97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB2256
 
Introduced 2/15/2011, by Sen. William R. Haine
 
SYNOPSIS AS INTRODUCED:
 

 
215 ILCS 5/368g new

     Amends the Illinois Insurance Code. Provides that no insurer shall implement any change to a provider contract that may adversely impact reimbursement unless, prior to the effective date of the change, the insurer gives the health care provider with whom the insurer has directly contracted and who is impacted by the change at least 60 days written notice of the change. Sets forth provisions concerning notice. 
  


LRB097 08544 RPM 48671 b

 
 
A BILL FOR
 

  
SB2256LRB097 08544 RPM 48671 b


  
1    AN ACT concerning insurance.
  
 
2    Be it enacted by the People of the State of Illinois,
 
3represented in the General Assembly:
  
 
 
4    Section 5. The Illinois Insurance Code is amended  by adding 
5Section 368g as follows:
 
6    (215 ILCS 5/368g new)
7    Sec. 368g. Provider contract changes. 
8    (a) No insurer shall implement a change to a provider 
9contract or modify policies and procedures that have been 
10incorporated or incorporated by reference into that contract 
11that may adversely impact reimbursement unless, prior to the 
12effective date of the change, the insurer gives the health care 
13provider with whom the insurer has directly contracted and who 
14is impacted by the change at least 60 days written notice of 
15the change.
16    (b) If the contracting health care provider objects to the 
17change that is the subject of the notice from the insurer, then 
18the health care provider may, within 30 days after the date of 
19the notice, give written notice to the insurer to terminate the 
20contract with the insurer effective upon the implementation 
21date of the adverse reimbursement change.
22    (c) The notice provisions required by this Section shall 
23not apply where:
 
 
SB2256- 2 -LRB097 08544 RPM 48671 b

1        (1) such change is otherwise required by law, 
2    regulation or applicable regulatory authority, or as a 
3    result of changes in fee schedules, reimbursement 
4    methodology, or payment policies established by a 
5    government agency or by the American Medical Association's 
6    current procedural terminology codes, reporting 
7    guidelines, and conventions; or
8        (2) such change is expressly provided for under the 
9    terms of the contract by the inclusion of or reference to a 
10    specific fee or fee schedule, reimbursement methodology, 
11    or payment policy indexing mechanism.