians licensed to practice medicine
20in all its branches, other health care professionals,
21hospitals, or other health care institutions that provide
22health care services.
23    "Tiered network" means a network that identifies and groups
24some or all types of provider and facilities into specific
25groups to which different provider reimbursement, covered
26person cost-sharing or provider access requirements, or any



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1combination thereof, apply for the same services.
2    "Woman's principal health care provider" means a physician
3licensed to practice medicine in all of its branches
4specializing in obstetrics, gynecology, or family practice.
5    Section 10. Network adequacy.
6    (a) An insurer or administrator providing a network plan
7shall file all of the following with the Director:
8        (1) The method of marketing the network plan.
9        (2) Written policies and procedures for maintaining a
10    network that is sufficient in numbers and appropriate types
11    of providers, including those that serve predominantly
12    low-income, medically underserved individuals, to ensure
13    that all covered services to beneficiaries, including
14    adults and children, low-income persons, persons with
15    serious, chronic, or complex health conditions or physical
16    or mental disabilities, or persons with limited English
17    proficiency, will be accessible without unreasonable
18    travel or delay.
19        (3) Written policies and procedures for the selection
20    and tiering, if any, of providers, including each health
21    care professional specialty. Selection and tiering
22    standards shall not:
23            (A) allow an insurer or administrator to
24        discriminate against high-risk populations by
25        excluding and tiering providers because they are



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1        located in geographic areas that contain populations
2        or providers presenting a risk of higher than average
3        claims, losses, or health care services utilization;
4            (B) exclude providers because they treat or
5        specialize in treating populations presenting a risk
6        of higher than average claims, losses, or health care
7        services utilization; or
8            (C) discriminate, with respect to participation
9        under the health benefit plan, against any provider who
10        is acting within the scope of the provider's license or
11        certification under applicable State law or rules.
12                (i) The provisions of this subdivision (C) do
13            not require an insurer or administrator or the
14            networks with which it contracts to employ
15            specific providers acting within the scope of
16            their licenses or certifications under applicable
17            State law who may meet the selection criteria of
18            the insurers or administrators or the networks
19            with which they contract or to contract with or
20            retain more providers acting within the scope of
21            their license or certification under applicable
22            State law than are necessary to maintain a
23            sufficient provider network.
24                (ii) The provisions of this subdivision (C)
25            may not be construed to require an insurer or
26            administrator to contract with any provider



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1            willing to abide by the terms and conditions for
2            participation established by the carrier.
3                (iii) The provisions of this subdivision (C)
4            shall not be construed to prohibit an insurer or
5            administrator from declining to select a provider
6            who fails to meet the other legitimate selection
7            criteria developed in compliance with this Act.
8            (D) An insurer or administrator shall not offer an
9        inducement to a provider that would encourage or
10        otherwise incentivize the provider to deliver less
11        than medically necessary services to a covered person.
12            (E) An insurer or administrator shall not prohibit
13        a preferred provider from discussing any specific or
14        all treatment options with beneficiaries irrespective
15        of the insurer's position on those treatment options or
16        from advocating on behalf of beneficiaries within the
17        utilization review, grievance, or appeals processes
18        established by the administrator or insurer in
19        accordance with any rights or remedies available under
20        applicable State or federal law.
21        (4) The written policies and procedures for
22    determining when the plan is closed to new providers
23    desiring to enter into a network plan.
24        (5) The written policies and procedures for adding
25    providers to meet patient needs based on increases in the
26    number of beneficiaries, changes in the



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1    patient-to-provider ratio, changes in medical and health
2    care capabilities, and increased demand for services.
3        (6) The written policies and procedures for making
4    referrals within and outside the network.
5        (7) Written policies and procedures on how the network
6    plan will provide 24-hour, 7-day per week access to
7    network-affiliated primary care, emergency services, and
8    woman's principal health care providers.
9    (b) Prior to going to market, administrators and insurers
10must file with the Director for review and approval a
11description of the services to be offered through a network
12plan. The description shall include all of the following:
13        (1) A geographic map of the area proposed to be served
14    by the plan by county service area and zip code, including
15    marked locations for preferred providers.
16        (2) The names, addresses, phone numbers, and
17    specialties of the providers who have entered into
18    preferred provider agreements under the network plan.
19        (3) The number of beneficiaries anticipated to be
20    covered by the network plan.
21        (4) An Internet website and toll-free telephone number
22    for beneficiaries and prospective beneficiaries to access
23    current and accurate lists of preferred providers,
24    additional information about the plan, as well as any other
25    information required by Department rule.
26        (5) A description of how health care services to be



