Full Text of HB3327 102nd General Assembly
HB3327 102ND GENERAL ASSEMBLY |
| | 102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022 HB3327 Introduced 2/19/2021, by Rep. Jackie Haas SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Insurance Code. In provisions concerning timely payment for health care services, provides that failure to make periodic payments within specified time periods shall entitle a health care professional, health care facility, independent practice association, physician-hospital organization, insurer, health maintenance organization, managed care plans health care plan, preferred provider organization, or third party administrator to interest at the rate of 9% semiannually (rather than 9% per year).
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| | A BILL FOR |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 368a as follows:
| 6 | | (215 ILCS 5/368a)
| 7 | | Sec. 368a. Timely payment for health care services.
| 8 | | (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
| 12 | | organizations (hereinafter referred to as "payors") that
| 13 | | 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.
| 19 | | (1) A payor
shall
make
periodic payments in accordance | 20 | | with item (3). Failure to make
periodic
payments
within | 21 | | the period of time specified in item (3) shall
entitle the
| 22 | | health care professional or health care facility to | 23 | | interest at the
rate of 9% semiannually
per year from
the |
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| 1 | | date payment was required to be made to the date of the | 2 | | late payment,
provided that
interest amounting
to less | 3 | | than $1 need not be paid. Any required interest payments | 4 | | shall be made
within 30 days after the payment.
| 5 | | (2) When a payor requires selection of a health care
| 6 | | professional or
health care facility, the selection shall | 7 | | be completed by the insured or
enrollee no later
than
30 | 8 | | days after enrollment. The payor shall provide written | 9 | | notice of this
requirement to all insureds and enrollees.
| 10 | | Nothing in this Section shall be construed to require a | 11 | | payor to select a
health care professional or health care | 12 | | facility for an insured or enrollee.
| 13 | | (3) A payor
shall provide the
health care professional | 14 | | or health care facility with
notice of the selection as a | 15 | | health care professional or
health care facility by
an
| 16 | | insured or
enrollee and the effective date of the | 17 | | selection within
60 calendar days after the selection. No | 18 | | later than the 60th day
following the
date an insured or | 19 | | enrollee has selected a health care
professional or health | 20 | | care facility or the date that selection becomes
| 21 | | effective, whichever is later, or in cases of | 22 | | retrospective enrollment only, 30
days after notice by an | 23 | | employer to the payor of the selection, a payor
shall | 24 | | begin periodic payment of
the required
amounts to the | 25 | | insured's or enrollee's health care professional or health | 26 | | care
facility, or the designee of either,
calculated from |
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| 1 | | the date of
selection or the date the selection becomes | 2 | | effective, whichever is later.
All subsequent payments | 3 | | shall be made
in accordance with
a monthly periodic cycle.
| 4 | | (b) Notwithstanding any other provision of this Section,
| 5 | | independent practice associations and physician-hospital | 6 | | organizations shall
make periodic payment of the required | 7 | | amounts in
accordance with a monthly periodic schedule after
| 8 | | an insured or enrollee has selected a health care professional | 9 | | or health care
facility or after that selection becomes | 10 | | effective, whichever
is later.
| 11 | | Notwithstanding any other provision of this Section, | 12 | | independent
practice associations and physician-hospital | 13 | | organizations shall make all
other payments for health | 14 | | services within 30 days after receipt of
due proof
of loss. | 15 | | Independent
practice associations and physician-hospital | 16 | | organizations shall notify the
insured, insured's assignee, | 17 | | health care professional, or health care facility
of any | 18 | | failure to provide sufficient documentation for a due proof of
| 19 | | loss within 30 days after receipt of the claim for health | 20 | | services.
| 21 | | Failure to pay within the required time period shall | 22 | | entitle the payee to
interest at the rate of 9% semiannually | 23 | | per year from the date the payment is due to the
date of the | 24 | | late payment, provided that interest amounting to less than $1
| 25 | | need not be paid. Any required interest payments shall be made | 26 | | within 30
days after the payment.
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| 1 | | (c) All insurers, health maintenance
organizations, | 2 | | managed care plans, health care plans, preferred provider
| 3 | | organizations, and third party administrators
shall ensure | 4 | | that all claims and indemnities
concerning health care | 5 | | services
other than for
any periodic payment shall be paid | 6 | | within 30 days after receipt of due
written proof of such loss. | 7 | | An insured, insured's assignee, health care
professional, or | 8 | | health care facility shall be
notified of any known failure to | 9 | | provide sufficient documentation for a
due proof of
loss | 10 | | within 30 days after receipt of the claim for health care
| 11 | | services.
Failure to pay
within such period shall entitle the | 12 | | payee
to interest at the rate of 9% semiannually per year from | 13 | | the 30th day after
receipt of such proof of loss to
the date of | 14 | | late payment, provided that interest amounting to less than | 15 | | one
dollar need not be paid. Any
required interest payments | 16 | | shall be made within 30 days after the payment.
| 17 | | (d) The Department shall enforce the provisions of this | 18 | | Section pursuant to
the enforcement powers granted to it by | 19 | | law.
| 20 | | (e) The Department is hereby granted specific authority to | 21 | | issue a
cease and desist order, fine, or otherwise penalize | 22 | | independent practice
associations and physician-hospital | 23 | | organizations that violate this Section.
The Department shall | 24 | | adopt reasonable rules to enforce compliance with this
Section | 25 | | by
independent practice associations and physician-hospital | 26 | | organizations.
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| 1 | | (Source: P.A. 97-813, eff. 7-13-12.)
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