Bill Amendment: IL HB3223 | 2017-2018 | 100th General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INS CD-MULTIPLE SCLEROSIS
Status: 2019-01-08 - Session Sine Die [HB3223 Detail]
Download: Illinois-2017-HB3223-Senate_Amendment_001.html
Bill Title: INS CD-MULTIPLE SCLEROSIS
Status: 2019-01-08 - Session Sine Die [HB3223 Detail]
Download: Illinois-2017-HB3223-Senate_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 3223
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2 | AMENDMENT NO. ______. Amend House Bill 3223 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Insurance Code is amended by | ||||||
5 | changing Section 356z.8 as follows:
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6 | (215 ILCS 5/356z.8)
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7 | Sec. 356z.8. Multiple sclerosis preventative physical | ||||||
8 | therapy. A group or individual policy of accident and health | ||||||
9 | insurance or managed care plan amended, delivered, issued, or | ||||||
10 | renewed after the effective date of this amendatory Act of the | ||||||
11 | 100th General Assembly this amendatory Act of the 94th General | ||||||
12 | Assembly must provide coverage for medically necessary | ||||||
13 | preventative physical therapy for insureds diagnosed with | ||||||
14 | multiple sclerosis. For the purposes of this Section, | ||||||
15 | "preventative physical therapy" means physical therapy that is | ||||||
16 | prescribed by a physician licensed to practice medicine in all |
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1 | of its branches for the purpose of treating parts of the body | ||||||
2 | affected by multiple sclerosis, but only where the physical | ||||||
3 | therapy includes reasonably defined goals, including, but not | ||||||
4 | limited to, sustaining the level of function the person has | ||||||
5 | achieved, with periodic evaluation of the efficacy of the | ||||||
6 | physical therapy against those goals. The coverage required | ||||||
7 | under this Section shall be subject to the same deductible and , | ||||||
8 | coinsurance requirements or other limitations , waiting period, | ||||||
9 | cost sharing limitation, treatment limitation, calendar year | ||||||
10 | maximum, or other limitations as provided for
other physical or | ||||||
11 | rehabilitative therapy benefits covered by the policy.
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12 | A group or individual policy of accident and health | ||||||
13 | insurance or managed care plan amended, delivered, issued, or | ||||||
14 | renewed after the effective date of this amendatory Act of the | ||||||
15 | 100th General Assembly shall offer an exception process from | ||||||
16 | treatment limitations for individuals diagnosed with primary | ||||||
17 | or secondary progressive multiple sclerosis. The exception | ||||||
18 | process must be posted on the insurer's website in an | ||||||
19 | easily-accessible location. An exception request must document | ||||||
20 | medical necessity for extended treatment that is reasonable and | ||||||
21 | appropriate to the individual's defined goals included in his | ||||||
22 | or her treatment plan. A health insurer shall, within 72 hours | ||||||
23 | after receiving the exception request, either approve or deny | ||||||
24 | the request. | ||||||
25 | The coverage required by this Section shall be subject to | ||||||
26 | other general exclusions and limitations of the policy, |
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1 | including coordination of benefits, participating provider | ||||||
2 | requirements, restrictions on services provided by family or | ||||||
3 | household members, utilization review of health care services, | ||||||
4 | including review of medical necessity, case management, | ||||||
5 | experimental or investigational treatments, and other managed | ||||||
6 | care provisions. | ||||||
7 | (Source: P.A. 94-1076, eff. 12-29-06.)".
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