Sen. Don Harmon
Filed: 5/5/2016
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1 | AMENDMENT TO SENATE BILL 345
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2 | AMENDMENT NO. ______. Amend Senate Bill 345 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 1. Short title. This Act may be cited as the | ||||||
5 | Autism and Co-Occurring Medical Conditions Awareness Act. | ||||||
6 | Section 5. Findings. The General Assembly finds the | ||||||
7 | following: | ||||||
8 | (1) The medical consensus is that autism is an | ||||||
9 | idiopathic disorder that has complex and multiple | ||||||
10 | etiologies. The development of autism appears to be a | ||||||
11 | complex interaction of multiple genetic and environmental | ||||||
12 | factors. Both the prevalence and incidence of autism has | ||||||
13 | risen in recent decades. | ||||||
14 | (2) The Centers for Disease Control estimates that one | ||||||
15 | in 68 children born in 2002 and one in 42 boys have been | ||||||
16 | identified as living with autism. |
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1 | (3) A 2012 survey conducted by the Centers for Disease | ||||||
2 | Control of U.S. households estimated one in 50 children | ||||||
3 | ages 6 to 17 has an autism spectrum disorder. | ||||||
4 | (4) Autism spectrum disorders occur among all racial, | ||||||
5 | ethnic, and socioeconomic groups. | ||||||
6 | (5) Autism spectrum disorders are almost 5 times more | ||||||
7 | common among boys than among girls. | ||||||
8 | (6) According to the Centers for Disease Control, | ||||||
9 | autism rates increased 78% between 2002 and 2008. The most | ||||||
10 | recent estimate is roughly 30% higher than the estimate for | ||||||
11 | 2008 (one in 88), 60% higher than the estimate for 2006 | ||||||
12 | (one in 110), and 120% higher than the estimates for 2000 | ||||||
13 | and 2002 (one in 150). | ||||||
14 | (7) While autism spectrum disorders have primarily | ||||||
15 | been diagnosed in measuring deficits in the areas of | ||||||
16 | communication, socialization, and behavior, recent | ||||||
17 | clinical and scientific investigations have determined | ||||||
18 | that co-occurring pathophysiological conditions may occur | ||||||
19 | more commonly in persons also diagnosed with autism.
These | ||||||
20 | pathologies include, but are not limited to, allergies, | ||||||
21 | autoimmune conditions, gastrointestinal diseases, immune | ||||||
22 | dysregulation, metabolic disturbances, mitochondrial | ||||||
23 | abnormalities, oxidative stress, neuroinflammation, and | ||||||
24 | seizure disorders. | ||||||
25 | (8) Scientific inquiry is providing evidence of | ||||||
26 | biological markers, including, but not limited to, single |
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1 | nucleotide polymorphisms, indications of cellular | ||||||
2 | inflammation, increased cellular oxidation and damage, and | ||||||
3 | abnormal DNA methylation, that may be clinically | ||||||
4 | significant in the provision of appropriate medical care | ||||||
5 | for persons also diagnosed with an autism spectrum | ||||||
6 | disorder. | ||||||
7 | Therefore, it is the intention of the General Assembly to | ||||||
8 | promote a greater awareness and the detection, diagnosis, and | ||||||
9 | treatment of underlying and co-occurring medical conditions | ||||||
10 | that occur more commonly in persons with autism to further | ||||||
11 | awareness, scientific understanding, and health outcomes for | ||||||
12 | persons living with autism. | ||||||
13 | Section 10. Definitions. In this Act: | ||||||
14 | "Autism spectrum disorder" means a neurobiological | ||||||
15 | disorder, including autism, regressive autism, Asperger | ||||||
16 | Syndrome, and pervasive developmental disorders not otherwise | ||||||
17 | specified. | ||||||
18 | "Clinical symptomatology" means any indication of disorder | ||||||
19 | or disease when experienced by an individual as a change from | ||||||
20 | normal function, sensation, or appearance. | ||||||
21 | "Co-occurring or otherwise diagnosed medical condition" | ||||||
22 | means a simultaneous illness, condition, injury, disease, | ||||||
23 | pathology, or disability that is not primarily diagnosed as an | ||||||
24 | autism spectrum disorder. | ||||||
25 | "Department" means the Department of Financial and |
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1 | Professional Regulation. | ||||||
2 | "Pathophysiological" means the functional alterations in | ||||||
3 | the body related to a disease or syndrome. | ||||||
4 | "Provider" means any provider of healthcare services in | ||||||
5 | this State. | ||||||
6 | Section 15. Study and education. Public partnerships and | ||||||
7 | private partnerships supporting the discovery of biomarkers | ||||||
