Illinois General Assembly - Full Text of HB2792
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Full Text of HB2792  101st General Assembly

HB2792 101ST GENERAL ASSEMBLY

  
  

 


 
101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB2792

 

Introduced , by Rep. Dan Ugaste

 

SYNOPSIS AS INTRODUCED:
 
820 ILCS 305/8.2

    Amends the Workers' Compensation Act. Makes existing medical fee schedules inoperative after August 31, 2020. Provides that the Illinois Workers' Compensation Commission shall establish new medical fee schedules applicable on and after September 1, 2020 in accordance with specified criteria. Provides for 4 non-hospital fee schedules and 14 hospital fee schedules applicable to different geographic areas of the State. Sets forth a procedure for petitioning the Commission if a maximum fee causes a significant limitation on access to quality health care in either a specific field of health care services or a specific geographic limitation on access to health care. Effective immediately.


LRB101 08381 JLS 53451 b

 

 

A BILL FOR

 

HB2792LRB101 08381 JLS 53451 b

1    AN ACT concerning employment.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Workers' Compensation Act is amended by
5changing Section 8.2 as follows:
 
6    (820 ILCS 305/8.2)
7    Sec. 8.2. Fee schedule.
8    (a) Except as provided for in subsection (c), for
9procedures, treatments, or services covered under this Act and
10rendered or to be rendered on and after February 1, 2006, the
11maximum allowable payment shall be 90% of the 80th percentile
12of charges and fees as determined by the Commission utilizing
13information provided by employers' and insurers' national
14databases, with a minimum of 12,000,000 Illinois line item
15charges and fees comprised of health care provider and hospital
16charges and fees as of August 1, 2004 but not earlier than
17August 1, 2002. These charges and fees are provider billed
18amounts and shall not include discounted charges. The 80th
19percentile is the point on an ordered data set from low to high
20such that 80% of the cases are below or equal to that point and
21at most 20% are above or equal to that point. The Commission
22shall adjust these historical charges and fees as of August 1,
232004 by the Consumer Price Index-U for the period August 1,

 

 

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12004 through September 30, 2005. The Commission shall establish
2fee schedules for procedures, treatments, or services for
3hospital inpatient, hospital outpatient, emergency room and
4trauma, ambulatory surgical treatment centers, and
5professional services. These charges and fees shall be
6designated by geozip or any smaller geographic unit. The data
7shall in no way identify or tend to identify any patient,
8employer, or health care provider. As used in this Section,
9"geozip" means a three-digit zip code based on data
10similarities, geographical similarities, and frequencies. A
11geozip does not cross state boundaries. As used in this
12Section, "three-digit zip code" means a geographic area in
13which all zip codes have the same first 3 digits. If a geozip
14does not have the necessary number of charges and fees to
15calculate a valid percentile for a specific procedure,
16treatment, or service, the Commission may combine data from the
17geozip with up to 4 other geozips that are demographically and
18economically similar and exhibit similarities in data and
19frequencies until the Commission reaches 9 charges or fees for
20that specific procedure, treatment, or service. In cases where
21the compiled data contains less than 9 charges or fees for a
22procedure, treatment, or service, reimbursement shall occur at
2376% of charges and fees as determined by the Commission in a
24manner consistent with the provisions of this paragraph.
25Providers of out-of-state procedures, treatments, services,
26products, or supplies shall be reimbursed at the lesser of that

 

 

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1state's fee schedule amount or the fee schedule amount for the
2region in which the employee resides. If no fee schedule exists
3in that state, the provider shall be reimbursed at the lesser
4of the actual charge or the fee schedule amount for the region
5in which the employee resides. Not later than September 30 in
62006 and each year thereafter, the Commission shall
7automatically increase or decrease the maximum allowable
8payment for a procedure, treatment, or service established and
9in effect on January 1 of that year by the percentage change in
10the Consumer Price Index-U for the 12 month period ending
11August 31 of that year. The increase or decrease shall become
12effective on January 1 of the following year. As used in this
13Section, "Consumer Price Index-U" means the index published by
14the Bureau of Labor Statistics of the U.S. Department of Labor,
15that measures the average change in prices of all goods and
16services purchased by all urban consumers, U.S. city average,
17all items, 1982-84=100.
18    The provisions of this subsection (a), other than this
19sentence, are inoperative after August 31, 2020.
20    (a-1) Notwithstanding the provisions of subsection (a) and
21unless otherwise indicated, the following provisions shall
22apply to the medical fee schedule starting on September 1,
232011:
24        (1) The Commission shall establish and maintain fee
25    schedules for procedures, treatments, products, services,
26    or supplies for hospital inpatient, hospital outpatient,

