Bill
HB 3796
HB 3796/P.A. 104-0333 ensures 90-day continuity of care when a provider leaves a network, with continued reimbursement and 60-day notices to protect patients.
Status and effective date
- Enacted as Public Act 104-0333; Governor approved August 15, 2025.
- Effective January 1, 2027.
- Passed both chambers (third reading May 22, 2025).
Purpose
- Strengthens continuity-of-care protections for insured patients when providers leave an insurer’s network and creates new regulatory requirements for carriers that establish provider panels. Seeks to improve notice, transparency, and procedural safeguards for enrollees and providers.
Key provisions — Network Adequacy and Transparency Act (amendment to Sec. 20)
- Continuity of care on provider departure:
- If a beneficiary’s provider leaves a network (other than for imminent harm or final disciplinary action) or benefits are lost due to contractual changes, the beneficiary may continue an ongoing course of treatment during a transitional period:
- 90 days from date of notice for ongoing treatment; or
- 90 days if beneficiary has a confirmed appointment scheduled before notice (A-5); or
- For beneficiaries in third trimester of pregnancy at disaffiliation, continuation that includes postpartum care related to delivery.
- Authorization and conditions during transition:
- Provider receives continued reimbursement at rates and terms applicable under the terminated contract (prior to the start of the transitional period).
- Provider must meet network quality assurance requirements and follow plan policies (including referrals and preauthorization).
- Exceptions: transition protections do not apply if beneficiary already moved to another network provider, has exhausted plan limits, care is not medically necessary, or appointments are rescheduled beyond the allowed period.
- Applies similarly to new enrollees whose current provider is out-of-network but inside service area (90 days from enrollment effective date or confirmed appointment; pregnancy protections also apply).
- Providers must comply with federal law 42 U.S.C. §300gg‑138.
Key provisions — Managed Care Reform and Patient Rights Act (new Sec. 62 and Sec. 20 changes)
- Definitions: establishes “carrier” and “provider panel” definitions; excludes open discounted-fee arrangements.
- Pre-establishment notice: carriers must file notice with the Illinois Department of Public Health prior to establishing a provider panel serving state residents.
- Transparency & lists: carriers must provide provider applications and lists of panel members upon request (details provided in bill).
- Notice requirements:
- Carriers must notify enrollees served by a provider at least 60 days before nonrenewal/termination (or immediate notice if provider license disciplined). Notices must provide contact information and opportunity for enrollee to request transitional care.
- Carriers must notify providers at least 60 days before termination from the panel.
- Continuity extensions and special circumstances:
- Generally, providers may continue to treat affected enrollees for at least 90 days after panel termination, except when terminated for cause.
- Extended continuations (at enrollee option) for: pregnancy (through postpartum), terminal illness (through remainder of life for related care), life‑threatening conditions (up to 180 days), and inpatient stays (until discharge) — all except where termination is for cause.
- Anti-discrimination: carriers cannot deny panel participation or terminate based on gender, race, age, sexual orientation, gender identity, religion, or national origin.
- Provider contracts & preauthorization:
- Carriers requiring preauthorization must have personnel available whenever preauthorization is required.
- Contracts may not require providers to deny medically necessary covered services.
- Prohibits certain contractual provisions (details in bill).
- Other administrative and conforming changes included.
Who is affected
- Carriers (insurers, HMOs, prepaid dental/optometric plans, entities arranging panels): new filing, notice, transparency, application and operational obligations.
- Health care providers: procedural protections for continued treatment, notice requirements, reimbursement terms during transition, and limits on contract provisions.
- Enrollees/beneficiaries: stronger continuity-of-care protections, clearer notice and ability to elect transitional care.
- Illinois Department of Public Health: receives pre-establishment notices and will be involved in oversight related to provider panels.
Procedural/timing notes
- Effective January 1, 2027 — carriers and providers must comply after that date.
- Enrolled as Public Act 104-0333 following bill amendments and floor action in spring 2025.
Potential impacts (practical effects)
- Increased continuity of care for patients during network changes, especially for pregnant, terminally ill, or critically ill enrollees.
- Administrative and compliance workload for carriers (pre-filing with DPH, notice systems, staffing for preauthorization).
- Financial implications for carriers due to reimbursement at prior contract rates during transition periods and potential limits on contract terms.
For full statutory language, consult Public Act 104‑0333 and the amended sections of the Network Adequacy and Transparency Act and the Managed Care Reform and Patient Rights Act.
Compiled from official sources — confirm details with the bill’s official record.
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