Illinois General Assembly - Full Text of HB3080
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Full Text of HB3080  102nd General Assembly


Sen. Laura Fine

Filed: 11/28/2022





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2    AMENDMENT NO. ______. Amend House Bill 3080 by replacing
3everything after the enacting clause with the following:
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



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1syndrome, including, but not limited to, the use of
2intravenous immunoglobulin therapy.
3    No group or individual policy of accident and health
4insurance or managed care plan shall deny or delay coverage
5for medically necessary treatment under this Section solely
6because the insured, enrollee, or beneficiary previously
7received any treatment, including the same or similar
8treatment, for pediatric autoimmune neuropsychiatric disorders
9associated with streptococcal infections or pediatric acute
10onset neuropsychiatric syndrome, or because the insured,
11enrollee, or beneficiary has been diagnosed with or receives
12treatment for an otherwise diagnosed condition.
13    For the purposes of this Section, coverage of pediatric
14autoimmune neuropsychiatric disorders associated with
15streptococcal infections and pediatric acute onset
16neuropsychiatric syndrome shall adhere to the treatment
17recommendations developed by a medical professional consortium
18convened for the purposes of researching, identifying, and
19publishing best practice standards for diagnosis and treatment
20of such disorders or syndrome that are accessible for medical
21professionals and are based on evidence of positive patient
22outcomes. Coverage for any form of medically necessary
23treatment shall not be limited over a lifetime of an insured,
24enrollee, or beneficiary or by policy period. Nothing in this
25Section prevents insurers from requesting treatment notes and
26anticipated duration of treatment and outcomes.



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1    For billing and diagnosis purposes, pediatric autoimmune
2neuropsychiatric disorders associated with streptococcal
3infections and pediatric acute onset neuropsychiatric syndrome
4shall be coded as autoimmune encephalitis until the American
5Medical Association and the Centers for Medicare and Medicaid
6Services create and assign a specific code for pediatric
7autoimmune neuropsychiatric disorders associated with
8streptococcal infections and pediatric acute onset
9neuropsychiatric syndrome. Thereafter, pediatric autoimmune
10neuropsychiatric disorders associated with streptococcal
11infections and pediatric acute onset neuropsychiatric syndrome
12may be coded as autoimmune encephalitis, pediatric autoimmune
13neuropsychiatric disorders associated with streptococcal
14infections, or pediatric acute onset neuropsychiatric
16    If, at any time, the Secretary of the United States
17Department of Health and Human Services, or its successor
18agency, promulgates rules or regulations to be published in
19the Federal Register or publishes a comment in the Federal
20Register or issues an opinion, guidance, or other action that
21would require the State, pursuant to any provision of the
22Patient Protection and Affordable Care Act (Public Law
23111-148), including, but not limited to, 42 U.S.C.
2418031(d)(3)(B) or any successor provision, to defray the cost
25of any coverage for pediatric autoimmune neuropsychiatric
26disorders associated with streptococcal infections and



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1pediatric acute onset neuropsychiatric syndrome outlined in
2this Section, then the requirement that an insurer cover
3pediatric autoimmune neuropsychiatric disorders associated
4with streptococcal infections and pediatric acute onset
5neuropsychiatric syndrome is inoperative other than any such
6coverage authorized under Section 1902 of the Social Security
7Act, 42 U.S.C. 1396a, and the State shall not assume any
8obligation for the cost of coverage for pediatric autoimmune
9neuropsychiatric disorders associated with streptococcal
10infections and pediatric acute onset neuropsychiatric
12(Source: P.A. 100-24, eff. 7-18-17; 100-863, eff. 8-14-18;
13101-488, eff. 8-23-19.)
14    Section 99. Effective date. This Act takes effect upon
15becoming law.".