Illinois HB 1331: $DPH-OSTEOPOROSIS PROGRAM

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HB1331 EnrolledLRB104 07370 BAB 17410 b

1 AN ACT concerning regulation.

2 Be it enacted by the People of the State of Illinois, 

3represented in the General Assembly:

4 Section 5. The Network Adequacy and Transparency Act is 

5amended by changing Section 10 as follows:

6 (215 ILCS 124/10)

7 (Text of Section from P.A. 103-650)

8 Sec. 10. Network adequacy.

9 (a) Before issuing, delivering, or renewing a network 

10plan, an issuer providing a network plan shall file a 

11description of all of the following with the Director:

12 (1) The written policies and procedures for adding 

13 providers to meet patient needs based on increases in the 

14 number of beneficiaries, changes in the 

15 patient-to-provider ratio, changes in medical and health 

16 care capabilities, and increased demand for services.

17 (2) The written policies and procedures for making 

18 referrals within and outside the network.

19 (3) The written policies and procedures on how the 

20 network plan will provide 24-hour, 7-day per week access 

21 to network-affiliated primary care, emergency services, 

22 and women's principal health care providers.

23 An issuer shall not prohibit a preferred provider from 

HB1331 Enrolled- 2 -LRB104 07370 BAB 17410 b

1discussing any specific or all treatment options with 

2beneficiaries irrespective of the insurer's position on those 

3treatment options or from advocating on behalf of 

4beneficiaries within the utilization review, grievance, or 

5appeals processes established by the issuer in accordance with 

6any rights or remedies available under applicable State or 

7federal law.

8 (b) Before issuing, delivering, or renewing