 

 

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1    emergency room, ambulatory surgical treatment centers,
2    accredited ambulatory surgical treatment facilities,
3    prescriptions filled and dispensed outside of a licensed
4    pharmacy, dental services, and professional services. This
5    fee schedule shall be based on the fee schedule amounts
6    already established by the Commission pursuant to
7    subsection (a) of this Section. However, starting on
8    January 1, 2012, these fee schedule amounts shall be
9    grouped into geographic regions in the following manner:
10            (A) Four regions for non-hospital fee schedule
11        amounts shall be utilized:
12                (i) Cook County;
13                (ii) DuPage, Kane, Lake, and Will Counties;
14                (iii) Bond, Calhoun, Clinton, Jersey,
15            Macoupin, Madison, Monroe, Montgomery, Randolph,
16            St. Clair, and Washington Counties; and
17                (iv) All other counties of the State.
18            (B) Fourteen regions for hospital fee schedule
19        amounts shall be utilized:
20                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
21            Kendall, and Grundy Counties;
22                (ii) Kankakee County;
23                (iii) Madison, St. Clair, Macoupin, Clinton,
24            Monroe, Jersey, Bond, and Calhoun Counties;
25                (iv) Winnebago and Boone Counties;
26                (v) Peoria, Tazewell, Woodford, Marshall, and

 

 

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1            Stark Counties;
2                (vi) Champaign, Piatt, and Ford Counties;
3                (vii) Rock Island, Henry, and Mercer Counties;
4                (viii) Sangamon and Menard Counties;
5                (ix) McLean County;
6                (x) Lake County;
7                (xi) Macon County;
8                (xii) Vermilion County;
9                (xiii) Alexander County; and
10                (xiv) All other counties of the State.
11        (2) If a geozip, as defined in subsection (a) of this
12    Section, overlaps into one or more of the regions set forth
13    in this Section, then the Commission shall average or
14    repeat the charges and fees in a geozip in order to
15    designate charges and fees for each region.
16        (3) In cases where the compiled data contains less than
17    9 charges or fees for a procedure, treatment, product,
18    supply, or service or where the fee schedule amount cannot
19    be determined by the non-discounted charge data,
20    non-Medicare relative values and conversion factors
21    derived from established fee schedule amounts, coding
22    crosswalks, or other data as determined by the Commission,
23    reimbursement shall occur at 76% of charges and fees until
24    September 1, 2011 and 53.2% of charges and fees thereafter
25    as determined by the Commission in a manner consistent with
26    the provisions of this paragraph.

 

 

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1        (4) To establish additional fee schedule amounts, the
2    Commission shall utilize provider non-discounted charge
3    data, non-Medicare relative values and conversion factors
4    derived from established fee schedule amounts, and coding
5    crosswalks. The Commission may establish additional fee
6    schedule amounts based on either the charge or cost of the
7    procedure, treatment, product, supply, or service.
8        (5) Implants shall be reimbursed at 25% above the net
9    manufacturer's invoice price less rebates, plus actual
10    reasonable and customary shipping charges whether or not
11    the implant charge is submitted by a provider in
12    conjunction with a bill for all other services associated
13    with the implant, submitted by a provider on a separate
14    claim form, submitted by a distributor, or submitted by the
15    manufacturer of the implant. "Implants" include the
16    following codes or any substantially similar updated code
17    as determined by the Commission: 0274
18    (prosthetics/orthotics); 0275 (pacemaker); 0276 (lens
19    implant); 0278 (implants); 0540 and 0545 (ambulance); 0624
20    (investigational devices); and 0636 (drugs requiring
21    detailed coding). Non-implantable devices or supplies
22    within these codes shall be reimbursed at 65% of actual
23    charge, which is the provider's normal rates under its
24    standard chargemaster. A standard chargemaster is the
25    provider's list of charges for procedures, treatments,
26    products, supplies, or services used to bill payers in a

 

 

