Full Text of HB0311 100th General Assembly
HB0311ham001 100TH GENERAL ASSEMBLY | Rep. Gregory Harris Filed: 3/10/2017
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| 1 | | AMENDMENT TO HOUSE BILL 311
| 2 | | AMENDMENT NO. ______. Amend House Bill 311 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the | 5 | | Network Adequacy and Transparency Act. | 6 | | Section 5. Definitions. In this Act: | 7 | | "Beneficiary" means an individual, an enrollee, an | 8 | | insured, a participant, or any other person entitled to | 9 | | reimbursement for covered expenses of or the discounting of | 10 | | provider fees for health care services under a program in which | 11 | | the beneficiary has an incentive to utilize the services of a | 12 | | provider that has entered into an agreement or arrangement with | 13 | | an insurer. | 14 | | "Department" means the Department of Insurance. | 15 | | "Director" means the Director of Insurance. | 16 | | "Insurer" means any entity that offers individual or group |
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| 1 | | accident and health insurance, including, but not limited to, | 2 | | health maintenance organizations, preferred provider | 3 | | organizations, exclusive provider organizations, and other | 4 | | plan structures requiring network participation, excluding the | 5 | | medical assistance program under the Illinois Public Aid Code, | 6 | | the State employees group health insurance program, workers | 7 | | compensation insurance, and pharmacy benefit managers. | 8 | | "Material change" means a significant reduction in the | 9 | | number of providers available in a network plan, including, but | 10 | | not limited to, a reduction of 10% or more in a specific type | 11 | | of providers, the removal of a major health system that causes | 12 | | a network to be significantly different from the network when | 13 | | the beneficiary purchased the network plan, or any change that | 14 | | would cause the network to no longer satisfy the requirements | 15 | | of this Act or the Department's rules for network adequacy and | 16 | | transparency. | 17 | | "Network" means the group or groups of preferred providers | 18 | | providing services to a network plan. | 19 | | "Network plan" means an individual or group policy of | 20 | | accident and health insurance that either requires a covered | 21 | | person to use or creates incentives, including financial | 22 | | incentives, for a covered person to use providers managed, | 23 | | owned, under contract with, or employed by the insurer. | 24 | | "Ongoing course of treatment" means (1) treatment for a | 25 | | life-threatening condition, which is a disease or condition for | 26 | | which likelihood of death is probable unless the course of the |
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| 1 | | disease or condition is interrupted; (2) treatment for a | 2 | | serious acute condition, defined as a disease or condition | 3 | | requiring complex ongoing care that the covered person is | 4 | | currently receiving, such as chemotherapy, radiation therapy, | 5 | | or post-operative visits; (3) a course of treatment for a | 6 | | health condition that a treating provider attests that | 7 | | discontinuing care by that provider would worsen the condition | 8 | | or interfere with anticipated outcomes; or (4) the third | 9 | | trimester of pregnancy through the post-partum period. | 10 | | "Preferred provider" means any provider who has entered, | 11 | | either directly or indirectly, into an agreement with an | 12 | | employer or risk-bearing entity relating to health care | 13 | | services that may be rendered to beneficiaries under a network | 14 | | plan. | 15 | | "Providers" means physicians licensed to practice medicine | 16 | | in all its branches, other health care professionals, | 17 | | hospitals, or other health care institutions that provide | 18 | | health care services. | 19 | | "Telehealth" has the meaning given to that term in Section | 20 | | 256z.22 of the Insurance Code. | 21 | | "Telemedicine" has the meaning given to that term in | 22 | | Section 49.5 of the Medical Practice Act of 1987. | 23 | | "Tiered network" means a network that identifies and groups | 24 | | some or all types of provider and facilities into specific | 25 | | groups to which different provider reimbursement, covered | 26 | | person cost-sharing or provider access requirements, or any |
