Disclaimer: This page provides general informational summaries only and does not constitute legal advice. AI-generated content may contain errors. Always consult a qualified attorney for guidance specific to your situation.
Read full disclaimer →
AI Summary
IL HB4735: TRANSPARENCY IN DOWNCODING ACT excludes self-insured plans under ERISA and Workers' Compensation-related health care.
Business Impact
If you are a health insurance issuer in Illinois, you must ensure downcoding decisions are made by licensed physicians or face penalties.
What do these statuses mean? ▼
Introduced
— Filed in the legislature; not yet heard in committee
In Committee
— Assigned to and being reviewed by a legislative committee
Passed
— Approved by one or both chambers; awaiting further action
Signed / Enacted
— Signed into law by the governor; may or may not be in effect yet
Dead / Vetoed
— Vetoed, failed to pass, or session expired without action
Unknown
— Status data not yet available or awaiting classification
Affected Industries
Topics How we classify →
What This Means
TRANSPARENCY IN DOWNCODING ACT — Track this IL bill and its compliance implications at AI Laws by State. Note: Excludes ERISA self-insured plans and Workers' Compensation health care.
Key Provisions
- Prohibits automated downcoding of claims by health insurance issuers.
- Requires downcoding decisions to be made by licensed physicians.
- Mandates notification of downcoded claims with specific reasons and physician credentials.
- Establishes an appeal process for downcoded claims.
- Prohibits discriminatory downcoding practices against physicians treating complex conditions.
- Imposes penalties for violations, including fines, restitution, and license suspension.
- Excludes employee or employer self-insured health benefit plans under ERISA and health care under Workers' Compensation Acts.
Latest Legislative Action
Rule 19(a) / Re-referred to Rules Committee
Bill Sponsors (showing 5 of 20)
| Name | Role |
|---|---|
| C.D. Davidsmeyer R | Primary |
| Don Harmon D | Primary |
| Frank J. Mautino | Primary |
| Jim Durkin | Primary |
| Julie Hamos | Primary |
Compliance Checklist
Ensure downcoding decisions are made by licensed physicians.
Who: Health insurance issuers.
Penalty: Fines up to $50,000 per violation.
Who: Health insurance issuers.
Penalty: Fines up to $50,000 per violation.
Provide clear notifications for downcoded claims.
Who: Health insurance issuers.
Penalty: Potential enforcement actions by the Department of Insurance.
Who: Health insurance issuers.
Penalty: Potential enforcement actions by the Department of Insurance.
Related & Companion Bills
Full Legal Analysis
Re-checked & corrected (3 fixes). Score: 90% → 90%. The AI-generated analysis accurately reflects the key provisions and requirements of the Transparency in Downcoding Act as described in the official documentation. The Act does not apply to employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974 and health care provided pursuant to the Workers' Compensation Act or the Workers' Occupational Diseases Act.
Official Source
Official Bill Text
View HB4735 on official legislature website →
Related Topics
Affected Industries
More Illinois AI Legislation
View All IL Laws →More Illinois AI Laws
Browse all published AI bills and regulations for Illinois.