Illinois General Assembly - Full Text of HB4941
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Full Text of HB4941  102nd General Assembly

HB4941ham001 102ND GENERAL ASSEMBLY

Rep. Theresa Mah

Filed: 3/1/2022

 

 


 

 


 
10200HB4941ham001LRB102 22842 BMS 37092 a

1
AMENDMENT TO HOUSE BILL 4941

2    AMENDMENT NO. ______. Amend House Bill 4941 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5changing Section 368b as follows:
 
6    (215 ILCS 5/368b)
7    Sec. 368b. Contracting procedures.
8    (a) A health care professional or health care provider
9offered a contract by an insurer, health maintenance
10organization, independent practice association, or physician
11hospital organization for signature after the effective date
12of this amendatory Act of the 93rd General Assembly shall be
13provided with a proposed health care professional or health
14care provider services contract including, if any, exhibits
15and attachments that the contract indicates are to be
16attached. Within 35 days after a written request, the health

 

 

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1care professional or health care provider offered a contract
2shall be given the opportunity to review and obtain a copy of
3the following: a specialty-specific fee schedule sample based
4on a minimum of the 50 highest volume fee schedule codes with
5the rates applicable to the health care professional or health
6care provider to whom the contract is offered, the network
7provider administration manual, and a summary capitation
8schedule, if payment is made on a capitation basis. If 50 codes
9do not exist for a particular specialty, the health care
10professional or health care provider offered a contract shall
11be given the opportunity to review or obtain a copy of a fee
12schedule sample with the codes applicable to that particular
13specialty. This information may be provided electronically. An
14insurer, health maintenance organization, independent practice
15association, or physician hospital organization may substitute
16the fee schedule sample with a document providing reference to
17the information needed to calculate the fee schedule that is
18available to the public at no charge and the percentage or
19conversion factor at which the insurer, health maintenance
20organization, preferred provider organization, independent
21practice association, or physician hospital organization sets
22its rates.
23    (b) The fee schedule, the capitation schedule, and the
24network provider administration manual constitute
25confidential, proprietary, and trade secret information and
26are subject to the provisions of the Illinois Trade Secrets

 

 

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1Act. The health care professional or health care provider
2receiving such protected information may disclose the
3information on a need to know basis and only to individuals and
4entities that provide services directly related to the health
5care professional's or health care provider's decision to
6enter into the contract or keep the contract in force. Any
7person or entity receiving or reviewing such protected
8information pursuant to this Section shall not disclose the
9information to any other person, organization, or entity,
10unless the disclosure is requested pursuant to a valid court
11order or required by a state or federal government agency.
12Individuals or entities receiving such information from a
13health care professional or health care provider as delineated
14in this subsection are subject to the provisions of the
15Illinois Trade Secrets Act.
16    (c) The health care professional or health care provider
17shall be allowed at least 30 days to review the health care
18professional or health care provider services contract,
19including exhibits and attachments, if any, before signing.
20The 30-day review period begins upon receipt of the health
21care professional or health care provider services contract,
22unless the information available upon request in subsection
23(a) is not included. If information is not included in the
24professional services contract and is requested pursuant to
25subsection (a), the 30-day review period begins on the date of
26receipt of the information. Nothing in this subsection shall

 

 

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1prohibit a health care professional or health care provider
2from signing a contract prior to the expiration of the 30-day
3review period.
4    (d) As used in this subsection:
5    "Change" means an increase or decrease in the fee schedule
6referred to in subsection (a).
7    "Nonroutine change" means any proposed change to the fee
8schedule except a change that is otherwise required by law,
9regulation, or an applicable regulatory authority or that is
10required as a result of changes in fee schedules,
11reimbursement methodology, or payment policies established by
12a government agency or by the American Medical Association's
13current procedural terminology codes, reporting guidelines,
14and conventions, or a change that is expressly provided for
15under the terms of the contract by the inclusion of or
16reference to a specific fee or fee schedule, reimbursement
17methodology, or payment policy indexing mechanism.
18    The insurer, health maintenance organization, independent
19practice association, or physician hospital organization shall
20provide all contracted health care professionals or health
21care providers with any changes to the fee schedule provided
22under subsection (a) not later than 35 days after the
23effective date of the changes, unless such changes are
24specified in the contract and the health care professional or
25health care provider is able to calculate the changed rates
26based on information in the contract and information available

 

 

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1to the public at no charge. Beginning January 1, 2023, with
2respect to nonroutine changes to the fee schedule, the
3insurer, health maintenance organization, independent practice
4association, or physician hospital organization shall provide
5all contracted health care professionals or health care
6providers impacted by the nonroutine change with notice of the
7change at least 60 days before the effective date of the
8change. The right to advance notice of nonroutine changes to
9the fee schedule may not be waived by the health care
10professional or health care provider.
11    For the purposes of this subsection, "changes" means an
12increase or decrease in the fee schedule referred to in
13subsection (a). This information may be made available by
14mail, e-mail, newsletter, website listing, or other reasonable
15method. For nonroutine changes, the information directing the
16health care professional or health care provider to the
17information provided by newsletter, website listing, or other
18reasonable method shall be provided by email or, if requested
19by the health care professional or health care provider, by
20mail. Upon request, a health care professional or health care
21provider may request an updated copy of the fee schedule
22referred to in subsection (a) every calendar quarter.
23    (e) Upon termination of a contract with an insurer, health
24maintenance organization, independent practice association, or
25physician hospital organization and at the request of the
26patient, a health care professional or health care provider

 

 

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1shall transfer copies of the patient's medical records. Any
2other provision of law notwithstanding, the costs for copying
3and transferring copies of medical records shall be assigned
4per the arrangements agreed upon, if any, in the health care
5professional or health care provider services contract.
6(Source: P.A. 93-261, eff. 1-1-04.)".