8 | and their implications in pathophysiological conditions shall | ||||||
9 | be encouraged and information derived from such discoveries | ||||||
10 | shall be disseminated to providers and made available to the | ||||||
11 | general public through research initiatives that may be | ||||||
12 | promoted by universities, medical clinics, health care | ||||||
13 | providers, consortiums, State agencies, private organizations, | ||||||
14 | public organizations, and any party that may contribute to the | ||||||
15 | scientific understanding of medical conditions associated or | ||||||
16 | occurring more often in persons also diagnosed with an autism | ||||||
17 | spectrum disorder than in the general population. | ||||||
18 | Universities, private organizations, public organizations, | ||||||
19 | and associations are encouraged to develop for providers who | ||||||
20 | treat persons with autism spectrum disorders continuing | ||||||
21 | education courses which address training in evaluation, | ||||||
22 | diagnosis, and treatments for co-occurring and otherwise | ||||||
23 | diagnosed pathophysiological conditions in autism spectrum | ||||||
24 | disorders to promote and align standard of care practices to | ||||||
25 | reflect emerging clinical findings and promising practices |
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1 | derived from improved patient outcomes. | ||||||
2 | Section 20. Treatment or service of persons with an autism | ||||||
3 | spectrum disorder. Providers are strongly encouraged to | ||||||
4 | evaluate persons diagnosed with an autism spectrum disorder for | ||||||
5 | co-occurring or otherwise diagnosed medical conditions when | ||||||
6 | clinical symptomatology is present or suspected and prescribe | ||||||
7 | appropriate treatments or services in alignment with care | ||||||
8 | practices for the condition, illness, injury, disease, or | ||||||
9 | disability. Providers may consider, without limitation, | ||||||
10 | whether or not a medication or any ingredient, allergen, | ||||||
11 | potential toxicant, or artificial agent may exacerbate | ||||||
12 | clinical symptomatology of autism spectrum disorder or a | ||||||
13 | related or co-occurring or otherwise diagnosed medical | ||||||
14 | condition and, if so, may consider adopting measures that would | ||||||
15 | result in the reduction or elimination of risk to the patient. | ||||||
16 | Section 25. Complaints. Any person with an autism spectrum | ||||||
17 | disorder, or the person's parent or legal guardian on his or | ||||||
18 | her behalf, who believes they have not received an appropriate | ||||||
19 | medical assessment, evaluation, diagnosis, service or | ||||||
20 | treatment from a provider because he or she is also diagnosed | ||||||
21 | with an autism spectrum disorder may report the incident to the | ||||||
22 | Department. | ||||||
23 | Section 30. Right to seek new care. A person with an autism |
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1 | spectrum disorder, or the person's parent or legal guardian on | ||||||
2 | his or her behalf, retains the right to seek further medical | ||||||
3 | opinions or care from other providers. | ||||||
4 | A parent or legal guardian shall not be threatened with | ||||||
5 | loss of parental or legal guardianship rights for a person with | ||||||
6 | autism spectrum disorder for pursuing additional medical | ||||||
7 | expertise, especially in the case of trying to ascertain | ||||||
8 | appropriate identification and diagnosis of underlying or | ||||||
9 | co-occurring medical conditions that may or may not be | ||||||
10 | exacerbating symptoms primarily associated with an autism | ||||||
11 | spectrum disorder. This Section does not abrogate or restrict | ||||||
12 | any responsibilities set forth under the Abused and Neglected | ||||||
13 | Child Reporting Act. | ||||||
14 | Any person diagnosed as having an autism spectrum disorder | ||||||
15 | or his or her parent or legal guardian shall not be denied the | ||||||
16 | right to pursue appropriate and available medical | ||||||
17 | interventions or treatments that may help to ameliorate or | ||||||
18 | improve the symptoms primarily associated with an autism | ||||||
19 | spectrum disorder or co-occurring or otherwise diagnosed | ||||||
20 | medical condition. | ||||||
21 | Any person diagnosed as having an autism spectrum disorder | ||||||
22 | or his or her parent or legal guardian shall not be denied the | ||||||
23 | right to decline a medical treatment or intervention. | ||||||
24 | Section 35. Repeal. In order to consider the most | ||||||
25 | innovative medical study and research involving autism and |
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1 | co-occurring medical conditions, this Act is repealed 5 year | ||||||
2 | after the effective date of this Act of the 99th General | ||||||
