Illinois General Assembly - Bill Status for HB4789
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 Bill Status of HB4789  103rd General Assembly


Short Description:  INS CD-DENTAL PREAUTHORIZATION

House Sponsors
Rep. Bob Morgan - Tom Weber, Travis Weaver, Dave Severin and Suzanne M. Ness

Senate Sponsors
(Sen. Dave Syverson)

Last Action
DateChamber Action
  4/17/2024SenateReferred to Assignments

Statutes Amended In Order of Appearance
215 ILCS 5/355d new


Synopsis As Introduced
Amends the Illinois Insurance Code. Provides that no insurer, dental service plan corporation, insurance network leasing company, or any company that amends, delivers, issues, or renews an individual or group policy of accident and health insurance that provides dental insurance on or after the effective date of the amendatory Act shall deny any claim subsequently submitted for procedures specifically included in a prior authorization unless certain circumstances apply. Provides that a dental service contractor shall not recoup a claim solely due to a loss of coverage for a patient or ineligibility if, at the time of treatment, the dental service contractor erroneously confirmed coverage and eligibility, but had sufficient information available to the dental service contractor indicating that the patient was no longer covered or was ineligible for coverage. Prohibits waiver of the provisions by contract.

House Committee Amendment No. 1
Adds reference to:
215 ILCS 5/355.4
215 ILCS 130/4003from Ch. 73, par. 1504-3
215 ILCS 165/10from Ch. 32, par. 604

Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes. Makes a change in the definition of "prior authorization". Defines "dental carrier" as an insurer, dental service corporation, insurance network leasing company, or any company that offers individual or group policies of accident and health insurance that provide coverage for dental services. Changes references from "dental service contractor" and "insurer" to "dental carrier". Provides that beginning on the effective date of the amendatory Act, a dental carrier shall not deny any claim subsequently submitted for procedures specifically included in a prior authorization unless certain circumstances apply. Removes language providing that no insurer, dental service plan corporation, insurance network leasing company, or any company that amends, delivers, issues, or renews an individual or group policy of accident and health insurance that provides dental insurance on or after the effective date of the amendatory Act shall deny any claim subsequently submitted for procedures specifically included in a prior authorization unless certain circumstances apply. Further amends the Illinois Insurance Code. In a provision requiring contracting entities to provide notification before any scheduled assignment or lease of the network to which the provider is a contracted provider, requires the notification to provide the specific URL address where the following are located: all contract terms, a policy manual, a fee schedule, and a statement that the provider has the right to choose not to participate in third-party access (instead of the notification including all contract terms, a policy manual, a fee schedule, and a statement that the provider has the right to choose not to participate in third-party access). Requires the notification to provide instructions for how the provider may obtain a copy of those materials. Amends the Limited Health Service Organization Act and Voluntary Health Services Plans Act to make conforming changes.

Actions 
DateChamber Action
  2/5/2024HouseFiled with the Clerk by Rep. Bob Morgan
  2/6/2024HouseFirst Reading
  2/6/2024HouseReferred to Rules Committee
  2/14/2024HouseAssigned to Insurance Committee
  3/7/2024HouseAdded Co-Sponsor Rep. Travis Weaver
  4/1/2024HouseHouse Committee Amendment No. 1 Filed with Clerk by Rep. Bob Morgan
  4/1/2024HouseHouse Committee Amendment No. 1 Referred to Rules Committee
  4/2/2024HouseHouse Committee Amendment No. 1 Rules Refers to Insurance Committee
  4/2/2024HouseHouse Committee Amendment No. 1 Adopted in Insurance Committee; by Voice Vote
  4/2/2024HouseDo Pass as Amended / Short Debate Insurance Committee; 015-000-000
  4/3/2024HousePlaced on Calendar 2nd Reading - Short Debate
  4/11/2024HouseSecond Reading - Short Debate
  4/11/2024HousePlaced on Calendar Order of 3rd Reading - Short Debate
  4/16/2024HouseThird Reading - Short Debate - Passed 111-000-001
  4/16/2024HouseAdded Co-Sponsor Rep. Dave Severin
  4/16/2024HouseAdded Chief Co-Sponsor Rep. Tom Weber
  4/16/2024HouseAdded Co-Sponsor Rep. Suzanne M. Ness
  4/17/2024SenateArrive in Senate
  4/17/2024SenatePlaced on Calendar Order of First Reading
  4/17/2024SenateChief Senate Sponsor Sen. Dave Syverson
  4/17/2024SenateFirst Reading
  4/17/2024SenateReferred to Assignments

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