SB2256 97TH GENERAL ASSEMBLY

LRB097 08544 RPM 48671 b

97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB2256

Introduced 2/15/2011, by Sen. William R. Haine

SYNOPSIS AS INTRODUCED:

215 ILCS 5/368g new

Amends the Illinois Insurance Code. Provides that no insurer shall implement any change to a provider contract that may adversely impact reimbursement unless, prior to the effective date of the change, the insurer gives the health care provider with whom the insurer has directly contracted and who is impacted by the change at least 60 days written notice of the change. Sets forth provisions concerning notice.

A BILL FOR

AN ACT concerning insurance.

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

Section 5. The Illinois Insurance Code is amended by adding Section 368g as follows:

(215 ILCS 5/368g new)

Sec. 368g. Provider contract changes.

(a) No insurer shall implement a change to a provider contract or modify policies and procedures that have been incorporated or incorporated by reference into that contract that may adversely impact reimbursement unless, prior to the effective date of the change, the insurer gives the health care provider with whom the insurer has directly contracted and who is impacted by the change at least 60 days written notice of the change.

(b) If the contracting health care provider objects to the change that is the subject of the notice from the insurer, then the health care provider may, within 30 days after the date of the notice, give written notice to the insurer to terminate the contract with the insurer effective upon the implementation date of the adverse reimbursement change.

(c) The notice provisions required by this Section shall not apply where:

(1) such change is otherwise required by law, regulation or applicable regulatory authority, or as a result of changes in fee schedules, reimbursement methodology, or payment policies established by a government agency or by the American Medical Association's current procedural terminology codes, reporting guidelines, and conventions; or

(2) such change is expressly provided for under the terms of the contract by the inclusion of or reference to a specific fee or fee schedule, reimbursement methodology, or payment policy indexing mechanism.