Ensuring network adequacy, transparency and uninterrupted service are all components of legislation recently signed into law by Illinois Gov. Bruce Rauner. An important patient protection measure initiated by the Illinois State Medical Society (ISMS) and supported by U.S. Pain Foundation, House Bill 311 creates new safeguards for Illinoisans impacted by one of the latest trends in health care: the narrowing of physician networks. The law is known as the Network Adequacy Transparency Act (NAT Act).
Director of State Advocacy and Alliance Development Shaina Smith says this legislation was a significant win for the chronic pain community. “This law will require networks to meet the needs of the patient,” Smith notes. “Networks must have health facilities and doctors, which includes specialists that people with chronic pain visit throughout the year, in close proximity to where health plan enrollees reside. This is a positive step by Gov. Rauner and we applaud his decision to support the chronic pain community by signing this bill into law.”
Aside from the network adequacy component to HB 311, the new law will allow for a more transparent process to networks as well. Insurers will be obligated to maintain updated provider directories. Patients also will be notified by the insurer if a doctor or hospital has been dropped from a network in a timely fashion. This will aid in the elimination of surprise, out-of-network charges to the patient. In addition, under the law, disruptions due to changes in health insurance networks are prohibited. Should a doctor be dropped from the network, patients will be able to remain with that provider while transitioning to a new doctor, allowing for an easier adjustment period.
“It is essential to maintain patient safety regardless of health plan changes,” Smith adds. “Illinois residents with complex conditions, such as chronic pain, will have a fair means to find a new health care provider should their previous doctor be dropped from the network. This patient protection will prove advantageous to many who cannot afford, either financially or health-wise, to have uninterrupted health benefits.”
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