103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB0101

 

Introduced 1/24/2023, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.25

    Amends the Illinois Insurance Code. Provides that no group or individual policy of accident and health insurance or managed care plan shall deny or delay coverage for medically necessary treatment because the insured, enrollee, or beneficiary previously received any treatment, including the same or similar treatment, for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections or pediatric acute onset neuropsychiatric syndrome, or because the insured, enrollee, or beneficiary has been diagnosed with or receives treatment for an otherwise diagnosed condition. Provides that coverage of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall adhere to the treatment recommendations developed by a medical professional consortium convened for the purposes of researching, identifying, and publishing best practice standards for diagnosis and treatment of such disorders or syndrome that are accessible for medical professionals and are based on evidence of positive patient outcomes. Provides that coverage for any form of medically necessary treatment shall not be limited over a lifetime of an insured, enrollee, or beneficiary, unless the patient is no longer benefiting from the treatment, or by policy period. Provides that nothing in the provisions prevents insurers from requesting treatment notes and anticipated duration of treatment and outcomes. Effective immediately.


LRB103 25077 BMS 51412 b

 

 

A BILL FOR

 

SB0101LRB103 25077 BMS 51412 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
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
17syndrome, including, but not limited to, the use of
18intravenous immunoglobulin therapy.
19    No group or individual policy of accident and health
20insurance or managed care plan shall deny or delay coverage
21for medically necessary treatment under this Section solely
22because the insured, enrollee, or beneficiary previously
23received any treatment, including the same or similar

 

 

SB0101- 2 -LRB103 25077 BMS 51412 b

1treatment, for pediatric autoimmune neuropsychiatric disorders
2associated with streptococcal infections or pediatric acute
3onset neuropsychiatric syndrome, or because the insured,
4enrollee, or beneficiary has been diagnosed with or receives
5treatment for an otherwise diagnosed condition.
6    For the purposes of this Section, coverage of pediatric
7autoimmune neuropsychiatric disorders associated with
8streptococcal infections and pediatric acute onset
9neuropsychiatric syndrome shall adhere to the treatment
10recommendations developed by a medical professional consortium
11convened for the purposes of researching, identifying, and
12publishing best practice standards for diagnosis and treatment
13of such disorders or syndrome that are accessible for medical
14professionals and are based on evidence of positive patient
15outcomes. Coverage for any form of medically necessary
16treatment shall not be limited over a lifetime of an insured,
17enrollee, or beneficiary, unless the patient is no longer
18benefiting from the treatment, or by policy period. Nothing in
19this Section prevents insurers from requesting treatment notes
20and anticipated duration of treatment and outcomes.
21    For billing and diagnosis purposes, pediatric autoimmune
22neuropsychiatric disorders associated with streptococcal
23infections and pediatric acute onset neuropsychiatric syndrome
24shall be coded as autoimmune encephalitis until the American
25Medical Association and the Centers for Medicare and Medicaid
26Services create and assign a specific code for pediatric

 

 

SB0101- 3 -LRB103 25077 BMS 51412 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
13the Federal Register or publishes a comment in the Federal
14Register or issues an opinion, guidance, or other action that
15would require the State, pursuant to any provision of the
16Patient Protection and Affordable Care Act (Public Law
17111-148), including, but not limited to, 42 U.S.C.
1818031(d)(3)(B) or any successor provision, to defray the cost
19of any coverage for pediatric autoimmune neuropsychiatric
20disorders associated with streptococcal infections and
21pediatric acute onset neuropsychiatric syndrome outlined in
22this Section, then the requirement that an insurer cover
23pediatric autoimmune neuropsychiatric disorders associated
24with streptococcal infections and pediatric acute onset
25neuropsychiatric syndrome is inoperative other than any such
26coverage authorized under Section 1902 of the Social Security

 

 

SB0101- 4 -LRB103 25077 BMS 51412 b

1Act, 42 U.S.C. 1396a, and the State shall not assume any
2obligation for the cost of coverage for pediatric autoimmune
3neuropsychiatric disorders associated with streptococcal
4infections and pediatric acute onset neuropsychiatric
5syndrome.
6(Source: P.A. 100-24, eff. 7-18-17; 100-863, eff. 8-14-18;
7101-488, eff. 8-23-19.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.