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| 1 | | combination thereof, apply for the same services. | 2 | | "Woman's principal health care provider" means a physician | 3 | | licensed to practice medicine in all of its branches | 4 | | specializing in obstetrics, gynecology, or family practice. | 5 | | Section 10. Network adequacy. | 6 | | (a) An insurer providing a network plan shall file a | 7 | | description of all of the following with the Director: | 8 | | (1) The written policies and procedures for adding | 9 | | providers to meet patient needs based on increases in the | 10 | | number of beneficiaries, changes in the | 11 | | patient-to-provider ratio, changes in medical and health | 12 | | care capabilities, and increased demand for services. | 13 | | (2) The written policies and procedures for making | 14 | | referrals within and outside the network. | 15 | | (3) The written policies and procedures on how the | 16 | | network plan will provide 24-hour, 7-day per week access to | 17 | | network-affiliated primary care, emergency services, and | 18 | | woman's principal health care providers. | 19 | | An insurer shall not prohibit a preferred provider from | 20 | | discussing any specific or all treatment options with | 21 | | beneficiaries irrespective of the insurer's position on those | 22 | | treatment options or from advocating on behalf of beneficiaries | 23 | | within the utilization review, grievance, or appeals processes | 24 | | established by the insurer in accordance with any rights or | 25 | | remedies available under applicable State or federal law. |
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| 1 | | (b) Prior to going to market, insurers must file with the | 2 | | Director for review and approval a description of the services | 3 | | to be offered through a network plan. The description shall | 4 | | include all of the following: | 5 | | (1) A geographic map of the area proposed to be served | 6 | | by the plan by county service area and zip code, including | 7 | | marked locations for preferred providers. | 8 | | (2) As deemed necessary by the Department, the names, | 9 | | addresses, phone numbers, and specialties of the providers | 10 | | who have entered into preferred provider agreements under | 11 | | the network plan. | 12 | | (3) The number of beneficiaries anticipated to be | 13 | | covered by the network plan. | 14 | | (4) An Internet website and toll-free telephone number | 15 | | for beneficiaries and prospective beneficiaries to access | 16 | | current and accurate lists of preferred providers, | 17 | | additional information about the plan, as well as any other | 18 | | information required by Department rule. | 19 | | (5) A description of how health care services to be | 20 | | rendered under the network plan are reasonably accessible | 21 | | and available to beneficiaries. The description shall | 22 | | address all of the following: | 23 | | (A) the type of health care services to be provided | 24 | | by the network plan; | 25 | | (B) the ratio of full-time equivalent physicians | 26 | | and other providers to beneficiaries, by specialty and |
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| 1 | | including primary care physicians and facility-based | 2 | | physicians when applicable under the contract, | 3 | | necessary to meet the health care needs and service | 4 | | demands of the currently enrolled population; | 5 | | (C) the travel and distance standards for plan | 6 | | beneficiaries in county service areas; and | 7 | | (D) a description of how the use of telemedicine, | 8 | | telehealth, or mobile care services may be used to | 9 | | partially meet the network adequacy standards, if | 10 | | applicable. | 11 | | (6) A provision ensuring that whenever a beneficiary | 12 | | has made a good faith effort, as evidenced by accessing the | 13 | | provider directory, calling the network plan, and calling | 14 | | the provider, to utilize preferred providers for a covered | 15 | | service and it is determined the insurer does not have the | 16 | | appropriate preferred providers due to insufficient | 17 | | number, type, or unreasonable travel distance or delay, the | 18 | | insurer shall ensure, directly or indirectly, by terms | 19 | | contained in the payer contract, that the beneficiary will | 20 | | be provided the covered service at no greater cost to the | 21 | | beneficiary than if the service had been provided by a | 22 | | preferred provider. This paragraph (6) does not apply to a | 23 | | beneficiary who willfully chooses to access a | 24 | | non-preferred provider for health care services available | 25 | | through the panel of preferred providers. In these | 26 | | circumstances, the contractual requirements for |
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| 1 | | non-preferred provider reimbursements shall apply. | 2 | | (7) A provision that the beneficiary shall receive | 3 | | emergency care coverage such that payment for this coverage | 4 | | is not dependent upon whether the emergency services are | 5 | | performed by a preferred or non-preferred provider and the | 6 | | coverage shall be at the same benefit level as if the | 7 | | service or treatment had been rendered by a preferred | 8 | | provider. For purposes of this paragraph (7), "the same | 9 | | benefit level" means that the beneficiary is provided the | 10 | | covered service at no greater cost to the beneficiary than | 11 | | if the service had been provided by a preferred provider. | 12 | | (8) A limitation that, if the plan provides that the | 13 | | beneficiary will incur a penalty for failing to pre-certify | 14 | | inpatient hospital treatment, the penalty may not exceed | 15 | | $1,000 per occurrence in addition to the plan cost sharing | 16 | | provisions. | 17 | | (c) The network plan shall demonstrate to the Director, | 18 | | prior to approval, a minimum ratio of full-time equivalent | 19 | | providers to plan beneficiaries as required by the Department. | 20 | | (1) The ratio of full-time equivalent physicians or | 21 | | other providers to plan beneficiaries shall be established | 22 | | annually by the Department in consultation with the | 23 | | Department of Public Health based upon the guidance from | 24 | | the federal Centers for Medicare and Medicaid Services | 25 | | concerning exchange plans or Medicare Advantage Plans. The | 26 | | Department shall consider establishing ratios for the |
