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90_HB3489
215 ILCS 125/2-8 from Ch. 111 1/2, par. 1407.01
410 ILCS 50/3.3 new
410 ILCS 50/4 from Ch. 111 1/2, par. 5404
Amends the Health Maintenance Organization Act and
Medical Patient Rights Act. Provides that a health care
provider may not bill patients for services except for
applicable deductibles or copayments or for services not
covered when the health care provider has provided the
services under a contract with an insurance company or health
maintenance organization under which the health care provider
has agreed not to seek payment from patients. Provides for
enforcement by the Director of Insurance.
LRB9011013JSmg
LRB9011013JSmg
1 AN ACT concerning health care provider billing practices,
2 amending named Acts.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Health Maintenance Organization Act is
6 amended by changing Section 2-8 as follows:
7 (215 ILCS 125/2-8) (from Ch. 111 1/2, par. 1407.01)
8 Sec. 2-8. Provider agreements.
9 (a) All provider contracts currently in existence between
10 any organization and any hospital which are renewed on or
11 after 180 days following the effective date of this
12 amendatory Act of 1987, and all contracts between any
13 organization and any hospital executed on or after 180 days
14 after such effective date, shall contain the following
15 "hold-harmless" clause: "The provider agrees that in no
16 event, including but not limited to nonpayment by the
17 organization of amounts due the hospital provider under this
18 contract, insolvency of the organization or any breach of
19 this contract by the organization, shall the hospital
20 provider or its assignees or subcontractors have a right to
21 seek any type of payment from, bill, charge, collect a
22 deposit from, or have any recourse against, the enrollee,
23 persons acting on the enrollee's behalf (other than the
24 organization), the employer or group contract holder for
25 services provided pursuant to this contract except for the
26 payment of applicable co-payments or deductibles for services
27 covered by the organization or fees for services not covered
28 by the organization. The requirements of this clause shall
29 survive any termination of this contract for services
30 rendered prior to such termination, regardless of the cause
31 of such termination. The organization's enrollees, the
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1 persons acting on the enrollee's behalf (other than the
2 organization) and the employer or group contract holder shall
3 be third party beneficiaries of this clause. This clause
4 supersedes any oral or written agreement now existing or
5 hereafter entered into between the provider and the enrollee,
6 persons acting on the enrollee's behalf (other than the
7 organization) and the employer or group contract holder." To
8 the extent that any hospital provider contract, which is
9 renewed or entered into on or after 180 days following the
10 effective date of this amendatory Act of 1987, fails to
11 incorporate such provisions, such provisions shall be deemed
12 incorporated into such contracts by operation of law as of
13 the date of such renewal or execution.
14 (b) Providers and their assignees or subcontractors shall
15 not seek any type of payment from, bill, charge, collect a
16 deposit from, or have any recourse against the enrollee,
17 persons acting on the enrollee's behalf (other than the
18 organization), the employer, or the group contract holder for
19 services provided pursuant to a contract, except for the
20 payment of applicable copayments or deductibles for services
21 covered by the organization or fees for services not covered
22 by the organization.
23 (c) Any collection or attempt to collect moneys or
24 maintain action against any subscriber or enrollee as
25 prohibited in subsection (b) may be reported to the Director
26 by any person. A person making such a report shall be immune
27 from liability for doing so. Within 14 days after the
28 Director's receipt of a report under this subsection, the
29 Director shall provide a written notice of the report to the
30 reported provider's licensing or disciplinary board or
31 committee.
32 (d) The Director shall maintain a record of all notices
33 to licensing or disciplinary boards or committees pursuant to
34 this Section. This record shall be provided to any person
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1 within 14 days of the Director's receipt of a written request
2 for the record.
3 (e) The Director shall require that the provider
4 reimburse, with interest at the rate of 8% per annum, the
5 subscriber or enrollee for any prohibited collection of
6 moneys described in subsection (b).
7 (f) The Department, any person, or any health maintenance
8 organization may pursue injunctive relief to ensure
9 compliance with this Section.
10 (g)(b) All provider and subcontractor contracts must
11 contain provisions whereby the provider or subcontractor
12 shall provide, arrange for, or participate in the quality
13 assurance programs mandated by this Act, unless the Illinois
14 Department of Public Health certifies that such programs will
15 be fully implemented without any participation or action from
16 such contracting provider.
17 (h)(c) The Director may promulgate rules requiring that
18 provider contracts contain provisions concerning reasonable
19 notices to be given between the parties and for the
20 organization to provide reasonable notice to its enrollees
21 and to the Director. Notice shall be given for such events
22 as, but not limited to, termination of insurance protection,
23 quality assurance or availability of medical care.
24 (Source: P.A. 86-620.)
25 Section 10. The Medical Patient Rights Act is amended by
26 changing Section 4 and adding Section 3.3 as follows:
27 (410 ILCS 50/3.3 new)
28 Sec. 3.3. Prohibed billing practices.
29 (a) Health care providers, physicians, and their
30 assignees or subcontractors shall not seek any type of
31 payment from, bill, charge, collect a deposit from, or have
32 any recourse against an insured patient, persons acting on
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1 the insured patient's behalf (other than the insurance
2 company or health services corporation), the employer, or the
3 group contract holder for services provided pursuant to a
4 contract in which an insurance company or health services
5 corporation has contractually agreed with a health care
6 provider or physician that the health care provider or
7 physician does not have such a right, except for the payment
8 of applicable copayments or deductibles for services covered
9 by the insurance company or health services corporation or
10 fees for services not covered by the insurance company or
11 health services corporation.
12 (b) The Director of Insurance shall enforce the
13 provisions of this Section.
14 (c) Any collection or attempt to collect moneys or
15 maintain action against any insured patient as prohibited in
16 subsection (a) may be reported to the Director of the
17 Department of Insurance by any person. Any person making
18 such a report shall be immune from liability for doing so.
19 Within 14 days of the Director's receipt of a report under
20 this Section, the Director shall provide a written notice of
21 the report to the reported health care provider's or
22 physician's licensing or disciplinary board or committee.
23 (d) The Director shall maintain a record of all notices
24 to licensing or disciplinary boards or committees pursuant to
25 this Section. This record shall be provided to any person
26 within 14 days of the Director's receipt of a written request
27 for the record.
28 (e) The Director shall require that the health care
29 provider or physician reimburse, with interest at a rate of
30 8% per annum, the insured patient for any prohibited
31 collection of moneys described in this Section.
32 (f) The Department, any insured patient, any insurance
33 company, or any health services corporation may pursue
34 injunctive relief to ensure compliance with this Section in
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1 addition to the penalties provided for under this Act.
2 (410 ILCS 50/4) (from Ch. 111 1/2, par. 5404)
3 Sec. 4. Any physician or health care provider that
4 violates a patient's rights as set forth in subparagraph (a)
5 of Section 3 or Section 3.3 is guilty of a petty offense and
6 shall be fined $500 per incident. Any insurance company or
7 health service corporation that violates a patient's rights
8 as set forth in subparagraph (b) of Section 3 is guilty of a
9 petty offense and shall be fined $1,000. Any physician,
10 health care provider, health services corporation or
11 insurance company that violates a patient's rights as set
12 forth in subsection (c) of Section 3 is guilty of a petty
13 offense and shall be fined $1,000.
14 (Source: P.A. 86-902.)