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| Public Act 103-0059 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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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.
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(Source: P.A. 100-24, eff. 7-18-17; 100-863, eff. 8-14-18; | ||
101-488, eff. 8-23-19.)
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Section 99. Effective date. This Act takes effect upon | ||
becoming law. | ||