Illinois’ Surprise Billing Law Has Broadened in Scope

June 10, 2022

Governor Pritzker recently signed House Bill 4703 into law, which expands the scope of Illinois’ surprise billing law to more closely align with the federal No Surprises Act (NSA).

Significantly, the new Illinois law extends the prohibition against balance billing to all non-participating facility-based physicians providing services at an in-network hospital or other facility, not just the five specialties that were previously enumerated.

The legislation also adopts the NSA definition of “qualifying payment amount,” specifically for reference in determining patient cost-sharing amounts for out-of-network services within the scope of the law. Importantly, Illinois lawmakers deliberately included legislative language that would prohibit the use of the Qualifying Payment Amount (QPA) as the primary consideration by arbitrators in payment disputes about out-of-network costs.

As state law remains silent on the issue of good faith estimates, all physicians and providers in Illinois will need to provide good faith estimates (GFEs), consistent with provisions in the NSA. In addition, the new law does not substantially change the arbitration process that exists in Illinois for surprise billing disputes.

ISMS’ newly updated Issue Brief, Surprise Billing: An Overview of the Federal No Surprises Act and Its Interaction with Illinois’ Law, covers Illinois’ surprise billing law, along with the changes from House Bill 4703 and the state and federal overlap.

The resource also offers guidance about what physicians need to address to comply with the federal No Surprises Act, with many of its provisions in effect as of Jan. 1, 2022.

Questions? Please contact the ISMS Health Policy Research and Advocacy team by email.

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