Illinois General Assembly - Bill Status for HB2652

Amends the Illinois Insurance Code, Health Maintenance Organization Act, and Voluntary Health Services Plans Act to provide coverage for prosthetic and customized orthotic devices that are no less favorable than the terms and conditions applicable to substantially all medical and surgical benefits provided under the plan or coverage. Provides that a policy or plan may require prior authorization. Provides that repairs and replacements of prosthetic and orthotic devices are also covered. Provides that a policy or plan may require that, if coverage is provided through a managed care plan, the benefits mandated pursuant to the Act shall be covered only if the prosthetic or orthotic devices are provided by a licensed provider employed by a provider service who contracts with or is designated by the carrier. Sets forth provisions concerning (i) patient access and (ii) in-network and out of network standards. Makes other changes. Contains a nonacceleration clause. Effective immediately.

Provides that the provisions shall apply to a policy, plan, or contract that provides coverage for prosthetic or custom orthotic care. Provides that covered benefits are limited to what is determined to be medically necessary (instead of the most appropriate model that adequately meets the medical needs of the patient as determined by the insured's treating physician). Deletes a provision requiring a minimum rate of reimbursement and coverage for prosthetic or orthotic devices as under the Illinois State Medicaid reimbursement schedule. Deletes the provisions concerning patient access. Provides instead that a policy or plan or contract shall also meet adequacy requirements as established by the Health Care Reimbursement Reform Act of 1985 of the Illinois Insurance Code.

Replaces everything after the enacting clause. Amends the Illinois Insurance Code, Health Maintenance Organization Act, and Voluntary Health Services Plans Act to provide that a group or individual major medical policy of accident or health insurance or managed care plan or medical, health, or hospital service corporation contract that provides coverage for prosthetic or custom orthotic care and is amended, delivered, issued, or renewed 6 months after the effective date of the amendatory Act must provide coverage for prosthetic and orthotic devices in accordance with specified provisions. Provides that the required coverage shall be subject to the other general exclusions, limitations, and financial requirements of the policy, including coordination of benefits, participating provider requirements, utilization review of health care services, including review of medical necessity, case management, and experimental and investigational treatments, and other managed care provisions under terms and conditions that are no less favorable than the terms and conditions that apply to substantially all medical and surgical benefits provided under the plan or coverage. Provides that repairs and replacements of prosthetic and orthotic devices are also covered. Provides that a policy or plan may require that, if coverage is provided through a managed care plan, the benefits mandated pursuant to the Act shall be covered only if the prosthetic or orthotic devices are provided by a licensed provider employed by a provider service who contracts with or is designated by the carrier. Makes revisory changes. Makes other changes.

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