SB3114 - 104th General Assembly (2025-2026)

TRANSPARENCY IN DOWNCODING ACT
Last Action
2/10/2026 - Senate: Assigned to Insurance
Hearings
Insurance Hearing Feb 17 2026 5:00PM Capitol 400 Springfield, IL
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.
Actions
DateChamberAction
2/02/2026SenateFiled with Secretary by Sen. David Koehler
2/02/2026SenateFirst Reading
2/02/2026SenateReferred to Assignments
2/10/2026SenateAssigned to Insurance
2/17/2026SenateAdded as Chief Co-Sponsor Sen. Julie A. Morrison
2/17/2026SenateAdded as Co-Sponsor Sen. Laura Fine