Illinois General Assembly - Bill Status for HB 1560

Amends the Illinois Insurance Code, the Health Maintenance Organization Act, the Limited Health Services Organization Act, and the Voluntary Health Services Plans Act to require coverage for (1) prescription enteral and oral formulas for home use for which a physician has issued a written order and that are medically necessary for the treatment or management of phenylketonuria or other inherited diseases involving amino acids or other organic acids; (2) up to $2,500 per year worth of food products modified to be low in protein for which a physician has issued a written order and that are medically necessary for the management of phenylketonuria or other inherited diseases involving amino acids or other organic acids; and (3) nonprescription amino acid based elemental formulas, regardless of delivery method, that are medically necessary for the management of phenylketonuria or other inherited diseases involving amino acids or other organic acids. Effective immediately.

Replaces everything after the enacting clause. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to provide coverage for nonprescription amino acid-based elemental formulas, regardless of delivery method, for the diagnosis and treatment of (i) milk protein allergies and intolerances, (ii) eosinophilic disorders, and (iii) impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract, when the prescribing physician has issued a written order stating that the amino acid-based elemental formula is medically necessary for the treatment of a disease or disorder and is the least restrictive and most cost-effective means for meeting the needs of the patient. Also requires coverage for specialized amino acid-based elemental formulas, regardless of delivery method, when the prescribing physician has issued a written order stating that such specialized amino acid-based elemental formula is medically necessary for the treatment of a disease or disorder and is the least restrictive and most cost-effective means for meeting the needs of the patient. Effective immediately.

Provides that a group or individual policy of accident and health insurance or managed care plan and the Department of Healthcare and Family Services must provide coverage and reimbursement when documentation is presented demonstrating a medical necessity and treatment plan for amino acid-based elemental formulas (instead of nonprescription amino acid-based elemental formulas), regardless of delivery method, for the diagnosis and treatment of (i) an individual with multiple food allergies or intolerances making amino acid-based elemental formulas a medically necessary treatment (instead of the treatment of milk protein allergies and intolerances), (ii) eosinophilic disorders, and (iii) short bowel syndrome (instead of impaired absorption of nutrients caused by the disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract), when the prescribing physician or dietician has issued a written order stating that the amino acid-based elemental formula is medically necessary for the treatment of a disease or disorder (instead of medically necessary for the treatment of the disease or disorder and the least restrictive and most cost-effective means for meeting the needs of the patient). Deletes a provision requiring coverage for specialized amino acid-based elemental formulas, regardless of delivery method, when the prescribing physician has issued a written order stating that such specialized amino acid-based elemental formula is medically necessary for the treatment of a disease or disorder and is the least restrictive and most cost-effective means for meeting the needs of the patient.

