Rep. Theresa Mah
Filed: 3/1/2022
 
 


 




10200HB4941ham001LRB102 22842 BMS 37092 a



1
AMENDMENT TO HOUSE BILL 4941 




2 AMENDMENT NO. ______. Amend House Bill 4941 by replacing 
3everything after the enacting clause with the following:


4 "Section 5. The Illinois Insurance Code is amended by 
5changing Section 368b as follows:




6 (215 ILCS 5/368b)



7 Sec. 368b. Contracting procedures. 

8 (a) A health care professional or health care provider 
9offered a contract by
an
insurer, health maintenance 
10organization,
independent practice association, or physician

11hospital organization for signature after the effective date 
12of this amendatory
Act of the
93rd General Assembly shall be 
13provided with a proposed health care
professional or
health 
14care provider
services contract including, if any, exhibits 
15and attachments that the contract
indicates are
to be 
16attached. Within 35 days after a written request, the health 
 
 
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1care
professional or health
care provider offered a contract 
2shall be given the opportunity to review and
obtain a
copy of 
3the following: a specialty-specific fee schedule sample based 
4on a
minimum of
the 50 highest volume fee schedule codes with 
5the rates applicable to the
health care
professional or health 
6care provider to whom the contract is offered, the
network

7provider
administration manual, and a summary capitation 
8schedule, if payment is made on
a
capitation basis. If 50 codes 
9do not exist for a particular specialty, the
health care

10professional or health care provider offered a contract shall 
11be given the
opportunity to
review or obtain a copy of a fee 
12schedule sample with the codes applicable to
that
particular 
13specialty. This information may be provided electronically. An

14insurer, health
maintenance organization, independent practice

15association, or physician hospital
organization may substitute 
16the fee schedule sample with a document providing
reference
to 
17the information needed to calculate the fee schedule that is 
18available to
the public at no
charge and the percentage or 
19conversion factor at which the insurer, health
maintenance

20organization, preferred provider organization, independent 
21practice
association, or physician hospital organization sets 
22its rates.

23 (b) The fee schedule, the capitation schedule, and
the 
24network provider
administration manual constitute 
25confidential, proprietary, and trade secret
information and 
26are subject to the provisions of the Illinois Trade Secrets

 
 
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1Act.
The health
care professional or health care provider 
2receiving such protected information
may disclose
the 
3information on a need to know basis and only to individuals and 
4entities
that provide
services directly related to the health 
5care professional's or health care
provider's decision
to 
6enter into the contract or keep the contract in force. Any 
7person or entity
receiving or
reviewing such protected 
8information pursuant to this Section shall not
disclose
the

9information to any other person, organization, or entity, 
10unless the disclosure
is requested
pursuant to a valid court 
11order or required by a state or federal government
agency.

12Individuals or entities receiving such information from a 
13health care
professional
or health care provider as delineated 
14in this subsection are subject to the
provisions of the

15Illinois Trade Secrets Act.

16 (c) The health care professional or health care provider 
17shall be allowed at
least
30 days to review the health care 
18professional or health care provider services
contract, 
19including
exhibits and
attachments, if any, before signing. 
20The 30-day review period begins upon
receipt of the
health 
21care
professional or health care provider services contract, 
22unless the information
available
upon request
in subsection 
23(a) is not included. If information is not included in the

24professional
services contract and is requested pursuant to 
25subsection (a), the 30-day
review period
begins on the date of 
26receipt of the information. Nothing in this subsection
shall 
 
 
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1prohibit
a health care professional or health care provider 
2from signing a contract
prior to the
expiration of the 30-day 
3review period.

4 (d) As used in this subsection:
5 "Change" means an increase or decrease in the fee schedule 
6referred to in subsection (a).
7 "Nonroutine change" means any proposed change to the fee 
8schedule except a change that is otherwise required by law, 
9regulation, or an applicable regulatory authority or that is 
10required as a result of changes in fee schedules, 
11reimbursement methodology, or payment policies established by 
12a government agency or by the American Medical Association's 
13current procedural terminology codes, reporting guidelines, 
14and conventions, or a change that is expressly provided for 
15under the terms of the contract by the inclusion of or 
16reference to a specific fee or fee schedule, reimbursement 
17methodology, or payment policy indexing mechanism. 
18 The insurer, health maintenance organization,
independent 
19practice
association, or physician hospital organization shall 
20provide all contracted
health care
professionals or health 
21care providers with any changes to the fee schedule
provided

22under subsection (a) not later than 35 days after the 
23effective date of the
changes,
unless such
changes are 
24specified in the contract and the health care professional or

25health care
provider is able to calculate the changed rates 
26based on information in the
contract and
information available 
 
 
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1to the public at no charge. Beginning January 1, 2023, with 
2respect to nonroutine changes to the fee schedule, the 
3insurer, health maintenance organization, independent practice 
4association, or physician hospital organization shall provide 
5all contracted health care professionals or health care 
6providers impacted by the nonroutine change with notice of the 
7change at least 60 days before the effective date of the 
8change. The right to advance notice of nonroutine changes to 
9the fee schedule may not be waived by the health care 
10professional or health care provider. 
11 For the purposes of this
subsection,
"changes" means an 
12increase or decrease in the fee schedule referred to in

13subsection (a).
This information may be made available by 
14mail, e-mail, newsletter, website
listing, or
other reasonable 
15method. For nonroutine changes, the information directing the 
16health care professional or health care provider to the 
17information provided by newsletter, website listing, or other 
18reasonable method shall be provided by email or, if requested 
19by the health care professional or health care provider, by 
20mail. Upon request, a health care professional or health
care 
21provider
may request an updated copy of the fee schedule 
22referred to in subsection (a)
every
calendar quarter.
23 (e) Upon termination of a contract with an insurer, health 
24maintenance
organization, independent practice
association, or 
25physician hospital
organization and at
the request of the 
26patient, a health care professional or health care provider

 
 
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1shall transfer
copies of the patient's medical records. Any 
2other provision of law
notwithstanding, the
costs for copying 
3and transferring copies of medical records shall be assigned

4per the
arrangements agreed upon, if any, in the health care 
5professional or health
care provider services
contract.

6(Source: P.A. 93-261, eff. 1-1-04.)".