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1 | AN ACT concerning regulation. | |||||||||||||||||||
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 | Protection Against Unnecessary Health Care Costs Act. | |||||||||||||||||||
6 | Section 5. Drug Discount Card Program. | |||||||||||||||||||
7 | (a) In this Section, "volume discount contracting" means a | |||||||||||||||||||
8 | negotiated purchase of a prescription drug in a large quantity | |||||||||||||||||||
9 | for a decreased cost. | |||||||||||||||||||
10 | (b) The State Comptroller shall establish the Drug | |||||||||||||||||||
11 | Discount Card Program to be made available for all residents | |||||||||||||||||||
12 | of this State. To further the purpose of the program, the State | |||||||||||||||||||
13 | Comptroller may cooperate with other states and territories of | |||||||||||||||||||
14 | the United States, or regional consortia to pool prescription | |||||||||||||||||||
15 | drug purchasing power to (1) lower prescription drug costs, | |||||||||||||||||||
16 | (2) negotiate discounts with prescription drug manufacturers, | |||||||||||||||||||
17 | (3) centralize the purchasing of prescription drugs, and (4) | |||||||||||||||||||
18 | establish volume discount contracting. | |||||||||||||||||||
19 | (c) The State Comptroller shall study the feasibility of | |||||||||||||||||||
20 | centralizing statewide contracts to consolidate the purchasing | |||||||||||||||||||
21 | of prescription and physician-administered drugs by State | |||||||||||||||||||
22 | agencies, State hospitals, State-operated community mental | |||||||||||||||||||
23 | health centers, and other public entities, as necessary. The |
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1 | study shall include an evaluation of (1) the potential cost | ||||||
2 | savings, administrative feasibility, and other benefits and | ||||||
3 | risks of centralizing and consolidating contracts, and (2) any | ||||||
4 | additional staff and resources required by the State | ||||||
5 | Comptroller to centrally procure and administer those | ||||||
6 | contracts. Not later than November 1, 2026, each State agency, | ||||||
7 | State hospital, community mental health center, and other | ||||||
8 | public entity, as necessary, that procures prescription or | ||||||
9 | physician-administered drugs shall provide information | ||||||
10 | regarding the types, amount, and cost of those drugs to the | ||||||
11 | State Comptroller, in a form and manner prescribed by the | ||||||
12 | State Comptroller. Not later than February 1, 2027, the State | ||||||
13 | Comptroller shall submit a report regarding the findings of | ||||||
14 | the study to the Governor and the General Assembly. | ||||||
15 | Section 10. Physician outreach and education on drug | ||||||
16 | patents. Not later than January 1, 2026, the Department of | ||||||
17 | Insurance, in consultation with the Consumer Protection | ||||||
18 | Division of the Office of the Attorney General, shall report | ||||||
19 | to the General Assembly and to the Governor recommendations | ||||||
20 | for establishing an outreach and education program to inform | ||||||
21 | licensed physicians on: (1) when a drug patent will expire and | ||||||
22 | become available in generic form; and (2) when generic | ||||||
23 | alternatives exist for drugs whose patent recently expired. | ||||||
24 | Section 15. Definitions. For the purposes of this Section |
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1 | through the Section immediately preceding Section 35: | ||||||
2 | "Contact" means any communication to promote or provide | ||||||
3 | information relating to a legend drug that is transmitted in | ||||||
4 | person or by telephone, email, text message, or other | ||||||
5 | electronic means between a pharmaceutical representative and a | ||||||
6 | prescribing practitioner or pharmacist. | ||||||
7 | "Department" means the Department of Financial and | ||||||
8 | Professional Regulation. | ||||||
9 | "Legend drug" has the meaning given to that term in | ||||||
10 | Section 3.23 of the Illinois Food, Drug and Cosmetic Act. | ||||||
11 | "Pharmaceutical manufacturer" means: (1) a person, whether | ||||||
12 | within or outside the boundaries of the State, that produces, | ||||||
13 | prepares, cultivates, grows, propagates, compounds, converts, | ||||||
14 | or processes a drug, device, or cosmetic, directly or | ||||||
15 | indirectly, by extraction from substances of natural origin, | ||||||
16 | by means of chemical synthesis, or by a combination of | ||||||
17 | extraction and chemical synthesis, or that packages, | ||||||
18 | repackages, labels, or relabels a container under the | ||||||
19 | manufacturer's own trademark or label or any other trademark | ||||||
20 | or label, or a drug, device, or cosmetic for the purpose of | ||||||
21 | selling the drug, device, or cosmetic, or (2) a sterile | ||||||
22 | compounding pharmacy. | ||||||
23 | "Pharmaceutical manufacturer" includes a virtual | ||||||
24 | manufacturer. | ||||||
25 | "Pharmaceutical marketing firm" means a pharmaceutical | ||||||
26 | manufacturer that employs pharmaceutical representatives. |
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1 | "Pharmaceutical representative" means any person, | ||||||
2 | including, but not limited to, a sales representative, who | ||||||
3 | markets, promotes, or provides information regarding a legend | ||||||
4 | drug for human use to a prescribing practitioner and is | ||||||
5 | employed or compensated by a pharmaceutical manufacturer. | ||||||
6 | "Pharmacist" means an individual licensed to engage in the | ||||||
7 | practice of pharmacy under the Pharmacy Practice Act or | ||||||
8 | licensed to engage in the practice of pharmacy in another | ||||||
9 | state. | ||||||
10 | "Prescribing practitioner" means an individual authorized | ||||||
11 | by law to prescribe the usage of certain drugs for medical | ||||||
12 | purposes. | ||||||
13 | "Secretary" means the Secretary of Financial and | ||||||
14 | Professional Regulation. | ||||||
15 | "Tagline" means a short statement written in a non-English | ||||||
16 | language that indicates the availability of language | ||||||
17 | assistance services free of charge. | ||||||
18 | Section 20. Pharmaceutical marketing firm registration. | ||||||
19 | (a) On and after October 1, 2025, a pharmaceutical | ||||||
20 | manufacturer that employs an individual to perform the duties | ||||||
21 | of a pharmaceutical sales representative shall register | ||||||
22 | annually with the Department of Financial and Professional | ||||||
23 | Regulation as a pharmaceutical marketing firm, in a form and | ||||||
24 | manner prescribed by the Department. No pharmaceutical | ||||||
25 | manufacturer shall authorize an individual to perform such |
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1 | duties on the manufacturer's behalf unless the manufacturer | ||||||
