Bill Text: IL SB2771 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Provides that an insurer, health maintenance organization, independent practice association, or physician hospital organization may not attempt a recoupment or offset until all appeal rights of a health care professional or health care provider are exhausted. Provides that no recoupment or offset may be requested or withheld from future payments 6 months or more after the original payment is made (rather than 18 months or more after the original payment is made). Effective January 1, 2021.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Failed) 2021-01-13 - Session Sine Die [SB2771 Detail]

Download: Illinois-2019-SB2771-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 SB2771 Introduced 2/4/2020, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
215 ILCS 5/368d
Amends the Illinois Insurance Code. Provides that an insurer, health maintenance organization, independent practice association, or physician hospital organization may not attempt a recoupment or offset until all appeal rights of a health care professional or health care provider are exhausted. Provides that no recoupment or offset may be requested or withheld from future payments 6 months or more after the original payment is made (rather than 18 months or more after the original payment is made). Effective January 1, 2021.
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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 368d as follows:
(215 ILCS 5/368d)
Sec. 368d. Recoupments.
(a) A health care professional or health care provider
shall be provided a remittance advice, which must include an
explanation of a recoupment or offset taken by an insurer,
health maintenance organization, independent practice
association, or physician hospital organization, if any. The
recoupment explanation shall, at a minimum, include the name of
the patient; the date of service; the service code or if no
service code is available a service description; the recoupment
amount; and the reason for the recoupment or offset. In
addition, an insurer, health maintenance organization,
independent practice association, or physician hospital
organization shall provide with the remittance advice, or with
any demand for recoupment or offset, a telephone number or
mailing address to initiate an appeal of the recoupment or
offset together with the deadline for initiating an appeal.
Such information shall be prominently displayed on the

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remittance advice or written document containing the demand for
recoupment or offset. Any appeal of a recoupment or offset by a
health care professional or health care provider must be made
within 60 days after receipt of the remittance advice. An
insurer, health maintenance organization, independent practice
association, or physician hospital organization may not
attempt a recoupment or offset until all appeal rights are
exhausted.
(b) It is not a recoupment when a health care professional
or health care provider is paid an amount prospectively or
concurrently under a contract with an insurer, health
maintenance organization, independent practice association, or
physician hospital organization that requires a retrospective
reconciliation based upon specific conditions outlined in the
contract.
(c) No recoupment or offset may be requested or withheld
from future payments 6 18 months or more after the original
payment is made, except in cases in which:
(1) a court, government administrative agency, other
tribunal, or independent third-party arbitrator makes or
has made a formal finding of fraud or material
misrepresentation;
(2) an insurer is acting as a plan administrator for
the Comprehensive Health Insurance Plan under the
Comprehensive Health Insurance Plan Act; or
(3) the provider has already been paid in full by any

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other payer, third party, or workers' compensation
insurer.
No contract between an insurer and a health care professional
or health care provider may provide for recoupments in
violation of this Section. Nothing in this Section shall be
construed to preclude insurers, health maintenance
organizations, independent practice associations, or physician
hospital organizations from resolving coordination of benefits
between or among each other, including, but not limited to,
resolution of workers' compensation and third-party liability
cases, without recouping payment from the provider beyond the
18-month time limit provided in this subsection (c).
(Source: P.A. 97-556, eff. 1-1-12.)
Section 99. Effective date. This Act takes effect January
1, 2021.