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1    rendered under the network plan are reasonably accessible
2    and available to beneficiaries. The description shall
3    address all of the following:
4            (A) the type of health care services to be provided
5        by the network plan;
6            (B) the ratio of full-time equivalent physicians
7        and other providers to beneficiaries, by specialty and
8        including primary care physicians and facility-based
9        physicians when applicable under the contract,
10        necessary to meet the health care needs and service
11        demands of the currently enrolled population;
12            (C) the travel and distance standards for plan
13        beneficiaries in county service areas; and
14            (D) a description for each network hospital of the
15        percentage of physicians in each of these specialties,
16        (i) emergency medicine, (ii) anesthesiology, (iii)
17        pathology, (iv) radiology, (v) neonatology, and (vi)
18        hospitalists, who practice in the hospital are in the
19        insurer's or administrator's network.
20        (6) A provision ensuring that whenever a beneficiary
21    has made a good faith effort, as evidenced by accessing the
22    provider directory and calling the provider when possible,
23    to utilize preferred providers for a covered service and it
24    is determined the administrator or insurer does not have
25    the appropriate preferred providers due to insufficient
26    number, type, or unreasonable travel distance or delay, the



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1    administrator or insurer shall ensure, directly or
2    indirectly, by terms contained in the payer contract, that
3    the beneficiary will be provided the covered service at no
4    greater cost to the beneficiary than if the service had
5    been provided by a preferred provider. This paragraph (6)
6    does not apply to a beneficiary who willfully chooses to
7    access a non-preferred provider for health care services
8    available through the administrator's panel of preferred
9    providers. In these circumstances, the contractual
10    requirements for non-preferred provider reimbursements
11    shall apply.
12        (7) The procedures for paying benefits when particular
13    physician specialties are not available within the
14    provider network.
15        (8) A provision that the beneficiary shall receive
16    emergency care coverage such that payment for this coverage
17    is not dependent upon whether the emergency services are
18    performed by a preferred or non-preferred provider and the
19    coverage shall be at the same benefit level as if the
20    service or treatment had been rendered by a preferred
21    provider. For purposes of this paragraph (8), "the same
22    benefit level" means that the beneficiary is provided the
23    covered service at no greater cost to the beneficiary than
24    if the service had been provided by a preferred provider.
25        (9) A limitation that, if the plan provides that the
26    beneficiary will incur a penalty for failing to pre-certify



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1    inpatient hospital treatment, the penalty may not exceed
2    $1,000 per occurrence in addition to the plan cost sharing
3    provisions.
4    (c) The network plan shall demonstrate to the Director,
5prior to approval, a minimum ratio of full-time equivalent
6providers to plan beneficiaries as required by the Department.
7        (1) The ratio of full-time equivalent physician or
8    other providers to plan beneficiaries shall be established
9    annually by the Department based upon the guidance from the
10    federal Centers for Medicare and Medicaid Services
11    concerning exchange plans or Medicare Advantage Plans.
12    These ratios at a minimum must include physicians or other
13    providers as follows:
14            (A) Primary Care;
15            (B) Pediatrics;
16            (C) Cardiology;
17            (D) Gastroenterology;
18            (E) General Surgery;
19            (F) Neurology;
20            (G) OB/GYN;
21            (H) Oncology/Radiation;
22            (I) Ophthalmology;
23            (J) Urology;
24            (K) Behavioral Health;
25            (L) Allergy/Immunology;
26            (M) Chiropractic;



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1            (N) Dermatology;
2            (O) Endocrinology;
3            (P) Ears, Nose, and Throat (ENT)/Otolaryngology;
4            (Q) Infectious Disease;
5            (R) Nephrology;
6            (S) Neurosurgery;
7            (T) Orthopedic Surgery;
8            (U) Physiatry/Rehabilitative;
9            (V) Plastic Surgery;
10            (W) Pulmonary;
11            (X) Rheumatology;
12            (Y) Anesthesiology;
13            (Z) Pain Medicine;
14            (AA) Pediatric Specialty Services;
15            (BB) Outpatient Dialysis; and
16            (CC) HIV.
17        (2) The Director shall establish a process for the
18    annual review of the adequacy of these standards, along
19    with an assessment of additional specialties to be included
20    in the list under this subsection (c).
21    (d) The network plan shall demonstrate to the Director,
22prior to approval, maximum travel and distance standards for
23plan beneficiaries, which shall be established annually by the
24Department based upon the guidance from the federal Centers for
25Medicare and Medicaid Services concerning exchange plans or
26Medicare Advantage Plans. These standards shall consist of the



