215 ILCS 220/40: Administration and enforcement.

(This Section may contain text from a Public Act with a delayed effective date)

(a) The Department of Insurance shall enforce the provisions of this Act pursuant to the enforcement powers granted to it by law, including, but not limited to, any powers granted to enforce the Illinois Insurance Code. Such enforcement shall extend to health care payors' compliance with this Act's procedural requirements and restrictions, compliance with this Act's standards for personnel and automated processes, and any pattern or practice of violating Section 20 of this Act. Nothing in this Act shall authorize the Department of Insurance to conduct any process under which a health care provider may submit an appeal for the purpose of receiving a determination from the Department of Insurance that is binding on the health care payor and the billing health care professional about the correctness of any particular downcoding decision under applicable coding guidelines, but the Department of Insurance shall have the authority to use any of its powers, including, but not limited to, the investigation of complaints, to enforce subsection (b) of Section 15.

(b) A health care payor shall be responsible for the compliance with this Act by any third party to whom the health care payor delegates any functions related to downcoding.

(c) The Department of Healthcare and Family Services shall enforce the provisions of this Act, subject to federal laws, rules, regulations, and regulatory guidance, as it applies to all Medicaid managed care organizations serving persons enrolled under Article V of the Illinois Public Aid Code or under the Children's Health Insurance Program Act.