Illinois General Assembly - Bill Status for HB1074

Replaces everything after the enacting clause. Amends the Illinois Insurance Code. Provides that a health care professional or health care provider offered a contract by an insurer, health maintenance organization, independent practice association, or physician hospital organization for signature after the effective date of this amendatory Act shall be provided with a proposed health care professional or health care provider services contract. Provides that, within 35 days after a written request, the health care professional or health care provider offered a contract shall be given the opportunity to review and obtain a copy of the following: a specialty-specific fee schedule sample based on a minimum of the 50 highest volume fee schedule codes with the rates applicable to the health care professional or health care provider to whom the contract is offered, the network provider administration manual, and a summary capitation schedule, if payment is made on a capitation basis. Provides that information contained in the fee schedule, the capitation schedule, and the network provider administration manual constitutes confidential, proprietary, and trade secret information and is subject to the provisions of the Illinois Trade Secrets Act. Provides guidelines for providing remittance advices, including an explanation of a recoupment or offset taken by an insurer, health maintenance organization, independent practice association, or physician hospital organization, to health care professionals and health care providers. Provides that, when a person presents a benefits information card, a health care professional or health care provider shall make a good faith effort to inform the person if the health care professional or health care provider has a participation contract with the insurer, health maintenance organization, other entity identified on the card. Provides for administration and enforcement of these provisions. In provisions concerning registration of administrators of preferred provider organizations, provides that preferred provider administrators are subject to the new contract provisions of the Code. Amends the Health Maintenance Organization Act. Adds to the list of Sections of the Illinois Insurance Code to which Health Maintenance Organizations are subject. Effective January 1, 2004.

Removes provisions (i) prohibiting health care professionals and health care providers from providing a statement that requires payment from the patient or group contract holder, or collect and have any recourse against an insured patient or group contract holder for services provided pursuant to a contract in which an insurer, health maintenance organization, independent practice association, or physician hospital organization has contractually agreed with a health care professional or health care provider that the health care professional or health care provider does not have such a right or rights and (ii) allowing health care professionals and health care providers to collect payment for applicable co-payments, co-insurance, and deductibles and payment for non-covered services directly from patients.

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