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1maximum minutes or miles to be traveled by a plan beneficiary
2for each county type, such as large counties, metro counties,
3or rural counties as defined by Department rule.
4        (1) The maximum travel time and distance standards must
5    include standards for each physician and other provider
6    category listed in paragraph (1) of subsection (c).
7        (2) The network plan must demonstrate, prior to
8    approval, that it has contracted with physicians who
9    specialize in emergency medicine, anesthesiology,
10    pathology, and radiology and hospitalists, in sufficient
11    numbers at any in-network facility or in-network hospital
12    included in such plan so that patients enrolled in the plan
13    have reasonable access to these in-network physician
14    specialists.
15        (3) The network plan must demonstrate, prior to
16    approval, that it has contracted with physicians who
17    specialize in pediatric hospital-based services, including
18    emergency medicine, anesthesiology, pathology, radiology,
19    and hospitalists, in sufficient numbers at any in-network
20    facility or in-network hospital included in such plan so
21    that pediatric patients enrolled in the plan have
22    reasonable access to these in-network physician
23    specialists.
24        (4) The Director shall establish a process for the
25    annual review of the adequacy of these standards along with
26    an assessment of additional specialties to be included in



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1    the list under this subsection (d).
2    (e) These ratio and time and distance standards apply to
3the lowest cost-sharing tier of any tiered network.
4    (f) Insurers and administrators who are not able to comply
5with the provider ratios and time and distance standards
6established by the Department may request an exception to these
7requirements from the Department. The Department may grant an
8exception in the following circumstances:
9        (1) if no providers or facilities meet the specific
10    time and distance standard in a specific service area and
11    the insurer or administrator (i) discloses information on
12    the distance and travel time points that beneficiaries
13    would have to travel beyond the required criterion to reach
14    the next closest contracted provider outside of the service
15    area and (ii) provides contact information, including
16    names, addresses, and phone numbers for the next closest
17    contracted provider or facility; or
18        (2) if patterns of care in the service area do not
19    support the need for the requested number of provider or
20    facility type and the insurer or administrator provides
21    data on local patterns of care, such as claims data,
22    referral patterns, or local provider interviews,
23    indicating where the beneficiaries currently seek this
24    type of care, where the physicians currently refer
25    beneficiaries, or both.
26    (g) Insurers and administrators are required to report to



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1the Director any material change to an approved network plan
2within 15 days after the change occurs and any change that
3would result in failure to meet the requirements of this Act.
4Upon notice from the insurer or administrator, the Director
5shall reevaluate the network plan's compliance with the network
6adequacy and transparency standards of this Act.
7    (h) The Director shall conduct quarterly audits of all
8network plans to verify compliance with network adequacy
9standards. These audits shall include surveys to be sent to
10plan beneficiaries and providers for the purpose of assessing
11network plan compliance with the provisions of this Section.
12    Section 15. Notice of nonrenewal or termination. A network
13plan must give at least 60 days' notice of nonrenewal or
14termination of a provider to the provider and to the
15beneficiaries served by the provider. The notice shall include
16a name and address to which a beneficiary or provider may
17direct comments and concerns regarding the nonrenewal or
18termination and the telephone number maintained by the
19Department for consumer complaints. Immediate written notice
20may be provided without 60 days' notice when a provider's
21license has been disciplined by a State licensing board or when
22the network plan reasonably believes direct imminent physical
23harm to patients under the providers care may occur.
24    Section 20. Transition of services.



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1    (a) A network plan shall provide for continuity of care for
2its beneficiaries as follows:
3        (1) If a beneficiary's physician or hospital provider
4    leaves the network plan's network of providers for reasons
5    other than termination of a contract in situations
6    involving imminent harm to a patient or a final
7    disciplinary action by a State licensing board and the
8    provider remains within the network plan's service area,
9    the network plan shall permit the beneficiary to continue
10    an ongoing course of treatment with that provider during a
11    transitional period for the following duration:
12            (A) 90 days from the date of the notice to the
13        beneficiary of the provider's disaffiliation from the
14        network plan if the beneficiary has an ongoing course
15        of treatment; or
16            (B) if the beneficiary has entered the third
17        trimester of pregnancy at the time of the provider's
18        disaffiliation, a period that includes the provision
19        of post-partum care directly related to the delivery.
20        (2) Notwithstanding the provisions of paragraph (1) of
21    this subsection (a), such care shall be authorized by the
22    network plan during the transitional period in accordance
23    with the following:
24            (A) the provider receives continued reimbursement
25        from the network plan at the rates and terms and
26        conditions applicable prior to the start of the



