HB5315 95TH GENERAL ASSEMBLY

LRB095 16868 KBJ 42909 b

95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008
HB5315

Introduced , by Rep. William Davis

SYNOPSIS AS INTRODUCED:

215 ILCS 5/370e.1 new

Amends the Illinois Insurance Code. Provides that no contract between a health care service plan and a physician, physician group, or other licensed health care practitioner shall contain any incentive plan that includes a specific payment made directly, in any type or form, to a physician, physician group, or other licensed health care practitioner as an inducement to prescribe a specific medication or type of medication or to deny, reduce, limit, or delay specific, medically necessary and appropriate services provided with respect to a specific enrollee or groups of enrollees with similar medical conditions. Provides that nothing in the provision shall be construed to prohibit contracts that contain incentive plans that involve general payments, such as capitation payments or shared-risk arrangements that are not tied to specific medical decisions involving specific enrollees or groups of enrollees with similar medical conditions. Provides that the payments rendered or to be rendered to physicians, physician groups, or other licensed health care practitioners under these arrangements shall be deemed confidential.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Insurance Code is amended by adding Section 370e.1 as follows:

(215 ILCS 5/370e.1 new)

Sec. 370e.1. Incentives prohibited. No contract between a health care service plan and a physician, physician group, or other licensed health care practitioner shall contain any incentive plan that includes a specific payment made directly, in any type or form, to a physician, physician group, or other licensed health care practitioner as an inducement to prescribe a specific medication or type of medication or deny, reduce, limit, or delay specific, medically necessary and appropriate services provided with respect to a specific enrollee or groups of enrollees with similar medical conditions. Nothing in this Section shall be construed to prohibit contracts that contain incentive plans that involve general payments, such as capitation payments or shared-risk arrangements that are not tied to specific medical decisions involving specific enrollees or groups of enrollees with similar medical conditions. The payments rendered or to be rendered to physicians, physician groups, or other licensed health care practitioners under these arrangements shall be deemed confidential.