Synopsis As Introduced 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, and the Voluntary Health Services Plans Act to provide coverage for habilitative services, including, but not limited to occupational therapy, physical therapy, and speech therapy for children under the age of 19 with congenital or genetic defects existing at or from birth or with a defect acquired at a young age. Amends the State Mandates Act to require implementation without reimbursement.
House Committee Amendment No. 1 Provides that there is no rulemaking authority under the amendatory Act, but that the Governor may suggest rules by filing them with the General Assembly and requesting that the General Assembly authorize such rulemaking by law, enact the suggested rules into law, or take other appropriate action in the General Assembly's discretion.
House Floor Amendment No. 2 Replaces everything after the enacting clause with the bill as amended by House Amendment No. 1 with the following changes: provides for coverage for habilitative services for children under 19 years of age with a congenital, genetic, or early acquired disorder (was congenital or genetic defect existing at or from birth or a defect acquired at a young age); provides conditions for the coverage; makes changes in the definition of "habilitative services"; sets forth general exclusions and limitations of the coverage; and provides that upon request of the reimbursing insurer, the provider under whose supervision the habilitative services are being provided shall furnish medical records, clinical notes, or other necessary data to allow the insurer to substantiate that initial or continued medical treatment is medically necessary and that the patient's condition is clinically improving.
Deletes everything after the enacting clause. Reinserts the contents of the bill as engrossed with the following changes. In the Section concerning habilitative services for children in the Illinois Insurance Code, (i) makes changes to the conditions that are necessary in order for a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed in this State to be required to provide coverage for habilitative services for children under 19 years of age with a congenital, genetic, or early acquired disorder and (ii) adds provisions concerning applicability and appeals and external review. Provides that provisions concerning mental and emotional disorders shall not be interpreted to require coverage for speech therapy or other habilitative services for those individuals covered under the provisions of the Illinois Insurance Code concerning the policies for habilitative services for children. Deletes the provision concerning rulemaking authority.