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SB3114 - 104th General Assembly
TRANSPARENCY IN DOWNCODING ACT
Last Action
Senate Sponsors
Sen. David Koehler - Julie A. Morrison - Cristina Castro - Robert Peters, Laura Fine, Andrew S. Chesney, Christopher Belt, Graciela Guzmán, Paul Faraci, Suzy Glowiak Hilton, Linda Holmes, Ram Villivalam, Mike Porfirio, Meg Loughran Cappel, Doris Turner, Sally J. Turner, Sue Rezin, Napoleon Harris, III, Rachel Ventura, Elgie R. Sims, Jr., Lakesia Collins, Michael W. Halpin, Mike Simmons, Chris Balkema and Emil Jones, IIIHouse Sponsors
(Rep. Sharon Chung - William E Hauter - Jeff Keicher - Katie Stuart - Jawaharial Williams, Nicolle Grasse, Dagmara Avelar, Ryan Spain, Dave Vella, Rick Ryan, Justin Cochran, Anthony DeLuca, Joyce Mason, Mary Gill, Michael J. Kelly, Natalie A. Manley, Matt Hanson, Martha Deuter, Tracy Katz Muhl, Harry Benton, Gregg Johnson, William "Will" Davis, Jennifer Gong-Gershowitz, Kelly M. Cassidy, Michelle Mussman, Maurice A. West, II, Mary Beth Canty, Bob Morgan, Stephanie A. Kifowit, Amy Briel, Sue Scherer, Lisa Davis, Rita Mayfield, Michael Crawford and Lawrence "Larry" Walsh, Jr.)Statutes Amended In Order of Appearance
New Act
Synopsis As Introduced
Creates the Transparency in Downcoding Act. Provides that the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for 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. Prohibits a health insurance issuer from using an automated process, system, or tool to downcode a claim; from downcoding a claim based solely on the reported diagnosis codes; and from using downcoding practices in a targeted or discriminatory manner against physicians who routinely treat patients with complex or chronic conditions. Requires downcoding decisions to be made by a physician licensed to practice medicine in all its branches in any United States jurisdiction and of the same or similar specialty as a physician who typically manages the medical condition or disease. Sets forth provisions concerning notification requirements for downcoded claims; the appeal process for downcoded claims; enforcement by the Department of Insurance; and penalties. Provides that any pattern or practice of discriminatory downcoding identified by the Director of Insurance or another regulatory authority shall be subject to enforcement actions, including fines, restitution, or suspension of the health insurance issuer's license in this State. Effective immediately.
Senate Floor Amendment No. 1
Adds reference to:
305 ILCS 5/5-5.12g new
Replaces everything after the enacting clause. Creates the Transparency in Downcoding Act. Provides that the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for 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. Establishes home rule provisions. Prohibits a health care payor from implementing any policy or using any algorithm or other automated process, system, or tool that bypasses the evaluation of all information included by the billing physician to downcode a claim. Provides that a health care payor may use an automated process to identify claims that may justify a downcoding determination. Provides that all downcoding determinations must be made or reviewed by a natural person using the most recently released American Medical Association Current Procedural Terminology coding guidelines and considering all information included by the billing provider on the claim submission in such determination. Prohibits a health care payor from downcoding a claim based solely on the reported diagnosis codes. Sets forth provisions concerning notification requirements and the dispute process for downcoded claims. Prohibits a health care payor from using downcoding practices in a targeted or discriminatory manner against physicians who routinely treat patients with complex or chronic conditions. Establishes administration and enforcement provisions. Amends the Illinois Public Aid Code. Provides that, notwithstanding any other provision of law to the contrary, all managed care organizations shall comply with the requirements of the Transparency in Downcoding Act. Effective January 1, 2028.
