Bill Text: IL HB5040 | 2019-2020 | 101st General Assembly | Introduced
Bill Title: Amends the Illinois Insurance Code to prohibit an individual or group policy of accident and health insurance or managed care plan from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on coverage of diagnostic testing for a pediatric autoimmune neuropsychiatric disorder if such diagnostic testing is ordered by a physician. Provides that an individual or group policy of accident and health insurance or managed care plan is not required to cover diagnostic testing for a pediatric autoimmune neuropsychiatric disorder if a physician indicates that such diagnostic testing is requested by a guardian, authorized representative, or parent of a minor patient. Amends the Medical Patient Rights Act. Provides that a physician may not refuse a request of a guardian, authorized representative, or parent of a minor patient for minimally invasive diagnostic testing for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2020-02-18 - Referred to Rules Committee [HB5040 Detail]
Download: Illinois-2019-HB5040-Introduced.html
| ||||||||||||||||||||||
| ||||||||||||||||||||||
| ||||||||||||||||||||||
| ||||||||||||||||||||||
| ||||||||||||||||||||||
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 Illinois Insurance Code is amended by | |||||||||||||||||||||
5 | changing Section 356z.25 as follows:
| |||||||||||||||||||||
6 | (215 ILCS 5/356z.25) | |||||||||||||||||||||
7 | Sec. 356z.25. Coverage for treatment of pediatric | |||||||||||||||||||||
8 | autoimmune neuropsychiatric disorders associated with | |||||||||||||||||||||
9 | streptococcal infections and pediatric acute onset | |||||||||||||||||||||
10 | neuropsychiatric syndrome. A group or individual policy of | |||||||||||||||||||||
11 | accident and health insurance or managed care plan that is | |||||||||||||||||||||
12 | amended, delivered, issued, or renewed after July 18, 2017 (the | |||||||||||||||||||||
13 | effective date of Public Act 100-24) shall provide coverage for | |||||||||||||||||||||
14 | treatment of pediatric autoimmune neuropsychiatric disorders | |||||||||||||||||||||
15 | associated with streptococcal infections and pediatric | |||||||||||||||||||||
16 | acute-onset neuropsychiatric syndrome, including, but not | |||||||||||||||||||||
17 | limited to, the use of intravenous immunoglobulin therapy. | |||||||||||||||||||||
18 | For billing and diagnosis purposes, pediatric autoimmune | |||||||||||||||||||||
19 | neuropsychiatric disorders associated with streptococcal | |||||||||||||||||||||
20 | infections and pediatric acute onset neuropsychiatric syndrome | |||||||||||||||||||||
21 | shall be coded as autoimmune encephalitis until the American | |||||||||||||||||||||
22 | Medical Association and the Centers for Medicare and Medicaid | |||||||||||||||||||||
23 | Services create and assign a specific code for pediatric |
| |||||||
| |||||||
1 | autoimmune neuropsychiatric disorders associated with | ||||||
2 | streptococcal infections and pediatric acute onset | ||||||
3 | neuropsychiatric syndrome. Thereafter, pediatric autoimmune | ||||||
4 | neuropsychiatric disorders associated with streptococcal | ||||||
5 | infections and pediatric acute onset neuropsychiatric syndrome | ||||||
6 | may be coded as autoimmune encephalitis, pediatric autoimmune | ||||||
7 | neuropsychiatric disorders associated with streptococcal | ||||||
8 | infections, or pediatric acute onset neuropsychiatric | ||||||
9 | syndrome. | ||||||
10 | If, at any time, the Secretary of the United States | ||||||
11 | Department of Health and Human Services, or its successor | ||||||
12 | agency, promulgates rules or regulations to be published in the | ||||||
13 | Federal Register or publishes a comment in the Federal Register | ||||||
14 | or issues an opinion, guidance, or other action that would | ||||||
15 | require the State, pursuant to any provision of the Patient | ||||||
16 | Protection and Affordable Care Act (Public Law 111-148), | ||||||
17 | including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any | ||||||
18 | successor provision, to defray the cost of any coverage for | ||||||
19 | pediatric autoimmune neuropsychiatric disorders associated | ||||||
20 | with streptococcal infections and pediatric acute onset | ||||||
21 | neuropsychiatric syndrome outlined in this Section, then the | ||||||
22 | requirement that an insurer cover pediatric autoimmune | ||||||
23 | neuropsychiatric disorders associated with streptococcal | ||||||
24 | infections and pediatric acute onset neuropsychiatric syndrome | ||||||
25 | is inoperative other than any such coverage authorized under | ||||||
26 | Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and |
| |||||||
| |||||||
1 | the State shall not assume any obligation for the cost of | ||||||
2 | coverage for pediatric autoimmune neuropsychiatric disorders | ||||||
3 | associated with streptococcal infections and pediatric acute | ||||||
4 | onset neuropsychiatric syndrome.
| ||||||
5 | An individual or group policy of accident and health | ||||||
6 | insurance or managed care plan may not impose a deductible, | ||||||
7 | coinsurance, copayment, or any other cost-sharing requirement | ||||||
8 | on coverage for diagnostic testing for pediatric autoimmune | ||||||
9 | neuropsychiatric disorders if such diagnostic testing is | ||||||
10 | ordered by a physician licensed to practice medicine in all its | ||||||
11 | branches. | ||||||
12 | An individual or group policy of accident and health | ||||||
13 | insurance or managed care plan is not required to provide | ||||||
14 | coverage for diagnostic testing for pediatric autoimmune | ||||||
15 | neuropsychiatric disorders if a physician indicates that such | ||||||
16 | diagnostic testing is requested by a guardian, authorized | ||||||
17 | representative, or parent of a minor patient. | ||||||
18 | (Source: P.A. 100-24, eff. 7-18-17; 100-863, eff. 8-14-18; | ||||||
19 | 101-488, eff. 8-23-19.)
| ||||||
20 | Section 10. The Medical Patient Rights Act is amended by | ||||||
21 | adding Section 3.5 as follows:
| ||||||
22 | (410 ILCS 50/3.5 new) | ||||||
23 | Sec. 3.5. Pediatric autoimmune neuropsychiatric disorder | ||||||
24 | diagnostic testing for minors. A physician may not refuse a |
| |||||||
| |||||||
1 | request of a guardian, authorized representative, or parent of | ||||||
2 | a minor patient for minimally invasive diagnostic testing for | ||||||
3 | pediatric autoimmune neuropsychiatric disorders associated | ||||||
4 | with streptococcal infections and pediatric acute-onset | ||||||
5 | neuropsychiatric syndrome.
|