Full Text of SB1518 95th General Assembly
SB1518 95TH GENERAL ASSEMBLY
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95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008 SB1518
Introduced 2/9/2007, by Sen. William R. Haine SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Insurance Code. Provides that a company authorized to do business in the State or accredited by the State to issue policies of health insurance, self-insured plans, group health plans, service benefit plans, managed care organizations, pharmacy benefit managers, or other parties that are by statute, contract, or agreement legally responsible for payment of a claim for a health care item or service as a condition of doing business in the State must follow specified guidelines concerning (1) the reporting of information to the Department of Healthcare and Family services; (2) the State's right of recovery for payment made under the medical programs of the Department; (3) the response to any inquiry by the Department regarding certain claims; and (4) an agreement not to deny a claim submitted to the Department that meet specified criteria. Effective immediately.
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A BILL FOR
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SB1518 |
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LRB095 07672 MJR 27824 b |
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| AN ACT concerning regulation.
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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 adding | 5 |
| Section 5.5 as follows: | 6 |
| (215 ILCS 5/5.5 new) | 7 |
| Sec. 5.5. Compliance with the Department of Healthcare and | 8 |
| Family Services. A company authorized to do business in this | 9 |
| State or accredited by the State to issue policies of health | 10 |
| insurance, including but not limited to, self-insured plans, | 11 |
| group health plans (as defined in Section 607(1) of the | 12 |
| Employee Retirement Income Security Act of 1974), service | 13 |
| benefit plans, managed care organizations, pharmacy benefit | 14 |
| managers, or other parties that are by statute, contract, or | 15 |
| agreement legally responsible for payment of a claim for a | 16 |
| health care item or service as a condition of doing business in | 17 |
| the State must: | 18 |
| (1) provide to the Department of Healthcare and Family | 19 |
| Services, or any successor agency, upon request | 20 |
| information to determine during what period any individual | 21 |
| may be, or may have been, covered by a health insurer and | 22 |
| the nature of the coverage that is or was provided by the | 23 |
| health insurer, including the name, address, and |
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SB1518 |
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LRB095 07672 MJR 27824 b |
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| identifying number of the plan; | 2 |
| (2) accept the State's right of recovery and the | 3 |
| assignment to the State of any right of an individual or | 4 |
| other entity to payment from the party for an item or | 5 |
| service for which payment has been made under the medical | 6 |
| programs of the Department of Healthcare and Family | 7 |
| Services, or any successor agency, under this Code or the | 8 |
| Illinois Public Aid Code; | 9 |
| (3) respond to any inquiry by the Department of | 10 |
| Healthcare and Family Services regarding a claim for | 11 |
| payment for any health care item or service that is | 12 |
| submitted not later than 3 years after the date of the | 13 |
| provision of such health care item or service; and | 14 |
| (4) agree not to deny a claim submitted by the | 15 |
| Department of Healthcare and Family Services solely on the | 16 |
| basis of the date of submission of the claim, the type or | 17 |
| format of the claim form, or a failure to present proper | 18 |
| documentation at the point-of-sale that is the basis of the | 19 |
| claim if (i) the claim is submitted by the Department of | 20 |
| Healthcare and Family Services within the 3-year period | 21 |
| beginning on the date on which the item or service was | 22 |
| furnished and (ii) any action by the Department of | 23 |
| Healthcare and Family Services to enforce its rights with | 24 |
| respect to such claim is commenced within 6 years of its | 25 |
| submission of such claim.
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| Section 99. Effective date. This Act takes effect upon |
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SB1518 |
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LRB095 07672 MJR 27824 b |
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| becoming law.
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