2 | has obtained a registration from the Department pursuant to | ||||||
3 | this Section. Registrations issued pursuant to this Section | ||||||
4 | shall expire annually on June 30. | ||||||
5 | (b) The nonrefundable fee for registration as a | ||||||
6 | pharmaceutical marketing firm and for annual renewal of that | ||||||
7 | registration is $150. Any pharmaceutical marketing firm that | ||||||
8 | fails to renew its registration on or before June 30 shall pay | ||||||
9 | a late fee of $100 for each year that the pharmaceutical | ||||||
10 | marketing firm did not renew, in addition to the annual | ||||||
11 | renewal fee required under this Section. | ||||||
12 | (c) On the date of its initial registration, and annually | ||||||
13 | thereafter, each pharmaceutical marketing firm shall provide | ||||||
14 | to the Department a list of all individuals employed by the | ||||||
15 | pharmaceutical marketing firm as a pharmaceutical sales | ||||||
16 | representative. Each pharmaceutical marketing firm shall | ||||||
17 | notify the Department, in a form and manner prescribed by the | ||||||
18 | Department, of each individual who is no longer employed as a | ||||||
19 | pharmaceutical sales representative or who was hired after the | ||||||
20 | date on which the pharmaceutical marketing firm provided the | ||||||
21 | annual list, not later than 2 weeks after the individual left | ||||||
22 | employment or was hired. | ||||||
23 | (d) The Department shall prominently post on its website | ||||||
24 | the most recent list provided by each pharmaceutical marketing | ||||||
25 | firm pursuant to subsection (c) of this Section. | ||||||
26 | (e) Any person who is not identified to the Department |
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1 | pursuant to subsection (c) of this Section shall not perform | ||||||
2 | the duties of a pharmaceutical sales representative on behalf | ||||||
3 | of the pharmaceutical marketing firm for any prescribing | ||||||
4 | practitioner in this State. | ||||||
5 | (f) Not later than July 1, 2025, and annually thereafter, | ||||||
6 | each pharmaceutical marketing firm shall provide the Secretary | ||||||
7 | with the following information regarding the performance for | ||||||
8 | the previous calendar year of each of its pharmaceutical sales | ||||||
9 | representatives identified to the Department pursuant to | ||||||
10 | subsection (c) of this Section at any time during the previous | ||||||
11 | calendar year, in a form and manner prescribed by the | ||||||
12 | Department: | ||||||
13 | (1) the aggregate number of contacts the | ||||||
14 | pharmaceutical sales representative had with prescribing | ||||||
15 | practitioners and pharmacists; | ||||||
16 | (2) the specialty of each prescribing practitioner and | ||||||
17 | pharmacist with whom the pharmaceutical sales | ||||||
18 | representative made contact; | ||||||
19 | (3) whether product samples, materials, or gifts of | ||||||
20 | any value were provided to a prescribing practitioner or | ||||||
21 | the practitioner's staff in a prescribing practitioner's | ||||||
22 | office or to a pharmacist; and | ||||||
23 | (4) an aggregate report of all free samples, by drug | ||||||
24 | name and strength, in a form and manner prescribed by the | ||||||
25 | Department. | ||||||
26 | (g) The Department shall annually analyze the information |
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1 | submitted pursuant to this Section and compile a report on the | ||||||
2 | activities and pharmaceutical representatives in the State. | ||||||
3 | Not later than December 1, 2026, and annually thereafter, the | ||||||
4 | Department shall post the report on its website and submit the | ||||||
5 | report to the Governor and the General Assembly. | ||||||
6 | Section 25. Legend drug marketing. Each pharmaceutical | ||||||
7 | representative engaged in legend drug marketing in this State | ||||||
8 | shall disclose, in writing, to a prescribing practitioner or | ||||||
9 | pharmacist, at the time of each contact with the prescribing | ||||||
10 | practitioner or pharmacist, the following: | ||||||
11 | (1) the list price of a legend drug when the | ||||||
12 | pharmaceutical representative provides information | ||||||
13 | concerning the legend drug to the prescribing practitioner | ||||||
14 | or pharmacist based on the dose and quantity of the legend | ||||||
15 | drug as described in the medication package insert; and | ||||||
16 | (2) information on the variation efficacy of the | ||||||
17 | legend drug marketed to different racial and ethnic | ||||||
18 | groups, if that information is available. | ||||||
19 | Section 30. Discipline of pharmaceutical marketing firms. | ||||||
20 | (a) The Department may: (1) refuse to authorize the | ||||||
21 | issuance or renewal of a registration to operate as a | ||||||
22 | pharmaceutical marketing firm; (2) revoke, suspend, or place | ||||||
23 | conditions on a registration to operate as a pharmaceutical | ||||||
24 | marketing firm; and (3) assess a penalty of up to $1,000 for |
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1 | each violation of any provision of Section 20 or 25, or take | ||||||
2 | other action permitted by law, if the applicant or holder of | ||||||
3 | the registration fails to comply with the requirements set | ||||||
4 | forth in Section 20 or 25. | ||||||
5 | (b) The Department may adopt rules as necessary to | ||||||
6 | implement this Section. | ||||||
7 | Section 35. Report of pharmacy benefit managers' | ||||||
8 | practices. Not later than January 1, 2026, the Department of | ||||||
9 | Public Health, in consultation with the Department of | ||||||
10 | Insurance, shall report to the General Assembly and the | ||||||
11 | Governor, its analysis of pharmacy benefit managers' practices | ||||||
12 | of prescription drug distribution, including, but not limited | ||||||
13 | to, spread pricing arrangements, manufacturing rebates and | ||||||
14 | transparency, fees charged, financial incentives for adding | ||||||
15 | drugs to health plan formularies and an evaluation of | ||||||
16 | prescription drug distribution practices conducted by pharmacy | ||||||
17 | benefit managers in other states. The report shall provide | ||||||
18 | recommendations (1) to reduce prescription drug costs for | ||||||
19 | consumers, and (2) for the regulation of pharmacy benefit | ||||||
20 | managers in this State. | ||||||
21 | Section 40. List of outpatient prescription drugs. | ||||||
22 | (a) On or before January 1, 2025, and annually thereafter, | ||||||
23 | the Director of Public Health, in consultation with the State | ||||||
24 | Comptroller and the Department of Insurance, shall prepare a |
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1 | list of not more than 10 outpatient prescription drugs that | ||||||