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| 1 | | following physicians or other providers: | 2 | | (A) Primary Care; | 3 | | (B) Pediatrics; | 4 | | (C) Cardiology; | 5 | | (D) Gastroenterology; | 6 | | (E) General Surgery; | 7 | | (F) Neurology; | 8 | | (G) OB/GYN; | 9 | | (H) Oncology/Radiation; | 10 | | (I) Ophthalmology; | 11 | | (J) Urology; | 12 | | (K) Behavioral Health; | 13 | | (L) Allergy/Immunology; | 14 | | (M) Chiropractic; | 15 | | (N) Dermatology; | 16 | | (O) Endocrinology; | 17 | | (P) Ears, Nose, and Throat (ENT)/Otolaryngology; | 18 | | (Q) Infectious Disease; | 19 | | (R) Nephrology; | 20 | | (S) Neurosurgery; | 21 | | (T) Orthopedic Surgery; | 22 | | (U) Physiatry/Rehabilitative; | 23 | | (V) Plastic Surgery; | 24 | | (W) Pulmonary; | 25 | | (X) Rheumatology; | 26 | | (Y) Anesthesiology; |
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| 1 | | (Z) Pain Medicine; | 2 | | (AA) Pediatric Specialty Services; | 3 | | (BB) Outpatient Dialysis; and | 4 | | (CC) HIV. | 5 | | (2) The Director shall establish a process for the | 6 | | annual review of the adequacy of these standards, along | 7 | | with an assessment of additional specialties to be included | 8 | | in the list under this subsection (c). | 9 | | (d) The network plan shall demonstrate to the Director, | 10 | | prior to approval, maximum travel and distance standards for | 11 | | plan beneficiaries, which shall be established annually by the | 12 | | Department in consultation with the Department of Public Health | 13 | | based upon the guidance from the federal Centers for Medicare | 14 | | and Medicaid Services concerning exchange plans or Medicare | 15 | | Advantage Plans. These standards shall consist of the maximum | 16 | | minutes or miles to be traveled by a plan beneficiary for each | 17 | | county type, such as large counties, metro counties, or rural | 18 | | counties as defined by Department rule. | 19 | | The maximum travel time and distance standards must include | 20 | | standards for each physician and other provider category listed | 21 | | for which ratios have been established. | 22 | | The Director shall establish a process for the annual | 23 | | review of the adequacy of these standards along with an | 24 | | assessment of additional specialties to be included in the list | 25 | | under this subsection (d). | 26 | | (e) These ratio and time and distance standards apply to |
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| 1 | | the lowest cost-sharing tier of any tiered network. | 2 | | (f) The network plan shall demonstrate sufficient | 3 | | inpatient services, including, but not limited to, services of | 4 | | preferred providers who specialize in emergency medicine, | 5 | | anesthesiology, pathology, and radiology. | 6 | | (g) The network plan may consider use of other health care | 7 | | service delivery options, such as telemedicine or telehealth, | 8 | | mobile clinics, and centers of excellence, or other ways of | 9 | | delivering care to partially meet the requirements set under | 10 | | this Section. | 11 | | (h) Insurers who are not able to comply with the provider | 12 | | ratios and time and distance standards established by the | 13 | | Department may request an exception to these requirements from | 14 | | the Department. The Department may grant an exception in the | 15 | | following circumstances: | 16 | | (1) if no providers or facilities meet the specific | 17 | | time and distance standard in a specific service area and | 18 | | the insurer (i) discloses information on the distance and | 19 | | travel time points that beneficiaries would have to travel | 20 | | beyond the required criterion to reach the next closest | 21 | | contracted provider outside of the service area and (ii) | 22 | | provides contact information, including names, addresses, | 23 | | and phone numbers for the next closest contracted provider | 24 | | or facility; | 25 | | (2) if patterns of care in the service area do not | 26 | | support the need for the requested number of provider or |
