98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB3018

 

Introduced , by Rep. David Reis

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/368b

    Amends the Illinois Insurance Code. With regard to a health care professional or health care provider offered a contract by an insurer, health maintenance organization, independent practice association, or physician hospital organization, provides that the insurer, health maintenance organization, independent practice association, physician hospital organization, or preferred provider organization shall provide health care professional applicants who are denied participation in any panel of in-network health care professionals with a specific reason for the denial. Provides that any participating health care professional must be provided 60 days' notice and an opportunity to initiate corrective action prior to the initiation of any attempts to terminate or otherwise remove the health care professional from a panel of in-network health care professionals and that the required notice shall include specific reasons for the proposed termination or removal. Provides that any participating health care professional terminated or removed from an in-network panel by his or her own written request must be provided an opportunity to appeal the decision. Provides that immediate written notice may be provided without 60 days' notice when a health care professional's license has been disciplined by a State licensing or disciplinary board.


LRB098 04025 RPM 34045 b

 

 

A BILL FOR

 

HB3018LRB098 04025 RPM 34045 b

1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 368b as follows:
 
6    (215 ILCS 5/368b)
7    Sec. 368b. Contracting procedures.
8    (a) A health care professional or health care provider
9offered a contract by an insurer, health maintenance
10organization, independent practice association, or physician
11hospital organization for signature after the effective date of
12this amendatory Act of the 93rd General Assembly shall be
13provided with a proposed health care professional or health
14care provider services contract including, if any, exhibits and
15attachments that the contract indicates are to be attached.
16Within 35 days after a written request, the health care
17professional or health care provider offered a contract shall
18be given the opportunity to review and obtain a copy of the
19following: a specialty-specific fee schedule sample based on a
20minimum of the 50 highest volume fee schedule codes with the
21rates applicable to the health care professional or health care
22provider to whom the contract is offered, the network provider
23administration manual, and a summary capitation schedule, if

 

 

HB3018- 2 -LRB098 04025 RPM 34045 b

1payment is made on a capitation basis. If 50 codes do not exist
2for a particular specialty, the health care professional or
3health care provider offered a contract shall be given the
4opportunity to review or obtain a copy of a fee schedule sample
5with the codes applicable to that particular specialty. This
6information may be provided electronically. An insurer, health
7maintenance organization, independent practice association, or
8physician hospital organization may substitute the fee
9schedule sample with a document providing reference to the
10information needed to calculate the fee schedule that is
11available to the public at no charge and the percentage or
12conversion factor at which the insurer, health maintenance
13organization, preferred provider organization, independent
14practice association, or physician hospital organization sets
15its rates.
16    (b) The fee schedule, the capitation schedule, and the
17network provider administration manual constitute
18confidential, proprietary, and trade secret information and
19are subject to the provisions of the Illinois Trade Secrets
20Act. The health care professional or health care provider
21receiving such protected information may disclose the
22information on a need to know basis and only to individuals and
23entities that provide services directly related to the health
24care professional's or health care provider's decision to enter
25into the contract or keep the contract in force. Any person or
26entity receiving or reviewing such protected information

 

 

HB3018- 3 -LRB098 04025 RPM 34045 b

1pursuant to this Section shall not disclose the information to
2any other person, organization, or entity, unless the
3disclosure is requested pursuant to a valid court order or
4required by a state or federal government agency. Individuals
5or entities receiving such information from a health care
6professional or health care provider as delineated in this
7subsection are subject to the provisions of the Illinois Trade
8Secrets Act.
9    (c) The health care professional or health care provider
10shall be allowed at least 30 days to review the health care
11professional or health care provider services contract,
12including exhibits and attachments, if any, before signing. The
1330-day review period begins upon receipt of the health care
14professional or health care provider services contract, unless
15the information available upon request in subsection (a) is not
16included. If information is not included in the professional
17services contract and is requested pursuant to subsection (a),
18the 30-day review period begins on the date of receipt of the
19information. Nothing in this subsection shall prohibit a health
20care professional or health care provider from signing a
21contract prior to the expiration of the 30-day review period.
22    (d) The insurer, health maintenance organization,
23independent practice association, or physician hospital
24organization shall provide all contracted health care
25professionals or health care providers with any changes to the
26fee schedule provided under subsection (a) not later than 35

 

 

HB3018- 4 -LRB098 04025 RPM 34045 b

1days after the effective date of the changes, unless such
2changes are specified in the contract and the health care
3professional or health care provider is able to calculate the
4changed rates based on information in the contract and
5information available to the public at no charge. For the
6purposes of this subsection, "changes" means an increase or
7decrease in the fee schedule referred to in subsection (a).
8This information may be made available by mail, e-mail,
9newsletter, website listing, or other reasonable method. Upon
10request, a health care professional or health care provider may
11request an updated copy of the fee schedule referred to in
12subsection (a) every calendar quarter.
13    (d-5) The insurer, health maintenance organization,
14independent practice association, physician hospital
15organization, or preferred provider organization shall provide
16health care professional applicants who are denied
17participation in any panel of in-network health care
18professionals with a specific reason for the denial. In
19addition, any participating health care professional must be
20provided 60 days' notice and an opportunity to initiate
21corrective action prior to the initiation of any attempts to
22terminate or otherwise remove the health care professional from
23a panel of in-network health care professionals. The required
24notice shall include specific reasons for the proposed
25termination or removal. Any participating health care
26professional terminated or removed from an in-network panel by

 

 

HB3018- 5 -LRB098 04025 RPM 34045 b

1his or her own written request must be provided an opportunity
2to appeal the decision. Immediate written notice may be
3provided without 60 days' notice when a health care
4professional's license has been disciplined by a State
5licensing or disciplinary board.
6    (e) Upon termination of a contract with an insurer, health
7maintenance organization, independent practice association, or
8physician hospital organization and at the request of the
9patient, a health care professional or health care provider
10shall transfer copies of the patient's medical records. Any
11other provision of law notwithstanding, the costs for copying
12and transferring copies of medical records shall be assigned
13per the arrangements agreed upon, if any, in the health care
14professional or health care provider services contract.
15(Source: P.A. 93-261, eff. 1-1-04.)