2 | the Director of Public Health, in the Director of Public | ||||||
3 | Health's discretion, determines are (A) provided at | ||||||
4 | substantial cost to the State, considering the net cost of | ||||||
5 | such drugs, or (B) critical to public health. The list shall | ||||||
6 | include outpatient prescription drugs from different | ||||||
7 | therapeutic classes of outpatient prescription drugs and not | ||||||
8 | less than one generic outpatient prescription drug. | ||||||
9 | (b) Prior to publishing the annual list pursuant to | ||||||
10 | subsection (a) of this Section, the Director of Public Health | ||||||
11 | shall prepare a preliminary list that includes outpatient | ||||||
12 | prescription drugs that the Director of Public Health plans to | ||||||
13 | include on the annual list. The Director of Public Health | ||||||
14 | shall make the preliminary list available for public comment | ||||||
15 | for not less than 30 days. During the public comment period, | ||||||
16 | any manufacturer of an outpatient prescription drug included | ||||||
17 | on the preliminary list may produce documentation, as | ||||||
18 | permitted by federal law, to the Director of Public Health to | ||||||
19 | establish that the wholesale acquisition cost of such drug, | ||||||
20 | less all rebates paid to the State for that outpatient | ||||||
21 | prescription drug during the immediately preceding calendar | ||||||
22 | year, does not exceed the limits established in subsection (c) | ||||||
23 | of this Section. If the documentation establishes, to the | ||||||
24 | satisfaction of the Director of Public Health, that the | ||||||
25 | wholesale acquisition cost of the drug, less all rebates paid | ||||||
26 | to the State for that drug during the immediately preceding |
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1 | calendar year, does not exceed the limits established in | ||||||
2 | subsection (c) of this Section, the Director of Public Health | ||||||
3 | shall, not later than 15 days after the closing of public | ||||||
4 | comment, remove that drug from the preliminary list before | ||||||
5 | publishing the annual list pursuant to subsection (a) of this | ||||||
6 | Section. | ||||||
7 | (c) The Director of Public Health shall not list any | ||||||
8 | outpatient prescription drugs under subsection (a) or (b) of | ||||||
9 | this Section unless the wholesale acquisition cost of that | ||||||
10 | outpatient prescription drug (A) increased by not less than | ||||||
11 | 16% cumulatively during the immediately preceding 2 calendar | ||||||
12 | years, and (B) was not less than $40 for a course of treatment. | ||||||
13 | (d)(1) The pharmaceutical manufacturer of an outpatient | ||||||
14 | prescription drug included on a list prepared by the Director | ||||||
15 | of Public Health pursuant to subsection (a) of this Section | ||||||
16 | shall provide to the Department of Public Health, in a form and | ||||||
17 | manner specified by the Director of Public Health, (i) a | ||||||
18 | written, narrative description, suitable for public release, | ||||||
19 | of all factors that caused the increase in the wholesale | ||||||
20 | acquisition cost of the listed outpatient prescription drug, | ||||||
21 | and (ii) aggregate, company-level research and development | ||||||
22 | costs and such other capital expenditures that the Director of | ||||||
23 | Public Health, in the Director of Public Health's discretion, | ||||||
24 | deems relevant for the most recent year for which final | ||||||
25 | audited data are available. | ||||||
26 | (2) The quality and types of information and data that a |
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1 | pharmaceutical manufacturer submits to the office under this | ||||||
2 | subsection shall be consistent with the quality and types of | ||||||
3 | information and data that the pharmaceutical manufacturer | ||||||
4 | includes in (i) the pharmaceutical manufacturer's annual | ||||||
5 | consolidated report on Securities and Exchange Commission Form | ||||||
6 | 10-K, or (ii) any other public disclosure. | ||||||
7 | (e) The Department of Public Health shall establish a | ||||||
8 | standardized form for reporting information and data pursuant | ||||||
9 | to this Section after consulting with pharmaceutical | ||||||
10 | manufacturers. The form shall be designed to minimize the | ||||||
11 | administrative burden and cost of reporting on the office and | ||||||
12 | pharmaceutical manufacturers. | ||||||
13 | Section 45. Hospital facility fees. | ||||||
14 | (a) As used in this Section: | ||||||
15 | "Affiliated provider" means a provider that is: (1) | ||||||
16 | employed by a hospital or health system; (2) under a | ||||||
17 | professional services agreement with a hospital or health | ||||||
18 | system that permits the hospital or health system to bill on | ||||||
19 | behalf of such provider; or (3) a clinical faculty member of a | ||||||
20 | medical school that is affiliated with a hospital or health | ||||||
21 | system in a manner that permits the hospital or health system | ||||||
22 | to bill on behalf of the clinical faculty member. | ||||||
23 | "Campus" means: (1) the physical area immediately adjacent | ||||||
24 | to a hospital's main buildings and other areas and structures | ||||||
25 | that are not strictly contiguous to the main buildings but are |
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1 | located within 250 yards of the main buildings; or (2) any | ||||||
2 | other area that has been determined on an individual case | ||||||
3 | basis by the Department of Public Health, the Department of | ||||||
4 | Human Services, or other State agency to be a part of a | ||||||
5 | hospital's campus. | ||||||
6 | "Facility fee" means any fee charged or billed by a | ||||||
7 | hospital or health system for outpatient services provided in | ||||||
8 | a hospital-based facility that is: (1) intended to compensate | ||||||
9 | the hospital or health system for the operational expenses of | ||||||
10 | the hospital or health system; and (2) separate and distinct | ||||||
11 | from a professional fee. | ||||||
12 | "Health care provider" means an individual, entity, | ||||||
13 | corporation, person or organization, whether for-profit or | ||||||
14 | not-for-profit, that furnishes bills or is paid for health | ||||||
15 | care service delivery in the normal course of business, | ||||||
16 | including, but not limited to, a health system, a hospital, a | ||||||
17 | hospital-based facility, a freestanding emergency department | ||||||
18 | and an urgent care center. | ||||||
19 | "Health system" means: (1) a parent corporation of one or | ||||||
20 | more hospitals and any entity affiliated with such parent | ||||||
21 | corporation through ownership, governance, membership, or | ||||||
22 | other means; or (2) a hospital and any entity affiliated with | ||||||
23 | the hospital through ownership, governance, membership, or | ||||||
