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| Public Act 103-0325 | ||||
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AN ACT concerning insurance.
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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 | ||||
adding Section 356z.61 as follows: | ||||
(215 ILCS 5/356z.61 new) | ||||
Sec. 356z.61. Proton beam
therapy. | ||||
(a) As used in this Section: | ||||
"Medically necessary" has the meaning given to that term | ||||
in the Prior Authorization Reform Act. | ||||
"Proton beam therapy" means a type of radiation
therapy | ||||
treatment that utilizes protons as the radiation delivery | ||||
method for the
treatment of tumors and cancerous cells. | ||||
"Radiation therapy treatment"
means the delivery of | ||||
biological effective doses with proton therapy,
intensity | ||||
modulated radiation therapy, brachytherapy,
stereotactic body | ||||
radiation therapy, three-dimensional conformal
radiation | ||||
therapy, or other forms of therapy using radiation. | ||||
(b) A group or individual policy of accident and health | ||||
insurance or managed care plan that is amended, delivered, | ||||
issued, or renewed on or after January 1, 2025 that provides | ||||
coverage for the treatment of cancer shall not apply a
higher | ||||
standard of clinical evidence for the coverage of proton beam
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therapy than the insurer applies for the coverage of any other | ||
form of
radiation therapy treatment. | ||
(c) A group or individual policy of accident and health | ||
insurance or managed care plan that is amended, delivered, | ||
issued, or renewed on or after January 1, 2025 that provides | ||
coverage or benefits to any resident
of this State for | ||
radiation oncology shall include coverage or benefits
for | ||
medically necessary proton beam therapy for the treatment of
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cancer. | ||
Section 10. The Illinois Public Aid Code is amended by | ||
adding Section 5-47 as follows: | ||
(305 ILCS 5/5-47 new) | ||
Sec. 5-47. Proton beam therapy; managed care. | ||
Notwithstanding any
other provision of this Article, a managed | ||
care organization under
contract with the Department to | ||
provide services to recipients of
medical assistance shall | ||
provide coverage for proton beam therapy. As
used in this | ||
Section, "proton beam therapy" means a type of radiation
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therapy treatment that utilizes protons as the radiation | ||
delivery method for the
treatment of tumors and cancerous | ||
cells. "Radiation therapy treatment"
means the delivery of | ||
biological effective doses with proton therapy,
intensity | ||
modulated radiation therapy, brachytherapy,
stereotactic body | ||
radiation therapy, three-dimensional conformal
radiation | ||
therapy, or other forms of therapy using radiation.
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Section 99. Effective date. This Act takes effect January | ||
1, 2024. | ||