IllinoisSB3114104th General Assembly (2025–2026)Senate

TRANSPARENCY IN DOWNCODING ACT

Sponsored By: David Koehler (Democratic)

Signed by Governor

Summary

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.

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Bill Overview

No Economic Impacts Identified for this Bill

Sponsors & Cosponsors

Sponsor

  • David Koehler

    Democratic • Senate

Cosponsors

  • Amy Briel

    Democratic • House

  • Andrew S. Chesney

    Republican • Senate

  • Anthony DeLuca

    Democratic • House

  • Bob Morgan

    Democratic • House

  • Chris Balkema

    Republican • Senate

  • Christopher Belt

    Democratic • Senate

  • Cristina Castro

    Democratic • Senate

  • Dagmara Avelar

    Democratic • House

  • Dave Vella

    Democratic • House

  • Doris Turner

    Democratic • Senate

  • Elgie R. Sims, Jr.

    Democratic • Senate

  • Emil Jones, III

    Democratic • Senate

  • Graciela Guzmán

    Democratic • Senate

  • Gregg Johnson

    Democratic • House

  • Harry Benton

    Democratic • House

  • Jawaharial Williams

    Democratic • House

  • Jeff Keicher

    Republican • House

  • Jennifer Gong-Gershowitz

    Democratic • House

  • Joyce Mason

    Democratic • House

  • Julie A. Morrison

    Democratic • Senate

  • Justin Cochran

    Democratic • House

  • Katie Stuart

    Democratic • House

  • Kelly M. Cassidy

    Democratic • House

  • Lakesia Collins

    Democratic • Senate

  • Laura Fine

    Democratic • Senate

  • Lawrence "Larry" Walsh, Jr.

    Democratic • House

  • Linda Holmes

    Democratic • Senate

  • Lisa Davis

    Democratic • House

  • Martha Deuter

    Democratic • House

  • Mary Beth Canty

    Democratic • House

  • Mary Gill

    Democratic • House

  • Matt Hanson

    Democratic • House

  • Maurice A. West, II

    Democratic • House

  • Meg Loughran Cappel

    Democratic • Senate

  • Michael Crawford

    Democratic • House

  • Michael J. Kelly

    Democratic • House

  • Michael W. Halpin

    Democratic • Senate

  • Michelle Mussman

    Democratic • House

  • Mike Porfirio

    Democratic • Senate

  • Mike Simmons

    Democratic • Senate

  • Napoleon Harris III

    Democratic • Senate

  • Natalie A. Manley

    Democratic • House

  • Nicolle Grasse

    Democratic • House

  • Paul Faraci

    Democratic • Senate

  • Rachel Ventura

    Democratic • Senate

  • Ram Villivalam

    Democratic • Senate

  • Rick Ryan

    Democratic • House

  • Rita Mayfield

    Democratic • House

  • Robert Peters

    Democratic • Senate

  • Ryan Spain

    Republican • House

  • Sally J. Turner

    Republican • Senate

  • Sharon Chung

    Democratic • House

  • Stephanie A. Kifowit

    Democratic • House

  • Sue Rezin

    Republican • Senate

  • Sue Scherer

    Democratic • House

  • Suzy Glowiak Hilton

    Democratic • Senate

  • Tracy Katz Muhl

    Democratic • House

  • William "Will" Davis

    Democratic • House

  • William E Hauter

    Republican • House

Roll Call Votes

All Roll Calls

Yes: 219 • No: 0

House vote • 5/27/2026

Third Reading - Short Debate - Passed

Yes: 111 • No: 0

House vote • 5/26/2026

Do Pass / Short Debate Insurance Committee;

Yes: 15 • No: 0

Senate vote • 5/14/2026

Third Reading - Passed;

Yes: 59 • No: 0

Senate vote • 5/13/2026

Senate Floor Amendment No. 2 Recommend Do Adopt Insurance;

Yes: 13 • No: 0

Senate vote • 4/14/2026

Senate Floor Amendment No. 1 Recommend Do Adopt Insurance;

Yes: 11 • No: 0

Senate vote • 3/11/2026

Do Pass Insurance;

Yes: 10 • No: 0

Bill Text

  • Engrossed

  • Enrolled

  • Introduced

  • Senate Amendment 1

  • Senate Amendment 2

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