Sen. William R. Haine

Filed: 4/11/2011

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 72

2    AMENDMENT NO. ______. Amend Senate Bill 72, AS AMENDED, by
3replacing everything after the enacting clause with the
4following:
 
5    "Section 5. The Illinois Insurance Code is amended by
6adding Section 356z.3b as follows:
 
7    (215 ILCS 5/356z.3b new)
8    Sec. 356z.3b. Facility-based physicians and providers.
9    (a) All insurers and health plans with networks of
10physicians and providers shall report the following
11information to the Department of Insurance:
12        (1) The reimbursement amounts per individual procedure
13    or service for all out-of-network facility-based
14    physicians and providers per hospital or ASTC.
15        (2) The reimbursement amounts per individual procedure
16    or service for all in-network facility-based physicians

 

 

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1    and providers per hospital or ASTC.
2        (3) The charges of all out-of-network facility-based
3    physicians and providers per individual procedure or
4    service per hospital or ASTC.
5        (4) The charges of all in-network facility-based
6    physicians and providers per individual procedure or
7    service per hospital or ASTC.
8    The information required under this subsection (a) shall be
9submitted based upon reimbursement amounts and charges as of
10January 1, 2010 for services rendered from January 1, 2009
11through December 31, 2010 and shall be submitted by October 1,
122011. The charges are physician or provider billed amounts and
13shall not include discounted charges. The data shall in no way
14identify any physician or provider or patient. The Department
15may request additional data necessary to comply with this
16Section.
17    The Director shall compile the data required under this
18subsection (a) and, no later than February 1, 2012, submit a
19written recommendation to the General Assembly for a
20reimbursement methodology for out-of-network facility-based
21physicians or providers.
22    (b) For purposes of this Section only "facility-based
23physician or provider" means a physician or other provider who
24provides radiology, anesthesiology, pathology, neonatology, or
25emergency department services to insureds, beneficiaries, or
26enrollees in a participating hospital or participating

 

 

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1ambulatory surgical treatment center.
 
2    Section 10. "An Act concerning insurance", approved
3February 14, 2011, Public Act 96-1523, is amended by adding
4Section 99 as follows:
 
5    (P.A. 96-1523, Sec. 99 new)
6    Sec. 99. Effective date. This Act takes effect July 1,
72012.
 
8    Section 999. Effective date. This Section and Section 10
9take effect upon becoming law.".