24 | other means. | ||||||
25 | "Hospital" means an institution, place, building, or | ||||||
26 | agency located in this State that is licensed as a general |
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1 | acute hospital by the Department of Public Health under the | ||||||
2 | Hospital Licensing Act, whether public or private and whether | ||||||
3 | organized for profit or not-for-profit. | ||||||
4 | "Hospital-based facility" means a facility that is owned | ||||||
5 | or operated, in whole or in part, by a hospital or health | ||||||
6 | system where hospital or professional medical services are | ||||||
7 | provided. | ||||||
8 | "Medicaid" means the federal medical assistance program | ||||||
9 | established under Title XIX of the Social Security Act. | ||||||
10 | "Observation" means services furnished by a hospital on | ||||||
11 | the hospital's campus, regardless of the length of stay, | ||||||
12 | including use of a bed and periodic monitoring by the | ||||||
13 | hospital's nursing or other staff to evaluate an outpatient's | ||||||
14 | condition or determine the need for admission to the hospital | ||||||
15 | as an inpatient. | ||||||
16 | "Payer mix" means the proportion of different sources of | ||||||
17 | payment received by a hospital or health system, including, | ||||||
18 | but not limited to, Medicare, Medicaid, other | ||||||
19 | government-provided insurance, private insurance, and self-pay | ||||||
20 | patients. | ||||||
21 | "Professional fee" means any fee charged or billed by a | ||||||
22 | provider for professional medical services provided in a | ||||||
23 | hospital-based facility. | ||||||
24 | "Provider" means an individual, entity, corporation, or | ||||||
25 | health care provider, whether for profit or not-for-profit, | ||||||
26 | whose primary purpose is to provide professional medical |
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1 | services. | ||||||
2 | (b) If a hospital or health system charges a facility fee | ||||||
3 | using a current procedural terminology evaluation (CPT E/M) | ||||||
4 | code or assessment and management (CPT A/M) code for | ||||||
5 | outpatient services provided at a hospital-based facility | ||||||
6 | where a professional fee is also expected to be charged, the | ||||||
7 | hospital or health system shall provide the patient with a | ||||||
8 | written notice that includes the following information: | ||||||
9 | (1) that the hospital-based facility is part of a | ||||||
10 | hospital or health system and that the hospital or health | ||||||
11 | system charges a facility fee that is in addition to and | ||||||
12 | separate from the professional fee charged by the | ||||||
13 | provider; | ||||||
14 | (2)(A) the amount of the patient's potential financial | ||||||
15 | liability, including any facility fee likely to be | ||||||
16 | charged, and, where professional medical services are | ||||||
17 | provided by an affiliated provider, any professional fee | ||||||
18 | likely to be charged, or, if the exact type and extent of | ||||||
19 | the professional medical services needed are not known or | ||||||
20 | the terms of a patient's health insurance coverage are not | ||||||
21 | known with reasonable certainty, an estimate of the | ||||||
22 | patient's financial liability based on typical or average | ||||||
23 | charges for visits to the hospital-based facility, | ||||||
24 | including the facility fee, (B) a statement that the | ||||||
25 | patient's actual financial liability will depend on the | ||||||
26 | professional medical services actually provided to the |
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1 | patient, (C) an explanation that the patient may incur | ||||||
2 | financial liability that is greater than the patient would | ||||||
3 | incur if the professional medical services were not | ||||||
4 | provided by a hospital-based facility, and (D) a telephone | ||||||
5 | number the patient may call for additional information | ||||||
6 | regarding the patient's potential financial liability, | ||||||
7 | including an estimate of the facility fee likely to be | ||||||
8 | charged based on the scheduled professional medical | ||||||
9 | services; and | ||||||
10 | (3) that a patient covered by a health insurance | ||||||
11 | policy should contact the health insurer for additional | ||||||
12 | information regarding the hospital's or health system's | ||||||
13 | charges and fees, including the patient's potential | ||||||
14 | financial liability, if any, for such charges and fees. | ||||||
15 | (c) If a hospital or health system charges a facility fee | ||||||
16 | without using a current procedural terminology evaluation and | ||||||
17 | management (CPT E/M) code for outpatient services provided at | ||||||
18 | a hospital-based facility, located outside of the hospital | ||||||
19 | campus, the hospital or health system shall provide the | ||||||
20 | patient with a written notice that includes the following | ||||||
21 | information: | ||||||
22 | (1) that the hospital-based facility is part of a | ||||||
23 | hospital or health system and that the hospital or health | ||||||
24 | system charges a facility fee that may be in addition to | ||||||
25 | and separate from the professional fee charged by a | ||||||
26 | provider: |
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1 | (2)(A) a statement that the patient's actual financial | ||||||
2 | liability will depend on the professional medical services | ||||||
3 | actually provided to the patient, (B) an explanation that | ||||||
4 | the patient may incur financial liability that is greater | ||||||
5 | than the patient would incur if the hospital-based | ||||||
6 | facility was not hospital-based, and (C) a telephone | ||||||
7 | number the patient may call for additional information | ||||||
8 | regarding the patient's potential financial liability, | ||||||
9 | including an estimate of the facility fee likely to be | ||||||
10 | charged based on the scheduled professional medical | ||||||
11 | services; and | ||||||
12 | (3) that a patient covered by a health insurance | ||||||
13 | policy should contact the health insurer for additional | ||||||
14 | information regarding the hospital's or health system's | ||||||
15 | charges and fees, including the patient's potential | ||||||
16 | financial liability, if any, for such charges and fees. | ||||||
17 | (d) Each initial billing statement that includes a | ||||||
18 | facility fee shall: (1) clearly identify the fee as a facility | ||||||
19 | fee that is billed in addition to, or separately from, any | ||||||
20 | professional fee billed by the provider; (2) provide the | ||||||
21 | corresponding Medicare facility fee reimbursement rate for the | ||||||
22 | same service as a comparison or, if there is no corresponding | ||||||
23 | Medicare facility fee for such service, (A) the approximate | ||||||
