SB0193eng 100TH GENERAL ASSEMBLY

SB0193 Engrossed LRB100 05979 SMS 16007 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.8 as follows:

(215 ILCS 5/356z.8)

Sec. 356z.8. Multiple sclerosis preventative physical therapy. A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 100th General Assembly this amendatory Act of the 94th General Assembly must provide coverage for medically necessary preventative physical therapy for insureds diagnosed with multiple sclerosis. For the purposes of this Section, "preventative physical therapy" means physical therapy that is prescribed by a physician licensed to practice medicine in all of its branches for the purpose of treating parts of the body affected by multiple sclerosis, but only where the physical therapy includes reasonably defined goals, including, but not limited to, sustaining the level of function the person has achieved, with periodic evaluation of the efficacy of the physical therapy against those goals. The coverage required under this Section shall be subject to the same deductible and , coinsurance requirements or other limitations , waiting period, cost sharing limitation, treatment limitation, calendar year maximum, or other limitations as provided for other physical or rehabilitative therapy benefits covered by the policy.

A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 100th General Assembly shall offer an exception process from treatment limitations for individuals diagnosed with primary or secondary progressive multiple sclerosis. The exception process must be posted on the insurer's website in an easily-accessible location. An exception request must document medical necessity for extended treatment that is reasonable and appropriate to the individual's defined goals included in his or her treatment plan. A health insurer shall, within 72 hours after receiving the exception request, either approve or deny the request.

The coverage required by this Section shall be subject to other general exclusions and limitations of the policy, including coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, utilization review of health care services, including review of medical necessity, case management, experimental or investigational treatments, and other managed care provisions.

(Source: P.A. 94-1076, eff. 12-29-06.)