3 | Assembly. | ||||||
4 | Section 90. The Illinois Insurance Code is amended by | ||||||
5 | changing Section 356z.14 and by adding Section 356z.24 as | ||||||
6 | follows: | ||||||
7 | (215 ILCS 5/356z.14) | ||||||
8 | Sec. 356z.14. Autism spectrum disorders. | ||||||
9 | (a) A group or individual policy of accident and health | ||||||
10 | insurance or managed care plan amended, delivered, issued, or | ||||||
11 | renewed after the effective date of this amendatory Act of the | ||||||
12 | 95th General Assembly must provide individuals under 21 years | ||||||
13 | of age coverage for the diagnosis of autism spectrum disorders | ||||||
14 | and for the treatment of autism spectrum disorders to the | ||||||
15 | extent that the diagnosis and treatment of autism spectrum | ||||||
16 | disorders are not already covered by the policy of accident and | ||||||
17 | health insurance or managed care plan. | ||||||
18 | (b) Coverage provided under this Section shall be subject | ||||||
19 | to a maximum benefit of $36,000 per year, but shall not be | ||||||
20 | subject to any limits on the number of visits to a service | ||||||
21 | provider. After December 30, 2009, the Director of the Division | ||||||
22 | of Insurance shall, on an annual basis, adjust the maximum | ||||||
23 | benefit for inflation using the Medical Care Component of the | ||||||
24 | United States Department of Labor Consumer Price Index for All |
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1 | Urban Consumers. Payments made by an insurer on behalf of a | ||||||
2 | covered individual for any care, treatment, intervention, | ||||||
3 | service, or item, the provision of which was for the treatment | ||||||
4 | of a health condition not diagnosed as an autism spectrum | ||||||
5 | disorder, shall not be applied toward any maximum benefit | ||||||
6 | established under this subsection. | ||||||
7 | (c) Coverage under this Section shall be subject to | ||||||
8 | copayment, deductible, and coinsurance provisions of a policy | ||||||
9 | of accident and health insurance or managed care plan to the | ||||||
10 | extent that other medical services covered by the policy of | ||||||
11 | accident and health insurance or managed care plan are subject | ||||||
12 | to these provisions. | ||||||
13 | (d) This Section shall not be construed as limiting | ||||||
14 | benefits that are otherwise available to an individual under a | ||||||
15 | policy of accident and health insurance or managed care plan | ||||||
16 | and benefits provided under this Section may not be subject to | ||||||
17 | dollar limits, deductibles, copayments, or coinsurance | ||||||
18 | provisions that are less favorable to the insured than the | ||||||
19 | dollar limits, deductibles, or coinsurance provisions that | ||||||
20 | apply to physical illness generally. | ||||||
21 | (e) An insurer may not deny or refuse to provide otherwise | ||||||
22 | covered services, or refuse to renew, refuse to reissue, or | ||||||
23 | otherwise terminate or restrict coverage under an individual | ||||||
24 | contract to provide services to an individual because the | ||||||
25 | individual or their dependent is diagnosed with an autism | ||||||
26 | spectrum disorder or due to the individual utilizing benefits |
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1 | in this Section. | ||||||
2 | (f) Upon request of the reimbursing insurer, a provider of | ||||||
3 | treatment for autism spectrum disorders shall furnish medical | ||||||
4 | records, clinical notes, or other necessary data that | ||||||
5 | substantiate that initial or continued medical treatment is | ||||||
6 | medically necessary and is resulting in improved clinical | ||||||
7 | status. When treatment is anticipated to require continued | ||||||
8 | services to achieve demonstrable progress, the insurer may | ||||||
9 | request a treatment plan consisting of diagnosis, proposed | ||||||
10 | treatment by type, frequency, anticipated duration of | ||||||
11 | treatment, the anticipated outcomes stated as goals, and the | ||||||
12 | frequency by which the treatment plan will be updated. | ||||||
13 | (g) When making a determination of medical necessity for a | ||||||
14 | treatment modality for autism spectrum disorders, an insurer | ||||||
15 | must make the determination in a manner that is consistent with | ||||||
16 | the manner used to make that determination with respect to | ||||||
17 | other diseases or illnesses covered under the policy, including | ||||||
18 | an appeals process. During the appeals process, any challenge | ||||||
19 | to medical necessity must be viewed as reasonable only if the | ||||||
20 | review includes a physician with expertise in the most current | ||||||
21 | and effective treatment modalities for autism spectrum | ||||||