24 | amount Medicare would have paid the hospital for the facility | ||||||
25 | fee on the billing statement, or (B) the percentage of the | ||||||
26 | hospital's charges that Medicare would have paid the hospital |
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1 | for the facility fee; (3) include a statement that the | ||||||
2 | facility fee is intended to cover the hospital's or health | ||||||
3 | system's operational expenses; (4) inform the patient that the | ||||||
4 | patient's financial liability may have been less if the | ||||||
5 | services had been provided at a facility not owned or operated | ||||||
6 | by the hospital or health system; and (5) include written | ||||||
7 | notice of the patient's right to request a reduction in the | ||||||
8 | facility fee or any other portion of the bill and a telephone | ||||||
9 | number that the patient may use to request such a reduction | ||||||
10 | without regard to whether such patient qualifies for, or is | ||||||
11 | likely to be granted, any reduction. Not later than January 1, | ||||||
12 | 2025, and annually thereafter, each hospital, health system, | ||||||
13 | and hospital-based facility shall submit to the Department of | ||||||
14 | Public Health a sample of a billing statement issued by the | ||||||
15 | hospital, health system, or hospital-based facility that | ||||||
16 | complies with this subsection and that represents the format | ||||||
17 | of billing statements received by patients. The billing | ||||||
18 | statement shall not contain patient identifying information. | ||||||
19 | (e) The written notice described in subsections (b), (c), | ||||||
20 | (d), (h), (i), and (j) of this Section shall be in plain | ||||||
21 | language and in a form that may be reasonably understood by a | ||||||
22 | patient who does not possess special knowledge regarding | ||||||
23 | hospital or health system facility fee charges. On and after | ||||||
24 | January 1, 2025, the written notices shall include taglines in | ||||||
25 | at least the top 15 languages spoken in the State indicating | ||||||
26 | that the notice is available in each of those languages. |
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| |||||||
1 | (f)(1) For nonemergency care, if a patient's appointment | ||||||
2 | is scheduled to occur 10 or more days after the appointment is | ||||||
3 | made, written notice shall be sent to the patient by | ||||||
4 | first-class mail, encrypted email, or a secure patient | ||||||
5 | Internet portal not less than 3 days after the appointment is | ||||||
6 | made. If an appointment is scheduled to occur less than 10 days | ||||||
7 | after the appointment is made or if the patient arrives | ||||||
8 | without an appointment, notice shall be hand-delivered to the | ||||||
9 | patient when the patient arrives at the hospital-based | ||||||
10 | facility. | ||||||
11 | (2) For emergency care, written notice shall be provided | ||||||
12 | to the patient as soon as practicable after the patient is | ||||||
13 | stabilized in accordance with the federal Emergency Medical | ||||||
14 | Treatment and Active Labor Act, 42 U.S.C. 1395dd, or is | ||||||
15 | determined not to have an emergency medical condition and | ||||||
16 | before the patient leaves the hospital-based facility. If the | ||||||
17 | patient is unconscious, under great duress, or for any other | ||||||
18 | reason unable to read the notice and understand and act on the | ||||||
19 | patient's rights, the notice shall be provided to the | ||||||
20 | patient's representative as soon as practicable. | ||||||
21 | (g) Subsections (b), (c), (d), (e), (f), and (l) of this | ||||||
22 | Section do not apply if a patient is insured by Medicare or | ||||||
23 | Medicaid. | ||||||
24 | (h) A hospital-based facility shall prominently display | ||||||
25 | written notice in locations that are readily accessible to and | ||||||
26 | visible by patients, including patient waiting or appointment |
| |||||||
| |||||||
1 | check-in areas, stating: (1) that the hospital-based facility | ||||||
2 | is part of a hospital or health system; (2) the name of the | ||||||
3 | hospital or health system; and (3) that if the hospital-based | ||||||
4 | facility charges a facility fee, the patient may incur a | ||||||
5 | financial liability greater than the patient would incur if | ||||||
6 | the hospital-based facility was not hospital-based. On and | ||||||
7 | after January 1, 2025, such notices shall include tag lines in | ||||||
8 | at least the top 15 languages spoken in the State indicating | ||||||
9 | that the notice is available in each of those top 15 languages. | ||||||
10 | Not later than January 1, 2025, and annually thereafter, each | ||||||
11 | hospital-based facility shall submit a copy of the written | ||||||
12 | notice required by this subsection to the Department of Public | ||||||
13 | Health. | ||||||
14 | (i) A hospital-based facility shall clearly hold itself | ||||||
15 | out to the public and payers as being hospital-based, | ||||||
16 | including, at a minimum, by stating the name of the hospital or | ||||||
17 | health system in its signage, marketing materials, websites, | ||||||
18 | and stationery. | ||||||
19 | (j) A hospital-based facility shall, when scheduling | ||||||
20 | services for which a facility fee may be charged, inform the | ||||||
21 | patient: (1) that the hospital-based facility is part of a | ||||||
22 | hospital or health system; (2) of the name of the hospital or | ||||||
23 | health system; (3) that the hospital or health system may | ||||||
24 | charge a facility fee in addition to and separate from the | ||||||
25 | professional fee charged by the provider; and (4) of the | ||||||
26 | telephone number the patient may call for additional |
| |||||||
| |||||||
1 | information regarding such patient's potential financial | ||||||
2 | liability. | ||||||
3 | (k)(1) If any business transaction results in the | ||||||
4 | establishment of a hospital-based facility at which facility | ||||||
5 | fees may be billed, where such a hospital-based facility did | ||||||
6 | not previously exist, the purchaser in such transaction shall, | ||||||
7 | not later than 30 days after such transaction, provide written | ||||||
8 | notice, by first-class mail, of the transaction to each | ||||||
9 | patient served within the 3 years preceding the date of the | ||||||
10 | transaction by the health care facility that has been | ||||||
11 | purchased as part of the transaction. | ||||||
12 | (2) Such notice shall include the following information: | ||||||
13 | (A) A statement that the health care facility is now a | ||||||
14 | hospital-based facility and is part of a hospital or | ||||||
15 | health system, the health care facility's full legal and | ||||||
16 | business name and the date of such facility's acquisition | ||||||
17 | by a hospital or health system. | ||||||
