Full Text of HB4941 102nd General Assembly
HB4941ham001 102ND GENERAL ASSEMBLY | Rep. Theresa Mah Filed: 3/1/2022
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| 1 | | AMENDMENT TO HOUSE BILL 4941
| 2 | | AMENDMENT NO. ______. Amend House Bill 4941 by replacing | 3 | | everything after the enacting clause with the following:
| 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 |
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| 1 | | care
professional or health
care provider offered a contract | 2 | | shall be given the opportunity to review and
obtain a
copy of | 3 | | the following: a specialty-specific fee schedule sample based | 4 | | on a
minimum of
the 50 highest volume fee schedule codes with | 5 | | the rates applicable to the
health care
professional or health | 6 | | care provider to whom the contract is offered, the
network
| 7 | | provider
administration manual, and a summary capitation | 8 | | schedule, if payment is made on
a
capitation basis. If 50 codes | 9 | | do not exist for a particular specialty, the
health care
| 10 | | professional or health care provider offered a contract shall | 11 | | be given the
opportunity to
review or obtain a copy of a fee | 12 | | schedule sample with the codes applicable to
that
particular | 13 | | specialty. This information may be provided electronically. An
| 14 | | insurer, health
maintenance organization, independent practice
| 15 | | association, or physician hospital
organization may substitute | 16 | | the fee schedule sample with a document providing
reference
to | 17 | | the information needed to calculate the fee schedule that is | 18 | | available to
the public at no
charge and the percentage or | 19 | | conversion factor at which the insurer, health
maintenance
| 20 | | organization, preferred provider organization, independent | 21 | | practice
association, or physician hospital organization sets | 22 | | its rates.
| 23 | | (b) The fee schedule, the capitation schedule, and
the | 24 | | network provider
administration manual constitute | 25 | | confidential, proprietary, and trade secret
information and | 26 | | are subject to the provisions of the Illinois Trade Secrets
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| 1 | | Act.
The health
care professional or health care provider | 2 | | receiving such protected information
may disclose
the | 3 | | information on a need to know basis and only to individuals and | 4 | | entities
that provide
services directly related to the health | 5 | | care professional's or health care
provider's decision
to | 6 | | enter into the contract or keep the contract in force. Any | 7 | | person or entity
receiving or
reviewing such protected | 8 | | information pursuant to this Section shall not
disclose
the
| 9 | | information to any other person, organization, or entity, | 10 | | unless the disclosure
is requested
pursuant to a valid court | 11 | | order or required by a state or federal government
agency.
| 12 | | Individuals or entities receiving such information from a | 13 | | health care
professional
or health care provider as delineated | 14 | | in this subsection are subject to the
provisions of the
| 15 | | Illinois Trade Secrets Act.
| 16 | | (c) The health care professional or health care provider | 17 | | shall be allowed at
least
30 days to review the health care | 18 | | professional or health care provider services
contract, | 19 | | including
exhibits and
attachments, if any, before signing. | 20 | | The 30-day review period begins upon
receipt of the
health | 21 | | care
professional or health care provider services contract, | 22 | | unless the information
available
upon request
in subsection | 23 | | (a) is not included. If information is not included in the
| 24 | | professional
services contract and is requested pursuant to | 25 | | subsection (a), the 30-day
review period
begins on the date of | 26 | | receipt of the information. Nothing in this subsection
shall |
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| 1 | | prohibit
a health care professional or health care provider | 2 | | from signing a contract
prior to the
expiration of the 30-day | 3 | | review period.
| 4 | | (d) As used in this subsection: | 5 | | "Change" means an increase or decrease in the fee schedule | 6 | | referred to in subsection (a). | 7 | | "Nonroutine change" means any proposed change to the fee | 8 | | schedule except a change that is otherwise required by law, | 9 | | regulation, or an applicable regulatory authority or that is | 10 | | required as a result of changes in fee schedules, | 11 | | reimbursement methodology, or payment policies established by | 12 | | a government agency or by the American Medical Association's | 13 | | current procedural terminology codes, reporting guidelines, | 14 | | and conventions, or a change that is expressly provided for | 15 | | under the terms of the contract by the inclusion of or | 16 | | reference to a specific fee or fee schedule, reimbursement | 17 | | methodology, or payment policy indexing mechanism. | 18 | | The insurer, health maintenance organization,
independent | 19 | | practice
association, or physician hospital organization shall | 20 | | provide all contracted
health care
professionals or health | 21 | | care providers with any changes to the fee schedule
provided
| 22 | | under subsection (a) not later than 35 days after the | 23 | | effective date of the
changes,
unless such
changes are | 24 | | specified in the contract and the health care professional or
| 25 | | health care
provider is able to calculate the changed rates | 26 | | based on information in the
contract and
information available |
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| 1 | | to the public at no charge. Beginning January 1, 2023, with | 2 | | respect to nonroutine changes to the fee schedule, the | 3 | | insurer, health maintenance organization, independent practice | 4 | | association, or physician hospital organization shall provide | 5 | | all contracted health care professionals or health care | 6 | | providers impacted by the nonroutine change with notice of the | 7 | | change at least 60 days before the effective date of the | 8 | | change. The right to advance notice of nonroutine changes to | 9 | | the fee schedule may not be waived by the health care | 10 | | professional or health care provider. | 11 | | For the purposes of this
subsection,
"changes" means an | 12 | | increase or decrease in the fee schedule referred to in
| 13 | | subsection (a).
This information may be made available by | 14 | | mail, e-mail, newsletter, website
listing, or
other reasonable | 15 | | method. For nonroutine changes, the information directing the | 16 | | health care professional or health care provider to the | 17 | | information provided by newsletter, website listing, or other | 18 | | reasonable method shall be provided by email or, if requested | 19 | | by the health care professional or health care provider, by | 20 | | mail. Upon request, a health care professional or health
care | 21 | | provider
may request an updated copy of the fee schedule | 22 | | referred to in subsection (a)
every
calendar quarter. | 23 | | (e) Upon termination of a contract with an insurer, health | 24 | | maintenance
organization, independent practice
association, or | 25 | | physician hospital
organization and at
the request of the | 26 | | patient, a health care professional or health care provider
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| 1 | | shall transfer
copies of the patient's medical records. Any | 2 | | other provision of law
notwithstanding, the
costs for copying | 3 | | and transferring copies of medical records shall be assigned
| 4 | | per the
arrangements agreed upon, if any, in the health care | 5 | | professional or health
care provider services
contract.
| 6 | | (Source: P.A. 93-261, eff. 1-1-04.)".
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