Senate Floor Amendment No. 2
Adds reference to:
305 ILCS 5/5-5.12g new
Replaces everything after the enacting clause. Creates the Transparency in Downcoding Act. Provides that, subject to federal requirements, the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for 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. Prohibits home rule units from regulating downcoding of medical claims in policies issued, amended, delivered, or renewed on or after January 1, 2028. Prohibits a health care payor from implementing any policy or using any algorithm or other automated process, system, or tool that bypasses the evaluation of all information included by the billing health care professional to downcode a claim. Provides that a health care payor may use an automated process to identify claims that may justify a downcoding determination. Provides that all downcoding determinations must be made or reviewed by a natural person following American Medical Association Current Procedural Terminology coding guidelines in effect at the time. Prohibits a health care payor from downcoding a claim based solely on the reported diagnosis codes. Sets forth provisions concerning notification requirements and the dispute process for downcoded claims. Prohibits a health care payor from using downcoding practices in a targeted or discriminatory manner against health care professionals who routinely treat patients with complex or chronic conditions. Establishes administration and enforcement provisions. Amends the Illinois Public Aid Code. Provides that, notwithstanding any other provision of law to the contrary, all managed care organizations shall comply with the requirements of the Transparency in Downcoding Act. Effective January 1, 2028.
Actions
| Date | Chamber | Action |
|---|---|---|
| 2/02/2026 | Senate | Filed with Secretary by Sen. David Koehler |
| 2/02/2026 | Senate | First Reading |
| 2/02/2026 | Senate | Referred to Assignments |
| 2/10/2026 | Senate | Assigned to Insurance |
| 2/17/2026 | Senate | Added as Chief Co-Sponsor Sen. Julie A. Morrison |
| 2/17/2026 | Senate | Added as Co-Sponsor Sen. Laura Fine |
| 2/17/2026 | Senate | Postponed - Insurance |
| 2/18/2026 | Senate | Added as Co-Sponsor Sen. Andrew S. Chesney |
| 2/19/2026 | Senate | Added as Co-Sponsor Sen. Christopher Belt |
| 2/19/2026 | Senate | Added as Co-Sponsor Sen. Graciela Guzmán |
| 2/24/2026 | Senate | Added as Co-Sponsor Sen. Paul Faraci |
| 2/24/2026 | Senate | Added as Co-Sponsor Sen. Suzy Glowiak Hilton |
| 2/25/2026 | Senate | Added as Co-Sponsor Sen. Linda Holmes |
| 2/25/2026 | Senate | Added as Co-Sponsor Sen. Ram Villivalam |
| 2/26/2026 | Senate | Added as Co-Sponsor Sen. Mike Porfirio |
| 2/26/2026 | Senate | Added as Co-Sponsor Sen. Meg Loughran Cappel |
| 2/26/2026 | Senate | Added as Chief Co-Sponsor Sen. Cristina Castro |
| 2/27/2026 | Senate | Added as Co-Sponsor Sen. Doris Turner |
| 3/03/2026 | Senate | Added as Chief Co-Sponsor Sen. Robert Peters |
| 3/03/2026 | Senate | Added as Co-Sponsor Sen. Sally J. Turner |
| 3/03/2026 | Senate | Postponed - Insurance |
| 3/04/2026 | Senate | Added as Co-Sponsor Sen. Sue Rezin |
| 3/05/2026 | Senate | Added as Co-Sponsor Sen. Napoleon Harris, III |
| 3/11/2026 | Senate | Do Pass Insurance; 010-000-000 |
| 3/11/2026 | Senate | Placed on Calendar Order of 2nd Reading March 12, 2026 |
| 3/12/2026 | Senate | Second Reading |
| 3/12/2026 | Senate | Placed on Calendar Order of 3rd Reading March 24, 2026 |
| 3/23/2026 | Senate | Added as Co-Sponsor Sen. Rachel Ventura |
| 3/26/2026 | Senate | Senate Floor Amendment No. 1 Filed with Secretary by Sen. David Koehler |
| 3/26/2026 | Senate | Senate Floor Amendment No. 1 Referred to Assignments |
| 3/26/2026 | Senate | Added as Co-Sponsor Sen. Elgie R. Sims, Jr. |
| 4/09/2026 | Senate | Added as Co-Sponsor Sen. Lakesia Collins |
| 4/14/2026 | Senate | Senate Floor Amendment No. 1 Assignments Refers to Insurance |
| 4/14/2026 | Senate | Senate Floor Amendment No. 1 Recommend Do Adopt Insurance; 011-000-000 |
| 4/17/2026 | Senate | Rule 2-10 Third Reading Deadline Established As May 8, 2026 |
| 5/06/2026 | Senate | Senate Floor Amendment No. 2 Filed with Secretary by Sen. David Koehler |
