HB3899 103RD GENERAL ASSEMBLY

LRB103 29521 KTG 55916 b

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.

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by changing Section 5-30.11 as follows:

(305 ILCS 5/5-30.11)

Sec. 5-30.11. Treatment of autism spectrum disorder. