093_HB2775ham001

 










                                     LRB093 07800 JLS 12981 a

 1                    AMENDMENT TO HOUSE BILL 2775

 2        AMENDMENT NO.     .  Amend House Bill 2775  by  replacing
 3    the title with the following:
 4        "AN ACT concerning insurance."; and

 5    by  replacing  everything  after the enacting clause with the
 6    following:

 7        "Section 5.  The Illinois Insurance Code  is  amended  by
 8    adding Section 368e as follows:

 9        (215 ILCS 5/368e new)
10        Sec.  368e.  Recoupments.  Any  attempt to recoup payment
11    made to a health care professional or health care provider by
12    an  insurer,  health  maintenance  organization,  independent
13    practice  association,  or  physician-hospital   organization
14    shall  be initiated by providing a written explanation of any
15    proposed recoupment, including, but not limited to, the  name
16    of  the  patient,  the date of service, the service code, and
17    the payment amount, the details concerning  the  reasons  for
18    the  recoupment,  and an explanation of the appeal process. A
19    health care professional or health  care  provider  shall  be
20    given  60  days to appeal the proposed recoupment or to repay
21    the recoupment amount. If the  health  care  professional  or
 
                            -2-      LRB093 07800 JLS 12981 a
 1    health   care   provider   chooses  to  appeal  the  proposed
 2    recoupment and,  upon  appeal,  the  proposed  recoupment  is
 3    determined to be appropriate, the health care professional or
 4    health  care  provider must pay the recoupment within 30 days
 5    of receiving the notice of the final  appeal's  decision.  If
 6    the health care professional or health care provider does not
 7    make  any  required  recoupment  payment  within  these  time
 8    frames,   the   insurer,   health  maintenance  organization,
 9    independent  practice  association,  or  physician   hospital
10    organization  may  offset  future  payments to effectuate the
11    recoupment.  Except in an instance in which the  health  care
12    professional or health care provider has been found guilty of
13    committing  civil  or criminal insurance fraud, no recoupment
14    of any payments may be initiated 24 months after the date the
15    moneys were paid, except when requested  or  initiated  by  a
16    governmental unit.  It is not a recoupment when a health care
17    professional  or  health  care  provider  is  paid  an amount
18    prospectively  under  a  contract  with  an  insurer,  health
19    maintenance organization, independent  practice  association,
20    or   physician   hospital   organization   that   includes  a
21    retrospective reconciliation based on the services provided.

22        Section 99. Effective date.  This  Act  takes  effect  on
23    December 1, 2003.".