102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3397

 

Introduced 2/22/2021, by Rep. Deanne M. Mazzochi

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.25
410 ILCS 50/3.5 new

    Amends the Illinois Insurance Code to prohibit an individual or group policy of accident and health insurance or managed care plan from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on coverage of diagnostic testing for a pediatric autoimmune neuropsychiatric disorder if such diagnostic testing is ordered by a physician. Provides that an individual or group policy of accident and health insurance or managed care plan is not required to cover diagnostic testing for a pediatric autoimmune neuropsychiatric disorder if a physician indicates that such diagnostic testing is requested by a guardian, authorized representative, or parent of a minor patient. Amends the Medical Patient Rights Act. Provides that a physician may not refuse a request of a guardian, authorized representative, or parent of a minor patient for minimally invasive diagnostic testing for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome.


LRB102 14484 BMS 19837 b

 

 

A BILL FOR

 

HB3397LRB102 14484 BMS 19837 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 356z.25 as follows:
 
6    (215 ILCS 5/356z.25)
7    Sec. 356z.25. Coverage for treatment of pediatric
8autoimmune neuropsychiatric disorders associated with
9streptococcal infections and pediatric acute onset
10neuropsychiatric syndrome. A group or individual policy of
11accident and health insurance or managed care plan that is
12amended, delivered, issued, or renewed after July 18, 2017
13(the effective date of Public Act 100-24) shall provide
14coverage for treatment of pediatric autoimmune
15neuropsychiatric disorders associated with streptococcal
16infections and pediatric acute-onset neuropsychiatric
17syndrome, including, but not limited to, the use of
18intravenous immunoglobulin therapy.
19    For billing and diagnosis purposes, pediatric autoimmune
20neuropsychiatric disorders associated with streptococcal
21infections and pediatric acute onset neuropsychiatric syndrome
22shall be coded as autoimmune encephalitis until the American
23Medical Association and the Centers for Medicare and Medicaid

 

 

HB3397- 2 -LRB102 14484 BMS 19837 b

1Services create and assign a specific code for pediatric
2autoimmune neuropsychiatric disorders associated with
3streptococcal infections and pediatric acute onset
4neuropsychiatric syndrome. Thereafter, pediatric autoimmune
5neuropsychiatric disorders associated with streptococcal
6infections and pediatric acute onset neuropsychiatric syndrome
7may be coded as autoimmune encephalitis, pediatric autoimmune
8neuropsychiatric disorders associated with streptococcal
9infections, or pediatric acute onset neuropsychiatric
10syndrome.
11    If, at any time, the Secretary of the United States
12Department of Health and Human Services, or its successor
13agency, promulgates rules or regulations to be published in
14the Federal Register or publishes a comment in the Federal
15Register or issues an opinion, guidance, or other action that
16would require the State, pursuant to any provision of the
17Patient Protection and Affordable Care Act (Public Law
18111-148), including, but not limited to, 42 U.S.C.
1918031(d)(3)(B) or any successor provision, to defray the cost
20of any coverage for pediatric autoimmune neuropsychiatric
21disorders associated with streptococcal infections and
22pediatric acute onset neuropsychiatric syndrome outlined in
23this Section, then the requirement that an insurer cover
24pediatric autoimmune neuropsychiatric disorders associated
25with streptococcal infections and pediatric acute onset
26neuropsychiatric syndrome is inoperative other than any such

 

 

HB3397- 3 -LRB102 14484 BMS 19837 b

1coverage authorized under Section 1902 of the Social Security
2Act, 42 U.S.C. 1396a, and the State shall not assume any
3obligation for the cost of coverage for pediatric autoimmune
4neuropsychiatric disorders associated with streptococcal
5infections and pediatric acute onset neuropsychiatric
6syndrome.
7    An individual or group policy of accident and health
8insurance or managed care plan may not impose a deductible,
9coinsurance, copayment, or any other cost-sharing requirement
10on coverage for diagnostic testing for pediatric autoimmune
11neuropsychiatric disorders if such diagnostic testing is
12ordered by a physician licensed to practice medicine in all
13its branches.
14    An individual or group policy of accident and health
15insurance or managed care plan is not required to provide
16coverage for diagnostic testing for pediatric autoimmune
17neuropsychiatric disorders if a physician indicates that such
18diagnostic testing is requested by a guardian, authorized
19representative, or parent of a minor patient.
20(Source: P.A. 100-24, eff. 7-18-17; 100-863, eff. 8-14-18;
21101-488, eff. 8-23-19.)
 
22    Section 10. The Medical Patient Rights Act is amended by
23adding Section 3.5 as follows:
 
24    (410 ILCS 50/3.5 new)

 

 

HB3397- 4 -LRB102 14484 BMS 19837 b

1    Sec. 3.5. Pediatric autoimmune neuropsychiatric disorder
2diagnostic testing for minors. A physician may not refuse a
3request of a guardian, authorized representative, or parent of
4a minor patient for minimally invasive diagnostic testing for
5pediatric autoimmune neuropsychiatric disorders associated
6with streptococcal infections and pediatric acute-onset
7neuropsychiatric syndrome.