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1    consistent manner.
2        (6) The Commission shall automatically update all
3    codes and associated rules with the version of the codes
4    and rules valid on January 1 of that year.
5    The provisions of this subsection (a-1), other than this
6sentence, are inoperative after August 31, 2020.
7    (a-1.5) The following provisions apply to procedures,
8treatments, services, products, and supplies covered under
9this Act and rendered or to be rendered on or after September
101, 2020:
11        (1) In this Section:
12        "CPT code" means each Current Procedural Terminology
13    code, for each geographic region specified in subsection
14    (b) of this Section, included on the most recent medical
15    fee schedule established by the Commission pursuant to this
16    Section.
17        "DRG code" means each current diagnosis related group
18    code, for each geographic region specified in subsection
19    (b) of this Section, included on the most recent medical
20    fee schedule established by the Commission pursuant to this
21    Section.
22        "Geozip" means a three-digit zip code based on data
23    similarities, geographical similarities, and frequencies.
24        "Health care services" means those CPT and DRG codes
25    for procedures, treatments, products, services or supplies
26    for hospital inpatient, hospital outpatient, emergency

 

 

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1    room, ambulatory surgical treatment centers, accredited
2    ambulatory surgical treatment facilities, and professional
3    services. It does not include codes classified as
4    healthcare common procedure coding systems or dental.
5        "Medicare maximum fee" means, for each CPT and DRG
6    code, the current maximum fee for that CPT or DRG code
7    allowed to be charged by the Centers for Medicare and
8    Medicaid Services for Medicare patients in that geographic
9    region. The Medicare maximum fee shall be the greater of
10    (i) the current maximum fee allowed to be charged by the
11    Centers for Medicare and Medicaid Services for Medicare
12    patients in the geographic region or (ii) the maximum fee
13    charged by the Centers for Medicare and Medicaid Services
14    for Medicare patients in the geographic region on January
15    1, 2020.
16        "Medicare percentage amount" means, for each CPT and
17    DRG code, the workers' compensation maximum fee as a
18    percentage of the Medicare maximum fee.
19        "Workers' compensation maximum fee" means, for each
20    CPT and DRG code, the current maximum fee allowed to be
21    charged under the medical fee schedule established by the
22    Commission for that CPT or DRG code in that geographic
23    region.
24        (2) The Commission shall establish and maintain fee
25    schedules for procedures, treatments, products, services,
26    or supplies for hospital inpatient, hospital outpatient,

 

 

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1    emergency room, ambulatory surgical treatment centers,
2    accredited ambulatory surgical treatment facilities,
3    prescriptions filled and dispensed outside of a licensed
4    pharmacy, dental services, and professional services.
5    These fee schedule amounts shall be grouped into geographic
6    regions in the following manner:
7            (A) Four regions for non-hospital fee schedule
8        amounts shall be utilized:
9                (i) Cook County;
10                (ii) DuPage, Kane, Lake, and Will Counties;
11                (iii) Bond, Calhoun, Clinton, Jersey,
12            Macoupin, Madison, Monroe, Montgomery, Randolph,
13            St. Clair, and Washington Counties; and
14                (iv) All other counties of the State.
15            (B) Fourteen regions for hospital fee schedule
16        amounts shall be utilized:
17                (i) Cook, DuPage, Will, Kane, McHenry, DeKalb,
18            Kendall, and Grundy Counties;
19                (ii) Kankakee County;
20                (iii) Madison, St. Clair, Macoupin, Clinton,
21            Monroe, Jersey, Bond, and Calhoun Counties;
22                (iv) Winnebago and Boone Counties;
23                (v) Peoria, Tazewell, Woodford, Marshall, and
24            Stark Counties;
25                (vi) Champaign, Piatt, and Ford Counties;
26                (vii) Rock Island, Henry, and Mercer Counties;

 

 

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1                (viii) Sangamon and Menard Counties;
2                (ix) McLean County;
3                (x) Lake County;
4                (xi) Macon County;
5                (xii) Vermilion County;
6                (xiii) Alexander County; and
7                (xiv) All other counties of the State.
8        If a geozip overlaps into one or more of the regions
9    set forth in this Section, then the Commission shall
10    average or repeat the charges and fees in a geozip in order
11    to designate charges and fees for each region.
12        (3) The initial workers' compensation maximum fee for
13    each CPT and DRG code as of September 1, 2020 shall be
14    determined as follows:
15            (A) Within 45 days after the effective date of this
16        amendatory Act of the 101st General Assembly, the
17        Commission shall determine the Medicare percentage
18        amount for each CPT and DRG code using the most recent
19        data available.
20            CPT or DRG codes which have a value, but are not
21        covered expenses under Medicare, are still compensable
22        under the medical fee schedule according to the rate
23        described in Section (B).
24            (B) Within 30 days after the Commission makes the
25        determinations required by subdivision (3)(A) of this
26        subsection (a-1.5), the Commission shall determine an

