102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB2930

 

Introduced 2/19/2021, by Rep. Deanne M. Mazzochi

 

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

    Amends the Illinois Insurance Code. In provisions concerning coverage for treatment of pediatric autoimmune neuropsychiatric disorders, provides that on and after the effective date of the amendatory Act, an insured shall have a cause of action for liquidated damages in the amount of $1,000 or actual damages, whichever is greater, against any entity issuing a group or individual policy of accident and health insurance or managed care plan that fails to provide the coverage required for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.


LRB102 15254 BMS 20609 b

 

 

A BILL FOR

 

HB2930LRB102 15254 BMS 20609 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    For billing and diagnosis purposes, pediatric autoimmune
20neuropsychiatric disorders associated with streptococcal
21infections and pediatric acute onset neuropsychiatric syndrome
22shall be coded as autoimmune encephalitis until the American
23Medical Association and the Centers for Medicare and Medicaid

 

 

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1Services create and assign a specific code for pediatric
2autoimmune neuropsychiatric disorders associated with
3streptococcal infections and pediatric acute onset
4neuropsychiatric syndrome. Thereafter, pediatric autoimmune
5neuropsychiatric disorders associated with streptococcal
6infections and pediatric acute onset neuropsychiatric syndrome
7may be coded as autoimmune encephalitis, pediatric autoimmune
8neuropsychiatric disorders associated with streptococcal
9infections, or pediatric acute onset neuropsychiatric
10syndrome.
11    If, at any time, the Secretary of the United States
12Department of Health and Human Services, or its successor
13agency, promulgates rules or regulations to be published in
14the Federal Register or publishes a comment in the Federal
15Register or issues an opinion, guidance, or other action that
16would require the State, pursuant to any provision of the
17Patient Protection and Affordable Care Act (Public Law
18111-148), including, but not limited to, 42 U.S.C.
1918031(d)(3)(B) or any successor provision, to defray the cost
20of any coverage for pediatric autoimmune neuropsychiatric
21disorders associated with streptococcal infections and
22pediatric acute onset neuropsychiatric syndrome outlined in
23this Section, then the requirement that an insurer cover
24pediatric autoimmune neuropsychiatric disorders associated
25with streptococcal infections and pediatric acute onset
26neuropsychiatric syndrome is inoperative other than any such

 

 

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1coverage authorized under Section 1902 of the Social Security
2Act, 42 U.S.C. 1396a, and the State shall not assume any
3obligation for the cost of coverage for pediatric autoimmune
4neuropsychiatric disorders associated with streptococcal
5infections and pediatric acute onset neuropsychiatric
6syndrome.
7    On and after the effective date of this amendatory Act of
8the 102nd General Assembly, an insured shall have a cause of
9action for liquidated damages in the amount of $1,000 or
10actual damages, whichever is greater, against any entity
11issuing a group or individual policy of accident and health
12insurance or managed care plan that fails to provide the
13coverage required under this Section.
14(Source: P.A. 100-24, eff. 7-18-17; 100-863, eff. 8-14-18;
15101-488, eff. 8-23-19.)