State of Illinois
92^nd General Assembly
Legislation

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92_SB2245eng

 
SB2245 Engrossed                              LRB9211443JSpcB

 1        AN ACT concerning insurance.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

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

 6        (215 ILCS 5/368a)
 7        Sec. 368a.  Timely payment for health care services.
 8        (a)  This Section applies to insurers, health maintenance
 9    organizations,  managed  care  plans,  health   care   plans,
10    preferred provider organizations, third party administrators,
11    independent  practice  associations,  and  physician-hospital
12    organizations  (hereinafter  referred  to  as  "payors") that
13    provide periodic payments, which are payments not requiring a
14    claim,  bill,  capitation  encounter  data,   or   capitation
15    reconciliation   reports,   such  as  prospective  capitation
16    payments,  to  health  care  professionals  and  health  care
17    facilities to provide medical or  health  care  services  for
18    insureds or enrollees.
19             (1)  A   payor   shall  make  periodic  payments  in
20        accordance with  item  (3).   Failure  to  make  periodic
21        payments  within the period of time specified in item (3)
22        shall entitle the health care professional or health care
23        facility  to interest at the rate of 9% per year from the
24        date payment was required to be made to the date  of  the
25        late  payment,  provided  that interest amounting to less
26        than $1 need not be paid.  Any required interest payments
27        shall be made within 30 days after the payment.
28             (2)  When a payor requires  selection  of  a  health
29        care  professional or health care facility, the selection
30        shall be completed by the insured or  enrollee  no  later
31        than  30  days after enrollment.  The payor shall provide
 
SB2245 Engrossed            -2-               LRB9211443JSpcB
 1        written notice of this requirement to  all  insureds  and
 2        enrollees.  Nothing in this Section shall be construed to
 3        require a payor to select a health care  professional  or
 4        health care facility for an insured or enrollee.
 5             (3)  A   payor   shall   provide   the  health  care
 6        professional or health care facility with notice  of  the
 7        selection  as  a  health care professional or health care
 8        facility by an insured or enrollee and the effective date
 9        of the  selection  within  60  calendar  days  after  the
10        selection.  No later than the 60th day following the date
11        an  insured  or  enrollee  has  selected  a  health  care
12        professional  or  health  care  facility or the date that
13        selection becomes effective, whichever is  later,  or  in
14        cases  of  retrospective  enrollment  only, 30 days after
15        notice by an employer to the payor of  the  selection,  a
16        payor  shall  begin  periodic  payment  of  the  required
17        amounts  to  the  insured's  or  enrollee's  health  care
18        professional  or health care facility, or the designee of
19        either, calculated from the date of selection or the date
20        the selection becomes effective, whichever is later.  All
21        subsequent  payments  shall  be made in accordance with a
22        monthly periodic cycle.
23        (b)  Notwithstanding any other provision of this Section,
24    independent  practice  associations  and   physician-hospital
25    organizations shall make begin making periodic payment of the
26    required  amounts  in  accordance  with  a  monthly  periodic
27    schedule  within  60  days  after  an insured or enrollee has
28    selected a health care professional or health  care  facility
29    or after the date that selection becomes effective, whichever
30    is   later.  Before  January  1,  2001,  subsequent  periodic
31    payments shall be made in accordance with a  60-day  periodic
32    schedule,  and  after  December 31, 2000, subsequent periodic
33    payments shall be made in accordance with a monthly  periodic
34    schedule.
 
SB2245 Engrossed            -3-               LRB9211443JSpcB
 1        Notwithstanding  any  other  provision  of  this Section,
 2    independent  practice  associations  and   physician-hospital
 3    organizations  shall  make  all  other  payments  for  health
 4    services within 30 60 days after receipt of due proof of loss
 5    received  before  January  1,  2001  and within 30 days after
 6    receipt of due proof of  loss  received  after  December  31,
 7    2000.       Independent     practice     associations     and
 8    physician-hospital organizations shall  notify  the  insured,
 9    insured's  assignee, health care professional, or health care
10    facility of any failure to provide  sufficient  documentation
11    for  a  due proof of loss within 30 days after receipt of the
12    claim for health services.
13        Failure to pay within  the  required  time  period  shall
14    entitle the payee to interest at the rate of 9% per year from
15    the  date the payment is due to the date of the late payment,
16    provided that interest amounting to less that $1 need not  be
17    paid.  Any required interest payments shall be made within 30
18    days after the payment.
19        (c)  All   insurers,  health  maintenance  organizations,
20    managed care plans, health  care  plans,  preferred  provider
21    organizations,  and  third  party administrators shall ensure
22    that  all  claims  and  indemnities  concerning  health  care
23    services other than for any periodic payment  shall  be  paid
24    within  30  days  after  receipt of due written proof of such
25    loss.   An   insured,   insured's   assignee,   health   care
26    professional, or health care facility shall  be  notified  of
27    any  known  failure to provide sufficient documentation for a
28    due proof of loss within 30 days after receipt of  the  claim
29    for  health care services.  Failure to pay within such period
30    shall entitle the payee to interest at the  rate  of  9%  per
31    year from the 30th day after receipt of such proof of loss to
32    the date of late payment, provided that interest amounting to
33    less than one dollar need not be paid.  Any required interest
34    payments shall be made within 30 days after the payment.
 
SB2245 Engrossed            -4-               LRB9211443JSpcB
 1        (d)  The  Department shall enforce the provisions of this
 2    Section pursuant to the enforcement powers granted to  it  by
 3    law.
 4        (e)  The  Department is hereby granted specific authority
 5    to issue  a  cease  and  desist  order,  fine,  or  otherwise
 6    penalize     independent     practice     associations    and
 7    physician-hospital organizations that violate  this  Section.
 8    The  Department  shall  adopt  reasonable  rules  to  enforce
 9    compliance   with   this   Section  by  independent  practice
10    associations and physician-hospital organizations.
11    (Source: P.A. 91-605, eff. 12-14-99; 91-788, eff. 6-9-00.)

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