 

 

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1        adjustment to be made to the workers' compensation
2        maximum fee for each CPT and DRG code as follows:
3                (i) If the Medicare percentage amount for that
4            CPT or DRG code is equal to or less than 125%, then
5            the workers' compensation maximum fee for that CPT
6            or DRG code shall be adjusted so that it equals
7            125% of the most recent Medicare maximum fee for
8            that CPT or DRG code.
9                (ii) If the Medicare percentage amount for
10            that CPT or DRG code is greater than 125% but less
11            than 150%, then the workers' compensation maximum
12            fee for that CPT or DRG code shall not be adjusted.
13                (iii) If the Medicare percentage amount for
14            that CPT or DRG code is greater than 150% but less
15            than or equal to 225%, then the workers'
16            compensation maximum fee for that CPT or DRG code
17            shall be adjusted so that it equals the greater of
18            (I) 150% of the most recent Medicare maximum fee
19            for that CPT or DRG code or (II) 85% of the most
20            recent workers' compensation maximum amount for
21            that CPT or DRG code.
22                (iv) If the Medicare percentage amount for
23            that CPT or DRG code is greater than 225% but less
24            than or equal to 428.57%, then the workers'
25            compensation maximum fee for that CPT or DRG code
26            shall be adjusted so that it equals the greater of

 

 

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1            (I) 191.25% of the most recent Medicare maximum fee
2            for that CPT or DRG code or (II) 70% of the most
3            recent workers' compensation maximum amount for
4            that CPT or DRG code.
5                (v) If the Medicare percentage amount for that
6            CPT or DRG code is greater than 428.57%, then the
7            workers' compensation maximum fee for that CPT or
8            DRG code shall be adjusted so that it equals 300%
9            of the most recent Medicare maximum fee for that
10            CPT or DRG code.
11            The Commission shall promptly publish the
12        adjustments determined pursuant to this subdivision
13        (3)(B) on its website.
14            (C) The initial workers' compensation maximum fee
15        for each CPT and DRG code as of September 1, 2020 shall
16        be equal to the workers' compensation maximum fee for
17        that code as determined and adjusted pursuant to
18        subdivision (3)(B) of this subsection, subject to any
19        further adjustments pursuant to subdivision (5) of
20        this subsection.
21        (4) The Commission, as of September 1, 2021 and
22    September 1 of each year thereafter, shall adjust the
23    workers' compensation maximum fee for each CPT or DRG code
24    to exactly half of the most recent annual increase in the
25    Consumer Price Index-U.
26        (5) A person who believes that the workers'

 

 

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1    compensation maximum fee for a CPT or DRG code, as
2    otherwise determined pursuant to this subsection, creates
3    or would create upon implementation a significant
4    limitation on access to quality health care in either a
5    specific field of health care services or a specific
6    geographic limitation on access to health care may petition
7    the Commission to modify the workers' compensation maximum
8    fee for that CPT or DRG code so as to not create that
9    significant limitation.
10        The petitioner bears the burden of demonstrating, by a
11    preponderance of the credible evidence, that the workers'
12    compensation maximum fee that would otherwise apply would
13    create a significant limitation on access to quality health
14    care in either a specific field of health care services or
15    a specific geographic limitation on access to health care.
16    Petitions shall be made publicly available. Such credible
17    evidence shall include empirical data demonstrating a
18    significant limitation on access to quality health care.
19    Other interested persons may file comments or responses to
20    a petition within 30 days of the filing of a petition.
21        The Commission shall take final action on each petition
22    within 180 days of filing. The Commission may, but is not
23    required to, seek the recommendation of the Medical Fee
24    Advisory Board to assist with this determination. If the
25    Commission grants the petition, the Commission shall
26    further increase the workers' compensation maximum fee for

 

 

