Sen. Terry Link
Filed: 3/6/2017
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1 | AMENDMENT TO SENATE BILL 193
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2 | AMENDMENT NO. ______. Amend Senate Bill 193 on page 1, by | ||||||
3 | replacing lines 13 and 14 with "preventative physical therapy | ||||||
4 | for insureds diagnosed with multiple"; and
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5 | on page 2, line 2, after " requirements ", by inserting " or other | ||||||
6 | limitations "; and | ||||||
7 | on page 2, immediately below line 5, by inserting the | ||||||
8 | following: | ||||||
9 | " 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 | 100th General Assembly shall offer an exception process from | ||||||
13 | treatment limitations for individuals diagnosed with primary | ||||||
14 | or secondary progressive multiple sclerosis. The exception | ||||||
15 | process must be posted on the insurer's website in an |
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1 | easily-accessible location. An exception request must document | ||||||
2 | medical necessity for extended treatment that is reasonable and | ||||||
3 | appropriate to the individual's defined goals included in his | ||||||
4 | or her treatment plan. A health insurer shall, within 72 hours | ||||||
5 | after receiving the exception request, either approve or deny | ||||||
6 | the request. | ||||||
7 | The coverage required by this Section shall be subject to | ||||||
8 | other general exclusions and limitations of the policy, | ||||||
9 | including coordination of benefits, participating provider | ||||||
10 | requirements, restrictions on services provided by family or | ||||||
11 | household members, utilization review of health care services, | ||||||
12 | including review of medical necessity, case management, | ||||||
13 | experimental or investigational treatments, and other managed | ||||||
14 | care provisions. ".
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