103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB3899

 

Introduced 2/17/2023, by Rep. Nabeela Syed

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-30.11

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the treatment of autism spectrum disorder through applied behavior analysis shall be covered under the medical assistance program for children with a diagnosis of autism spectrum disorder when ordered by a certified, registered, or licensed health care professional with expertise in treating the effects of autism spectrum disorders when the care is determined to be medically necessary and ordered by a physician licensed to practice medicine in all its branches. Provides that certain treatment shall be covered, including, but not limited to, psychiatric, psychological, rehabilitative, and therapeutic care. Effective July 1, 2023.


LRB103 29521 KTG 55916 b

 

 

A BILL FOR

 

HB3899LRB103 29521 KTG 55916 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-30.11 as follows:
 
6    (305 ILCS 5/5-30.11)
7    Sec. 5-30.11. Treatment of autism spectrum disorder.
8Treatment of autism spectrum disorder through applied behavior
9analysis shall be covered under the medical assistance program
10under this Article for children with a diagnosis of autism
11spectrum disorder in the following instances: (1) when ordered
12by: (1) a physician licensed to practice medicine in all its
13branches and rendered by a licensed or certified health care
14professional with expertise in applied behavior analysis; or
15(2) when evaluated and treated by a behavior analyst licensed
16by the Department of Financial and Professional Regulation to
17practice applied behavior analysis in this State; or (3) when
18ordered by a certified, registered, or licensed health care
19professional with expertise in treating the effects of autism
20spectrum disorders when the care is determined to be medically
21necessary and ordered by a physician licensed to practice
22medicine in all its branches. Treatment covered under this
23Section shall include, but not be limited to, the following:

 

 

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1        (1) Psychiatric care, meaning direct, consultative, or
2    diagnostic services provided by a licensed psychiatrist.
3        (2) Psychological care, meaning direct or consultative
4    services provided by a licensed psychologist.
5        (3) Habilitative or rehabilitative care, meaning
6    professional, counseling, and guidance services and
7    treatment programs, including applied behavior analysis,
8    that are intended to develop, maintain, and restore the
9    functioning of an individual. As used in this subsection,
10    "applied behavior analysis" means the design,
11    implementation, and evaluation of environmental
12    modifications using behavioral stimuli and consequences to
13    produce socially significant improvement in human
14    behavior, including the use of direct observation,
15    measurement, and functional analysis of the relations
16    between environment and behavior. Applied behavior
17    analysis shall be covered if provided by a Board Certified
18    Behavior Analyst who possesses at least a master's degree
19    or higher level of education in qualifying fields and
20    possesses certification from the Behavior Analyst
21    Certification Board. Applied behavior analysis can also be
22    provided and shall be covered when provided by a
23    Registered Behavior Technician who is certified and in
24    direct supervision of a Board Certified Behavior Analyst.
25        (4) Therapeutic care, including behavioral, speech,
26    occupational, and physical therapies that provide

 

 

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1    treatment in the following areas: (i) self care and
2    feeding; (ii) pragmatic, receptive, and expressive
3    language; (iii) cognitive functioning; (iv) applied
4    behavior analysis, intervention, and modification; (v)
5    motor planning; and (vi) sensory processing.
6. Such coverage may be limited to age ranges based on
7evidence-based best practices. Appropriate State plan
8amendments as well as rules regarding provision of services
9and providers will be submitted by September 1, 2019.
10(Source: P.A. 101-10, eff. 6-5-19; 102-558, eff. 8-20-21;
11102-953, eff. 5-27-22.)
 
12    Section 99. Effective date. This Act takes effect July 1,
132023.