18 | (B) The name, business address, and phone number of | ||||||
19 | the hospital or health system that is the purchaser of the | ||||||
20 | health care facility. | ||||||
21 | (C) A statement that the hospital-based facility | ||||||
22 | bills, or is likely to bill, patients a facility fee that | ||||||
23 | may be in addition to, and separate from, any professional | ||||||
24 | fee billed by a health care provider at the hospital-based | ||||||
25 | facility. | ||||||
26 | (D) A statement that the patient's actual financial |
| |||||||
| |||||||
1 | liability will depend on the professional medical services | ||||||
2 | actually provided to the patient, and an explanation that | ||||||
3 | the patient may incur financial liability that is greater | ||||||
4 | than the patient would incur if the hospital-based | ||||||
5 | facility were not a hospital-based facility. | ||||||
6 | (E) The estimated amount or range of amounts the | ||||||
7 | hospital-based facility may bill for a facility fee or an | ||||||
8 | example of the average facility fee billed at the | ||||||
9 | hospital-based facility for the most common services | ||||||
10 | provided at the hospital-based facility. | ||||||
11 | (F) A statement that, prior to seeking services at the | ||||||
12 | hospital-based facility, a patient covered by a health | ||||||
13 | insurance policy should contact the patient's health | ||||||
14 | insurer for additional information regarding the | ||||||
15 | hospital-based facility fees, including the patient's | ||||||
16 | potential and financial liability, if any, for those | ||||||
17 | hospital-based facility fees. | ||||||
18 | (3) A copy of the written notice provided to patients in | ||||||
19 | accordance with this subsection shall be filed with the | ||||||
20 | Department of Insurance. A link to copies of these written | ||||||
21 | notices shall be conspicuously available on the Department's | ||||||
22 | website. | ||||||
23 | (4) A hospital, health system or hospital-based facility | ||||||
24 | shall not collect a facility fee for services provided at a | ||||||
25 | hospital-based facility that is subject to this subsection | ||||||
26 | from the date of transaction until at least 30 days after the |
| |||||||
| |||||||
1 | written notice required pursuant to this subsection is mailed | ||||||
2 | to the patient or a copy of such notice is filed with the | ||||||
3 | Department of Public Health, whichever is later. A violation | ||||||
4 | of this subsection is a deceptive business practice under the | ||||||
5 | Consumer Fraud and Deceptive Business Practices Act. | ||||||
6 | (5) Not later than July 1, 2025, and annually thereafter, | ||||||
7 | each hospital-based facility that was the subject of a | ||||||
8 | transaction, as described in paragraph (1) of this subsection, | ||||||
9 | during the preceding calendar year shall report to the | ||||||
10 | Department of Insurance the number of patients served by the | ||||||
11 | hospital-based facility in the preceding 3 years. | ||||||
12 | (l)(1) Notwithstanding any other provision of this | ||||||
13 | Section, no hospital, health system, or hospital-based | ||||||
14 | facility shall collect a facility fee for (A) outpatient | ||||||
15 | health care services that use a current procedural terminology | ||||||
16 | evaluation and management (CPT E/M) code or assessment and | ||||||
17 | management (CPT A/M) code and are provided at a hospital-based | ||||||
18 | facility located off-site from a hospital campus, or (B) | ||||||
19 | outpatient health care services provided at a hospital-based | ||||||
20 | facility located off-site from a hospital campus received by a | ||||||
21 | patient who is uninsured of more than the Medicare rate. | ||||||
22 | (2) Notwithstanding any other provision of this Section, | ||||||
23 | on and after July 1, 2025, no hospital or health system shall | ||||||
24 | collect a facility fee for outpatient health care services | ||||||
25 | that use a current procedural terminology evaluation and | ||||||
26 | management (CPT E/M) code or assessment and management (CPT |
| |||||||
| |||||||
1 | A/M) code and are provided on the hospital campus. The | ||||||
2 | provisions of this paragraph do not apply to (A) an emergency | ||||||
3 | department located on a hospital campus, or (B) observation | ||||||
4 | stays on a hospital campus and (CPT E/M) and (CPT A/M) codes | ||||||
5 | when billed for the following services: (i) wound care, (ii) | ||||||
6 | orthopedics, (iii) anticoagulation, (iv) oncology, (v) | ||||||
7 | obstetrics, and (vi) solid organ transplant. | ||||||
8 | (3) Notwithstanding the provisions of paragraphs (1) and | ||||||
9 | (2) of this subsection, in circumstances when an insurance | ||||||
10 | contract that was in effect on or after July 1, 2025, provides | ||||||
11 | reimbursement for facility fees prohibited under the | ||||||
12 | provisions of paragraph (1) of this subsection, and in | ||||||
13 | circumstances when an insurance contract that is in effect on | ||||||
14 | July 1, 2025, provides reimbursement for facility fees | ||||||
15 | prohibited under the provisions of paragraph (2) of this | ||||||
16 | subsection, a hospital or health system may continue to | ||||||
17 | collect reimbursement from the health insurer for such | ||||||
18 | facility fees until the applicable date of expiration, | ||||||
19 | renewal, or amendment of such contract, whichever date is | ||||||
20 | earliest. | ||||||
21 | (4) The provisions of this subsection do not apply to a | ||||||
22 | freestanding emergency department. As used in this paragraph, | ||||||
23 | "freestanding emergency department" means a freestanding | ||||||
24 | facility that (A) is structurally separate and distinct from a | ||||||
25 | hospital, (B) provides emergency care, (C) is a department of | ||||||
26 | a hospital licensed under Hospital Licensing Act, and (D) has |
| |||||||
| |||||||
1 | been issued a certificate of need to operate as a freestanding | ||||||
2 | emergency department by the Health Facilities and Services | ||||||
3 | Review Board by showing the need for such a department in the | ||||||
4 | geographic area where the facility is situated. | ||||||
5 | (5)(A) On and after July 1, 2025, if the Director of Public | ||||||
6 | Health receives information and has a reasonable belief, after | ||||||
7 | evaluating such information, that any hospital, health system, | ||||||
8 | or hospital-based facility charged facility fees, other than | ||||||
9 | through isolated clerical or electronic billing errors, in | ||||||
10 | violation of any provision of this Section, or rule adopted | ||||||
11 | thereunder, such hospital, health system, or hospital-based | ||||||
12 | facility shall be subject to a civil penalty of up to $1,000. | ||||||
13 | The Director of Public Health may issue a notice of violation | ||||||
14 | and civil penalty by first-class mail or personal service. | ||||||
