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91_HB3262
LRB9112138JSpc
1 AN ACT to amend the Health Maintenance Organization Act
2 by adding Section 4-6.6.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Health Maintenance Organization Act is
6 amended by adding Section 4-6.6 as follows:
7 (215 ILCS 125/4-6.6 new)
8 Sec 4-6.6. Surgical procedures of jaw and facial region.
9 A contract or other evidence of coverage that provides
10 coverage for any diagnostic or surgical procedure involving
11 bones or joints of the skeleton and that is amended,
12 delivered, issued, or renewed after the effective date of
13 this amendatory Act of the 91st General Assembly shall not
14 discriminate against coverage or reimbursement for any
15 similar diagnostic or surgical procedure involving bones or
16 joints of the jaw and facial region if, under accepted
17 medical standards, the procedure or surgery is medically
18 necessary to treat conditions caused by congenital or
19 developmental deformity, disease, or injury. A health
20 maintenance organization shall demonstrate that enrollees
21 have access to specialized treatment expertise when the
22 treatment is medically or clinically indicated in the
23 professional judgement of the treating health professional,
24 in consultation with the enrollee.
25 Section 99. Effective date. This Act takes effect upon
26 becoming law.