Amends the Managed Care Reform and Patient Rights Act. Sets forth requirements for carriers that offer a provider panel. Requires notice of the development of a provider panel to be filed with Department of Public Health prior to establishment. Provides that a carrier that uses a provider panel shall establish procedure for notifying an enrollee of the termination of a health care provider. Sets forth provisions permitting, under certain circumstances, a health care provider to continue to render health care services following termination from the carrier's provider panel. Requires a carrier to provide a list of members in the carrier's provider panel. Establishes notice requirements for benefit reductions and termination of health care providers from the carrier's provider panel. Requires any carrier requiring preauthorization for medical treatment to have personnel available to provide preauthorization at all times when the preauthorization is required. Provides that no contract between a health care provider and a carrier shall include provisions that require a health care provider to deny covered services that the provider knows to be medically necessary and appropriate that are provided with respect to a specific enrollee or group of enrollees with similar medical conditions. Sets forth prohibited provisions in a contract between a carrier and a health care provider. Defines terms. Makes other and conforming changes.
House Floor Amendment No. 1: Replaces everything after the enacting clause. Amends the Network Adequacy and Transparency Act. In provisions concerning continuity of care for beneficiaries, provides that the network plan shall permit the beneficiary to continue an ongoing course of treatment with that provider during a transitional period for 90 days from the date of the notice to the beneficiary of the provider's disaffiliation from the network plan if the beneficiary has a confirmed appointment and the provider attests that the appointment was scheduled prior to the date of notification. Requires a network plan to provide for continuity of care for new beneficiaries during a transition period of 90 days from the effective date of enrollment if the beneficiary has a confirmed appointment and the current provider attests that the appointment was scheduled prior to the effective date of enrollment. Limits the applicability of continuity of care requirements if the provider or beneficiary reschedules an appointment or schedules any follow up appointments after 90 days from the effective date of enrollment. Effective January 1, 2027.

Statutes affected:
Introduced: 215 ILCS 134/20, 215 ILCS 134/62
Engrossed: 215 ILCS 124/20
Enrolled: 215 ILCS 124/20