Full Text of HB4941 102nd General Assembly
HB4941 102ND GENERAL ASSEMBLY |
| | 102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022 HB4941 Introduced 1/27/2022, by Rep. Theresa Mah SYNOPSIS AS INTRODUCED: |
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Amends the Accident and Health Insurance Article of the Illinois Insurance Code. In provisions concerning contracting procedures, replaces language concerning changes to the fee schedule with language providing that an insurer, health maintenance organization, independent practice association, or physician hospital organization shall provide all contracted health care professionals or health care providers with notice of any changes to the fee schedule at least 90 days before the effective date of the change, that the right to advance notice of changes to the fee schedule cannot be waived by the health care professional or provider, and that changes to the fee schedule cannot be applied retroactively from the effective date of the changes. Provides that if the changes to the fee schedule include a reduction in fees greater than 3% of the Medicare rate established for the current calendar year, the health care professional or health care provider may propose alternative changes to the fee schedule. Provides that any changes to the fee schedule must be final at least 30 days before the effective date of the changes. Provides that fee schedule information must be provided directly to the contracted health care professional or health care provider (rather than may be made available) by mail, e-mail, or telephone, and that this information may also be provided by newsletter, website listing, or other reasonable method.
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| | A BILL FOR |
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| | | HB4941 | | LRB102 22842 BMS 34494 b |
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| 1 | | AN ACT concerning regulation.
| 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 | 12 | | of 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 | 15 | | and attachments that the contract
indicates are
to be | 16 | | attached. Within 35 days after a written request, the health | 17 | | care
professional or health
care provider offered a contract | 18 | | shall be given the opportunity to review and
obtain a
copy of | 19 | | the following: a specialty-specific fee schedule sample based | 20 | | on a
minimum of
the 50 highest volume fee schedule codes with | 21 | | the rates applicable to the
health care
professional or health | 22 | | care provider to whom the contract is offered, the
network
| 23 | | provider
administration manual, and a summary capitation |
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| 1 | | schedule, if payment is made on
a
capitation basis. If 50 codes | 2 | | do not exist for a particular specialty, the
health care
| 3 | | professional or health care provider offered a contract shall | 4 | | be given the
opportunity to
review or obtain a copy of a fee | 5 | | schedule sample with the codes applicable to
that
particular | 6 | | specialty. This information may be provided electronically. An
| 7 | | insurer, health
maintenance organization, independent practice
| 8 | | association, or physician hospital
organization may substitute | 9 | | the fee schedule sample with a document providing
reference
to | 10 | | the 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 | 25 | | enter into the contract or keep the contract in force. Any | 26 | | person or entity
receiving or
reviewing such protected |
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| 1 | | information pursuant to this Section shall not
disclose
the
| 2 | | information to any other person, organization, or entity, | 3 | | unless the disclosure
is requested
pursuant to a valid court | 4 | | order or required by a state or federal government
agency.
| 5 | | Individuals or entities receiving such information from a | 6 | | health care
professional
or health care provider as delineated | 7 | | in this subsection are subject to the
provisions of the
| 8 | | Illinois Trade 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. | 13 | | The 30-day review period begins upon
receipt of the
health | 14 | | care
professional or health care provider services contract, | 15 | | unless the information
available
upon request
in subsection | 16 | | (a) is not included. If information is not included in the
| 17 | | professional
services contract and is requested pursuant to | 18 | | subsection (a), the 30-day
review period
begins on the date of | 19 | | receipt of the information. Nothing in this subsection
shall | 20 | | prohibit
a health care professional or health care provider | 21 | | from signing a contract
prior to the
expiration of the 30-day | 22 | | review period.
| 23 | | (d) The insurer, health maintenance organization, | 24 | | independent practice association, or physician hospital | 25 | | organization shall provide all contracted health care | 26 | | professionals or health care providers with notice of any |
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| 1 | | changes to the fee schedule provided under subsection (a) at | 2 | | least 90 days before the effective date of the changes. The | 3 | | right to advance notice of changes to the fee schedule cannot | 4 | | be waived by the health care professional or provider. Changes | 5 | | to the fee schedule cannot be applied retroactively from the | 6 | | effective date of the changes. If the changes to the fee | 7 | | schedule include a reduction in fees greater than 3% of the | 8 | | Medicare rate established for the current calendar year, the | 9 | | health care professional or health care provider may propose | 10 | | alternative changes to the fee schedule to the insurer, health | 11 | | maintenance organization, independent practice association, or | 12 | | physician hospital organization. Any changes to the fee | 13 | | schedule must be final at least 30 days before the effective | 14 | | date of the changes. The insurer, health maintenance | 15 | | organization,
independent practice
association, or physician | 16 | | hospital organization shall provide all contracted
health care
| 17 | | professionals or health care providers with any changes to the | 18 | | fee schedule
provided
under subsection (a) not later than 35 | 19 | | days after the effective date of the
changes,
unless such
| 20 | | changes are specified in the contract and the health care | 21 | | professional or
health care
provider is able to calculate the | 22 | | changed rates based on information in the
contract and
| 23 | | information available to the public at no charge. | 24 | | For the purposes of this
subsection,
"changes" means an | 25 | | increase or decrease in the fee schedule referred to in
| 26 | | subsection (a).
This information must be provided directly to |
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| 1 | | the contracted health care professional or health care | 2 | | provider may be made available by mail, e-mail, or telephone. | 3 | | In addition to communicating directly with the contracted | 4 | | health care professional or health care provider, this | 5 | | information may also be provided by newsletter, website
| 6 | | listing, or
other reasonable method. Upon request, a health | 7 | | care professional or health
care provider
may request an | 8 | | updated copy of the fee schedule referred to in subsection (a)
| 9 | | every
calendar quarter. | 10 | | (e) Upon termination of a contract with an insurer, health | 11 | | maintenance
organization, independent practice
association, or | 12 | | physician hospital
organization and at
the request of the | 13 | | patient, a health care professional or health care provider
| 14 | | shall transfer
copies of the patient's medical records. Any | 15 | | other provision of law
notwithstanding, the
costs for copying | 16 | | and transferring copies of medical records shall be assigned
| 17 | | per the
arrangements agreed upon, if any, in the health care | 18 | | professional or health
care provider services
contract.
| 19 | | (Source: P.A. 93-261, eff. 1-1-04.)
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