22 | disorders. | ||||||
23 | (h) Coverage for medically necessary early intervention | ||||||
24 | services must be delivered by certified early intervention | ||||||
25 | specialists, as defined in 89 Ill. Admin. Code 500 and any | ||||||
26 | subsequent amendments thereto. |
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1 | (h-5) If an individual has been diagnosed as having an | ||||||
2 | autism spectrum disorder, meeting the diagnostic criteria in | ||||||
3 | place at the time of diagnosis, and treatment is determined | ||||||
4 | medically necessary, then that individual shall remain | ||||||
5 | eligible for coverage under this Section even if subsequent | ||||||
6 | changes to the diagnostic criteria are adopted by the American | ||||||
7 | Psychiatric Association. If no changes to the diagnostic | ||||||
8 | criteria are adopted after April 1, 2012, and before December | ||||||
9 | 31, 2014, then this subsection (h-5) shall be of no further | ||||||
10 | force and effect. | ||||||
11 | (h-10) An insurer may not require, as a condition for | ||||||
12 | coverage of other covered services, that an individual | ||||||
13 | diagnosed with an autism spectrum disorder receive any | ||||||
14 | medication or intervention that has been determined by the | ||||||
15 | individual's health care provider to be medically | ||||||
16 | contraindicated for the individual. An insurer may not deny or | ||||||
17 | refuse to provide covered services, or refuse to renew, refuse | ||||||
18 | to reissue, or otherwise terminate or restrict coverage under | ||||||
19 | an individual contract, for a person diagnosed with an autism | ||||||
20 | spectrum disorder on the basis that the individual declined an | ||||||
21 | alternative medication or covered service when the | ||||||
22 | individual's health care provider determined that such | ||||||
23 | medication or covered service may exacerbate clinical | ||||||
24 | symptomatology and is medically contraindicated for the | ||||||
25 | individual. For the purposes of this subsection (h-10), | ||||||
26 | "clinical symptomatology" means any indication of disorder or |
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1 | disease when experienced by an individual as a change from | ||||||
2 | normal function, sensation, or appearance. | ||||||
3 | (h-15) If, at any time, the Secretary of the United States | ||||||
4 | Department of Health and Human Services, or its successor | ||||||
5 | agency, promulgates rules or regulations to be published in the | ||||||
6 | Federal Register or publishes a comment in the Federal Register | ||||||
7 | or issues an opinion, guidance, or other action that would | ||||||
8 | require the State, pursuant to any provision of the Patient | ||||||
9 | Protection and Affordable Care Act (Public Law 111–148), | ||||||
10 | including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any | ||||||
11 | successor provision, to defray the cost of any coverage | ||||||
12 | outlined in subsection (h-10), then subsection (h-10) is | ||||||
13 | inoperative with respect to all coverage outlined in subsection | ||||||
14 | (h-10) other than that authorized under Section 1902 of the | ||||||
15 | Social Security Act, 42 U.S.C. 1396a, and the State shall not | ||||||
16 | assume any obligation for the cost of the coverage set forth in | ||||||
17 | subsection (h-10). | ||||||
18 | (i) As used in this Section: | ||||||
19 | "Autism spectrum disorders" means pervasive developmental | ||||||
20 | disorders as defined in the most recent edition of the | ||||||
21 | Diagnostic and Statistical Manual of Mental Disorders, | ||||||
22 | including autism, Asperger's disorder, and pervasive | ||||||
23 | developmental disorder not otherwise specified. | ||||||
24 | "Diagnosis of autism spectrum disorders" means one or more | ||||||
25 | tests, evaluations, or assessments to diagnose whether an | ||||||
26 | individual has autism spectrum disorder that is prescribed, |
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1 | performed, or ordered by (A) a physician licensed to practice | ||||||
2 | medicine in all its branches or (B) a licensed clinical | ||||||
3 | psychologist with expertise in diagnosing autism spectrum | ||||||
4 | disorders. | ||||||
5 | "Medically necessary" means any care, treatment, | ||||||
6 | intervention, service or item which will or is reasonably | ||||||
7 | expected to do any of the following: (i) prevent the onset of | ||||||
8 | an illness, condition, injury, disease or disability; (ii) | ||||||
9 | reduce or ameliorate the physical, mental or developmental | ||||||
10 | effects of an illness, condition, injury, disease or | ||||||
11 | disability; or (iii) assist to achieve or maintain maximum | ||||||
12 | functional activity in performing daily activities. | ||||||
