Full Text of SB0193 100th General Assembly
SB0193eng 100TH GENERAL ASSEMBLY |
| | SB0193 Engrossed | | LRB100 05979 SMS 16007 b |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 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 | 17 | | of its branches for the purpose of treating parts of the body | 18 | | affected by multiple sclerosis, but only where the physical | 19 | | therapy includes reasonably defined goals, including, but not | 20 | | limited to, sustaining the level of function the person has | 21 | | achieved, with periodic evaluation of the efficacy of the | 22 | | physical therapy against those goals. The coverage required | 23 | | under this Section shall be subject to the same deductible and , |
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| 1 | | coinsurance requirements or other limitations , waiting period, | 2 | | cost sharing limitation, treatment limitation, calendar year | 3 | | maximum, or other limitations as provided for
other physical or | 4 | | rehabilitative therapy benefits covered by the policy.
| 5 | | A group or individual policy of accident and health | 6 | | insurance or managed care plan amended, delivered, issued, or | 7 | | renewed after the effective date of this amendatory Act of the | 8 | | 100th General Assembly shall offer an exception process from | 9 | | treatment limitations for individuals diagnosed with primary | 10 | | or secondary progressive multiple sclerosis. The exception | 11 | | process must be posted on the insurer's website in an | 12 | | easily-accessible location. An exception request must document | 13 | | medical necessity for extended treatment that is reasonable and | 14 | | appropriate to the individual's defined goals included in his | 15 | | or her treatment plan. A health insurer shall, within 72 hours | 16 | | after receiving the exception request, either approve or deny | 17 | | the request. | 18 | | The coverage required by this Section shall be subject to | 19 | | other general exclusions and limitations of the policy, | 20 | | including coordination of benefits, participating provider | 21 | | requirements, restrictions on services provided by family or | 22 | | household members, utilization review of health care services, | 23 | | including review of medical necessity, case management, | 24 | | experimental or investigational treatments, and other managed | 25 | | care provisions. | 26 | | (Source: P.A. 94-1076, eff. 12-29-06.)
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