Illinois General Assembly - Full Text of SB1900
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Full Text of SB1900  95th General Assembly


Sen. James A. DeLeo

Filed: 4/8/2008





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2     AMENDMENT NO. ______. Amend Senate Bill 1900, AS AMENDED,
3 with reference to page and line numbers of Senate Amendment No.
4 1 as follows:
5 on page 6, immediately below line 2, by inserting the
6 following:
7     "(f) Upon request of the reimbursing insurer, a provider of
8 treatment for autism spectrum disorders shall furnish medical
9 records, clinical notes, or other necessary data that
10 substantiate that initial or continued medical treatment is
11 medically necessary and is resulting in improved clinical
12 status. When treatment is anticipated to require continued
13 services to achieve demonstrable progress, the insurer may
14 request a treatment plan consisting of diagnosis, proposed
15 treatment by type, frequency, anticipated duration of
16 treatment, the anticipated outcomes stated as goals, and the
17 frequency by which the treatment plan will be updated.



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1     (g) When making a determination of medical necessity for a
2 treatment modality for autism spectrum disorders, an insurer
3 must make the determination in a manner that is consistent with
4 the manner used to make that determination with respect to
5 other diseases or illnesses covered under the policy, including
6 an appeals process. During the appeals process, any challenge
7 to medical necessity must be viewed as reasonable only if the
8 review includes a physician with expertise in the most current
9 and effective treatment modalities for autism spectrum
10 disorders.
11     (h) Coverage for medically necessary early intervention
12 services must be delivered by certified early intervention
13 specialists, as defined in the early intervention operational
14 standards by the Department of Human Services and in accordance
15 with applicable certification requirements."; and
16 on page 6, line 3, by replacing "(f)" with "(i)"; and
17 on page 6, lines 12 through 13, by replacing "a certified,
18 registered, or licensed health care professional" with "a
19 licensed clinical psychologist"; and
20 on page 6, line 17, by replacing "following;" with
21 "following:"; and
22 on page 6, line 18, by replacing "disability." with



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1 "disability;"; and
2 on page 6, line 21, by replacing "disability." with
3 "disability; or"; and
4 on page 7, line 6, by replacing "(A)" with "(1)"; and
5 on page 7, line 7, by replacing "(B)" with "(2)"; and
6 on page 7, line 8, by replacing "(C)" with "(3)"; and
7 on page 7, line 9, by replacing "(D)" with "(4)"; and
8 on page 7, line 15, by replacing "integration." with
9 "processing.".