15 | Such notice shall include: (i) a reference to the Section of | ||||||
16 | the statutes, rule, or Section of the rules alleged to have | ||||||
17 | been violated; (ii) a short and plain language statement of | ||||||
18 | the matters asserted or charged; (iii) a description of the | ||||||
19 | activity to cease; (iv) a statement of the amount of the civil | ||||||
20 | penalty or penalties that may be imposed; (v) a statement | ||||||
21 | concerning the right to a hearing; and (vi) a statement that | ||||||
22 | the hospital, health system, or hospital-based facility may, | ||||||
23 | not later than 10 business days after receipt of the notice, | ||||||
24 | make a request for a hearing on the matters asserted. | ||||||
25 | (B) The hospital, health system, or hospital-based | ||||||
26 | facility to whom notice is provided pursuant to subparagraph |
| |||||||
| |||||||
1 | (A) of this paragraph (5) may, not later than 10 business days | ||||||
2 | after receipt of such notice, make written application to the | ||||||
3 | Department of Public Health to request a hearing to | ||||||
4 | demonstrate that such violation did not occur. The failure to | ||||||
5 | make a timely request for a hearing shall result in the | ||||||
6 | issuance of a cease and desist order or civil penalty. All | ||||||
7 | hearings held under this subsection shall be conducted in | ||||||
8 | accordance with Illinois Administrative Procedure Act. | ||||||
9 | (C) Following any hearing pursuant to this paragraph, if | ||||||
10 | the Department of Public Health finds, by a preponderance of | ||||||
11 | the evidence, that the hospital, health system, or | ||||||
12 | hospital-based facility violated or is violating any provision | ||||||
13 | of this subsection, any rule adopted thereunder, or any order | ||||||
14 | issued by the Department of Public Health, the Department of | ||||||
15 | Public Health shall issue a final cease and desist order in | ||||||
16 | addition to any civil penalty the Department of Public Health | ||||||
17 | imposes. | ||||||
18 | (m)(1) Each hospital and health system shall report not | ||||||
19 | later than November 1, 2025, and thereafter not later than | ||||||
20 | July 1, 2026, and annually thereafter, to the Director of | ||||||
21 | Public Health, on a form prescribed by the Department of | ||||||
22 | Public Health, concerning facility fees charged or billed | ||||||
23 | during the preceding calendar year. The report shall include, | ||||||
24 | but need not be limited to: (A) the name and address of each | ||||||
25 | facility owned or operated by the hospital or health system | ||||||
26 | that provides services for which a facility fee is charged or |
| |||||||
| |||||||
1 | billed, and an indication as to whether each facility is | ||||||
2 | located on or outside of the hospital or health system campus; | ||||||
3 | (B) the number of patient visits at each such facility for | ||||||
4 | which a facility fee was charged or billed; (C) the number, | ||||||
5 | total amount, and range of allowable facility fees paid at | ||||||
6 | each such facility disaggregated by payer mix; (D) for each | ||||||
7 | facility, the total amount of facility fees charged and the | ||||||
8 | total amount of revenue received by the hospital or health | ||||||
9 | system derived from facility fees, (E) the total amount of | ||||||
10 | facility fees charged and the total amount of revenue received | ||||||
11 | by the hospital or health system from all facilities derived | ||||||
12 | from facility fees; (F) a description of the 10 procedures or | ||||||
13 | services that generated the greatest amount of facility fee | ||||||
14 | gross revenue, disaggregated by current procedural terminology | ||||||
15 | category (CPT) code for each such procedure or service and, | ||||||
16 | for each such procedure or service, patient volume and the | ||||||
17 | total amount of gross and net revenue received by the hospital | ||||||
18 | or health system derived from facility fees, disaggregated by | ||||||
19 | on-campus and off-campus; and (G) the top 10 procedures or | ||||||
20 | services for which facility fees are charged based on patient | ||||||
21 | volume and the gross and net revenue received by the hospital | ||||||
22 | or health system for each such procedure or service, | ||||||
23 | disaggregated by on-campus and off-campus. For purposes of | ||||||
24 | this subsection, "facility" means a hospital-based facility | ||||||
25 | that is located on a hospital campus or outside a hospital | ||||||
26 | campus. |
| |||||||
| |||||||
1 | (2) The Department of Public Health shall publish the | ||||||
2 | information reported pursuant to paragraph (1) of this | ||||||
3 | subsection or post a link to such information on the | ||||||
4 | Department of Public Health's website. | ||||||
5 | Section 50. Hearings. | ||||||
6 | (a) The Director of Public Health, or any agent authorized | ||||||
7 | by the Director of Public Health to conduct any inquiry, | ||||||
8 | investigation, or hearing under this Act, has the power to | ||||||
9 | administer oaths and take testimony under oath relative to the | ||||||
10 | matter of inquiry or investigation. At any hearing ordered by | ||||||
11 | the Department of Public Health, the Director of Public | ||||||
12 | Health, or an agent having authority by law to issue such | ||||||
13 | process may subpoena witnesses and require the production of | ||||||
14 | records, papers, and documents pertinent to the inquiry. If | ||||||
15 | any person disobeys the process or refuses to answer any | ||||||
16 | pertinent question put to that person by the Director of | ||||||
17 | Public Health or the Director of Public Health's authorized | ||||||
18 | agent or to produce any records and papers so requested, the | ||||||
19 | Director of Public Health or Director of Public Health's | ||||||
20 | authorized agent may apply to the Circuit Court for the | ||||||
21 | district wherein such person resides or where the business has | ||||||
22 | been conducted, setting forth the disobedience to the process | ||||||
23 | or refusal to answer, and said court shall order such person to | ||||||
24 | appear before that court and to answer the questions or | ||||||
25 | produce the records requested. |
| |||||||
| |||||||
1 | (b) If the Director of Public Health or the Director of | ||||||
2 | Public Health's agent has received information and has a | ||||||
3 | reasonable belief that any person, health care facility, or | ||||||
4 | other institution has violated or is violating any provision | ||||||
5 | of this Act, or any rule or order of the Department of Public | ||||||
6 | Health, the Director of Public Health or the Director of | ||||||
7 | Public Health's agent may issue a notice pursuant to this | ||||||
8 | Section. The Department of Public Health shall notify the | ||||||
