093_SB1774sam001

 










                                     LRB093 03725 JLS 12983 a

 1                    AMENDMENT TO SENATE BILL 1774

 2        AMENDMENT NO.     .  Amend Senate Bill 1774 by  replacing
 3    the title with the following:

 4        "AN ACT concerning insurance."; and

 5     by  replacing  everything after the enacting clause with the
 6    following:

 7        "Section 5.  The Illinois Insurance Code  is  amended  by
 8    adding Section 368d as follows:

 9        (215 ILCS 5/368d new)
10        Sec. 368d.  Fairness in contracting procedures.
11        (a)  A  health  care professional or health care provider
12    offered a contract for signature after the effective date  of
13    this  amendatory  Act  of  the 93rd General Assembly shall be
14    provided with a complete copy of  any  proposed  professional
15    services  contract.  Upon request, a health care professional
16    or health care provider, paid on a service by service  basis,
17    shall be given the opportunity to review the relevant medical
18    policies,  fee  schedules,  and claims submission and payment
19    procedures related to the covered  services.  If  the  health
20    care  professional  or  health care provider is not paid on a
21    service by service basis, the amounts payable  and  terms  of
 
                            -2-      LRB093 03725 JLS 12983 a
 1    payment  under  that  alternative  payment  system  shall  be
 2    provided upon request. The health care professional or health
 3    care provider shall be allowed at least 30 days to review the
 4    complete contract before signing.
 5        (b)  An   insurer,   health   maintenance   organization,
 6    independent   practice  association,  or  physician  hospital
 7    organization shall  notify  a  health  care  professional  or
 8    health  care provider within 35 days of the effective date of
 9    any material changes to the payment rates. This notice may be
10    provided by mail, e-mail,  newsletter,  website  listing,  or
11    other reasonable method.
12        (c)  Upon  termination  of  a  contract  with an insurer,
13    health   maintenance   organization,   independent   practice
14    association, or physician  hospital  organization,  a  health
15    care  professional  or  health  care  provider  shall, at the
16    request of a patient, transfer copies of medical records.

17        Section 99.  Effective date. This  Act  takes  effect  on
18    December 1, 2003.".