| 5/06/2026 | Senate | Senate Floor Amendment No. 2 Referred to Assignments |
| 5/08/2026 | Senate | Rule 2-10 Third Reading Deadline Established As May 15, 2026 |
| 5/12/2026 | Senate | Senate Floor Amendment No. 2 Assignments Refers to Insurance |
| 5/13/2026 | Senate | Senate Floor Amendment No. 2 Recommend Do Adopt Insurance; 013-000-000 |
| 5/14/2026 | Senate | Recalled to Second Reading |
| 5/14/2026 | Senate | Senate Floor Amendment No. 1 Adopted; Koehler |
| 5/14/2026 | Senate | Senate Floor Amendment No. 2 Adopted; Koehler |
| 5/14/2026 | Senate | Placed on Calendar Order of 3rd Reading |
| 5/14/2026 | Senate | Third Reading - Passed; 059-000-000 |
| 5/14/2026 | Senate | Added as Co-Sponsor Sen. Michael W. Halpin |
| 5/14/2026 | Senate | Added as Co-Sponsor Sen. Mike Simmons |
| 5/14/2026 | House | Arrived in House |
| 5/14/2026 | House | Chief House Sponsor Rep. Sharon Chung |
| 5/15/2026 | House | First Reading |
| 5/15/2026 | House | Referred to Rules Committee |
| 5/15/2026 | House | Assigned to Insurance Committee |
| 5/15/2026 | House | Committee/Final Action Deadline Extended-9(b) May 31, 2026 |
| 5/19/2026 | Senate | Added as Co-Sponsor Sen. Chris Balkema |
| 5/21/2026 | House | Added Alternate Co-Sponsor Rep. Nicolle Grasse |
| 5/21/2026 | House | Added Alternate Co-Sponsor Rep. Dagmara Avelar |
| 5/21/2026 | House | Added Alternate Co-Sponsor Rep. Ryan Spain |
| 5/21/2026 | House | Added Alternate Chief Co-Sponsor Rep. William E Hauter |
| 5/21/2026 | House | Added Alternate Chief Co-Sponsor Rep. Jeff Keicher |
| 5/21/2026 | House | Added Alternate Chief Co-Sponsor Rep. Katie Stuart |
| 5/21/2026 | House | Added Alternate Co-Sponsor Rep. Dave Vella |
| 5/22/2026 | House | Added Alternate Co-Sponsor Rep. Rick Ryan |
| 5/22/2026 | Senate | Added as Co-Sponsor Sen. Emil Jones, III |
| 5/26/2026 | House | Do Pass / Short Debate Insurance Committee; 015-000-000 |
| 5/26/2026 | House | Placed on Calendar 2nd Reading - Short Debate |
| 5/26/2026 | House | Second Reading - Short Debate |
| 5/26/2026 | House | Held on Calendar Order of Second Reading - Short Debate |
| 5/27/2026 | House | Added Alternate Chief Co-Sponsor Rep. Jawaharial Williams |
| 5/27/2026 | House | Placed on Calendar Order of 3rd Reading - Short Debate |
| 5/27/2026 | House | Third Reading - Short Debate - Passed 111-000-000 |
| 5/27/2026 | Senate | Passed Both Houses |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Justin Cochran |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Anthony DeLuca |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Joyce Mason |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Mary Gill |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Michael J. Kelly |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Natalie A. Manley |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Matt Hanson |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Martha Deuter |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Tracy Katz Muhl |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Harry Benton |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Gregg Johnson |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. William "Will" Davis |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Jennifer Gong-Gershowitz |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Kelly M. Cassidy |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Michelle Mussman |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Maurice A. West, II |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Mary Beth Canty |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Bob Morgan |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Stephanie A. Kifowit |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Amy Briel |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Sue Scherer |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Lisa Davis |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Rita Mayfield |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Michael Crawford |
| 5/27/2026 | House | Added Alternate Co-Sponsor Rep. Lawrence "Larry" Walsh, Jr. |