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1        transitional period;
2            (B) the provider adheres to the network plan's
3        quality assurance requirements, including provision to
4        the network plan of necessary medical information
5        related to such care; and
6            (C) the provider otherwise adheres to the network
7        plan's policies and procedures, including, but not
8        limited to, procedures regarding referrals and
9        obtaining preauthorizations for treatment.
10        (3) The provisions of this Section governing health
11    care provided during the transition period do not apply if
12    the beneficiary has successfully transitioned to another
13    provider participating in the network plan, if the
14    beneficiary has already met or exceeded the benefit
15    limitations of the plan, or if the care provided is not
16    medically necessary.
17    (b) The termination or departure of a beneficiary's
18physician or hospital provider from a network plan shall
19constitute a qualifying event, allowing beneficiaries to
20select a new network plan outside of a standard open enrollment
21period within 60 days of notice of termination or departure.
22    (c) A network plan shall provide for continuity of care for
23new beneficiaries as follows:
24        (1) If a new beneficiary whose provider is not a member
25    of the network plan's provider network, but is within the
26    network plan's service area, enrolls in the network plan,



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1    the network plan shall permit the beneficiary to continue
2    an ongoing course of treatment with the beneficiary's
3    current physician during a transitional period:
4            (A) of 90 days from the effective date of
5        enrollment if the beneficiary has an ongoing course of
6        treatment; or
7            (B) if the beneficiary has entered the third
8        trimester of pregnancy at the effective date of
9        enrollment, that includes the provision of post-partum
10        care directly related to the delivery.
11        (2) If a beneficiary elects to continue to receive care
12    from such provider pursuant to paragraph (1) of this
13    subsection (c), such care shall be authorized by the
14    network plan for the transitional period in accordance with
15    the following:
16            (A) the provider receives reimbursement from the
17        network plan at rates established by the network plan;
18            (B) the provider adheres to the network plan's
19        quality assurance requirements, including provision to
20        the network plan of necessary medical information
21        related to such care; and
22            (C) the provider otherwise adheres to the network
23        plan's policies and procedures, including, but not
24        limited to, procedures regarding referrals and
25        obtaining preauthorization for treatment.
26        (3) The provisions of this Section governing health



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1    care provided during the transition period do not apply if
2    the beneficiary has successfully transitioned to another
3    provider participating in the network plan, if the
4    beneficiary has already met or exceeded the benefit
5    limitations of the plan, or if the care provided is not
6    medically necessary.
7    (d) In no event shall this Section be construed to require
8a network plan to provide coverage for benefits not otherwise
9covered or to diminish or impair preexisting condition
10limitations contained in the beneficiary's contract.
11    Section 25. Network transparency.
12    (a) A network plan shall post electronically an up-to-date,
13accurate, and complete provider directory for each of its
14network plans, with the information and search functions, as
15described in this Section.
16        (1) In making the directory available electronically,
17    the network plans shall ensure that the general public is
18    able to view all of the current providers for a plan
19    through a clearly identifiable link or tab and without
20    creating or accessing an account or entering a policy or
21    contract number.
22        (2) The network plan shall provide updates to the
23    online provider directory within 10 business days after
24    knowing a change is necessary.
25        (3) The network plan shall audit monthly at least 25%



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1    of its provider directories for accuracy, make any
2    corrections necessary, and retain documentation of the
3    audit. The network plan shall submit the audit annually to
4    the Director. As part of these audits, the network plan
5    shall contact any provider in its network that has not
6    submitted a claim to the plan or otherwise communicated his
7    or her intent to continue participation in the plan's
8    network within a 6-month period.
9        (4) A network plan shall provide a print copy of a
10    current provider directory or a print copy of the requested
11    directory information upon request of a beneficiary or a
12    prospective beneficiary. Print copies must be updated
13    monthly or provide an errata that reflects changes in the
14    provider network, to be updated monthly.
15        (5) For each network plan, a network plan shall
16    include, in plain language in both the electronic and print
17    directory, the following general information:
18            (A) in plain language, a description of the
19        criteria the plan has used to build its provider
20        network;
21            (B) if applicable, in plain language, a
22        description of the criteria the administrator,
23        insurer, or network plan has used to create tiered
24        networks;
25            (C) if applicable, in plain language, how the
26        network plan designates the different provider tiers



