On May 25, ILL LEG passed bill, implement federal insurance standard
ILL LEG passed bill HB 5395 to provide for the expeditious and timely implementation of the Network adequacy and transparency act; bill amends ILL INS 215 (insurance).
Follows ILL INS bulletin issued regarding health plan filing requirements, see #211861.
Key Provisions
Implements federal standards for provider ratios, travel time and distance, wait times.
If such standards apply to health insurance coverage, are more stringent than State standards extant at the time final federal standards are published may be adopted.
Requires the issuer of a network plan to submit a self-audit of its provider directory.
Makes changes to the information that must be provided in a network plan directory.
Sets forth actions if issuer/department identifies provider incorrectly listed in directory.
Provisions re confidentiality; transition of services; unreasonable and inadequate rates.
Definitions of excepted benefits and step therapy requirement; off-formulary requests; algo automated review processes; utilization review criteria; adverse determinations.
Provides that specified provisions do not apply to group policies issued in the large group market as defined in Illinois health insurance portability and accountability act.
Legislative History
On Feb. 9, 2024, bill introduced in the House; on Apr. 18, 2024, bill passed in House.
On Apr. 19, 2024, bill introduced in Senate; on May 23, 2024, bill passed in Senate.
On May 25, 2024, House concurred with amendments, bill has passed both chambers.
Effectiveness
If bill is approved, act will become effective on Jan. 1, 2025, except that certain changes to the Managed Care Reform and Patient Rights Act take effect Jan. 1, 2026.
