HB0311ham002 100TH GENERAL ASSEMBLY

Rep. Gregory Harris

Filed: 3/29/2017

10000HB0311ham002 LRB100 05356 SMS 24527 a

AMENDMENT TO HOUSE BILL 311

AMENDMENT NO. ______. Amend House Bill 311, AS AMENDED, with reference to page and line numbers of House Amendment No. 1, on page 1, immediately below line 5, by inserting the following:

"Section 3. Applicability of Act. This Act applies to an individual or group policy of accident and health insurance with a network plan amended, delivered, issued, or renewed in this State on or after January 1, 2019."; and

on page 1, immediately below line 6, by inserting the following:

""Authorized representative" means a person to whom a beneficiary has given express written consent to represent the beneficiary; a person authorized by law to provide substituted consent for a beneficiary; or the beneficiary's treating provider only when the beneficiary or his or her family member is unable to provide consent."; and

on page 3, line 20, by replacing "256z.22 of the Insurance Code" with "356z.22 of the Illinois Insurance Code"; and

on page 5, by replacing lines 1 and 2 with the following:

"(b) Insurers must file for review a description of the services"; and

on page 5, line 25, by deleting "full-time equivalent"; and

on page 6, line 22, by replacing "apply to" with "apply to: (A)"; and

on page 6, line 25, by replacing "providers." with "providers, or (B) a beneficiary enrolled in a health maintenance organization."; and

on page 7, by replacing lines 17 and 18 with the following:

"(c) The network plan shall demonstrate to the Director a minimum ratio of"; and

on page 7, line 20, by deleting "full-time equivalent"; and

on page 7, line 25, by deleting "concerning exchange plans or Medicare Advantage Plans"; and

on page 9, lines 6 and 22, by deleting "annual" each time it appears; and

on page 9, lines 9 and 10, by deleting ", prior to approval,"; and

on page 9, by replacing lines 14 and 15 with "and Medicaid Services. These standards shall consist of the maximum"; and

on page 9, line 26, by replacing "These" with "Except for network plans solely offered as a group health plan, these"; and

by replacing line 15 on page 11 through line 1 on page 12 with the following:

"Section 15. Notice of renewal or termination.

(a) A network plan must give at least 60 days' notice of nonrenewal or termination of a provider to the provider and to the beneficiaries served by the provider. The notice shall include a name and address to which a beneficiary or provider may direct comments and concerns regarding the nonrenewal or termination and the telephone number maintained by the Department for consumer complaints. Immediate written notice may be provided without 60 days' notice when a provider's license has been disciplined by a State licensing board or when the network plan reasonably believes direct imminent physical harm to patients under the providers care may occur.

(b) Primary care providers must notify active affected patients of nonrenewal or termination of the provider from the network plan, except in the case of incapacitation."; and

on page 14, by replacing line 9 with the following:

"(2) If a beneficiary, or a beneficiary's authorized representative, elects in writing to continue to receive care"; and

on page 16, line 8, by deleting "annually"; and

on page 16, line 9, after "Director", by inserting "upon request"; and

on page 20, immediately below line 23, by inserting the following:

"Section 30. Facility nonparticipating provider transparency. Prior to providing a non-emergency outpatient procedure to a beneficiary in an in-network facility or during the admission or as soon as practicable thereafter, the hospital must provide an insured patient with written notice that:

(1) the patient may receive separate bills for services provided by health care professionals affiliated with the hospital;

(2) if applicable, some hospital staff members may not be participating providers in the same insurance plans and networks as the hospital;

(3) if applicable, the patient may have a greater financial responsibility for services provided by health care professionals at the hospital who are not under contract with the patient's health care plan; and

(4) questions about coverage or benefit levels should be directed to the patient's health care plan and the patient's certificate of coverage."; and

on page 20, line 24, by replacing "30" with "35"; and

on page 21, by replacing lines 12 through 16 with "pursuant to the enforcement powers granted to it by law."; and

on page 21, by replacing lines 19 and 20 with the following:

"Section 99. Effective date. This Act takes effect upon becoming law.".