13 | "Treatment for autism spectrum disorders" shall include | ||||||
14 | the following care prescribed, provided, or ordered for an | ||||||
15 | individual diagnosed with an autism spectrum disorder by (A) a | ||||||
16 | physician licensed to practice medicine in all its branches or | ||||||
17 | (B) a certified, registered, or licensed health care | ||||||
18 | professional with expertise in treating effects of autism | ||||||
19 | spectrum disorders when the care is determined to be medically | ||||||
20 | necessary and ordered by a physician licensed to practice | ||||||
21 | medicine in all its branches: | ||||||
22 | (1) Psychiatric care, meaning direct, consultative, or | ||||||
23 | diagnostic services provided by a licensed psychiatrist. | ||||||
24 | (2) Psychological care, meaning direct or consultative | ||||||
25 | services provided by a licensed psychologist. | ||||||
26 | (3) Habilitative or rehabilitative care, meaning |
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1 | professional, counseling, and guidance services and | ||||||
2 | treatment programs, including applied behavior analysis, | ||||||
3 | that are intended to develop, maintain, and restore the | ||||||
4 | functioning of an individual. As used in this subsection | ||||||
5 | (i), "applied behavior analysis" means the design, | ||||||
6 | implementation, and evaluation of environmental | ||||||
7 | modifications using behavioral stimuli and consequences to | ||||||
8 | produce socially significant improvement in human | ||||||
9 | behavior, including the use of direct observation, | ||||||
10 | measurement, and functional analysis of the relations | ||||||
11 | between environment and behavior. | ||||||
12 | (4) Therapeutic care, including behavioral, speech, | ||||||
13 | occupational, and physical therapies that provide | ||||||
14 | treatment in the following areas: (i) self care and | ||||||
15 | feeding, (ii) pragmatic, receptive, and expressive | ||||||
16 | language, (iii) cognitive functioning, (iv) applied | ||||||
17 | behavior analysis, intervention, and modification, (v) | ||||||
18 | motor planning, and (vi) sensory processing. | ||||||
19 | (j) Rulemaking authority to implement this amendatory Act | ||||||
20 | of the 95th General Assembly, if any, is conditioned on the | ||||||
21 | rules being adopted in accordance with all provisions of the | ||||||
22 | Illinois Administrative Procedure Act and all rules and | ||||||
23 | procedures of the Joint Committee on Administrative Rules; any | ||||||
24 | purported rule not so adopted, for whatever reason, is | ||||||
25 | unauthorized.
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26 | (Source: P.A. 96-1000, eff. 7-2-10; 97-972, eff. 1-1-13.) |
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1 | (215 ILCS 5/356z.24 new) | ||||||
2 | Sec. 356z.24. Immune gamma globulin therapy. | ||||||
3 | (a) Patients with primary immunodeficiency are susceptible | ||||||
4 | to the ravages of infection because they have impaired antibody | ||||||
5 | response and quality. Immune gamma globulin therapy is intended | ||||||
6 | for continuous replacement therapy for primary | ||||||
7 | immunodeficiency and may be delivered through intravenous | ||||||
8 | immunoglobulin or subcutaneous immunoglobulin. For patients | ||||||
9 | with a primary immunodeficiency, immune gamma globulin therapy | ||||||
10 | protects against life-threatening infections, reduces | ||||||
11 | hospitalizations, preserves organ function, increases life | ||||||
12 | span, and is lifesaving. Immune gamma globulin is a human | ||||||
13 | plasma product regulated by the United States Food and Drug | ||||||
14 | Administration and approved for the treatment of primary | ||||||
15 | immunodeficiency. No generic immune gamma globulin product | ||||||
16 | exists. Patients diagnosed with primary immunodeficiency may | ||||||
17 | have varying clinical responses to a prescribed drug, including | ||||||
18 | those that may qualify as a serious medical contraindication. | ||||||
19 | Infusions should not be interrupted to learn about a patient's | ||||||
20 | tolerance for frequency of infusion as this will put the | ||||||
21 | patient's life at risk and to do so would be consistent with | ||||||
22 | medical malpractice. Some patients with primary | ||||||
23 | immunodeficiency have normal levels of immunoglobulins at | ||||||
24 | diagnosis but cannot make the antibodies that will neutralize | ||||||
25 | infection. In these cases, trough dosing is not clinically |
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1 | appropriate. | ||||||
2 | (b) A group or individual policy of accident and health | ||||||
3 | insurance or managed care plan amended, delivered, issued, or | ||||||
4 | renewed after the effective date of this amendatory Act of the | ||||||
