Illinois General Assembly - Bill Status for HB1560

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.

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