SB0193sam001 100TH GENERAL ASSEMBLY

Sen. Terry Link

Filed: 3/6/2017

10000SB0193sam001 LRB100 05979 SMS 23021 a

AMENDMENT TO SENATE BILL 193

AMENDMENT NO. ______. Amend Senate Bill 193 on page 1, by replacing lines 13 and 14 with "preventative physical therapy for insureds diagnosed with multiple"; and

on page 2, line 2, after "requirements", by inserting "or other limitations"; and

on page 2, immediately below line 5, by inserting the following:

"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.".