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SB 3648

NETWORK ADEQUACY-DIRECTORY

104th Regular Session Introduced by Dave Syverson

SB3648 requires providers to use a uniform electronic directory form to update issuer provider directories, standardizing and speeding accurate directory information.

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Bill Summary · SB 3648

Summary of SB3648 (104th General Assembly) – Illinois

Title

NETWORK ADEQUACY-DIRECTORY

Purpose and Intent

SB3648 amends the Network Adequacy and Transparency Act to standardize and streamline the process by which health care provider directory information is communicated to health insurance issuers. The core goal is to ensure issuers maintain accurate, up-to-date provider directories by requiring providers to notify issuers of any changes and by establishing a uniform electronic form for directory information.

Key Provisions and Changes

  • Uniform Electronic Directory Form and Process (Section 55)

    • Creates a requirement for providers to notify all contracted issuers of any changes to their directory information.
    • Requires issuers to use the provider-submitted information to update their directories within timeframes specified in the Act.
    • Allows issuers to use their own electronic systems to receive updates, provided those systems enable providers to submit the required information.

  • Department-Driven Uniform Form Development (new responsibility)

    • The Department must develop and publish, by January 1, 2026, a uniform electronic provider directory information form.
    • The form will be used by issuers to onboard, update, or terminate preferred providers and to reflect current directory information and plan-specific details (e.g., whether a provider is a preferred provider or accepting new patients under a given plan).
    • The form may be delivered as a PDF or through a web portal with the same information requirements.

  • Mandatory Adoption by Providers (timelines)

    • Beginning no later than July 1, 2026 (and six months after the form’s publication), all providers must use the uniform form to notify issuers of their directory information.
    • Paper or fax submissions to issuers will no longer be accepted.

  • Uniform Electronic Provider Directory Information Form Task Force (new)

    • A Task Force is created to advise the Department on form development.
    • Members include state agency representatives and appointed stakeholders, including physicians, nurses, hospital and pharmacy associations, mental health and substance use providers, health plan issuers or associations, and health care consumer advocates.
    • The Department must convene the task force by April 1, 2025.

  • Guiding Principles and Interoperability (Section 55 considerations)

    • The form and process should emphasize readability, user experience, and interoperability.
    • Coordination with federal and state programs (e.g., CMS, HFS, IDPH, DFPR) and potential data-duplication avoidance.
    • Consideration of integration with existing provider credentialing data and other provider directories (including potential alignment with federal CMS directories and the Patients’ Right to Know Act).
    • Compatibility with the Illinois Health Benefits Exchange and provider licensing processes.
    • Adequate reporting for specialty classifications where boards or licenses may not exist.

Who is Affected

  • Providers: Must submit provider directory information via the uniform form starting mid-2026.
  • Contracted Health Insurance Issuers: Must update their provider directories using the information providers submit, within the Department-defined timeframes.
  • State Departments and Entities: Department of Insurance leads form development; Task Force includes multiple state agencies (Marketplace Director, DPC, IDPH, HFS, etc.).
  • Consumer and Provider Groups: Health insurance issuers and consumer advocates have representation on the Task Force.

Timelines and Effective Date

  • Uniform form development: By January 1, 2026.
  • Provider adoption deadline: On or before July 1, 2026 (six months after form publication).
  • Task Force creation and meetings: Task Force convened by April 1, 2025.
  • Effective date: The act takes effect upon becoming law.

Impact Overview

Overall, SB3648 aims to improve accuracy, consistency, and timeliness of provider directory information across Illinois health plans by mandating a standardized electronic form, a uniform submission process, and collaborative oversight to reduce discrepancies and enhance consumer access to reliable provider data.

Compiled from official sources — confirm details with the bill’s official record.

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