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| 1 | | facility type and the insurer provides data on local | 2 | | patterns of care, such as claims data, referral patterns, | 3 | | or local provider interviews, indicating where the | 4 | | beneficiaries currently seek this type of care or where the | 5 | | physicians currently refer beneficiaries, or both; or | 6 | | (3) other circumstances deemed appropriate by the | 7 | | Department consistent with the requirements of this Act. | 8 | | (i) Insurers are required to report to the Director any | 9 | | material change to an approved network plan within 15 days | 10 | | after the change occurs and any change that would result in | 11 | | failure to meet the requirements of this Act. Upon notice from | 12 | | the insurer, the Director shall reevaluate the network plan's | 13 | | compliance with the network adequacy and transparency | 14 | | standards of this Act. | 15 | | Section 15. Notice of nonrenewal or termination. A network | 16 | | plan must give at least 60 days' notice of nonrenewal or | 17 | | termination of a provider to the provider and to the | 18 | | beneficiaries served by the provider. The notice shall include | 19 | | a name and address to which a beneficiary or provider may | 20 | | direct comments and concerns regarding the nonrenewal or | 21 | | termination and the telephone number maintained by the | 22 | | Department for consumer complaints. Immediate written notice | 23 | | may be provided without 60 days' notice when a provider's | 24 | | license has been disciplined by a State licensing board or when | 25 | | the network plan reasonably believes direct imminent physical |
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| 1 | | harm to patients under the providers care may occur. | 2 | | Section 20. Transition of services. | 3 | | (a) A network plan shall provide for continuity of care for | 4 | | its beneficiaries as follows: | 5 | | (1) If a beneficiary's physician or hospital provider | 6 | | leaves the network plan's network of providers for reasons | 7 | | other than termination of a contract in situations | 8 | | involving imminent harm to a patient or a final | 9 | | disciplinary action by a State licensing board and the | 10 | | provider remains within the network plan's service area, | 11 | | the network plan shall permit the beneficiary to continue | 12 | | an ongoing course of treatment with that provider during a | 13 | | transitional period for the following duration: | 14 | | (A) 90 days from the date of the notice to the | 15 | | beneficiary of the provider's disaffiliation from the | 16 | | network plan if the beneficiary has an ongoing course | 17 | | of treatment; or | 18 | | (B) if the beneficiary has entered the third | 19 | | trimester of pregnancy at the time of the provider's | 20 | | disaffiliation, a period that includes the provision | 21 | | of post-partum care directly related to the delivery. | 22 | | (2) Notwithstanding the provisions of paragraph (1) of | 23 | | this subsection (a), such care shall be authorized by the | 24 | | network plan during the transitional period in accordance | 25 | | with the following: |
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| 1 | | (A) the provider receives continued reimbursement | 2 | | from the network plan at the rates and terms and | 3 | | conditions applicable under the terminated contract | 4 | | prior to the start of the transitional period; | 5 | | (B) the provider adheres to the network plan's | 6 | | quality assurance requirements, including provision to | 7 | | the network plan of necessary medical information | 8 | | related to such care; and | 9 | | (C) the provider otherwise adheres to the network | 10 | | plan's policies and procedures, including, but not | 11 | | limited to, procedures regarding referrals and | 12 | | obtaining preauthorizations for treatment. | 13 | | (3) The provisions of this Section governing health | 14 | | care provided during the transition period do not apply if | 15 | | the beneficiary has successfully transitioned to another | 16 | | provider participating in the network plan, if the | 17 | | beneficiary has already met or exceeded the benefit | 18 | | limitations of the plan, or if the care provided is not | 19 | | medically necessary. | 20 | | (b) A network plan shall provide for continuity of care for | 21 | | new beneficiaries as follows: | 22 | | (1) If a new beneficiary whose provider is not a member | 23 | | of the network plan's provider network, but is within the | 24 | | network plan's service area, enrolls in the network plan, | 25 | | the network plan shall permit the beneficiary to continue | 26 | | an ongoing course of treatment with the beneficiary's |
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| 1 | | current physician during a transitional period: | 2 | | (A) of 90 days from the effective date of | 3 | | enrollment if the beneficiary has an ongoing course of | 4 | | treatment; or | 5 | | (B) if the beneficiary has entered the third | 6 | | trimester of pregnancy at the effective date of | 7 | | enrollment, that includes the provision of post-partum | 8 | | care directly related to the delivery. | 9 | | (2) If a beneficiary elects to continue to receive care | 10 | | from such provider pursuant to paragraph (1) of this | 11 | | subsection (b), such care shall be authorized by the | 12 | | network plan for the transitional period in accordance with | 13 | | the following: | 14 | | (A) the provider receives reimbursement from the | 15 | | network plan at rates established by the network plan; | 16 | | (B) the provider adheres to the network plan's | 17 | | quality assurance requirements, including provision to | 18 | | the network plan of necessary medical information | 19 | | related to such care; and | 20 | | (C) the provider otherwise adheres to the network | 21 | | plan's policies and procedures, including, but not | 22 | | limited to, procedures regarding referrals and | 23 | | obtaining preauthorization for treatment. | 24 | | (3) The provisions of this Section governing health | 25 | | care provided during the transition period do not apply if | 26 | | the beneficiary has successfully transitioned to another |
