Full Text of HB3223 100th General Assembly
HB3223sam001 100TH GENERAL ASSEMBLY | Sen. Terry Link Filed: 4/10/2018
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| 1 | | AMENDMENT TO HOUSE BILL 3223
| 2 | | AMENDMENT NO. ______. Amend House Bill 3223 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 356z.8 as follows: | 6 | | (215 ILCS 5/356z.8)
| 7 | | Sec. 356z.8. Multiple sclerosis preventative physical | 8 | | therapy. A group or individual policy of accident and health | 9 | | insurance or managed care plan amended, delivered, issued, or | 10 | | renewed after the effective date of this amendatory Act of the | 11 | | 100th General Assembly this amendatory Act of the 94th General | 12 | | Assembly must provide coverage for medically necessary | 13 | | preventative physical therapy for insureds diagnosed with | 14 | | multiple sclerosis. For the purposes of this Section, | 15 | | "preventative physical therapy" means physical therapy that is | 16 | | prescribed by a physician licensed to practice medicine in all |
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| 1 | | of its branches for the purpose of treating parts of the body | 2 | | affected by multiple sclerosis, but only where the physical | 3 | | therapy includes reasonably defined goals, including, but not | 4 | | limited to, sustaining the level of function the person has | 5 | | achieved, with periodic evaluation of the efficacy of the | 6 | | physical therapy against those goals. The coverage required | 7 | | under this Section shall be subject to the same deductible and , | 8 | | coinsurance requirements or other limitations , waiting period, | 9 | | cost sharing limitation, treatment limitation, calendar year | 10 | | maximum, or other limitations as provided for
other physical or | 11 | | rehabilitative therapy benefits covered by the policy.
| 12 | | A group or individual policy of accident and health | 13 | | insurance or managed care plan amended, delivered, issued, or | 14 | | renewed after the effective date of this amendatory Act of the | 15 | | 100th General Assembly shall offer an exception process from | 16 | | treatment limitations for individuals diagnosed with primary | 17 | | or secondary progressive multiple sclerosis. The exception | 18 | | process must be posted on the insurer's website in an | 19 | | easily-accessible location. An exception request must document | 20 | | medical necessity for extended treatment that is reasonable and | 21 | | appropriate to the individual's defined goals included in his | 22 | | or her treatment plan. A health insurer shall, within 72 hours | 23 | | after receiving the exception request, either approve or deny | 24 | | the request. | 25 | | The coverage required by this Section shall be subject to | 26 | | other general exclusions and limitations of the policy, |
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| 1 | | including coordination of benefits, participating provider | 2 | | requirements, restrictions on services provided by family or | 3 | | household members, utilization review of health care services, | 4 | | including review of medical necessity, case management, | 5 | | experimental or investigational treatments, and other managed | 6 | | care provisions. | 7 | | (Source: P.A. 94-1076, eff. 12-29-06.)".
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