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

    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.


LRB101 18227 BMS 67669 b

 

 

A BILL FOR

 

HB5040LRB101 18227 BMS 67669 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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 (the
13effective date of Public Act 100-24) shall provide coverage for
14treatment of pediatric autoimmune neuropsychiatric disorders
15associated with streptococcal infections and pediatric
16acute-onset neuropsychiatric syndrome, including, but not
17limited to, the use of intravenous immunoglobulin therapy.
18    For billing and diagnosis purposes, pediatric autoimmune
19neuropsychiatric disorders associated with streptococcal
20infections and pediatric acute onset neuropsychiatric syndrome
21shall be coded as autoimmune encephalitis until the American
22Medical Association and the Centers for Medicare and Medicaid
23Services create and assign a specific code for pediatric

 

 

HB5040- 2 -LRB101 18227 BMS 67669 b

1autoimmune neuropsychiatric disorders associated with
2streptococcal infections and pediatric acute onset
3neuropsychiatric syndrome. Thereafter, pediatric autoimmune
4neuropsychiatric disorders associated with streptococcal
5infections and pediatric acute onset neuropsychiatric syndrome
6may be coded as autoimmune encephalitis, pediatric autoimmune
7neuropsychiatric disorders associated with streptococcal
8infections, or pediatric acute onset neuropsychiatric
9syndrome.
10    If, at any time, the Secretary of the United States
11Department of Health and Human Services, or its successor
12agency, promulgates rules or regulations to be published in the
13Federal Register or publishes a comment in the Federal Register
14or issues an opinion, guidance, or other action that would
15require the State, pursuant to any provision of the Patient
16Protection and Affordable Care Act (Public Law 111-148),
17including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
18successor provision, to defray the cost of any coverage for
19pediatric autoimmune neuropsychiatric disorders associated
20with streptococcal infections and pediatric acute onset
21neuropsychiatric syndrome outlined in this Section, then the
22requirement that an insurer cover pediatric autoimmune
23neuropsychiatric disorders associated with streptococcal
24infections and pediatric acute onset neuropsychiatric syndrome
25is inoperative other than any such coverage authorized under
26Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and

 

 

HB5040- 3 -LRB101 18227 BMS 67669 b

1the State shall not assume any obligation for the cost of
2coverage for pediatric autoimmune neuropsychiatric disorders
3associated with streptococcal infections and pediatric acute
4onset neuropsychiatric syndrome.
5    An individual or group policy of accident and health
6insurance or managed care plan may not impose a deductible,
7coinsurance, copayment, or any other cost-sharing requirement
8on coverage for diagnostic testing for pediatric autoimmune
9neuropsychiatric disorders if such diagnostic testing is
10ordered by a physician licensed to practice medicine in all its
11branches.
12    An individual or group policy of accident and health
13insurance or managed care plan is not required to provide
14coverage for diagnostic testing for pediatric autoimmune
15neuropsychiatric disorders if a physician indicates that such
16diagnostic testing is requested by a guardian, authorized
17representative, or parent of a minor patient.
18(Source: P.A. 100-24, eff. 7-18-17; 100-863, eff. 8-14-18;
19101-488, eff. 8-23-19.)
 
20    Section 10. The Medical Patient Rights Act is amended by
21adding Section 3.5 as follows:
 
22    (410 ILCS 50/3.5 new)
23    Sec. 3.5. Pediatric autoimmune neuropsychiatric disorder
24diagnostic testing for minors. A physician may not refuse a

 

 

HB5040- 4 -LRB101 18227 BMS 67669 b

1request of a guardian, authorized representative, or parent of
2a minor patient for minimally invasive diagnostic testing for
3pediatric autoimmune neuropsychiatric disorders associated
4with streptococcal infections and pediatric acute-onset
5neuropsychiatric syndrome.