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

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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 29-0)

Status: (Failed) 2018-05-30 - Total Veto Stands [SB0193 Detail]

Download: Illinois-2017-SB0193-Engrossed.html

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SB0193 Engrossed LRB100 05979 SMS 16007 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.8 as follows:
(215 ILCS 5/356z.8)
Sec. 356z.8. Multiple sclerosis preventative physical
therapy. A group or individual policy of accident and health
insurance or managed care plan amended, delivered, issued, or
renewed after the effective date of this amendatory Act of the
100th General Assembly this amendatory Act of the 94th General
Assembly must provide coverage for medically necessary
preventative physical therapy for insureds diagnosed with
multiple sclerosis. For the purposes of this Section,
"preventative physical therapy" means physical therapy that is
prescribed by a physician licensed to practice medicine in all
of its branches for the purpose of treating parts of the body
affected by multiple sclerosis, but only where the physical
therapy includes reasonably defined goals, including, but not
limited to, sustaining the level of function the person has
achieved, with periodic evaluation of the efficacy of the
physical therapy against those goals. The coverage required
under this Section shall be subject to the same deductible and ,

SB0193 Engrossed - 2 - LRB100 05979 SMS 16007 b
coinsurance requirements or other limitations , waiting period,
cost sharing limitation, treatment limitation, calendar year
maximum, or other limitations as provided for other physical or
rehabilitative therapy benefits covered by the policy.
A group or individual policy of accident and health
insurance or managed care plan amended, delivered, issued, or
renewed after the effective date of this amendatory Act of the
100th General Assembly shall offer an exception process from
treatment limitations for individuals diagnosed with primary
or secondary progressive multiple sclerosis. The exception
process must be posted on the insurer's website in an
easily-accessible location. An exception request must document
medical necessity for extended treatment that is reasonable and
appropriate to the individual's defined goals included in his
or her treatment plan. A health insurer shall, within 72 hours
after receiving the exception request, either approve or deny
the request.
The coverage required by this Section shall be subject to
other general exclusions and limitations of the policy,
including coordination of benefits, participating provider
requirements, restrictions on services provided by family or
household members, utilization review of health care services,
including review of medical necessity, case management,
experimental or investigational treatments, and other managed
care provisions.
(Source: P.A. 94-1076, eff. 12-29-06.)