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SB 1471

Veterans Services, Department of; powers and duties of Commissioner, online portal.

2025 Regular Session Introduced by Creigh Deeds

SB 1471: clarifies ambulance billing by allowing providers not to bill where prohibited by law/contract, shifting payment rules and protecting patients from improper charges.

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Bill Summary · SB 1471

Summary — SB 1471 (INS — Health Care / Ambulance) — Illinois (Introduced 2025)

Note: The provided document includes text from multiple states (Arizona, Hawaii) and appears to combine different drafts. This summary focuses on the Illinois material titled INS‑HEALTH CARE/AMBULANCE (SB 1471), introduced by Sen. Linda Holmes on January 31, 2025, because that matches the bill title and Insurance Code amendments shown.

Purpose

SB 1471 would amend portions of the Illinois Insurance Code and related statutes to clarify billing and payment rules for ambulance providers and to revise definitions and payment requirements for emergency services and health care providers. The bill seeks to (1) state that nothing in the cited provisions requires an ambulance provider to bill in situations where other law, contract, or ordinance prohibits billing, (2) change definitions for “emergency services” and “health care provider,” and (3) remove or modify existing HMO payment requirements for emergency ambulance transportation.

Key provisions (as reflected in the available text)

  • Explicitly provides that nothing in the amended provisions “shall require an ambulance provider to bill a beneficiary, insured, enrollee, or health insurance issuer when prohibited by any other law, rule, ordinance, contract, or agreement.” In short: ambulance providers would not be compelled to issue bills where another law or agreement forbids billing.
  • Revises definitions in the Illinois Insurance Code:
    • Rewrites the statutory definitions of “emergency services,” “emergency department of a hospital,” “emergency medical screening examination,” and related terms to clarify scope of covered emergency care and ancillary services.
    • Alters the definition of “health care provider” to exclude providers of air ambulance or ground ambulance services for purposes of the specific statutory sections being amended.
    • Expands/clarifies the scope of “ancillary services” and specifies certain diagnostic and specialty services covered in emergency settings.
  • Amends the Health Maintenance Organization Act language: removes (or modifies) a provision that formerly required HMOs, upon reasonable demand by an emergency ambulance provider, to promptly pay the provider for emergency ambulance charges subject to coverage limitations stated in the contract or evidence of coverage. (The draft text deletes or alters that payment obligation.)
  • Includes a provision limiting home‑rule powers (briefly referenced in summary language), though the most specific home‑rule language is not contained in the truncated text.

Who would be affected

  • Ambulance providers (ground and air) — changes in billing obligations and in how they are categorized in statute.
  • Insureds, beneficiaries, and enrollees — potential effects on whether they receive bills from ambulance providers and on cost‑sharing exposure.
  • Health insurance issuers and HMOs — changes to payment obligations and network/contracting implications for emergency and ancillary services.
  • Hospitals, freestanding emergency centers, and other emergency facilities — impacted by clarified definitions of emergency services and facility status (participating vs. nonparticipating).

Potential impacts and issues

  • Excluding ambulance providers from the statutory definition of “health care provider” in these sections could remove them from certain payment protections or billing rules that apply to other providers; conversely, the explicit statement that ambulance providers are not required to bill where prohibited could protect patients from duplicate or unlawful billing in some circumstances.
  • Removing the HMO “prompt payment upon reasonable demand” language may shift negotiation leverage to insurers and could increase disputes or delays in ambulance provider reimbursement unless other payment mechanisms are specified.
  • Clarified definitions of “emergency services” and “ancillary services” could alter which out‑of‑network charges are permitted and affect balance‑billing protections; the net effect depends on implementing rules and insurer contract practices.
  • The bill’s effect on patient balance billing, surprise billing protections, and reimbursements will depend on how the exclusions and definition changes interact with federal law (e.g., surprise billing rules) and other state statutes.

Procedural status (from the provided document)

  • Introduced and filed Jan 31, 2025 (Sen. Linda Holmes).
  • First reading recorded Jan 31, 2025.
  • Referred to Assignments; subsequently assigned to Insurance (listed Feb 11, 2025).
  • Further committee referrals/actions pending per legislative process.
  • Companion bills: HB 3253 and HB 1152.

Caveats / Document limitations

  • The supplied packet contains truncated and mixed content from other states (Arizona motor‑fuel tax bill, Hawaii civil‑service text) that is unrelated to the Illinois Insurance bill. The summary above relies only on the Illinois portions provided, which are themselves partially truncated. Specific statutory cross‑references or full legislative text should be checked in the official Illinois Legislative Information System for a complete and authoritative bill text and any subsequent amendments.

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

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