NETWORK ADEQUACY-DIRECTORY

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3648

Introduced 2/5/2026, by Sen. Dave Syverson

SYNOPSIS AS INTRODUCED:

215 ILCS 124/55

Amends the Network Adequacy and Transparency Act. Replaces provisions
concerning uniform electronic provider directory information forms.
Provides that each provider shall notify all contracted health insurance
issuers of any change to the provider's information. Provides that the
health insurance issuer shall use the information to update its provider
directory within the time frames required under the Act. Provides that
nothing in the provisions shall prohibit a health insurance issuer from
using its own process, platform, or electronic system to receive provider
directory updates, so long as the system allows providers to submit the
required information. Effective immediately.
LRB104 17458 BAB 30884 b

A BILL FOR

SB3648
LRB104 17458 BAB 30884 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Network Adequacy and Transparency Act is
5
amended by changing Section 55 as follows:

6

(215 ILCS 124/55)
7

Sec. 55.
Provider directory notification of changes

8
Uniform electronic provider directory information notification
9
forms
.

10

(a) Each provider shall notify all contracted issuers of
11
any change to the provider's information as set forth in
12
Section 35 of this Act.

13

(b) The issuer shall use the information provided under
14
subsection (a) to update its provider directory within the
15
time frames required under Section 25 of this Act.

16

(c) Nothing in this Section shall prohibit an issuer from
17
using its own process, platform, or electronic system to
18
receive provider directory updates, so long as the system
19
allows providers to submit the information required under this
20
Section.

21

(a) On or before January 1, 2026, the Department shall
22
develop and publish a uniform electronic provider directory
23
information form that issuers shall make available to

SB3648
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LRB104 17458 BAB 30884 b
1
onboarding, current, and former preferred providers to notify
2
the issuer of the provider's currently accurate provider
3
directory information under Section 25 of this Act and 42
4
U.S.C. 300gg-139. The form shall address information needed
5
from newly onboarding preferred providers, updates to
6
previously supplied provider directory information, reporting
7
an inaccurate directory entry of previously supplied
8
information, contract terminations, and differences in
9
information for specific network plans offered by an issuer,
10
such as whether the provider is a preferred provider for the
11
network plan or is accepting new patients under that plan. The
12
Department shall allow issuers to implement this form through
13
either a PDF or a web portal that requests the same
14
information.
15

(b) Notwithstanding any other provision of law to the
16
contrary, beginning 6 months after the Department publishes
17
the uniform electronic provider directory information form and
18
no later than July 1, 2026, every provider must use the uniform
19
electronic provider directory information form to notify
20
issuers of their provider directory information as required
21
under Section 25 of this Act and 42 U.S.C. 300gg-139. Issuers
22
shall accept this form as sufficient to update their provider
23
directories. Issuers shall not accept paper or fax submissions
24
of provider directory information from providers.
25

(c) The Uniform Electronic Provider Directory Information
26
Form Task Force is created. The purpose of this task force is

SB3648
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LRB104 17458 BAB 30884 b
1
to provide input and advice to the Department of Insurance in
2
the development of a uniform electronic provider directory
3
information form. The task force shall include at least the
4
following individuals:
5

(1) the Director of Insurance or a designee, as chair;
6

(2) the Marketplace Director or a designee;
7

(3) the Director of the Division of Professional
8

Regulation or a designee;
9

(4) the Director of Public Health or a designee;
10

(5) the Secretary of Innovation and Technology or a
11

designee;
12

(6) the Director of Healthcare and Family Services or
13

a designee;
14

(7) the following individuals appointed by the
15

Director:
16

(A) one representative of a statewide association
17

representing physicians;
18

(B) one representative of a statewide association
19

representing nurses;
20

(C) one representative of a statewide organization
21

representing a majority of Illinois hospitals;
22

(D) one representative of a statewide organization
23

representing Illinois pharmacies;
24

(E) one representative of a statewide organization
25

representing mental health care providers;
26

(F) one representative of a statewide organization

SB3648
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LRB104 17458 BAB 30884 b
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representing substance use disorder health care
2

providers;
3

(G) 2 representatives of health insurance issuers
4

doing business in this State or issuer trade
5

associations, at least one of which represents a
6

State-domiciled mutual health insurance company, with
7

a demonstrated expertise in the business of health
8

insurance or health benefits administration; and
9

(H) 2 representatives of a health insurance
10

consumer advocacy group.
11

(d) The Department shall convene the task force described
12
in this Section no later than April 1, 2025.
13

(e) The Department, in development of the uniform
14
electronic provider directory information form, and the task
15
force, in offering input, shall take into consideration the
16
following:
17

(1) readability and user experience;
18

(2) interoperability;
19

(3) existing regulations established by the federal
20

Centers for Medicare and Medicaid Services, the Department
21

of Insurance, the Department of Healthcare and Family
22

Service, the Department of Financial and Professional
23

Regulation, and the Department of Public Health;
24

(4) potential opportunities to avoid duplication of
25

data collection efforts, including, but not limited to,
26

opportunities related to:

SB3648
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LRB104 17458 BAB 30884 b
1

(A) integrating any provider reporting required
2

under Section 25 of this Act and 42 U.S.C. 300gg-139
3

with the provider reporting required under the Health
4

Care Professional Credentials Data Collection Act;
5

(B) furnishing information to any national
6

provider directory established by the federal Centers
7

for Medicare and Medicaid Services or another federal
8

agency with jurisdiction over health care providers;
9

and
10

(C) furnishing information in compliance with the
11

Patients' Right to Know Act;
12

(5) compatibility with the Illinois Health Benefits
13

Exchange;
14

(6) provider licensing requirements and forms; and
15

(7) information needed to classify a provider under
16

any specialty type for which a network adequacy standard
17

may be established under this Act when a specialty board
18

certification or State license does not currently exist.
19
(Source: P.A. 103-650, eff. 1-1-25
.)

20

Section 99.
Effective date.
This Act takes effect upon
21
becoming law.

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