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1    that CPT or DRG code by the amount minimally necessary to
2    avoid creating a significant limitation on access to
3    quality health care in either a specific field of health
4    care services or a specific geographic limitation on access
5    to health care. The increased workers' compensation
6    maximum fee shall take effect upon entry of the
7    Commission's final action.
8    (a-2) For procedures, treatments, services, or supplies
9covered under this Act and rendered or to be rendered on or
10after September 1, 2011, the maximum allowable payment shall be
1170% of the fee schedule amounts, which shall be adjusted yearly
12by the Consumer Price Index-U, as described in subsection (a)
13of this Section. The provisions of this subsection (a-2), other
14than this sentence, are inoperative after August 31, 2020.
15    (a-3) Prescriptions filled and dispensed outside of a
16licensed pharmacy shall be subject to a fee schedule that shall
17not exceed the Average Wholesale Price (AWP) plus a dispensing
18fee of $4.18. AWP or its equivalent as registered by the
19National Drug Code shall be set forth for that drug on that
20date as published in Medispan.
21    (b) Notwithstanding the provisions of subsection (a), if
22the Commission finds that there is a significant limitation on
23access to quality health care in either a specific field of
24health care services or a specific geographic limitation on
25access to health care, it may change the Consumer Price Index-U
26increase or decrease for that specific field or specific

 

 

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1geographic limitation on access to health care to address that
2limitation.
3    (c) The Commission shall establish by rule a process to
4review those medical cases or outliers that involve
5extra-ordinary treatment to determine whether to make an
6additional adjustment to the maximum payment within a fee
7schedule for a procedure, treatment, or service.
8    (d) When a patient notifies a provider that the treatment,
9procedure, or service being sought is for a work-related
10illness or injury and furnishes the provider the name and
11address of the responsible employer, the provider shall bill
12the employer or its designee directly. The employer or its
13designee shall make payment for treatment in accordance with
14the provisions of this Section directly to the provider, except
15that, if a provider has designated a third-party billing entity
16to bill on its behalf, payment shall be made directly to the
17billing entity. Providers shall submit bills and records in
18accordance with the provisions of this Section.
19        (1) All payments to providers for treatment provided
20    pursuant to this Act shall be made within 30 days of
21    receipt of the bills as long as the bill contains
22    substantially all the required data elements necessary to
23    adjudicate the bill.
24        (2) If the bill does not contain substantially all the
25    required data elements necessary to adjudicate the bill, or
26    the claim is denied for any other reason, in whole or in

 

 

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1    part, the employer or insurer shall provide written
2    notification to the provider in the form of an explanation
3    of benefits explaining the basis for the denial and
4    describing any additional necessary data elements within
5    30 days of receipt of the bill. The Commission, with
6    assistance from the Medical Fee Advisory Board, shall adopt
7    rules detailing the requirements for the explanation of
8    benefits required under this subsection.
9        (3) In the case (i) of nonpayment to a provider within
10    30 days of receipt of the bill which contained
11    substantially all of the required data elements necessary
12    to adjudicate the bill, (ii) of nonpayment to a provider of
13    a portion of such a bill, or (iii) where the provider has
14    not been issued an explanation of benefits for a bill, the
15    bill, or portion of the bill up to the lesser of the actual
16    charge or the payment level set by the Commission in the
17    fee schedule established in this Section, shall incur
18    interest at a rate of 1% per month payable by the employer
19    to the provider. Any required interest payments shall be
20    made by the employer or its insurer to the provider within
21    30 days after payment of the bill.
22        (4) If the employer or its insurer fails to pay
23    interest within 30 days after payment of the bill as
24    required pursuant to paragraph (3), the provider may bring
25    an action in circuit court for the sole purpose of seeking
26    payment of interest pursuant to paragraph (3) against the

 

 

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1    employer or its insurer responsible for insuring the
2    employer's liability pursuant to item (3) of subsection (a)
3    of Section 4. The circuit court's jurisdiction shall be
4    limited to enforcing payment of interest pursuant to
5    paragraph (3). Interest under paragraph (3) is only payable
6    to the provider. An employee is not responsible for the
7    payment of interest under this Section. The right to
8    interest under paragraph (3) shall not delay, diminish,
9    restrict, or alter in any way the benefits to which the
10    employee or his or her dependents are entitled under this
11    Act.
12    The changes made to this subsection (d) by this amendatory
13Act of the 100th General Assembly apply to procedures,
14treatments, and services rendered on and after the effective
15date of this amendatory Act of the 100th General Assembly.
16    (e) Except as provided in subsections (e-5), (e-10), and
17(e-15), a provider shall not hold an employee liable for costs
18related to a non-disputed procedure, treatment, or service
19rendered in connection with a compensable injury. The
20provisions of subsections (e-5), (e-10), (e-15), and (e-20)
21shall not apply if an employee provides information to the
22provider regarding participation in a group health plan. If the
23employee participates in a group health plan, the provider may
24submit a claim for services to the group health plan. If the
25claim for service is covered by the group health plan, the
26employee's responsibility shall be limited to applicable

