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90_HB0333
New Act
30 ILCS 105/5.449 new
Creates the Illinois Patient Communication Act. Bars an
entity offering a health plan from interfering with certain
communications between a health care provider and a patient
through contractual provisions, policies, or retaliatory
actions taken against the health care provider. Provides for
civil penalties and private enforcement actions. Amends the
State Finance Act to create the Patient Communication
Administration Fund.
LRB9000208DPccA
LRB9000208DPccA
1 AN ACT to create the Illinois Patient Communication Act.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. Short title. This Act may be cited as the
5 Illinois Patient Communication Act.
6 Section 10. Legislative findings. The General Assembly
7 finds that:
8 (1) Patients cannot make appropriate health care
9 decisions without access to all relevant information relating
10 to those decisions.
11 (2) Restrictions on the ability of physicians and other
12 health care providers to discuss all relevant information
13 with patients making health care decisions violate the
14 principles of informed consent and the ethical standards of
15 the health care professions.
16 (3) Serious concerns have been raised about the use by
17 health plans of contractual clauses or policies that
18 interfere with communications between physicians or other
19 health care providers and their patients and the impact of
20 such clauses and policies on the quality of care received by
21 those patients.
22 (4) These concerns make it appropriate to regulate an
23 insurance practice that affects the spreading of policyholder
24 risk, that is an integral part of the policy relationship
25 between the insurer and the insured, and that is limited to
26 entities within the insurance industry.
27 Section 15. Definitions. As used in this Section:
28 (a) "Department" means the Department of Public Health.
29 (b) "Health care provider" means any person or entity
30 licensed under State law to provide health care services.
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1 (c) "Health plan" means any public or private health
2 insurance program that provides or pays the cost of health
3 benefits, including but not limited to an organization of
4 health care providers that furnishes health care services
5 under a contract or agreement with such a plan.
6 (d) "Medical communication" means any communication,
7 other than a knowing and willful misrepresentation, made (i)
8 by a health care provider within the scope of his or her
9 license under the applicable State law and within the
10 standard of care of like health care providers, (ii)
11 regarding the mental or physical health care needs or
12 treatment of a patient and the provisions, terms, or
13 requirements of the health plan or another health plan
14 relating to such needs or treatment, and (iii) between the
15 provider and a current, former, or prospective patient (or
16 the guardian or legal representative of a patient), the
17 provider and an employee or representative of the entity
18 offering such plan, or the provider and an employee or
19 representative of a State or federal authority with
20 responsibility for the licensing or oversight relating to
21 such entity or plan.
22 "Medical communications" include, but are not limited to,
23 the following:
24 (1) tests, consultations, and treatment options;
25 (2) risks or benefits associated with such tests,
26 consultations, and treatment options;
27 (3) variations in experience, quality, or outcomes
28 among health care providers and institutions providing
29 health care services;
30 (4) the basis or standard for the decision of an
31 entity offering a health plan to authorize or deny health
32 care services or benefits;
33 (5) the process used by such an entity to determine
34 whether to authorize or deny health care services or
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1 benefits; and
2 (6) financial incentives or disincentives provided
3 by such an entity to a health care provider that are
4 based on service utilization.
5 Section 20. Prohibited actions.
6 (a) An entity offering a health plan may not restrict,
7 by contract, agreement, or formal or informal policy imposed
8 upon a health care provider, or in any other manner interfere
9 with a medical communication. A contractual provision
10 prohibited under this paragraph is null and void.
11 This subsection shall apply to contracts or agreements
12 entered into or renewed on or after the effective date of
13 this Act, and to contracts and agreements entered into before
14 the effective date of this Act beginning 30 days after that
15 date.
16 (b) An entity offering a health plan may not take any of
17 the following actions against a health care provider on the
18 basis of a medical communication:
19 (1) refuse to contract with the health care
20 provider;
21 (2) terminate or refuse to renew a contract with
22 the health care provider;
23 (3) refuse to refer patients to or allow others to
24 refer patients to the health care provider;
25 (4) refuse to compensate the health care provider
26 for covered services; or
27 (5) any other retaliatory action against the health
28 care provider.
29 This subsection shall apply to actions taken on or after
30 the effective date of this Act, regardless of when the
31 communication on which the action is based occurred.
32 Section 25. Private enforcement. Any health care
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1 provider who is the subject of an action described in
2 subsection (b) of Section 20 may, within one year from such
3 action, bring a private action against such entity and
4 recover either 3 times the actual damages or $75,000,
5 whichever is greater, plus reasonable attorney fees and
6 costs.
7 Section 30. Civil penalties.
8 (a) An entity that is determined by the Department after
9 reasonable notice and opportunity for a fair and impartial
10 hearing to have violated a provision of this Act is liable to
11 the State for a civil penalty of no more than $5,000 for each
12 violation. Each day that a violation continues constitutes a
13 separate offense. The penalty shall be assessed by the
14 Department by written notice to the violator. In determining
15 the amount of a penalty, the Department shall consider, at a
16 minimum, the nature, circumstances, extent, and gravity of
17 the violation and, with respect to an entity found to have
18 committed a violation, the degree of culpability, history of
19 prior offenses, and ability to pay.
20 (b) A civil penalty assessed under subsection (a) of
21 this Section is recoverable by the Department through
22 collection from the violator or in an action brought by a
23 State's Attorney or the Attorney General on behalf of the
24 State in a circuit court. Civil penalties collected under
25 this Section shall be deposited into the Patient
26 Communication Administration Fund.
27 (c) There is hereby created in the State Treasury a
28 special fund to be known as the Patient Communication
29 Administration Fund. Subject to appropriation, moneys
30 deposited into the Fund shall be used by the Department to
31 help offset the costs of administering and enforcing this
32 Act.
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1 Section 35. Construction. Nothing in this Act shall be
2 construed as:
3 (1) requiring an entity offering a health plan to enter
4 into or renew a contract or agreement with any willing health
5 care provider; or
6 (2) preventing such an entity from acting on information
7 relating to treatment actually provided to a patient or the
8 failure of a health care provider to comply with legal
9 standards relating to the provision of care.
10 Section 80. The State Finance Act is amended by adding
11 Section 5.449 as follows:
12 (30 ILCS 105/5.449 new)
13 Sec. 5.449. The Patient Communication Administration
14 Fund.