Bill Text: IL HB3509 | 2015-2016 | 99th General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Provides that contracts between insurers and health care professionals or providers for the provision of health care to the insured shall not contain terms allowing the plan to change a material term of the contract or a term affecting reimbursement rates established in the contract unless the term has been negotiated and agreed to or the change is necessary to comply with State or federal law or regulations or accreditation requirements. Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2015-03-27 - Rule 19(a) / Re-referred to Rules Committee [HB3509 Detail]

Download: Illinois-2015-HB3509-Introduced.html

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99TH GENERAL ASSEMBLY State of Illinois 2015 and 2016 HB3509 Introduced , by Rep. Greg Harris SYNOPSIS AS INTRODUCED:
215 ILCS 5/368b
Amends the Illinois Insurance Code. Provides that contracts between insurers and health care professionals or providers for the provision of health care to the insured shall not contain terms allowing the plan to change a material term of the contract or a term affecting reimbursement rates established in the contract unless the term has been negotiated and agreed to or the change is necessary to comply with State or federal law or regulations or accreditation requirements. Effective immediately.
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A BILL FOR
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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
changing Section 368b as follows:
(215 ILCS 5/368b)
Sec. 368b. Contracting procedures.
(a) A health care professional or health care provider
offered a contract by an insurer, health maintenance
organization, independent practice association, or physician
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 provider
administration manual, and a summary capitation schedule, if

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payment is made on a capitation basis. If 50 codes do not exist
for a particular specialty, the health care 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 insurer, health
maintenance organization, independent practice 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
organization, preferred provider organization, independent
practice association, or physician hospital organization sets
its rates.
(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
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

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pursuant to this Section shall not disclose the 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. 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 Illinois Trade
Secrets Act.
(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 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.
(d) 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 under subsection (a) not later than 35

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days after the effective date of the changes, unless such
changes are specified in the contract and the health care
professional or 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. For the
purposes of this subsection, "changes" means an increase or
decrease in the fee schedule referred to in subsection (a).
This information may be made available by mail, e-mail,
newsletter, website listing, or other reasonable method. 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
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
per the arrangements agreed upon, if any, in the health care
professional or health care provider services contract.
(f) No contract between an insurer, health maintenance
organization, managed care plan, health care plan, preferred
provider organization, third party administrator, independent
practice association, or physician-hospital organization and a
health care provider or health care professional for the

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provision of health care services to an insured, enrollee,
beneficiary, or subscriber shall contain terms allowing the
plan to change a material term of the contract or a term
affecting reimbursement rates established in the contract,
including changes made by amending a manual, policy, procedure
document, or other document referenced in the contract, unless
the change has first been negotiated and agreed to by the
provider or professional and the plan or the change is
necessary to comply with State or federal law or regulations or
any accreditation requirements of a private sector
accreditation organization.
(Source: P.A. 93-261, eff. 1-1-04.)
Section 99. Effective date. This Act takes effect upon
becoming law.