Full Text of HB4847 93rd General Assembly
HB4847 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 HB4847
Introduced 02/04/04, by Karen May, Mary E. Flowers, Kathleen A. Ryg, Carolyn H. Krause, Sandra M. Pihos SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Insurance Code. Requires payors to notify individual insureds or enrollees within 30 days if the chosen health care physician no longer participates in the physician network. Requires payors to notify insureds or enrollees of their right to transition services under Section 25 of the Managed Care Reform and Patient Rights Act.
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A BILL FOR
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HB4847 |
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LRB093 14813 SAS 40374 b |
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| AN ACT concerning insurance.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Insurance Code is amended by | 5 |
| changing Section 368a as follows:
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| (215 ILCS 5/368a)
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| Sec. 368a. Timely payment for health care services.
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| (a) This Section applies to insurers, health maintenance | 9 |
| organizations,
managed care plans, health care plans, | 10 |
| preferred provider organizations, third
party
administrators, | 11 |
| independent practice associations, and physician-hospital
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| organizations (hereinafter referred to as "payors") that
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| provide
periodic payments, which are payments not requiring a | 14 |
| claim, bill, capitation
encounter
data, or capitation | 15 |
| reconciliation reports, such as
prospective capitation | 16 |
| payments, to
health care professionals and health care | 17 |
| facilities
to provide medical or health care services for | 18 |
| insureds or enrollees.
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| (1) A payor
shall
make
periodic payments in accordance | 20 |
| with item (3). Failure to make
periodic
payments
within the | 21 |
| period of time specified in item (3) shall
entitle the
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| health care professional or health care facility to | 23 |
| interest at the
rate of 9%
per year from
the date payment | 24 |
| was required to be made to the date of the late payment,
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| provided that
interest amounting
to less than $1 need not | 26 |
| be paid. Any required interest payments shall be made
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| within 30 days after the payment.
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| (2) When a payor requires selection of a health care
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| professional or
health care facility, the selection shall | 30 |
| be completed by the insured or
enrollee no later
than
30 | 31 |
| days after enrollment. The payor shall provide written | 32 |
| notice of this
requirement to all insureds and enrollees.
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HB4847 |
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LRB093 14813 SAS 40374 b |
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| Nothing in this Section shall be construed to require a | 2 |
| payor to select a
health care professional or health care | 3 |
| facility for an insured or enrollee.
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| (3) A payor
shall provide the
health care professional | 5 |
| or health care facility with
notice of the selection as a | 6 |
| health care professional or
health care facility by
an
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| insured or
enrollee and the effective date of the selection | 8 |
| within
60 calendar days after the selection. No later than | 9 |
| the 60th day
following the
date an insured or enrollee has | 10 |
| selected a health care
professional or health care facility | 11 |
| or the date that selection becomes
effective, whichever is | 12 |
| later, or in cases of retrospective enrollment only, 30
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| days after notice by an employer to the payor of the | 14 |
| selection, a payor
shall begin periodic payment of
the | 15 |
| required
amounts to the insured's or enrollee's health care | 16 |
| professional or health care
facility, or the designee of | 17 |
| either,
calculated from the date of
selection or the date | 18 |
| the selection becomes effective, whichever is later.
All | 19 |
| subsequent payments shall be made
in accordance with
a | 20 |
| monthly periodic cycle. Payors are required to notify | 21 |
| individual insureds or enrollees within 30 days if the | 22 |
| insured's or enrollee's chosen health care professional no | 23 |
| longer participates in the physician network. Payors must | 24 |
| notify insureds or enrollees of their right to transition | 25 |
| services under Section 25 of the Managed Care Reform and | 26 |
| Patient Rights Act.
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| (b) Notwithstanding any other provision of this Section,
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| independent practice associations and physician-hospital | 29 |
| organizations shall
make periodic payment of the required | 30 |
| amounts in
accordance with a monthly periodic schedule after
an | 31 |
| insured or enrollee has selected a health care professional or | 32 |
| health care
facility or after that selection becomes effective, | 33 |
| whichever
is later.
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| Notwithstanding any other provision of this Section, | 35 |
| independent
practice associations and physician-hospital | 36 |
| organizations shall make all
other payments for health services |
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HB4847 |
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LRB093 14813 SAS 40374 b |
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| within 30 days after receipt of
due proof
of loss. Independent
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| practice associations and physician-hospital organizations | 3 |
| shall notify the
insured, insured's assignee, health care | 4 |
| professional, or health care facility
of any failure to provide | 5 |
| sufficient documentation for a due proof of
loss within 30 days | 6 |
| after receipt of the claim for health services.
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| Failure to pay within the required time period shall | 8 |
| entitle the payee to
interest at the rate of 9% per year from | 9 |
| the date the payment is due to the
date of the late payment, | 10 |
| provided that interest amounting to less that $1
need not be | 11 |
| paid. Any required interest payments shall be made within 30
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| days after the payment.
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| (c) All insurers, health maintenance
organizations, | 14 |
| managed care plans, health care plans, preferred provider
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| organizations, and third party administrators
shall ensure | 16 |
| that all claims and indemnities
concerning health care services
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| other than for
any periodic payment shall be paid within 30 | 18 |
| days after receipt of due
written proof of such loss. An | 19 |
| insured, insured's assignee, health care
professional, or | 20 |
| health care facility shall be
notified of any known failure to | 21 |
| provide sufficient documentation for a
due proof of
loss within | 22 |
| 30 days after receipt of the claim for health care
services.
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| Failure to pay
within such period shall entitle the payee
to | 24 |
| interest at the rate of 9% per year from the 30th day after
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| receipt of such proof of loss to
the date of late payment, | 26 |
| provided that interest amounting to less than one
dollar need | 27 |
| not be paid. Any
required interest payments shall be made | 28 |
| within 30 days after the payment.
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| (d) The Department shall enforce the provisions of this | 30 |
| Section pursuant to
the enforcement powers granted to it by | 31 |
| law.
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| (e) The Department is hereby granted specific authority to | 33 |
| issue a
cease and desist order, fine, or otherwise penalize | 34 |
| independent practice
associations and physician-hospital | 35 |
| organizations that violate this Section.
The Department shall | 36 |
| adopt reasonable rules to enforce compliance with this
Section |
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HB4847 |
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LRB093 14813 SAS 40374 b |
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| by
independent practice associations and physician-hospital | 2 |
| organizations.
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| (Source: P.A. 91-605, eff. 12-14-99; 91-788, eff. 6-9-00; | 4 |
| 92-745, eff. 1-1-03.)
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