5 | 99th General Assembly may not allow for the delay, | ||||||
6 | discontinuation, or interruption of immune gamma globulin | ||||||
7 | therapy for persons who are diagnosed with a primary | ||||||
8 | immunodeficiency when prescribed immune gamma globulin therapy | ||||||
9 | by a physician licensed to practice medicine in all of its | ||||||
10 | branches. Administration of immune gamma globulin therapy | ||||||
11 | shall not be delayed or interrupted by an insurer once a | ||||||
12 | diagnosis is established and immune gamma globulin is | ||||||
13 | prescribed. For the purposes of this Section, delay, | ||||||
14 | interruption, or discontinuation of therapy means interfering | ||||||
15 | with treatment as prescribed by the licensed physician by | ||||||
16 | altering the prescribed dose, frequency, route, venue, | ||||||
17 | product, or administration, which is determined by the | ||||||
18 | physician based on patient tolerability, individual patient | ||||||
19 | characteristics, needs, and clinical response. Product | ||||||
20 | interchangeability not authorized by a prescribing physician | ||||||
21 | is prohibited. | ||||||
22 | (c) Upon the diagnosis of primary immunodeficiency by the | ||||||
23 | prescribing physician, authorization or reauthorization by | ||||||
24 | insurers of immune gamma globulin therapy shall be expedited by | ||||||
25 | insurers. Due to the potential lifesaving necessity of immune | ||||||
26 | gamma globulin, determination of authorization or |
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1 | reauthorization may not take more than 2 weeks and | ||||||
2 | reauthorization may not be required more frequently than every | ||||||
3 | 12 months unless a more frequent duration has been indicated by | ||||||
4 | the prescribing physician. Since immune gamma globulin therapy | ||||||
5 | is intended for continuous replacement of antibodies, once a | ||||||
6 | diagnosis of primary immunodeficiency is made, the previous | ||||||
7 | diagnosis and current clinical judgment of the prescribing | ||||||
8 | physician shall be sufficient for renewed authorization or | ||||||
9 | authorization for continuation of care if the patient requires | ||||||
10 | new authorization due to change in insurers. | ||||||
11 | (d) Review of a patient's clinical history for meaningful | ||||||
12 | infections and the available laboratory findings, genetic | ||||||
13 | findings, and imaging studies, along with physical evidence of | ||||||
14 | end-organ damage from recurrent infections and the favorable | ||||||
15 | effect of immune gamma globulin replacement on clinical course | ||||||
16 | and the treating physician's clinical judgment is sufficient to | ||||||
17 | validate an antibody deficiency diagnosis. Trough levels of | ||||||
18 | antibodies and normal immune globulin levels may be used by | ||||||
19 | clinicians to monitor treatment and shall not be used to | ||||||
20 | discontinue or otherwise deny coverage of immune gamma globulin | ||||||
21 | therapy for a patient determined by a physician to have a | ||||||
22 | primary immunodeficiency. | ||||||
23 | (e) Any standards, policies, provisions, or practices by | ||||||
24 | insurers that require a person who is diagnosed with a primary | ||||||
25 | immunodeficiency to delay, discontinue, or interrupt immune | ||||||
26 | gamma globulin therapy that could result in a potentially life |
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1 | threatening situation are prohibited when prescribed by a | ||||||
2 | physician licensed to practice medicine in all its branches. | ||||||
3 | (f) If, at any time, the Secretary of the United States | ||||||
4 | Department of Health and Human Services, or its successor | ||||||
5 | agency, promulgates rules or regulations to be published in the | ||||||
6 | Federal Register or publishes a comment in the Federal Register | ||||||
7 | or issues an opinion, guidance, or other action that would | ||||||
8 | require the State, pursuant to any provision of the Patient | ||||||
9 | Protection and Affordable Care Act (Public Law 111–148), | ||||||
10 | including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any | ||||||
11 | successor provision, to defray the cost of any coverage | ||||||
12 | outlined in subsections (b) and (c), then subsections (b) and | ||||||
13 | (c) are inoperative with respect to all coverage outlined in | ||||||
14 | subsections (b) and (c) other than that authorized under | ||||||
15 | Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and | ||||||
16 | the State shall not assume any obligation for the cost of the | ||||||
17 | coverage set forth in subsections (b) and (c). | ||||||
18 | Section 99. Effective date. This Act takes effect upon | ||||||
19 | becoming law.".
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