99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB2355

 

Introduced 1/28/2016, by Sen. Linda Holmes

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/355.4 new

    Amends the Illinois Insurance Code. Provides that a contracting entity may not sell, lease, rent, or otherwise grant access to the dental services of a participating provider under a dental services contract unless expressly authorized by the dental services contract. Requires a contracting entity to make certain disclosures to the participating provider. Provides that any contract entered into or renewed on or after the effective date of the amendatory Act shall require that any time a contracting entity leases, rents, or otherwise grants access to the dental services of a participating provider it must allow the participating provider the option to refuse to continue to provide services to third-parties entities that have bought, leased, rented, or otherwise been granted access to the health care services of a participating provider by the contracting entity. Requires contracting entities to timely update their provider directories to reflect participating providers who have refused to continue to provide services. Requires third parties who contract with contracting entities to provide certain information to participating providers.


LRB099 16016 MLM 40334 b

 

 

A BILL FOR

 

SB2355LRB099 16016 MLM 40334 b

1    AN ACT concerning regulation.
 
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 355.4 as follows:
 
6    (215 ILCS 5/355.4 new)
7    Sec. 355.4. Provider notification of network plan changes.
8    (a) As used in this Section:
9    "Contracting entity" means any person or entity that is
10engaged in the act of contracting with participating providers
11and has a direct contract with a participating provider for the
12delivery of dental services or the selling or assigning of
13dental network plans to other health care entities.
14    "Identify" means to provide, in writing, by e-mail, or
15otherwise, to the participating provider the name, address,
16telephone number, and website link.
17    "Network plan" means health insurance coverage offered by a
18health insurance issuer under which the financing and delivery
19of dental care, including items and services paid for as dental
20care, are provided, in whole or in part, through a defined set
21of participating providers under contract with the issuer.
22    "Participating provider" any person licensed to practice
23dentistry under the Illinois Dental Practice Act.

 

 

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1    (b) A contracting entity may not sell, lease, rent, or
2otherwise grant access to the dental services of a
3participating provider under a dental services contract unless
4expressly authorized by the dental services contract. The
5dental service contract must specifically provide that one
6purpose of the contract is the selling, renting, or giving the
7contracting entity rights to the services of the participating
8provider, including network plans. At the time a dental service
9contract is entered into with a participating provider, the
10contracting entity shall, to the extent possible, identify any
11third party to which the contracting entity has granted access
12to the dental services of the participating provider.
13    (c) Upon a request by a participating provider, a
14contracting entity must properly identify any third party that
15has been granted access to the dental services of the
16participating provider.
17    (d) Any contracts entered into or renewed on or after the
18effective date of this amendatory Act of the 99th General
19Assembly shall require that any time a contracting entity
20leases, rents, or otherwise grants access to the dental
21services of a participating provider it must allow the
22participating provider the option to refuse to continue to
23provide services to third-parties entities that have bought,
24leased, rented, or otherwise been granted access to the health
25care services of a participating provider by the contracting
26entity. Contracting entities must timely update their provider

 

 

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1directories of any participating providers who have refused to
2continue to provide services to the new contracting entity as
3required under item (ii) of paragraph (c) of subsection (5) of
4Section 355a of this Code, paragraph (5) of subsection (a) of
5Section 25 of the Dental Care Patient Protection Act, and
6Sections 44 and 45 of the Illinois Dental Practice Act.
7    (e) Any third-party entity, within 30 days of leasing,
8renting, or otherwise accessing the dental services of a
9participating provider, must provide to the participating
10provider a listing of the 100 most frequently reimbursed
11American Dental Association Current Dental Terminology (CDT)
12codes by the third-party entity and the amount by which the
13third-party entity reimburses a participating provider.
14    (f) A contracting entity that leases, rents, or otherwise
15grants access to a participating provider's dental services
16must ensure that an explanation of benefits or remittance
17advice furnished to the participating provider that delivers
18dental services under the dental services contract identifies
19the contractual source of any applicable discount.
20    (g) All third parties that have contracted with a
21contracting entity to purchase, rent, assign, or otherwise have
22been granted access to the participating provider's discounted
23rate shall comply with the dentist's contract, including all
24requirements to encourage access to the participating provider
25and pay the participating provider pursuant to the rates of
26payment and methodology set forth in that contract, unless

 

 

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1otherwise agreed to by a participating provider.
2    (h) A contracting entity is deemed in compliance with this
3Section when the insured's identification card provides
4information that identifies the insurance carrier to be used to
5reimburse the participating provider for covered services.