093_SB0459

 
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 1        AN ACT concerning health care professionals.

 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    Provider Termination Notification Act.

 6        Section 10. Definitions. For the purposes of this Act:
 7        "Adverse  action"  means  (i) an action taken by a health
 8    care  licensing  board  that  reduces,   limits,   restricts,
 9    impairs,  suspends,  revokes,  denies,  or fails to renew the
10    license  of  a  physician  or  other  licensed  health   care
11    professional  or  (ii)  an  adverse  finding,  conclusion, or
12    determination of a peer review committee  of  a  hospital  or
13    other  health  care  entity  with  respect  to  an allegation
14    against  a  physician   or   other   licensed   health   care
15    professional  on  a  matter  that relates to the professional
16    conduct or qualifications of the  physician  or  health  care
17    professional.
18        "Health  care  licensing  board"  means  an agency of the
19    State that is responsible for the licensing of a health  care
20    professional  to  furnish  health  care items and services to
21    individuals in  the  State.  "Health  care  licensing  board"
22    includes committees of the agency that are legally authorized
23    to take adverse actions against a physician or other licensed
24    health care practitioner on behalf of the agency.
25        "Health  carrier" or "carrier" means an entity subject to
26    the insurance laws and regulations of this State  or  subject
27    to  the  jurisdiction  of  the  Department  of Insurance that
28    contracts or offers to contract to provide, deliver,  arrange
29    for,  pay  for,  or reimburse any of the costs of health care
30    services,  including  a  sickness  and   accident   insurance
31    company,  a  health  maintenance  organization,  a  preferred
 
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 1    provider   organization,  a  nonprofit  hospital  and  health
 2    services corporation, and any other entity providing  a  plan
 3    of insurance, health benefits, or health services.
 4        "Licensed  health  care professional" means an individual
 5    who is licensed or otherwise authorized  by  law  to  provide
 6    health care items and services.

 7        Section 15. Notice required.
 8        (a)  A  health care licensing board that takes an adverse
 9    action against a licensed health care  professional  or  that
10    has  reported  to it an adverse action taken by a hospital or
11    other health care professional  review  committee  against  a
12    licensed  health  care  professional  shall notify any health
13    carrier that voluntarily provides the licensing board a point
14    of contact to receive information of adverse actions.
15        (b)  Notice to the health plan shall occur not later than
16    15 days after the close of the month in which the  action  is
17    taken  or  reported  to the  licensing board, except that the
18    Department of Professional Regulation may by  rule  designate
19    categories  or  types of cases in which more timely notice is
20    appropriate and specify a deadline for notice in those cases.
21    Notice may be received in either written or electronic  form,
22    as designated by the health carrier.

23        Section  20.  Contents  of Notice. Except that the notice
24    may  not  include  any   individually   identifiable   health
25    information  with respect to a patient of the licensed health
26    care professional, the notice required by Section 15 of  this
27    Act  shall  be  in  the  form  required  by the Department of
28    Professional Regulation  by  rule  and  shall  at  a  minimum
29    specify the following:
30             (1)  the adverse action taken;
31             (2)  the date on which the action becomes effective,
32        and
 
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 1             (3)  any  corrective  actions taken by the licensing
 2        board, including but not limited to obtaining  additional
 3        CME credits and other training issues.

 4        Section  25.  Effective  date  of  health carrier actions
 5    based on notice. A limitation,  restriction,  suspension,  or
 6    termination  imposed  by  the health carrier on the agreement
 7    under which the licensed health care  professional  furnishes
 8    health    care    items   and   services   to   participants,
 9    beneficiaries, or enrollees of the health carrier, or in  the
10    case  of  an  agreement  with  a group of physicians or other
11    licensed health care professionals  on  such  agreement,  may
12    become  effective  on  the  date  on  which  the notice under
13    Section 15 is provided to the health carrier if:
14             (1)  the health  carrier  determines  that  (i)  the
15        licensed  health  care  professional  poses  an  imminent
16        threat   to   the  health  and  safety  of  participants,
17        beneficiaries, or enrollees  of  the  plan  or  (ii)  the
18        licensed   health   care   professional  has  engaged  in
19        fraudulent activities with respect to the health carrier,
20        has provided  false  or  misleading  information  to  the
21        health  carrier,  or  has  withheld  information from the
22        health carrier on matters relating  to  the  professional
23        conduct  or  qualifications  of  the licensed health care
24        professional; or
25             (2)  the adverse action of which the health  carrier
26        was   notified   pursuant   to   Section  15  removes  or
27        significantly impairs the ability of the licensed  health
28        care  professional  to  furnish  health  care  items  and
29        services  to  participants  beneficiaries or enrollees of
30        the health carrier.

31        Section  30.  Termination,  suspension,  restriction,  or
32    limitation of agreement. Notwithstanding any other  provision
 
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 1    of law, health carriers terminating, suspending, restricting,
 2    or limiting an agreement with a provider consistent with this
 3    Act  are not subject to any continuity of care or any willing
 4    provider laws of this State with respect to such  terminated,
 5    suspended, restricted, or limited provider agreement.

 6        Section 35. No action for damages. A licensed health care
 7    professional  who  is  the  subject  of an action by a health
 8    carrier  to  limit,  restrict,  suspend,  or  terminate   the
 9    agreement  under  which the licensed health care professional
10    furnishes health care items or services  to  members  of  the
11    health  carrier,  based  on  the  notice of an adverse action
12    provided to the health carrier under this Act shall  have  no
13    cause  of  action  for  damages  under  any law of this State
14    arising from such action of the health carrier.

15        Section 40.  Action on notice. Nothing in this Act  shall
16    require a health carrier to take any action with respect to a
17    licensed   health  care  professional  based  on  the  notice
18    provided for herein.

19        Section 45. Conflict between Act and  agreement.  To  the
20    extent  that  the  agreement between the health carrier and a
21    physician, group of physicians, or  a  licensed  health  care
22    professional  permits  an action based on the notice provided
23    for by the Act that is  more  restrictive  than  the  adverse
24    action  that  is the subject of the notice, the provisions of
25    such agreement shall apply.