Illinois HB 4735: DESIGNATIONS-MONARCH MONTH

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 Full Text of HB4735

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104TH GENERAL ASSEMBLY 
State of Illinois 
2025 and 2026
HB4735

Introduced , by Rep. Sharon Chung 

SYNOPSIS AS INTRODUCED:

New Act

 Creates the Transparency in Downcoding Act. Provides that the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974 and health care provided pursuant to the Workers' Compensation Act or the Workers' Occupational Diseases Act. Prohibits a health insurance issuer from using an automated process, system, or tool to downcode a claim; from downcoding a claim based solely on the reported diagnosis codes; and from using downcoding practices in a targeted or discriminatory manner against physicians who routinely treat patients with complex or chronic conditions. Requires downcoding decisions to be made by a physician licensed to practice medicine in all its branches in any United States jurisdiction and of the same or similar specialty as a physician who typically manages the medical condition or disease. Sets forth provisions concerning notification requirements for downcoded claims; the appeal process for downcoded claims; enforcement by the Department of Insurance; and penalties. Provides that any pattern or practice of discriminatory downcoding identified by the Director of Insurance or another regulatory authority shall be subject to enforcement actions, including fines, restitution, or suspension of the health insurance issuer's license in this State. Effective immediately.

LRB104 19666 BAB 33115 b

A BILL FOR

HB4735LRB104 19666 BAB 33115 b

1 AN ACT concerning regulation.

2 Be it enacted b