Bill Text: IL SB0193 | 2017-2018 | 100th General Assembly | Engrossed


Bill Title: Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance must provide coverage for medically necessary preventative physical therapy for insureds diagnosed with multiple sclerosis without any treatment limitation or calendar year maximum. Removes requirements that coverage under this provision be subject to the same waiting period, cost sharing limitation, treatment limitation, calendar year maximum, or other limitation as provided for other physical or rehabilitative therapy benefits.

Spectrum: Partisan Bill (Democrat 16-0)

Status: (Engrossed) 2017-05-19 - Committee Deadline Extended-Rule 9(b) May 26, 2017 [SB0193 Detail]

Download: Illinois-2017-SB0193-Engrossed.html



SB0193 EngrossedLRB100 05979 SMS 16007 b
1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The Illinois Insurance Code is amended by
5changing Section 356z.8 as follows:
6 (215 ILCS 5/356z.8)
7 Sec. 356z.8. Multiple sclerosis preventative physical
8therapy. A group or individual policy of accident and health
9insurance or managed care plan amended, delivered, issued, or
10renewed after the effective date of this amendatory Act of the
11100th General Assembly this amendatory Act of the 94th General
12Assembly must provide coverage for medically necessary
13preventative physical therapy for insureds diagnosed with
14multiple sclerosis. For the purposes of this Section,
15"preventative physical therapy" means physical therapy that is
16prescribed by a physician licensed to practice medicine in all
17of its branches for the purpose of treating parts of the body
18affected by multiple sclerosis, but only where the physical
19therapy includes reasonably defined goals, including, but not
20limited to, sustaining the level of function the person has
21achieved, with periodic evaluation of the efficacy of the
22physical therapy against those goals. The coverage required
23under this Section shall be subject to the same deductible and ,

SB0193 Engrossed- 2 -LRB100 05979 SMS 16007 b
1coinsurance requirements or other limitations , waiting period,
2cost sharing limitation, treatment limitation, calendar year
3maximum, or other limitations as provided for other physical or
4rehabilitative therapy benefits covered by the policy.
5 A group or individual policy of accident and health
6insurance or managed care plan amended, delivered, issued, or
7renewed after the effective date of this amendatory Act of the
8100th General Assembly shall offer an exception process from
9treatment limitations for individuals diagnosed with primary
10or secondary progressive multiple sclerosis. The exception
11process must be posted on the insurer's website in an
12easily-accessible location. An exception request must document
13medical necessity for extended treatment that is reasonable and
14appropriate to the individual's defined goals included in his
15or her treatment plan. A health insurer shall, within 72 hours
16after receiving the exception request, either approve or deny
17the request.
18 The coverage required by this Section shall be subject to
19other general exclusions and limitations of the policy,
20including coordination of benefits, participating provider
21requirements, restrictions on services provided by family or
22household members, utilization review of health care services,
23including review of medical necessity, case management,
24experimental or investigational treatments, and other managed
25care provisions.
26(Source: P.A. 94-1076, eff. 12-29-06.)
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