HB 4941

Abstract

Amends the Accident and Health Insurance Article of the Illinois Insurance Code. In provisions concerning contracting procedures, replaces language concerning changes to the fee schedule with language providing that an insurer, health maintenance organization, independent practice association, or physician hospital organization shall provide all contracted health care professionals or health care providers with notice of any changes to the fee schedule at least 90 days before the effective date of the change, that the right to advance notice of changes to the fee schedule cannot be waived by the health care professional or provider, and that changes to the fee schedule cannot be applied retroactively from the effective date of the changes. Provides that if the changes to the fee schedule include a reduction in fees greater than 3% of the Medicare rate established for the current calendar year, the health care professional or health care provider may propose alternative changes to the fee schedule. Provides that any changes to the fee schedule must be final at least 30 days before the effective date of the changes. Provides that fee schedule information must be provided directly to the contracted health care professional or health care provider (rather than may be made available) by mail, e-mail, or telephone, and that this information may also be provided by newsletter, website listing, or other reasonable method. House Floor Amendment No. 1 Replaces everything after the enacting clause. 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". Senate Floor Amendment No. 1 Provides that 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.