9 | person, health care facility, or institution against whom such | ||||||
10 | order is issued by first-class mail or personal service. The | ||||||
11 | notice shall include: (1) a reference to the Section of the | ||||||
12 | statutes, rule, or Section of the rules believed to have been | ||||||
13 | violated; (2) a short and plain language statement of the | ||||||
14 | matters asserted or charged; (3) a description of the activity | ||||||
15 | alleged to have violated a statute or rule pursuant to | ||||||
16 | paragraph (1) of this subsection; (4) a statement concerning | ||||||
17 | the right to a hearing of such person, health care facility, or | ||||||
18 | institution; and (5) a statement that the person, health care | ||||||
19 | facility, or institution may, not later than 10 business days | ||||||
20 | after receipt of the notice, make a written request for a | ||||||
21 | hearing on the matters asserted, to be sent to the executive | ||||||
22 | director of the health care facility or institution or the | ||||||
23 | agent of the executive director. | ||||||
24 | (c) The person, health care facility, or institution to | ||||||
25 | whom notice is provided under subsection (b) of this Section | ||||||
26 | may, not later than 10 business days after receipt of the |
| |||||||
| |||||||
1 | notice, make written application to the unit to request a | ||||||
2 | hearing to demonstrate that such violation has not occurred, | ||||||
3 | or present other defenses applicable. A failure to make a | ||||||
4 | timely request for a hearing shall result in the Department | ||||||
5 | issuing a cease and desist order. Each hearing held under this | ||||||
6 | subsection shall be conducted and contested pursuant to | ||||||
7 | Illinois Administrative Procedure Act. | ||||||
8 | (d) If the Department finds, by a preponderance of the | ||||||
9 | evidence, following a hearing held under subsection (c) of | ||||||
10 | this Section that a person, health care facility, or | ||||||
11 | institution has violated or is violating any provision of this | ||||||
12 | Act, or any rule or order of the Department, the Department | ||||||
13 | shall issue a cease and desist order to such person, health | ||||||
14 | care facility, or institution that shall be considered a final | ||||||
15 | decision subject to appeal to the Circuit Court in accordance | ||||||
16 | with the Administrative Review Law of the Code of Civil | ||||||
17 | Procedure. | ||||||
18 | (e) Any cease and desist order issued under this Section | ||||||
19 | may be enforced by the Attorney General. | ||||||
20 | Section 55. Report of the utilization management and | ||||||
21 | provider payment practices of Medicare Advantage plans. | ||||||
22 | (a) Not later than January 1, 2026, the Department of | ||||||
23 | Insurance, in consultation with the Department of Public | ||||||
24 | Health, shall report to the Governor and to the General | ||||||
25 | Assembly an analysis of the utilization management and |
| |||||||
| |||||||
1 | provider payment practices of Medicare Advantage plans, | ||||||
2 | including, but not limited to, (1) the impact of such | ||||||
3 | practices on the delivery of hospital outpatient and inpatient | ||||||
4 | services, including patient placement, discharges, transfers, | ||||||
5 | and other clinical plans, (2) the costs to hospitals and plan | ||||||
6 | members associated with such practices, (3) the effect of such | ||||||
7 | practices on commercial, non-Medicare payment rates and access | ||||||
8 | to services, including behavioral health services, and (4) a | ||||||
9 | comparison of claims denials, modifications, and reversals on | ||||||
10 | appeal among Medicare Advantage plans and with traditional | ||||||
11 | Medicare, Medicaid, and commercial non-Medicare product lines. | ||||||
12 | To the extent information and data are not available to | ||||||
13 | support specified areas of such analysis, such unavailability | ||||||
14 | shall be noted in the report. | ||||||
15 | (b) Based on the findings of the analysis such report | ||||||
16 | shall provide recommendations on (1) improving quality of and | ||||||
17 | access to care, (2) improving the timely delivery of care, (3) | ||||||
18 | reducing provider administrative costs associated with | ||||||
19 | utilization management, (4) addressing payment practices that | ||||||
20 | inappropriately reduce provider payments, (5) improving any | ||||||
21 | practices identified in the study contributing to unwarranted | ||||||
22 | changes to clinical care plans, (6) considering quarterly | ||||||
23 | monitoring of prior authorization requests, service denials | ||||||
24 | and payment denials by Medicare Advantage plans and comparing | ||||||
25 | such data with commercial plans and Medicaid, (7) addressing | ||||||
26 | the broad effect of Medicare Advantage plan practices on the |
| |||||||
| |||||||
1 | health care delivery system, including costs borne by | ||||||
2 | non-Medicare Advantage consumers and plan sponsors, (8) | ||||||
3 | reducing costs for consumers, and (9) the extent to which | ||||||
4 | states have the authority to regulate Medicare Advantage | ||||||
5 | plans. To the extent the analysis does not support | ||||||
6 | recommendations in any of the specified areas, that outcome | ||||||
7 | should be noted in the report. | ||||||
8 | (c) The Department of Insurance may engage the services of | ||||||
9 | third-party professionals and specialists the Director of | ||||||
10 | Insurance deems necessary to assist the Director of Insurance | ||||||
11 | in fulfilling the requirements of this Section. The costs and | ||||||
12 | services shall be paid from the General Revenue Fund, subject | ||||||
13 | to appropriation. | ||||||
14 | Section 90. The Illinois Health Facilities Planning Act is | ||||||
15 | amended by adding Section 6.5 as follows: | ||||||
16 | (20 ILCS 3960/6.5 new) | ||||||
17 | Sec. 6.5. Notice of intent to file an application. Any | ||||||
18 | health care facility that intends to file an application for a | ||||||
19 | certificate of need with the Board shall, in advance of filing | ||||||
20 | such an application, post notice of the health care facility's | ||||||
21 | intent to file in a conspicuous location on its website, if | ||||||
22 | such a website exists. After filing an application for a | ||||||
23 | certificate of need, the health care facility shall post, in a | ||||||
24 | conspicuous location on its website, a notice of the |
| ||||||||||||||||||||||||||||||||||||
| ||||||||||||||||||||||||||||||||||||
1 | application having been filed and a digital copy of the | |||||||||||||||||||||||||||||||||||
2 | application. | |||||||||||||||||||||||||||||||||||
3 | Section 99. Effective date. This Act takes effect upon | |||||||||||||||||||||||||||||||||||
4 | becoming law. | |||||||||||||||||||||||||||||||||||
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