Date	Chamber	Action
1/13/2009	House	Session Sine Die

Date	Chamber	Action
2/22/2007	House	Filed with the Clerk by Rep. Kathleen A. Ryg
2/22/2007	House	Added Chief Co-Sponsor Rep. Naomi D. Jakobsson
2/22/2007	House	First Reading
2/22/2007	House	Referred to Rules Committee
2/27/2007	House	Assigned to Health Care Availability and Access Committee
3/7/2007	House	Added Chief Co-Sponsor Rep. Elizabeth Coulson
3/14/2007	House	Added Co-Sponsor Rep. Jack McGuire
3/15/2007	House	Added Co-Sponsor Rep. Esther Golar
3/15/2007	House	Added Co-Sponsor Rep. Karen May
3/15/2007	House	Added Co-Sponsor Rep. Lisa M. Dugan
3/15/2007	House	Added Co-Sponsor Rep. Rosemary Mulligan
3/15/2007	House	Added Co-Sponsor Rep. Mary E. Flowers
3/20/2007	House	House Amendment No. 1 Filed with Clerk by Health Care Availability and Access Committee
3/20/2007	House	House Amendment No. 1 Adopted in Health Care Availability and Access Committee; by Voice Vote
3/20/2007	House	Do Pass as Amended / Short Debate Health Care Availability and Access Committee; 012-000-000
3/20/2007	House	Placed on Calendar 2nd Reading - Short Debate
3/22/2007	House	House Amendment No. 1 Fiscal Note Requested as Amended by Rep. William B. Black
3/22/2007	House	House Amendment No. 1 State Mandates Fiscal Note Requested as Amended by Rep. William B. Black
3/22/2007	House	Added Co-Sponsor Rep. John A. Fritchey
3/27/2007	House	Added Co-Sponsor Rep. Fred Crespo
3/28/2007	House	House Amendment No. 1 Fiscal Note Filed as Amended
4/17/2007	House	House Amendment No. 1 State Mandates Fiscal Note Filed as Amended
4/17/2007	House	Added Co-Sponsor Rep. Michael Tryon
4/24/2007	House	House Amendment No. 2 Filed with Clerk by Rep. Kathleen A. Ryg
4/24/2007	House	House Amendment No. 2 Referred to Rules Committee
4/24/2007	House	Fiscal Note Filed
4/24/2007	House	Added Co-Sponsor Rep. Aaron Schock
4/24/2007	House	House Amendment No. 1 Fiscal Note Filed as Amended
4/25/2007	House	House Amendment No. 2 Recommends Be Adopted Rules Committee; 005-000-000
4/25/2007	House	Added Chief Co-Sponsor Rep. Sidney H. Mathias
4/25/2007	House	Added Chief Co-Sponsor Rep. Jack McGuire
4/25/2007	House	Removed Co-Sponsor Rep. Jack McGuire
4/25/2007	House	Second Reading - Short Debate
4/25/2007	House	House Amendment No. 2 Adopted by Voice Vote
4/25/2007	House	Placed on Calendar Order of 3rd Reading - Short Debate
4/27/2007	House	Third Reading/Final Action Deadline Extended-9(b) May 3, 2007
5/1/2007	House	Third Reading - Short Debate - Passed 086-030-000
5/2/2007	Senate	Arrive in Senate
5/2/2007	Senate	Placed on Calendar Order of First Reading
5/2/2007	Senate	Chief Senate Sponsor Sen. Terry Link
5/2/2007	Senate	First Reading
5/2/2007	Senate	Referred to Rules
5/2/2007	Senate	Added as Alternate Chief Co-Sponsor Sen. Susan Garrett
5/3/2007	Senate	Added as Alternate Chief Co-Sponsor Sen. Don Harmon
5/3/2007	Senate	Added as Alternate Co-Sponsor Sen. William Delgado
5/8/2007	Senate	Added as Alternate Co-Sponsor Sen. Pamela J. Althoff
5/8/2007	House	Added Co-Sponsor Rep. Jack D. Franks
5/16/2007	House	Added Co-Sponsor Rep. Michael P. McAuliffe
5/16/2007	Senate	Added as Alternate Co-Sponsor Sen. Ira I. Silverstein
5/15/2008	Senate	Rule 2-10 Committee Deadline Established As May 22, 2008; Substantive House Bills Out of Committee
1/13/2009	House	Session Sine Die

	Fiscal Note, House Amendment No. 1 (Financial & Professional Regulation)
	There is no anticipated fiscal impact to the Department resulting from this legislation. However, this legislation may subject other State agencies to additional fiscal responsibilities.

	State Mandates Fiscal Note, House Amendment No. 1 (Dept. of Commerce & Economic Opportunity)
	In the opinion of the Department of Commerce and Economic Opportunity, HB 1560 (H-AM 1) creates a personnel mandate under the State Mandates Act.

	Fiscal Note (Dept. of Healthcare & Family Services)
	There will be additional costs to the benefit program upon passage. All non-prescription products are explicitly excluded from coverage by the State benefit plans, even when purchased with a written medical provider's order. However, since these are not covered services, utilization or historical data does not exist to project costs.

	Adds reference to:
	5 ILCS 375/6.11