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Public Act 103-0059


 

Public Act 0059 103RD GENERAL ASSEMBLY

  
  
  

 


 
Public Act 103-0059
 
SB0101 EnrolledLRB103 25077 BMS 51412 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Insurance Code is amended by
changing Section 356z.25 as follows:
 
    (215 ILCS 5/356z.25)
    Sec. 356z.25. Coverage for treatment of pediatric
autoimmune neuropsychiatric disorders associated with
streptococcal infections and pediatric acute onset
neuropsychiatric syndrome. A group or individual policy of
accident and health insurance or managed care plan that is
amended, delivered, issued, or renewed after July 18, 2017
(the effective date of Public Act 100-24) shall provide
coverage for treatment of pediatric autoimmune
neuropsychiatric disorders associated with streptococcal
infections and pediatric acute-onset neuropsychiatric
syndrome, including, but not limited to, the use of
intravenous immunoglobulin therapy.
    No group or individual policy of accident and health
insurance or managed care plan shall deny or delay coverage
for medically necessary treatment under this Section solely
because the insured, enrollee, or beneficiary previously
received any treatment, including the same or similar
treatment, for pediatric autoimmune neuropsychiatric disorders
associated with streptococcal infections or pediatric acute
onset neuropsychiatric syndrome, or because the insured,
enrollee, or beneficiary has been diagnosed with or receives
treatment for an otherwise diagnosed condition.
    For the purposes of this Section, coverage of pediatric
autoimmune neuropsychiatric disorders associated with
streptococcal infections and pediatric acute onset
neuropsychiatric syndrome shall adhere to the treatment
recommendations developed by a medical professional consortium
convened for the purposes of researching, identifying, and
publishing best practice standards for diagnosis and treatment
of such disorders or syndrome that are accessible for medical
professionals and are based on evidence of positive patient
outcomes. Coverage for any form of medically necessary
treatment shall not be limited over a lifetime of an insured,
enrollee, or beneficiary, unless the patient is no longer
benefiting from the treatment, or by policy period. Nothing in
this Section prevents insurers from requesting treatment notes
and anticipated duration of treatment and outcomes.
    For billing and diagnosis purposes, pediatric autoimmune
neuropsychiatric disorders associated with streptococcal
infections and pediatric acute onset neuropsychiatric syndrome
shall be coded as autoimmune encephalitis until the American
Medical Association and the Centers for Medicare and Medicaid
Services create and assign a specific code for pediatric
autoimmune neuropsychiatric disorders associated with
streptococcal infections and pediatric acute onset
neuropsychiatric syndrome. Thereafter, pediatric autoimmune
neuropsychiatric disorders associated with streptococcal
infections and pediatric acute onset neuropsychiatric syndrome
may be coded as autoimmune encephalitis, pediatric autoimmune
neuropsychiatric disorders associated with streptococcal
infections, or pediatric acute onset neuropsychiatric
syndrome.
    If, at any time, the Secretary of the United States
Department of Health and Human Services, or its successor
agency, promulgates rules or regulations to be published in
the Federal Register or publishes a comment in the Federal
Register or issues an opinion, guidance, or other action that
would require the State, pursuant to any provision of the
Patient Protection and Affordable Care Act (Public Law
111-148), including, but not limited to, 42 U.S.C.
18031(d)(3)(B) or any successor provision, to defray the cost
of any coverage for pediatric autoimmune neuropsychiatric
disorders associated with streptococcal infections and
pediatric acute onset neuropsychiatric syndrome outlined in
this Section, then the requirement that an insurer cover
pediatric autoimmune neuropsychiatric disorders associated
with streptococcal infections and pediatric acute onset
neuropsychiatric syndrome is inoperative other than any such
coverage authorized under Section 1902 of the Social Security
Act, 42 U.S.C. 1396a, and the State shall not assume any
obligation for the cost of coverage for pediatric autoimmune
neuropsychiatric disorders associated with streptococcal
infections and pediatric acute onset neuropsychiatric
syndrome.
(Source: P.A. 100-24, eff. 7-18-17; 100-863, eff. 8-14-18;
101-488, eff. 8-23-19.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 6/9/2023