Bill Text: IL HB4941 | 2021-2022 | 102nd General Assembly | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

Bill Title: Amends the Illinois Insurance Code. Provides that, 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, that the right to advance notice of nonroutine changes to the fee schedule may not be waived by the health care professional or provider, and that, 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. Defines "nonroutine change".

Spectrum: Partisan Bill (Democrat 8-0)

Status: (Passed) 2022-05-27 - Public Act . . . . . . . . . 102-0957 [HB4941 Detail]

Download: Illinois-2021-HB4941-Enrolled.html

---

HB4941 Enrolled LRB102 22842 BMS 34494 b
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

HB4941 Enrolled - 2 - LRB102 22842 BMS 34494 b
schedule, if 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

HB4941 Enrolled - 3 - LRB102 22842 BMS 34494 b
information 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) 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

HB4941 Enrolled - 4 - LRB102 22842 BMS 34494 b
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
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
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

HB4941 Enrolled - 5 - LRB102 22842 BMS 34494 b
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
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
shall transfer copies of the patient's medical records. Any

HB4941 Enrolled - 6 - LRB102 22842 BMS 34494 b
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.
(Source: P.A. 93-261, eff. 1-1-04.)