093_SB0459eng SB459 Engrossed LRB093 03318 AMC 03336 b 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) a final 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 SB459 Engrossed -2- LRB093 03318 AMC 03336 b 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 so requests and voluntarily provides the 14 licensing board a point of contact to receive information of 15 adverse actions. 16 (b) Notice to the health plan shall occur not later than 17 15 days after the close of the month in which the action is 18 taken or reported to the licensing board, except that the 19 Department of Professional Regulation may by rule designate 20 categories or types of cases in which more timely notice is 21 appropriate and specify a deadline for notice in those cases. 22 Notice may be received in either written or electronic form, 23 as designated by the health carrier. 24 Section 20. Contents of Notice. Except that the notice 25 may not include any individually identifiable health 26 information with respect to a patient of the licensed health 27 care professional, the notice required by Section 15 of this 28 Act shall be in the form required by the Department of 29 Professional Regulation by rule and shall at a minimum 30 specify the following: 31 (1) the adverse action taken; 32 (2) the date on which the action becomes effective, SB459 Engrossed -3- LRB093 03318 AMC 03336 b 1 and 2 (3) any corrective actions taken by the licensing 3 board, including but not limited to obtaining additional 4 CME credits and other training issues. 5 Section 25. Effective date of health carrier actions 6 based on notice. A limitation, restriction, suspension, or 7 termination imposed by the health carrier on the agreement 8 under which the licensed health care professional furnishes 9 health care items and services to participants, 10 beneficiaries, or enrollees of the health carrier, or in the 11 case of an agreement with a group of physicians or other 12 licensed health care professionals on such agreement, may 13 become effective on the date on which the notice under 14 Section 15 is provided to the health carrier if: 15 (1) the health carrier determines that (i) the 16 licensed health care professional poses an imminent 17 threat to the health and safety of participants, 18 beneficiaries, or enrollees of the plan or (ii) the 19 licensed health care professional has engaged in 20 fraudulent activities with respect to the health carrier, 21 has provided false or misleading information to the 22 health carrier, or has withheld information from the 23 health carrier on matters relating to the professional 24 conduct or qualifications of the licensed health care 25 professional; or 26 (2) the adverse action of which the health carrier 27 was notified pursuant to Section 15 removes or 28 significantly impairs the ability of the licensed health 29 care professional to furnish health care items and 30 services to participants beneficiaries or enrollees of 31 the health carrier. 32 Section 30. Termination, suspension, restriction, or SB459 Engrossed -4- LRB093 03318 AMC 03336 b 1 limitation of agreement. Notwithstanding any other provision 2 of law, health carriers terminating, suspending, restricting, 3 or limiting an agreement with a provider consistent with this 4 Act are not subject to any continuity of care or any willing 5 provider laws of this State with respect to such terminated, 6 suspended, restricted, or limited provider agreement. 7 Section 40. Action on notice. Nothing in this Act shall 8 require a health carrier to take any action with respect to a 9 licensed health care professional based on the notice 10 provided for herein. 11 Section 45. Conflict between Act and agreement. To the 12 extent that the agreement between the health carrier and a 13 physician, group of physicians, or a licensed health care 14 professional permits an action based on the notice provided 15 for by the Act that is more restrictive than the adverse 16 action that is the subject of the notice, the provisions of 17 such agreement shall apply. 18 Section 50. Confidentiality. Adverse actions by a peer 19 review committee of a hospital or other health care entity 20 are confidential as provided by State and federal law and may 21 not be redisclosed by a health carrier without written 22 consent of the licensed health care professional, except as 23 provided by State and federal law.