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.

Sponsorship: Partisan Bill (Republican 1)

Status: (Introduced - Dead) 2020-02-18 - Referred to Rules Committee [HB5040 Detail]

Download: Illinois-2019-HB5040-Introduced.html

---

101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 HB5040 Introduced , by Rep. Deanne M. Mazzochi SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.25
410 ILCS 50/3.5 new
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.
LRB101 18227 BMS 67669 b
A BILL FOR
HB5040 LRB101 18227 BMS 67669 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 356z.25 as follows:
(215 ILCS 5/356z.25)
Sec. 356z.25. Coverage for treatment of pediatric
autoimmune neuropsychiatric disorders associated with
streptococcal infections and pediatric acute onset
neuropsychiatric syndrome. A group or individual policy of
accident and health insurance or managed care plan that is
amended, delivered, issued, or renewed after July 18, 2017 (the
effective date of Public Act 100-24) shall provide coverage for
treatment of pediatric autoimmune neuropsychiatric disorders
associated with streptococcal infections and pediatric
acute-onset neuropsychiatric syndrome, including, but not
limited to, the use of intravenous immunoglobulin therapy.
For billing and diagnosis purposes, pediatric autoimmune
neuropsychiatric disorders associated with streptococcal
infections and pediatric acute onset neuropsychiatric syndrome
shall be coded as autoimmune encephalitis until the American
Medical Association and the Centers for Medicare and Medicaid
Services create and assign a specific code for pediatric

HB5040 - 2 - LRB101 18227 BMS 67669 b
autoimmune neuropsychiatric disorders associated with
streptococcal infections and pediatric acute onset
neuropsychiatric syndrome. Thereafter, pediatric autoimmune
neuropsychiatric disorders associated with streptococcal
infections and pediatric acute onset neuropsychiatric syndrome
may be coded as autoimmune encephalitis, pediatric autoimmune
neuropsychiatric disorders associated with streptococcal
infections, or pediatric acute onset neuropsychiatric
syndrome.
If, at any time, the Secretary of the United States
Department of Health and Human Services, or its successor
agency, promulgates rules or regulations to be published in the
Federal Register or publishes a comment in the Federal Register
or issues an opinion, guidance, or other action that would
require the State, pursuant to any provision of the Patient
Protection and Affordable Care Act (Public Law 111-148),
including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
successor provision, to defray the cost of any coverage for
pediatric autoimmune neuropsychiatric disorders associated
with streptococcal infections and pediatric acute onset
neuropsychiatric syndrome outlined in this Section, then the
requirement that an insurer cover pediatric autoimmune
neuropsychiatric disorders associated with streptococcal
infections and pediatric acute onset neuropsychiatric syndrome
is inoperative other than any such coverage authorized under
Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and

HB5040 - 3 - LRB101 18227 BMS 67669 b
the State shall not assume any obligation for the cost of
coverage for pediatric autoimmune neuropsychiatric disorders
associated with streptococcal infections and pediatric acute
onset neuropsychiatric syndrome.
An individual or group policy of accident and health
insurance or managed care plan may not impose a deductible,
coinsurance, copayment, or any other cost-sharing requirement
on coverage for diagnostic testing for pediatric autoimmune
neuropsychiatric disorders if such diagnostic testing is
ordered by a physician licensed to practice medicine in all its
branches.
An individual or group policy of accident and health
insurance or managed care plan is not required to provide
coverage for diagnostic testing for pediatric autoimmune
neuropsychiatric disorders if a physician indicates that such
diagnostic testing is requested by a guardian, authorized
representative, or parent of a minor patient.
(Source: P.A. 100-24, eff. 7-18-17; 100-863, eff. 8-14-18;
101-488, eff. 8-23-19.)
Section 10. The Medical Patient Rights Act is amended by
adding Section 3.5 as follows:
(410 ILCS 50/3.5 new)
Sec. 3.5. Pediatric autoimmune neuropsychiatric disorder
diagnostic testing for minors. A physician may not refuse a

HB5040 - 4 - LRB101 18227 BMS 67669 b
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.