Full Text of HB4847 93rd General Assembly
HB4847eng 93RD GENERAL ASSEMBLY
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HB4847 Engrossed |
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LRB093 14813 SAS 40374 b |
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| AN ACT concerning insurance.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Insurance Code is amended by | 5 |
| changing Section 368a as follows:
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| (215 ILCS 5/368a)
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| Sec. 368a. Timely payment for health care services.
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| (a) This Section applies to insurers, health maintenance | 9 |
| organizations,
managed care plans, health care plans, | 10 |
| preferred provider organizations, third
party
administrators, | 11 |
| independent practice associations, and physician-hospital
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| organizations (hereinafter referred to as "payors") that
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| provide
periodic payments, which are payments not requiring a | 14 |
| claim, bill, capitation
encounter
data, or capitation | 15 |
| reconciliation reports, such as
prospective capitation | 16 |
| payments, to
health care professionals and health care | 17 |
| facilities
to provide medical or health care services for | 18 |
| insureds or enrollees.
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| (1) A payor
shall
make
periodic payments in accordance | 20 |
| with item (3). Failure to make
periodic
payments
within the | 21 |
| period of time specified in item (3) shall
entitle the
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| health care professional or health care facility to | 23 |
| interest at the
rate of 9%
per year from
the date payment | 24 |
| was required to be made to the date of the late payment,
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| provided that
interest amounting
to less than $1 need not | 26 |
| be paid. Any required interest payments shall be made
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| within 30 days after the payment.
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| (2) When a payor requires selection of a health care
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| professional or
health care facility, the selection shall | 30 |
| be completed by the insured or
enrollee no later
than
30 | 31 |
| days after enrollment. The payor shall provide written | 32 |
| notice of this
requirement to all insureds and enrollees.
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HB4847 Engrossed |
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LRB093 14813 SAS 40374 b |
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| Nothing in this Section shall be construed to require a | 2 |
| payor to select a
health care professional or health care | 3 |
| facility for an insured or enrollee.
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| (3) A payor
shall provide the
health care professional | 5 |
| or health care facility with
notice of the selection as a | 6 |
| health care professional or
health care facility by
an
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| insured or
enrollee and the effective date of the selection | 8 |
| within
60 calendar days after the selection. No later than | 9 |
| the 60th day
following the
date an insured or enrollee has | 10 |
| selected a health care
professional or health care facility | 11 |
| or the date that selection becomes
effective, whichever is | 12 |
| later, or in cases of retrospective enrollment only, 30
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| days after notice by an employer to the payor of the | 14 |
| selection, a payor
shall begin periodic payment of
the | 15 |
| required
amounts to the insured's or enrollee's health care | 16 |
| professional or health care
facility, or the designee of | 17 |
| either,
calculated from the date of
selection or the date | 18 |
| the selection becomes effective, whichever is later.
All | 19 |
| subsequent payments shall be made
in accordance with
a | 20 |
| monthly periodic cycle. Payors are required to notify | 21 |
| individual insureds or enrollees within 30 days if the | 22 |
| insured's or enrollee's chosen health care professional no | 23 |
| longer participates in the physician network. Payors must | 24 |
| notify insureds or enrollees of their right to transition | 25 |
| services under Section 25 of the Managed Care Reform and | 26 |
| Patient Rights Act.
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| (b) Notwithstanding any other provision of this Section,
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| independent practice associations and physician-hospital | 29 |
| organizations shall
make periodic payment of the required | 30 |
| amounts in
accordance with a monthly periodic schedule after
an | 31 |
| insured or enrollee has selected a health care professional or | 32 |
| health care
facility or after that selection becomes effective, | 33 |
| whichever
is later.
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| Notwithstanding any other provision of this Section, | 35 |
| independent
practice associations and physician-hospital | 36 |
| organizations shall make all
other payments for health services |
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HB4847 Engrossed |
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LRB093 14813 SAS 40374 b |
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| within 30 days after receipt of
due proof
of loss. Independent
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| practice associations and physician-hospital organizations | 3 |
| shall notify the
insured, insured's assignee, health care | 4 |
| professional, or health care facility
of any failure to provide | 5 |
| sufficient documentation for a due proof of
loss within 30 days | 6 |
| after receipt of the claim for health services.
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| Failure to pay within the required time period shall | 8 |
| entitle the payee to
interest at the rate of 9% per year from | 9 |
| the date the payment is due to the
date of the late payment, | 10 |
| provided that interest amounting to less that $1
need not be | 11 |
| paid. Any required interest payments shall be made within 30
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| days after the payment.
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| (c) All insurers, health maintenance
organizations, | 14 |
| managed care plans, health care plans, preferred provider
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| organizations, and third party administrators
shall ensure | 16 |
| that all claims and indemnities
concerning health care services
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| other than for
any periodic payment shall be paid within 30 | 18 |
| days after receipt of due
written proof of such loss. An | 19 |
| insured, insured's assignee, health care
professional, or | 20 |
| health care facility shall be
notified of any known failure to | 21 |
| provide sufficient documentation for a
due proof of
loss within | 22 |
| 30 days after receipt of the claim for health care
services.
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| Failure to pay
within such period shall entitle the payee
to | 24 |
| interest at the rate of 9% per year from the 30th day after
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| receipt of such proof of loss to
the date of late payment, | 26 |
| provided that interest amounting to less than one
dollar need | 27 |
| not be paid. Any
required interest payments shall be made | 28 |
| within 30 days after the payment.
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| (d) The Department shall enforce the provisions of this | 30 |
| Section pursuant to
the enforcement powers granted to it by | 31 |
| law.
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| (e) The Department is hereby granted specific authority to | 33 |
| issue a
cease and desist order, fine, or otherwise penalize | 34 |
| independent practice
associations and physician-hospital | 35 |
| organizations that violate this Section.
The Department shall | 36 |
| adopt reasonable rules to enforce compliance with this
Section |
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HB4847 Engrossed |
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LRB093 14813 SAS 40374 b |
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| by
independent practice associations and physician-hospital | 2 |
| organizations.
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| (Source: P.A. 91-605, eff. 12-14-99; 91-788, eff. 6-9-00; | 4 |
| 92-745, eff. 1-1-03.)
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