101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB0273

 

Introduced , by Rep. Kathleen Willis

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.2
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. In provisions concerning coverage for anesthetics provided in conjunction with dental care to an individual diagnosed with autism spectrum disorder, removes the requirement that the individual be under age 19. Amends the Illinois Public Aid Code. Provides that the medical assistance program shall include coverage for anesthetics provided in conjunction with dental care to an individual diagnosed with autism spectrum disorder.


LRB101 03955 SMS 48963 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB0273LRB101 03955 SMS 48963 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.2 as follows:
 
6    (215 ILCS 5/356z.2)
7    Sec. 356z.2. Coverage for adjunctive services in dental
8care.
9    (a) An individual or group policy of accident and health
10insurance amended, delivered, issued, or renewed after January
111, 2003 (the effective date of Public Act 92-764) shall cover
12charges incurred, and anesthetics provided, in conjunction
13with dental care that is provided to a covered individual in a
14hospital or an ambulatory surgical treatment center if any of
15the following applies:
16        (1) the individual is a child age 6 or under;
17        (2) the individual has a medical condition that
18    requires hospitalization or general anesthesia for dental
19    care; or
20        (3) the individual is a person with a disability.
21    (a-5) An individual or group policy of accident and health
22insurance amended, delivered, issued, or renewed after the
23effective date of this amendatory Act of the 101st General

 

 

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1Assembly January 1, 2016 (the effective date of Public Act
299-141) shall cover charges incurred, and anesthetics provided
3by a dentist with a permit provided under Section 8.1 of the
4Illinois Dental Practice Act, in conjunction with dental care
5that is provided to a covered individual in a dental office,
6oral surgeon's office, hospital, or ambulatory surgical
7treatment center if the individual is under age 19 and has been
8diagnosed with an autism spectrum disorder as defined in
9Section 10 of the Autism Spectrum Disorders Reporting Act or a
10developmental disability. A covered individual shall be
11required to make 2 visits to the dental care provider prior to
12accessing other coverage under this subsection.
13    For purposes of this subsection, "developmental
14disability" means a disability that is attributable to an
15intellectual disability or a related condition, if the related
16condition meets all of the following conditions:
17        (1) it is attributable to cerebral palsy, epilepsy, or
18    any other condition, other than mental illness, found to be
19    closely related to an intellectual disability because that
20    condition results in impairment of general intellectual
21    functioning or adaptive behavior similar to that of
22    individuals with an intellectual disability and requires
23    treatment or services similar to those required for those
24    individuals; for purposes of this definition, autism is
25    considered a related condition;
26        (2) it is manifested before the individual reaches age

 

 

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1    22;
2        (3) it is likely to continue indefinitely; and
3        (4) it results in substantial functional limitations
4    in 3 or more of the following areas of major life activity:
5    self-care, language, learning, mobility, self-direction,
6    and capacity for independent living.
7    (b) For purposes of this Section, "ambulatory surgical
8treatment center" has the meaning given to that term in Section
93 of the Ambulatory Surgical Treatment Center Act.
10    For purposes of this Section, "person with a disability"
11means a person, regardless of age, with a chronic disability if
12the chronic disability meets all of the following conditions:
13        (1) It is attributable to a mental or physical
14    impairment or combination of mental and physical
15    impairments.
16        (2) It is likely to continue.
17        (3) It results in substantial functional limitations
18    in one or more of the following areas of major life
19    activity:
20            (A) self-care;
21            (B) receptive and expressive language;
22            (C) learning;
23            (D) mobility;
24            (E) capacity for independent living; or
25            (F) economic self-sufficiency.
26    (c) The coverage required under this Section may be subject

 

 

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1to any limitations, exclusions, or cost-sharing provisions
2that apply generally under the insurance policy.
3    (d) This Section does not apply to a policy that covers
4only dental care.
5    (e) Nothing in this Section requires that the dental
6services be covered.
7    (f) The provisions of this Section do not apply to
8short-term travel, accident-only, limited, or specified
9disease policies, nor to policies or contracts designed for
10issuance to persons eligible for coverage under Title XVIII of
11the Social Security Act, known as Medicare, or any other
12similar coverage under State or federal governmental plans.
13(Source: P.A. 99-141, eff. 1-1-16; 99-143, eff. 7-27-15;
1499-642, eff. 7-28-16.)
 
15    Section 10. The Illinois Public Aid Code is amended by
16changing Section 5-16.8 as follows:
 
17    (305 ILCS 5/5-16.8)
18    Sec. 5-16.8. Required health benefits. The medical
19assistance program shall (i) provide the post-mastectomy care
20benefits required to be covered by a policy of accident and
21health insurance under Section 356t and the coverage required
22under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and
23356z.29, and 356z.32 and subsection (a-5) of Section 356z.2 of
24the Illinois Insurance Code and (ii) be subject to the

 

 

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1provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of the
2Illinois Insurance Code.
3    On and after July 1, 2012, the Department shall reduce any
4rate of reimbursement for services or other payments or alter
5any methodologies authorized by this Code to reduce any rate of
6reimbursement for services or other payments in accordance with
7Section 5-5e.
8    To ensure full access to the benefits set forth in this
9Section, on and after January 1, 2016, the Department shall
10ensure that provider and hospital reimbursement for
11post-mastectomy care benefits required under this Section are
12no lower than the Medicare reimbursement rate.
13(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
1499-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff.
158-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
1610-4-18.)