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91_SB0471
LRB9102448JSpc
1 AN ACT concerning payment for health care by insureds,
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 and stipulations.
9 (a) All provider contracts currently in existence
10 between any organization and any provider hospital which are
11 renewed on or after 180 days following the effective date of
12 this amendatory Act of 1987, and all contracts between any
13 organization and any provider hospital executed on or after
14 180 days after such effective date, shall contain the
15 following "hold-harmless" clause: "The provider agrees that
16 in no 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 may
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 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 under an enrollee's evidence of coverage.
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. Any person making such a report shall be
27 immune from liability for doing so.
28 (d) The Director shall investigate such reports.
29 (e) If the Director finds that providers and their
30 assignees or subcontractors are not in compliance with this
31 Section, he or she shall provide the person attempting to
32 bill, charge, collect a deposit from, or institute recourse
33 against an enrollee with a written notice of the reasons for
34 the finding and shall allow 14 days to supply additional
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1 information demonstrating compliance with the requirements of
2 this Section and the opportunity to request a hearing. The
3 Director shall send a hearing notice by certified mail,
4 return receipt requested, and conduct a hearing in accordance
5 with the Illinois Administrative Procedure Act.
6 (f) Within 14 days after the final decision is rendered
7 under subsection (e), the Director shall provide a written
8 notice of the report to the reported provider's licensing or
9 disciplinary board or committee and require that the provider
10 reimburse, with interest at the rate of 8% per year, the
11 subscriber or enrollee any moneys found to be collected in
12 violation of this Section.
13 (g) The Director shall maintain a record of all notices
14 to licensing or disciplinary boards or committees pursuant to
15 this Section. This record shall be provided to any person
16 within 14 days after the Director's receipt of a written
17 request for the record.
18 (h) The Department, any enrollee, subscriber, or health
19 maintenance organization may pursue injunctive relief to
20 ensure compliance with this Section.
21 (i)(b) All provider and subcontractor contracts must
22 contain provisions whereby the provider or subcontractor
23 shall provide, arrange for, or participate in the quality
24 assurance programs mandated by this Act, unless the Illinois
25 Department of Public Health certifies that such programs will
26 be fully implemented without any participation or action from
27 such contracting provider.
28 (j)(c) The Director may promulgate rules requiring that
29 provider contracts contain provisions concerning reasonable
30 notices to be given between the parties and for the
31 organization to provide reasonable notice to its enrollees
32 and to the Director. Notice shall be given for such events
33 as, but not limited to, termination of insurance protection,
34 quality assurance or availability of medical care.
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1 (Source: P.A. 86-620.)
2 Section 10. The Medical Patient Rights Act is amended by
3 changing Section 4 and adding Section 3.3 as follows:
4 (410 ILCS 50/3.3 new)
5 Sec. 3.3. Patient billing limitation.
6 (a) Health care providers, physicians, and their
7 assignees or subcontractors may not seek any type of payment
8 from, bill, charge, collect a deposit from, or have any
9 recourse against an insured patient, persons acting on the
10 insured patient's behalf (other than the organization), the
11 employer, or group contract holder for services provided
12 pursuant to a contract in which an insurance company or
13 health services corporation has contractually agreed with a
14 health care provider or physician that the health care
15 provider or physician does not have such a right or rights,
16 except for the payment of applicable copayments or
17 deductibles for services covered by the insurance company or
18 health services corporation or fees for services not covered
19 under an enrollee's evidence of coverage.
20 (b) The Department of Insurance shall enforce the
21 provisions of this Section:
22 (1) Any collection or attempt to collect moneys or
23 maintain action against any insured patient as prohibited
24 in subsection (a) may be reported to the Director by any
25 person. Any person making such a report shall be immune
26 from liability for doing so.
27 (2) The Director shall investigate such reports.
28 (3) If the Director finds that providers,
29 physicians, and their assignees or subcontractors are not
30 in compliance with this Section, he or she shall provide
31 the person attempting to bill, charge, collect a deposit
32 from, or institute recourse against an insured patient
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1 with a written notice of the reasons for the finding and
2 shall allow 14 days to supply additional information
3 demonstrating compliance with the requirements of this
4 Section and the opportunity to request a hearing. The
5 Director shall send a hearing notice by certified mail,
6 return receipt requested, and conduct a hearing in
7 accordance with the Illinois Administrative Procedure
8 Act.
9 (4) Within 14 days after the final decision is
10 rendered under subsection (3), the Director shall provide
11 a written notice of the report to the reported provider's
12 or physician's licensing or disciplinary board or
13 committee and require that the provider or physician
14 reimburse, with interest at the rate of 8% per year, the
15 insured patient or subscriber for moneys found to be
16 collected in violation of this Section.
17 (5) The Director shall maintain a record of all
18 notices to licensing or disciplinary boards or committees
19 pursuant to this Section. This record shall be provided
20 to any person within 14 days after the Director's receipt
21 of a written request for the record.
22 (6) The Department, any insured patient,
23 subscriber, insurance company, or health services
24 corporation may pursue injunctive relief to ensure
25 compliance with this Section in addition to the penalties
26 provided for under this Act.
27 (410 ILCS 50/4) (from Ch. 111 1/2, par. 5404)
28 Sec. 4. Penalties. Any physician or health care
29 provider that violates a patient's rights as set forth in
30 subparagraph (a) of Section 3 or in Section 3.3 is guilty of
31 a petty offense and shall be fined $500 per incident. Any
32 insurance company or health service corporation that violates
33 a patient's rights as set forth in subparagraph (b) of
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1 Section 3 is guilty of a petty offense and shall be fined
2 $1,000. Any physician, health care provider, health services
3 corporation or insurance company that violates a patient's
4 rights as set forth in subsection (c) of Section 3 is guilty
5 of a petty offense and shall be fined $1,000.
6 (Source: P.A. 86-902.)