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1        or levels in the network and identifies for each
2        specific provider, hospital, or other type of facility
3        in the network which tier each is placed, for example,
4        by name, symbols, or grouping, in order for a
5        beneficiary-covered person or a prospective
6        beneficiary-covered person to be able to identify the
7        provider tier; and
8            (D) if applicable, a notation that authorization
9        or referral may be required to access some providers.
10        (6) A network plan shall make it clear for both its
11    electronic and print directories what provider directory
12    applies to which network plan, such as including the
13    specific name of the network plan as marketed and issued in
14    this State. The network plan shall include in both its
15    electronic and print directories a customer service email
16    address and telephone number or electronic link that
17    beneficiaries or the general public may use to notify the
18    network plan of inaccurate provider directory information
19    and contact information for the Department's Office of
20    Consumer Health Insurance.
21        (7) A provider directory, whether in electronic or
22    print format, shall accommodate the communication needs of
23    individuals with disabilities, and include a link to or
24    information regarding available assistance for persons
25    with limited English proficiency.
26    (b) For each network plan, a network plan shall make



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1available through an electronic provider directory the
2following information in a searchable format:
3        (1) for health care professionals:
4            (A) name;
5            (B) gender;
6            (C) participating office locations;
7            (D) specialty, if applicable;
8            (E) medical group affiliations, if applicable;
9            (F) facility affiliations, if applicable;
10            (G) participating facility affiliations, if
11        applicable;
12            (H) languages spoken other than English, if
13        applicable;
14            (I) whether accepting new patients; and
15            (J) board certifications, if applicable.
16        (2) for hospitals:
17            (A) hospital name;
18            (B) hospital type (such as acute, rehabilitation,
19        children's, or cancer);
20            (C) participating hospital location; and
21            (D) hospital accreditation status; and
22        (3) for facilities, other than hospitals, by type:
23            (A) facility name;
24            (B) facility type;
25            (C) types of services performed; and
26            (D) participating facility location or locations.



HB0311- 22 -LRB100 05356 RPS 15367 b

1    (c) For the electronic provider directories, for each
2network plan, a network plan shall make available all of the
3following information in addition to the searchable
4information required in this Section:
5        (1) for health care professionals:
6            (A) contact information; and
7            (B) languages spoken other than English by
8        clinical staff, if applicable;
9        (2) for hospitals, telephone number; and
10        (3) for facilities other than hospitals, telephone
11    number.
12    (d) The administrator, insurer, or network plan shall make
13available in print, upon request, the following provider
14directory information for the applicable network plan:
15        (1) for health care professionals:
16            (A) name;
17            (B) contact information;
18            (C) participating office location or locations;
19            (D) specialty, if applicable;
20            (E) languages spoken other than English, if
21        applicable; and
22            (F) whether accepting new patients.
23        (2) for hospitals:
24            (A) hospital name;
25            (B) hospital type (such as acute, rehabilitation,
26        children's, or cancer); and



HB0311- 23 -LRB100 05356 RPS 15367 b

1            (C) participating hospital location and telephone
2        number; and
3        (3) for facilities, other than hospitals, by type:
4            (A) facility name;
5            (B) facility type;
6            (C) types of services performed; and
7            (D) participating facility location or locations
8        and telephone numbers.
9    (e) The network plan shall include a disclosure in the
10print format provider directory that the information included
11in the directory is accurate as of the date of printing and
12that beneficiaries or prospective beneficiaries should consult
13the insurer's or administrator's electronic provider directory
14on its website and contact the provider. The network plan shall
15also include a telephone number in the print format provider
16directory for a customer service representative where the
17beneficiary can obtain current provider directory information.
18    (f) The Director shall conduct semi-annual audits of the
19accuracy of provider directories to ensure plan compliance.
20    Section 30. Administration and enforcement.
21    (a) Insurers and administrators, as defined in this Act,
22have a continuing obligation to comply with the requirements of
23this Act. Other than the duties specifically created in this
24Act, nothing in this Act is intended to preclude, prevent, or
25require the adoption, modification, or termination of any



HB0311- 24 -LRB100 05356 RPS 15367 b

1utilization management, quality management, or claims
2processing methodologies of an insurer or administrator.
3    (b) Nothing in this Act precludes, prevents, or requires
4the adoption, modification, or termination of any network plan
5term, benefit, coverage or eligibility provision, or payment
7    (c) The Director shall enforce the provisions of this Act
8pursuant to the enforcement powers granted to it by law.
9    (d) The Director is hereby granted specific authority to
10issue a cease and desist order against, fine, or otherwise
11penalize any insurer or administrator for violations of any
12provision of this Act.
13    (e) The Department shall adopt rules to enforce compliance
14with this Act to the extent necessary.
15    Section 99. Effective date. This Act takes effect January
161, 2018.