SPRINGFIELD, Ill. (WCIA) — The Illinois Department of Insurance has proposed a new set of regulations that would more strictly enforce current network adequacy laws and improve transparency for patients. 

The new rules filed on Friday would require insurance companies to disclose more regular, accurate information detailing distance and drive times between patients and their available medical providers. The data, which is currently considered confidential, would help state regulators and the public quickly analyze how many doctors or specialists are available to see them in their area. 

Insurers would have an annual obligation to file their provider directories for every plan they sell patients, specifying when those specialists are only available for virtual visits.

Language in the 14-page document would also clear up confusion over the existing time-distance standards that the Department of Insurance relies on to determine whether a network is adequate.

As the law stands, insurance companies have to offer a certain number of primary care doctors and specialists within a 30, 45, or 60-minute drive. (The time varies based on provider type and whether the area is urban or rural.) But the law appears to leave the starting point of that drive, and the route a patient would take, up to the interpretation of the regulators who enforce it.

The newly proposed rules say distance is based on a straight line from the patient’s residence to their provider “using Google Maps output data for a weekday at Noon that does not occur during the week of any federal or State holiday.”

Maps with marked locations for each provider type would have to be included in the annual filing to the Department of Insurance, along with a lengthy list of data about each provider included in the directories. Target 3 investigators called through a couple of Blue Cross Blue Shield of Illinois’ online directories and we found dozens of errors, including inaccurate addresses, phone numbers, and other cases where doctors were retired or never worked at the listed address to begin with. The Department of Insurance would have oversight to catch these inaccuracies.

The number of doctors needed in a network is also based on the number of patients on the insurance plan in a given area. The added rules would require companies to disclose the number of patients “anticipated to be covered by each network plan.”

When a “material change” happens to a network, like the break up between BCBSIL and Springfield Clinic that spurred this Target 3 investigation, insurers would have to submit a new network adequacy filing to the state. The law only requires companies to report that a “material change” has occurred at this point.

After Target 3 investigators revealed the widespread impact of Blue Cross’s split with Springfield Clinic, the Department agreed it was a material change and fined BCBSIL $339,000 for failing to report it.

Starting in September, the Department of Insurance wants a sample copy of notices sent to providers and customers anytime there’s a contract termination with a healthcare facility. The rules spell out exactly what would need to be disclosed in those notices, including the availability of transitional services and who qualifies for them, like continuing to offer care at an in-network rate for cancer patients undergoing radiation.

Every other rule would go into effect immediately, pending adoption by the Joint Committee on Administrative Rules (JCAR).

If lawmakers on the bipartisan legislative oversight committee approve the proposal, insurance companies will be subject to scheduled audits, including self-audits at least every 90 days. Those would be attached to each yearly report to the DOI.

Lastly, the adoption of these rules would improve transparency. Target 3 reporters tried to obtain detailed geographic maps from Blue Cross to get to the bottom of the access and affordability issues for countless Springfield Clinic patients. The Department of Insurance couldn’t release those by law. That’s one piece of information in a list that would no longer be considered confidential.