House Sponsors: DART-COULSON-MOORE,ANDREA-MCKEON-FRANKS AND SCOTT. Senate Sponsors: MADIGAN,R Short description: INS CD-PAYMENTS WITHIN 30 DAYS Synopsis of Bill as introduced: Amends the Health Maintenance Organization Act. Makes a technical change in provisions prohibiting denial of coverage by an HMO in certain circumstances. Amends the Medical Assistance Article of the Illinois Public Aid Code. Makes a technical change in provisions concerning managed care. HOUSE AMENDMENT NO. 3. Deletes reference to: 215 ILCS 125/5-7.1 Adds reference to: 215 ILCS 5/370b from Ch. 73, par. 982b 215 ILCS 125/5-7.1a new Deletes everything. Amends the Illinois Insurance Code, the Health Maintenance Organization Act, and the Medical Assistance Article of the Illinois Public Aid Code to provide that the appropriate medical insurer under each Act shall provide reimbursement to a service provider for a service provided to an enrollee of the insurer's plan within 30 days after the date of receipt of due proof of loss by certain medical providers. Provides that, if a medical insurer fails to provide reimbursement for hospital or medical service covered under a health care plan within 30 day days after the date of receipt of due proof of loss, the service provider may file a complaint with the Illinois Department of Insurance to seek immediate relief for non-payment. Provides that, beginning on the 31st day after the date of receipt of due proof of loss, the service provider shall be entitled to receive interest for each day that the reimbursement is unpaid. Effective immediately. SENATE AMENDMENT NO. 1. Deletes reference to: 215 ILCS 125/5-7.1a new 305 ILCS 5/5-16 Adds reference to: 215 ILCS 5/370b from Ch. 73, par. 982b Deletes all substantive provisions. Makes a change in the caption of a Section of the Illinois Insurance Code regarding reimbursement. SENATE AMENDMENT NO. 2. Deletes reference to: 215 ILCS 125/370b Adds reference to: 5 ILCS 375/6-12 new 215 ILCS 5/356y new 215 ILCS 5/357.9 from Ch. 73, par. 969.9 215 ILCS 5/370a from Ch. 73, par. 982a 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 Replaces the title and everything after the enacting clause. Amends the Illinois Insurance Code. Provides that insurers must pay claims for health care services within 30 days after the insurer receives proof of loss. Requires independent practice associations and physician-hospital organizations to make the payments within 60 days before January 1, 2001 and within 30 days after December 31, 2000. Provides that insurer payments to a health care professional and health care facility under capitation type plans or other plans that require periodic payments must begin within 60 days after an enrollee selects the health care professional and health care facility physician. Amends the State Employees Group Insurance Act of 1971, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act to incorporate the payment requirements. Effective 120 days after becoming law. SENATE AMENDMENT NO. 3. Requires notice of any "known" failure (now, any failure) to provide sufficient documentation for a due proof of loss. Last action on Bill: PUBLIC ACT.............................. 91-0605 Last action date: 99-08-16 Location: House Amendments to Bill: AMENDMENTS ADOPTED: HOUSE - 1 SENATE - 3 END OF INQUIRY Full Text Bill Status