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| 1 | | provider participating in the network plan, if the | 2 | | beneficiary has already met or exceeded the benefit | 3 | | limitations of the plan, or if the care provided is not | 4 | | medically necessary. | 5 | | (c) In no event shall this Section be construed to require | 6 | | a network plan to provide coverage for benefits not otherwise | 7 | | covered or to diminish or impair preexisting condition | 8 | | limitations contained in the beneficiary's contract. | 9 | | Section 25. Network transparency. | 10 | | (a) A network plan shall post electronically an up-to-date, | 11 | | accurate, and complete provider directory for each of its | 12 | | network plans, with the information and search functions, as | 13 | | described in this Section. | 14 | | (1) In making the directory available electronically, | 15 | | the network plans shall ensure that the general public is | 16 | | able to view all of the current providers for a plan | 17 | | through a clearly identifiable link or tab and without | 18 | | creating or accessing an account or entering a policy or | 19 | | contract number. | 20 | | (2) The network plan shall update the online provider | 21 | | directory at least monthly. Providers shall notify the | 22 | | network plan electronically or in writing of any changes to | 23 | | their information as listed in the provider directory. The | 24 | | network plan shall update its online provider directory in | 25 | | a manner consistent with the information provided by the |
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| 1 | | provider within 10 business days after being notified of | 2 | | the change by the provider. Nothing in this paragraph (2) | 3 | | shall void any contractual relationship between the | 4 | | provider and the plan. | 5 | | (3) The network plan shall audit periodically at least | 6 | | 25% of its provider directories for accuracy, make any | 7 | | corrections necessary, and retain documentation of the | 8 | | audit. The network plan shall submit the audit annually to | 9 | | the Director. As part of these audits, the network plan | 10 | | shall contact any provider in its network that has not | 11 | | submitted a claim to the plan or otherwise communicated his | 12 | | or her intent to continue participation in the plan's | 13 | | network. | 14 | | (4) A network plan shall provide a print copy of a | 15 | | current provider directory or a print copy of the requested | 16 | | directory information upon request of a beneficiary or a | 17 | | prospective beneficiary. Print copies must be updated | 18 | | quarterly and an errata that reflects changes in the | 19 | | provider network must be updated quarterly. | 20 | | (5) For each network plan, a network plan shall | 21 | | include, in plain language in both the electronic and print | 22 | | directory, the following general information: | 23 | | (A) in plain language, a description of the | 24 | | criteria the plan has used to build its provider | 25 | | network; | 26 | | (B) if applicable, in plain language, a |
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| 1 | | description of the criteria the insurer or network plan | 2 | | has used to create tiered networks; | 3 | | (C) if applicable, in plain language, how the | 4 | | network plan designates the different provider tiers | 5 | | or levels in the network and identifies for each | 6 | | specific provider, hospital, or other type of facility | 7 | | in the network which tier each is placed, for example, | 8 | | by name, symbols, or grouping, in order for a | 9 | | beneficiary-covered person or a prospective | 10 | | beneficiary-covered person to be able to identify the | 11 | | provider tier; and | 12 | | (D) if applicable, a notation that authorization | 13 | | or referral may be required to access some providers. | 14 | | (6) A network plan shall make it clear for both its | 15 | | electronic and print directories what provider directory | 16 | | applies to which network plan, such as including the | 17 | | specific name of the network plan as marketed and issued in | 18 | | this State. The network plan shall include in both its | 19 | | electronic and print directories a customer service email | 20 | | address and telephone number or electronic link that | 21 | | beneficiaries or the general public may use to notify the | 22 | | network plan of inaccurate provider directory information | 23 | | and contact information for the Department's Office of | 24 | | Consumer Health Insurance. | 25 | | (7) A provider directory, whether in electronic or | 26 | | print format, shall accommodate the communication needs of |
