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Public Act 103-0059
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| SB0101 Enrolled | LRB103 25077 BMS 51412 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by |
changing Section 356z.25 as follows:
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(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. |
No group or individual policy of accident and health |
insurance or managed care plan shall deny or delay coverage |
for medically necessary treatment under this Section solely |
because the insured, enrollee, or beneficiary previously |
received any treatment, including the same or similar |
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treatment, for pediatric autoimmune neuropsychiatric disorders |
associated with streptococcal infections or pediatric acute |
onset neuropsychiatric syndrome, or because the insured, |
enrollee, or beneficiary has been diagnosed with or receives |
treatment for an otherwise diagnosed condition. |
For the purposes of this Section, coverage of pediatric |
autoimmune neuropsychiatric disorders associated with |
streptococcal infections and pediatric acute onset |
neuropsychiatric syndrome shall adhere to the treatment |
recommendations developed by a medical professional consortium |
convened for the purposes of researching, identifying, and |
publishing best practice standards for diagnosis and treatment |
of such disorders or syndrome that are accessible for medical |
professionals and are based on evidence of positive patient |
outcomes. Coverage for any form of medically necessary |
treatment shall not be limited over a lifetime of an insured, |
enrollee, or beneficiary, unless the patient is no longer |
benefiting from the treatment, or by policy period. Nothing in |
this Section prevents insurers from requesting treatment notes |
and anticipated duration of treatment and outcomes. |
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 |
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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 |