 

 

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1deductibles, co-payments, or co-insurance. Except as provided
2under subsections (e-5), (e-10), (e-15), and (e-20), a provider
3shall not bill or otherwise attempt to recover from the
4employee the difference between the provider's charge and the
5amount paid by the employer or the insurer on a compensable
6injury, or for medical services or treatment determined by the
7Commission to be excessive or unnecessary.
8    (e-5) If an employer notifies a provider that the employer
9does not consider the illness or injury to be compensable under
10this Act, the provider may seek payment of the provider's
11actual charges from the employee for any procedure, treatment,
12or service rendered. Once an employee informs the provider that
13there is an application filed with the Commission to resolve a
14dispute over payment of such charges, the provider shall cease
15any and all efforts to collect payment for the services that
16are the subject of the dispute. Any statute of limitations or
17statute of repose applicable to the provider's efforts to
18collect payment from the employee shall be tolled from the date
19that the employee files the application with the Commission
20until the date that the provider is permitted to resume
21collection efforts under the provisions of this Section.
22    (e-10) If an employer notifies a provider that the employer
23will pay only a portion of a bill for any procedure, treatment,
24or service rendered in connection with a compensable illness or
25disease, the provider may seek payment from the employee for
26the remainder of the amount of the bill up to the lesser of the

 

 

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1actual charge, negotiated rate, if applicable, or the payment
2level set by the Commission in the fee schedule established in
3this Section. Once an employee informs the provider that there
4is an application filed with the Commission to resolve a
5dispute over payment of such charges, the provider shall cease
6any and all efforts to collect payment for the services that
7are the subject of the dispute. Any statute of limitations or
8statute of repose applicable to the provider's efforts to
9collect payment from the employee shall be tolled from the date
10that the employee files the application with the Commission
11until the date that the provider is permitted to resume
12collection efforts under the provisions of this Section.
13    (e-15) When there is a dispute over the compensability of
14or amount of payment for a procedure, treatment, or service,
15and a case is pending or proceeding before an Arbitrator or the
16Commission, the provider may mail the employee reminders that
17the employee will be responsible for payment of any procedure,
18treatment or service rendered by the provider. The reminders
19must state that they are not bills, to the extent practicable
20include itemized information, and state that the employee need
21not pay until such time as the provider is permitted to resume
22collection efforts under this Section. The reminders shall not
23be provided to any credit rating agency. The reminders may
24request that the employee furnish the provider with information
25about the proceeding under this Act, such as the file number,
26names of parties, and status of the case. If an employee fails

 

 

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1to respond to such request for information or fails to furnish
2the information requested within 90 days of the date of the
3reminder, the provider is entitled to resume any and all
4efforts to collect payment from the employee for the services
5rendered to the employee and the employee shall be responsible
6for payment of any outstanding bills for a procedure,
7treatment, or service rendered by a provider.
8    (e-20) Upon a final award or judgment by an Arbitrator or
9the Commission, or a settlement agreed to by the employer and
10the employee, a provider may resume any and all efforts to
11collect payment from the employee for the services rendered to
12the employee and the employee shall be responsible for payment
13of any outstanding bills for a procedure, treatment, or service
14rendered by a provider as well as the interest awarded under
15subsection (d) of this Section. In the case of a procedure,
16treatment, or service deemed compensable, the provider shall
17not require a payment rate, excluding the interest provisions
18under subsection (d), greater than the lesser of the actual
19charge or the payment level set by the Commission in the fee
20schedule established in this Section. Payment for services
21deemed not covered or not compensable under this Act is the
22responsibility of the employee unless a provider and employee
23have agreed otherwise in writing. Services not covered or not
24compensable under this Act are not subject to the fee schedule
25in this Section.
26    (f) Nothing in this Act shall prohibit an employer or

 

 

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1insurer from contracting with a health care provider or group
2of health care providers for reimbursement levels for benefits
3under this Act different from those provided in this Section.
4    (g) On or before January 1, 2010 the Commission shall
5provide to the Governor and General Assembly a report regarding
6the implementation of the medical fee schedule and the index
7used for annual adjustment to that schedule as described in
8this Section.
9(Source: P.A. 100-1117, eff. 11-27-18; 100-1175, eff.
101-11-19.)
 
11    Section 99. Effective date. This Act takes effect upon
12becoming law.