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| 1 | | individuals with disabilities, and include a link to or | 2 | | information regarding available assistance for persons | 3 | | with limited English proficiency. | 4 | | (b) For each network plan, a network plan shall make | 5 | | available through an electronic provider directory the | 6 | | following information in a searchable format: | 7 | | (1) for health care professionals: | 8 | | (A) name; | 9 | | (B) gender; | 10 | | (C) participating office locations; | 11 | | (D) specialty, if applicable; | 12 | | (E) medical group affiliations, if applicable; | 13 | | (F) facility affiliations, if applicable; | 14 | | (G) participating facility affiliations, if | 15 | | applicable; | 16 | | (H) languages spoken other than English, if | 17 | | applicable; | 18 | | (I) whether accepting new patients; and | 19 | | (J) board certifications, if applicable. | 20 | | (2) for hospitals: | 21 | | (A) hospital name; | 22 | | (B) hospital type (such as acute, rehabilitation, | 23 | | children's, or cancer); | 24 | | (C) participating hospital location; and | 25 | | (D) hospital accreditation status; and | 26 | | (3) for facilities, other than hospitals, by type: |
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| 1 | | (A) facility name; | 2 | | (B) facility type; | 3 | | (C) types of services performed; and | 4 | | (D) participating facility location or locations. | 5 | | (c) For the electronic provider directories, for each | 6 | | network plan, a network plan shall make available all of the | 7 | | following information in addition to the searchable | 8 | | information required in this Section: | 9 | | (1) for health care professionals: | 10 | | (A) contact information; and | 11 | | (B) languages spoken other than English by | 12 | | clinical staff, if applicable; | 13 | | (2) for hospitals, telephone number; and | 14 | | (3) for facilities other than hospitals, telephone | 15 | | number. | 16 | | (d) The insurer or network plan shall make available in | 17 | | print, upon request, the following provider directory | 18 | | information for the applicable network plan: | 19 | | (1) for health care professionals: | 20 | | (A) name; | 21 | | (B) contact information; | 22 | | (C) participating office location or locations; | 23 | | (D) specialty, if applicable; | 24 | | (E) languages spoken other than English, if | 25 | | applicable; and | 26 | | (F) whether accepting new patients. |
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| 1 | | (2) for hospitals: | 2 | | (A) hospital name; | 3 | | (B) hospital type (such as acute, rehabilitation, | 4 | | children's, or cancer); and | 5 | | (C) participating hospital location and telephone | 6 | | number; and | 7 | | (3) for facilities, other than hospitals, by type: | 8 | | (A) facility name; | 9 | | (B) facility type; | 10 | | (C) types of services performed; and | 11 | | (D) participating facility location or locations | 12 | | and telephone numbers. | 13 | | (e) The network plan shall include a disclosure in the | 14 | | print format provider directory that the information included | 15 | | in the directory is accurate as of the date of printing and | 16 | | that beneficiaries or prospective beneficiaries should consult | 17 | | the insurer's electronic provider directory on its website and | 18 | | contact the provider. The network plan shall also include a | 19 | | telephone number in the print format provider directory for a | 20 | | customer service representative where the beneficiary can | 21 | | obtain current provider directory information. | 22 | | (f) The Director may conduct periodic audits of the | 23 | | accuracy of provider directories. | 24 | | Section 30. Administration and enforcement.
| 25 | | (a) Insurers, as defined in this Act, have a continuing |
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| 1 | | obligation to comply with the requirements of this Act. Other | 2 | | than the duties specifically created in this Act, nothing in | 3 | | this Act is intended to preclude, prevent, or require the | 4 | | adoption, modification, or termination of any utilization | 5 | | management, quality management, or claims processing | 6 | | methodologies of an insurer. | 7 | | (b) Nothing in this Act precludes, prevents, or requires | 8 | | the adoption, modification, or termination of any network plan | 9 | | term, benefit, coverage or eligibility provision, or payment | 10 | | methodology. | 11 | | (c) The Director shall enforce the provisions of this Act | 12 | | pursuant to the enforcement powers granted to it by law, | 13 | | including, but not limited to, compliance audits, such as | 14 | | market conduct examinations, and issuance of cease and desist | 15 | | orders, fines, or other penalties for violations of any | 16 | | provision of this Act. | 17 | | (d) The Department shall adopt rules to enforce compliance | 18 | | with this Act to the extent necessary.
| 19 | | Section 99. Effective date. This Act takes effect January | 20 | | 1, 2018.".
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