[ Search ] [ PDF text ] [ Legislation ]
[ Home ] [ Back ] [ Bottom ]
92_HB3052
LRB9208265LBmb
1 AN ACT in relation to healthcare.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 1. Short title. This Act may be cited as the
5 Notice to Health Carriers Act.
6 Section 5. Definitions. For purposes of this Act:
7 "Adverse action" means any action by the Department
8 reducing, limiting, restricting, impairing, suspending,
9 revoking, denying, or failing to renew the license of a
10 physician or other licensed health care professional.
11 "Department" means the Department of Professional
12 Regulation.
13 "Health carrier" or "carrier" means an entity subject to
14 the insurance laws of this State that contracts or offers to
15 contract to provide, deliver, arrange for, pay for, or
16 reimburse any of the costs of health care services.
17 "Licensed health care professional" means an individual
18 who is licensed or otherwise authorized by law to provide
19 health care items and services.
20 Section 10. Required notice. Whenever the Department of
21 Professional Regulation takes any adverse action against a
22 physician or other licensed health care professional, the
23 Department shall notify each health carrier that requests
24 that information not later than 7 days after the close of
25 the month in which the action is taken, except that the
26 Department may by rule designate categories or types of cases
27 in which more timely notice is appropriate and specify a
28 deadline for the notice in those cases.
29 Section 15. Contents of notice. The notice required by
-2- LRB9208265LBmb
1 Section 10 shall be in such a form as the Department may
2 require and shall specify the adverse action taken, the date
3 on which the action becomes effective, and any corrective
4 actions taken by the Department including, but not limited
5 to, requiring the physician or other health care professional
6 to obtain additional continuing education credits or other
7 training, except that the notice may not include any
8 individually identifiable health information with respect to
9 a patient of the physician or other licensed health care
10 professional.
11 Section 20. Effect on health carrier contracts. A health
12 carrier may impose a limitation, restriction, suspension, or
13 termination on the agreement under which a physician or
14 licensed health care professional who is the subject of a
15 notice under Section 10 furnishes health care items and
16 services to participants, beneficiaries, or enrollees of the
17 health carrier effective on or after the date upon which the
18 notice under Section 10 is provided to the health carrier, if
19 the health carrier determines that:
20 (1) the physician or licensed health care
21 professional poses an imminent threat to the health and
22 safety of participants, beneficiaries, or enrollees of
23 the plan;
24 (2) the physician or licensed health care
25 professional has engaged in fraudulent activities with
26 respect to the health carrier or has provided false or
27 misleading information to the health carrier or withheld
28 information from the health carrier on matters relating
29 to the professional conduct or qualifications of the
30 physician or licensed health care professional; or
31 (3) the adverse action of which the health carrier
32 was notified pursuant to Section 10 removes or
33 significantly impairs the ability of the physician or
-3- LRB9208265LBmb
1 licensed health care professional to furnish health care
2 items and services to participants, beneficiaries, or
3 enrollees of the health carrier.
4 Section 25. Immunity. A physician or licensed health
5 care professional who is the subject of a limitation,
6 restriction, suspension, or termination of the agreement
7 under which the physician or health care professional
8 furnishes health care items or services to participants,
9 beneficiaries, or enrollees of a health carrier shall have no
10 cause of action for damages arising from such action of the
11 health carrier.
12 Section 99. Effective date. This Act takes effect upon
13 becoming law.