Public Act 92-0745  SB2245 Enrolled                               LRB9211443JSpcB      AN ACT concerning insurance.      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 368a as follows:      (215 ILCS 5/368a)     Sec. 368a.  Timely payment for health care services.     (a)  This Section applies to insurers, health maintenance organizations,  managed  care  plans,  health   care   plans, preferred provider organizations, third party administrators, independent  practice  associations,  and  physician-hospital organizations  (hereinafter  referred  to  as  "payors") that provide periodic payments, which are payments not requiring a claim,  bill,  capitation  encounter  data,   or   capitation reconciliation   reports,   such  as  prospective  capitation payments,  to  health  care  professionals  and  health  care facilities to provide medical or  health  care  services  for insureds or enrollees.          (1)  A   payor   shall  make  periodic  payments  in     accordance with  item  (3).   Failure  to  make  periodic     payments  within the period of time specified in item (3)     shall entitle the health care professional or health care     facility  to interest at the rate of 9% per year from the     date payment was required to be made to the date  of  the     late  payment,  provided  that interest amounting to less     than $1 need not be paid.  Any required interest payments     shall be made within 30 days after the payment.          (2)  When a payor requires  selection  of  a  health     care  professional or health care facility, the selection     shall be completed by the insured or  enrollee  no  later     than  30  days after enrollment.  The payor shall provide     written notice of this requirement to  all  insureds  and     enrollees.  Nothing in this Section shall be construed to     require a payor to select a health care  professional  or     health care facility for an insured or enrollee.          (3)  A   payor   shall   provide   the  health  care     professional or health care facility with notice  of  the     selection  as  a  health care professional or health care     facility by an insured or enrollee and the effective date     of the  selection  within  60  calendar  days  after  the     selection.  No later than the 60th day following the date     an  insured  or  enrollee  has  selected  a  health  care     professional  or  health  care  facility or the date that     selection becomes effective, whichever is  later,  or  in     cases  of  retrospective  enrollment  only, 30 days after     notice by an employer to the payor of  the  selection,  a     payor  shall  begin  periodic  payment  of  the  required     amounts  to  the  insured's  or  enrollee's  health  care     professional  or health care facility, or the designee of     either, calculated from the date of selection or the date     the selection becomes effective, whichever is later.  All     subsequent  payments  shall  be made in accordance with a     monthly periodic cycle.     (b)  Notwithstanding any other provision of this Section, independent  practice  associations  and   physician-hospital organizations shall make begin making periodic payment of the required  amounts  in  accordance  with  a  monthly  periodic schedule  within  60  days  after  an insured or enrollee has selected a health care professional or health  care  facility or after the date that selection becomes effective, whichever is   later.  Before  January  1,  2001,  subsequent  periodic payments shall be made in accordance with a  60-day  periodic schedule,  and  after  December 31, 2000, subsequent periodic payments shall be made in accordance with a monthly  periodic schedule.     Notwithstanding  any  other  provision  of  this Section, independent  practice  associations  and   physician-hospital organizations  shall  make  all  other  payments  for  health services within 30 60 days after receipt of due proof of loss received  before  January  1,  2001  and within 30 days after receipt of due proof of  loss  received  after  December  31, 2000.       Independent     practice     associations     and physician-hospital organizations shall  notify  the  insured, insured's  assignee, health care professional, or health care facility of any failure to provide  sufficient  documentation for  a  due proof of loss within 30 days after receipt of the claim for health services.     Failure to pay within  the  required  time  period  shall entitle the payee to interest at the rate of 9% per year from the  date the payment is due to the date of the late payment, provided that interest amounting to less that $1 need not  be paid.  Any required interest payments shall be made within 30 days after the payment.     (c)  All   insurers,  health  maintenance  organizations, managed care plans, health  care  plans,  preferred  provider organizations,  and  third  party administrators shall ensure that  all  claims  and  indemnities  concerning  health  care services other than for any periodic payment  shall  be  paid within  30  days  after  receipt of due written proof of such loss.   An   insured,   insured's   assignee,   health   care professional, or health care facility shall  be  notified  of any  known  failure to provide sufficient documentation for a due proof of loss within 30 days after receipt of  the  claim for  health care services.  Failure to pay within such period shall entitle the payee to interest at the  rate  of  9%  per year from the 30th day after receipt of such proof of loss to the date of late payment, provided that interest amounting to less than one dollar need not be paid.  Any required interest payments shall be made within 30 days after the payment.     (d)  The  Department shall enforce the provisions of this Section pursuant to the enforcement powers granted to  it  by law.     (e)  The  Department is hereby granted specific authority to issue  a  cease  and  desist  order,  fine,  or  otherwise penalize     independent     practice     associations    and physician-hospital organizations that violate  this  Section. The  Department  shall  adopt  reasonable  rules  to  enforce compliance   with   this   Section  by  independent  practice associations and physician-hospital organizations. (Source: P.A. 91-605, eff. 12-14-99; 91-788, eff. 6-9-00.)     Passed in the General Assembly May 29, 2002.     Approved July 25, 2002.