Full Text of HB5040 101st General Assembly
HB5040 101ST GENERAL ASSEMBLY |
| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020 HB5040 Introduced 2/18/2020, by Rep. Deanne M. Mazzochi SYNOPSIS AS INTRODUCED: |
| 215 ILCS 5/356z.25 | | 410 ILCS 50/3.5 new | |
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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.
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| | A BILL FOR |
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| | | HB5040 | | LRB101 18227 BMS 67669 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.25 as follows: | 6 | | (215 ILCS 5/356z.25) | 7 | | Sec. 356z.25. Coverage for treatment of pediatric | 8 | | autoimmune neuropsychiatric disorders associated with | 9 | | streptococcal infections and pediatric acute onset | 10 | | neuropsychiatric syndrome. A group or individual policy of | 11 | | accident and health insurance or managed care plan that is | 12 | | amended, delivered, issued, or renewed after July 18, 2017 (the | 13 | | effective date of Public Act 100-24) shall provide coverage for | 14 | | treatment of pediatric autoimmune neuropsychiatric disorders | 15 | | associated with streptococcal infections and pediatric | 16 | | acute-onset neuropsychiatric syndrome, including, but not | 17 | | limited to, the use of intravenous immunoglobulin therapy. | 18 | | For billing and diagnosis purposes, pediatric autoimmune | 19 | | neuropsychiatric disorders associated with streptococcal | 20 | | infections and pediatric acute onset neuropsychiatric syndrome | 21 | | shall be coded as autoimmune encephalitis until the American | 22 | | Medical Association and the Centers for Medicare and Medicaid | 23 | | Services create and assign a specific code for pediatric |
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| 1 | | autoimmune neuropsychiatric disorders associated with | 2 | | streptococcal infections and pediatric acute onset | 3 | | neuropsychiatric syndrome. Thereafter, pediatric autoimmune | 4 | | neuropsychiatric disorders associated with streptococcal | 5 | | infections and pediatric acute onset neuropsychiatric syndrome | 6 | | may be coded as autoimmune encephalitis, pediatric autoimmune | 7 | | neuropsychiatric disorders associated with streptococcal | 8 | | infections, or pediatric acute onset neuropsychiatric | 9 | | syndrome. | 10 | | If, at any time, the Secretary of the United States | 11 | | Department of Health and Human Services, or its successor | 12 | | agency, promulgates rules or regulations to be published in the | 13 | | Federal Register or publishes a comment in the Federal Register | 14 | | or issues an opinion, guidance, or other action that would | 15 | | require the State, pursuant to any provision of the Patient | 16 | | Protection and Affordable Care Act (Public Law 111-148), | 17 | | including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any | 18 | | successor provision, to defray the cost of any coverage for | 19 | | pediatric autoimmune neuropsychiatric disorders associated | 20 | | with streptococcal infections and pediatric acute onset | 21 | | neuropsychiatric syndrome outlined in this Section, then the | 22 | | requirement that an insurer cover pediatric autoimmune | 23 | | neuropsychiatric disorders associated with streptococcal | 24 | | infections and pediatric acute onset neuropsychiatric syndrome | 25 | | is inoperative other than any such coverage authorized under | 26 | | Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and |
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| 1 | | the State shall not assume any obligation for the cost of | 2 | | coverage for pediatric autoimmune neuropsychiatric disorders | 3 | | associated with streptococcal infections and pediatric acute | 4 | | onset neuropsychiatric syndrome.
| 5 | | An individual or group policy of accident and health | 6 | | insurance or managed care plan may not impose a deductible, | 7 | | coinsurance, copayment, or any other cost-sharing requirement | 8 | | on coverage for diagnostic testing for pediatric autoimmune | 9 | | neuropsychiatric disorders if such diagnostic testing is | 10 | | ordered by a physician licensed to practice medicine in all its | 11 | | branches. | 12 | | An individual or group policy of accident and health | 13 | | insurance or managed care plan is not required to provide | 14 | | coverage for diagnostic testing for pediatric autoimmune | 15 | | neuropsychiatric disorders if a physician indicates that such | 16 | | diagnostic testing is requested by a guardian, authorized | 17 | | representative, or parent of a minor patient. | 18 | | (Source: P.A. 100-24, eff. 7-18-17; 100-863, eff. 8-14-18; | 19 | | 101-488, eff. 8-23-19.) | 20 | | Section 10. The Medical Patient Rights Act is amended by | 21 | | adding Section 3.5 as follows: | 22 | | (410 ILCS 50/3.5 new) | 23 | | Sec. 3.5. Pediatric autoimmune neuropsychiatric disorder | 24 | | diagnostic testing for minors. A physician may not refuse a |
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| 1 | | request of a guardian, authorized representative, or parent of | 2 | | a minor patient for minimally invasive diagnostic testing for | 3 | | pediatric autoimmune neuropsychiatric disorders associated | 4 | | with streptococcal infections and pediatric acute-onset | 5 | | neuropsychiatric syndrome.
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