093_HB2777

 
                                     LRB093 08497 JLS 08721 b

 1        AN ACT concerning the provision of insurance benefits.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  5.  The  Illinois  Insurance  Code is amended by
 5    adding Section 361.5 as follows:

 6        (215 ILCS 5/361.5 new)
 7        Sec.   361.5.  Independent   practice   association   and
 8    physician-hospital organization registration.
 9        (a)  No person may maintain, operate, or represent itself
10    as an independent practice association or  physician-hospital
11    organization, unless once every year the person registers the
12    independent   practice   association   or  physician-hospital
13    organization with the Department.
14        (b)  The provisions of this Section do not apply to:
15             (1)  persons    providing    independent    practice
16        association or physician-hospital  organization  services
17        only to the federal government; or
18             (2)  self-insured  health  plans  under  the federal
19        Employee Retirement Income Security Act of 1974, however,
20        this  Section  does  apply  to  persons   conducting   an
21        independent  practice  association  or physician-hospital
22        organization on behalf of these health plans.
23        (c)  The registration shall include submission of all  of
24    the  following information regarding the independent practice
25    association  or   physician-hospital   organization   program
26    activities:
27             (1)  The  name, address, and telephone number of the
28        independent practice  association  or  physician-hospital
29        organization.
30             (2)  The organization and governing structure of the
31        independent  practice  association  or physician-hospital
 
                            -2-      LRB093 08497 JLS 08721 b
 1        organization.
 2             (3)  The number of  physicians,  practitioners,  and
 3        health care providers under contract with the independent
 4        practice  association  or physician-hospital organization
 5        by health care specialty.
 6             (4)  The number of lives for which  the  independent
 7        practice  association  or physician-hospital organization
 8        is responsible.
 9             (5)  Hours of operation of each independent practice
10        association or physician-hospital organization.
11             (6)  Description of the grievance  process  for  the
12        independent  practice  association  or physician-hospital
13        organization.
14             (7)  The number  of  covered  lives  for  which  the
15        independent  practice  association  or physician-hospital
16        organization was responsible during the previous calendar
17        year, if any.
18             (8)  Written policies and procedures for  protecting
19        confidential  information  according  to applicable State
20        and federal laws including the federal  Health  Insurance
21        Portability and Accountability Act of 1996.
22             (9)  Information  required by the Department by rule
23        to establish adequate risk-based capital retention.
24        (d)  If the Department finds that an independent practice
25    association or  physician-hospital  organization  is  not  in
26    compliance  with  this  Section, the Department shall issue a
27    corrective action plan and allow a reasonable amount of  time
28    for  compliance  with  the  plan. If the independent practice
29    association or physician-hospital organization does not  come
30    into  compliance, the Department may issue a cease and desist
31    order. Before issuing a cease and  desist  order  under  this
32    Section,   the   Department  shall  provide  the  independent
33    practice association or physician-hospital organization  with
34    a  written  notice  of  the reasons for the order and allow a
 
                            -3-      LRB093 08497 JLS 08721 b
 1    reasonable amount of time to  supply  additional  information
 2    demonstrating  compliance  with  requirements of this Section
 3    and to request a hearing. The hearing notice shall be sent by
 4    certified mail, return receipt  requested,  and  the  hearing
 5    shall   be   conducted   in   accordance  with  the  Illinois
 6    Administrative Procedure Act.
 7        (e)  An    independent    practice     association     or
 8    physician-hospital   organization  subject  to  a  corrective
 9    action plan may continue to conduct business  until  a  final
10    decision has been issued by the Department.
11        (f)  The  Department may by rule establish a registration
12    fee    for    independent    practice     associations     or
13    physician-hospital   organizations.  All  fees  paid  to  and
14    collected by the  Department  under  this  Section  shall  be
15    deposited into the Insurance Producer Administration Fund.

16        Section  99.  Effective  date.  This  Act takes effect on
17    December 1, 2003.