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Public Act 102-0957 | ||||
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AN ACT concerning regulation.
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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 | ||||
changing Section 368b as follows:
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(215 ILCS 5/368b)
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Sec. 368b. Contracting procedures.
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(a) A health care professional or health care provider | ||||
offered a contract by
an
insurer, health maintenance | ||||
organization,
independent practice association, or physician
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hospital organization for signature after the effective date | ||||
of this amendatory
Act of the
93rd General Assembly shall be | ||||
provided with a proposed health care
professional or
health | ||||
care provider
services contract including, if any, exhibits | ||||
and attachments that the contract
indicates are
to be | ||||
attached. Within 35 days after a written request, the health | ||||
care
professional or health
care provider offered a contract | ||||
shall be given the opportunity to review and
obtain a
copy of | ||||
the following: a specialty-specific fee schedule sample based | ||||
on a
minimum of
the 50 highest volume fee schedule codes with | ||||
the rates applicable to the
health care
professional or health | ||||
care provider to whom the contract is offered, the
network
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provider
administration manual, and a summary capitation |
schedule, if payment is made on
a
capitation basis. If 50 codes | ||
do not exist for a particular specialty, the
health care
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professional or health care provider offered a contract shall | ||
be given the
opportunity to
review or obtain a copy of a fee | ||
schedule sample with the codes applicable to
that
particular | ||
specialty. This information may be provided electronically. An
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insurer, health
maintenance organization, independent practice
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association, or physician hospital
organization may substitute | ||
the fee schedule sample with a document providing
reference
to | ||
the information needed to calculate the fee schedule that is | ||
available to
the public at no
charge and the percentage or | ||
conversion factor at which the insurer, health
maintenance
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organization, preferred provider organization, independent | ||
practice
association, or physician hospital organization sets | ||
its rates.
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(b) The fee schedule, the capitation schedule, and
the | ||
network provider
administration manual constitute | ||
confidential, proprietary, and trade secret
information and | ||
are subject to the provisions of the Illinois Trade Secrets
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Act.
The health
care professional or health care provider | ||
receiving such protected information
may disclose
the | ||
information on a need to know basis and only to individuals and | ||
entities
that provide
services directly related to the health | ||
care professional's or health care
provider's decision
to | ||
enter into the contract or keep the contract in force. Any | ||
person or entity
receiving or
reviewing such protected |
information pursuant to this Section shall not
disclose
the
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information to any other person, organization, or entity, | ||
unless the disclosure
is requested
pursuant to a valid court | ||
order or required by a state or federal government
agency.
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Individuals or entities receiving such information from a | ||
health care
professional
or health care provider as delineated | ||
in this subsection are subject to the
provisions of the
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Illinois Trade Secrets Act.
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(c) The health care professional or health care provider | ||
shall be allowed at
least
30 days to review the health care | ||
professional or health care provider services
contract, | ||
including
exhibits and
attachments, if any, before signing. | ||
The 30-day review period begins upon
receipt of the
health | ||
care
professional or health care provider services contract, | ||
unless the information
available
upon request
in subsection | ||
(a) is not included. If information is not included in the
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professional
services contract and is requested pursuant to | ||
subsection (a), the 30-day
review period
begins on the date of | ||
receipt of the information. Nothing in this subsection
shall | ||
prohibit
a health care professional or health care provider | ||
from signing a contract
prior to the
expiration of the 30-day | ||
review period.
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(d) As used in this subsection: | ||
"Change" means an increase or decrease in the fee schedule | ||
referred to in subsection (a). | ||
"Nonroutine change" means any proposed change to the fee |
schedule except a change that is otherwise required by law, | ||
regulation, or an applicable regulatory authority or that is | ||
required as a result of changes in fee schedules, | ||
reimbursement methodology, or payment policies established by | ||
a government agency or by the American Medical Association's | ||
current procedural terminology codes, reporting guidelines, | ||
and conventions, or a change that is expressly provided for | ||
under the terms of the contract by the inclusion of or | ||
reference to a specific fee or fee schedule, reimbursement | ||
methodology, or payment policy indexing mechanism. | ||
The insurer, health maintenance organization,
independent | ||
practice
association, or physician hospital organization shall | ||
provide all contracted
health care
professionals or health | ||
care providers with any changes to the fee schedule
provided
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under subsection (a) not later than 35 days after the | ||
effective date of the
changes,
unless such
changes are | ||
specified in the contract and the health care professional or
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health care
provider is able to calculate the changed rates | ||
based on information in the
contract and
information available | ||
to the public at no charge. Beginning January 1, 2023, with | ||
respect to nonroutine changes to the fee schedule, the | ||
insurer, health maintenance organization, independent practice | ||
association, or physician hospital organization shall provide | ||
all contracted health care professionals or health care | ||
providers impacted by the nonroutine change with notice of the | ||
change at least 60 days before the effective date of the |
change. The right to advance notice of nonroutine changes to | ||
the fee schedule may not be waived by the health care | ||
professional or health care provider. For the purposes of this | ||
subsection (d), health maintenance organizations that provide | ||
or arrange for and pay or reimburse for the cost of any health | ||
care services for persons who are enrolled in the medical | ||
assistance programs under the Illinois Public Aid Code shall | ||
comply with provider notification requirements established by | ||
the Department of Healthcare and Family Services. | ||
For the purposes of this
subsection,
"changes" means an | ||
increase or decrease in the fee schedule referred to in
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subsection (a).
This information may be made available by | ||
mail, e-mail, newsletter, website
listing, or
other reasonable | ||
method. For nonroutine changes, the information directing the | ||
health care professional or health care provider to the | ||
information provided by newsletter, website listing, or other | ||
reasonable method shall be provided by email or, if requested | ||
by the health care professional or health care provider, by | ||
mail. Upon request, a health care professional or health
care | ||
provider
may request an updated copy of the fee schedule | ||
referred to in subsection (a)
every
calendar quarter. | ||
(e) Upon termination of a contract with an insurer, health | ||
maintenance
organization, independent practice
association, or | ||
physician hospital
organization and at
the request of the | ||
patient, a health care professional or health care provider
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shall transfer
copies of the patient's medical records. Any |
other provision of law
notwithstanding, the
costs for copying | ||
and transferring copies of medical records shall be assigned
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per the
arrangements agreed upon, if any, in the health care | ||
professional or health
care provider services
contract.
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(Source: P.A. 93-261, eff. 1-1-04.)
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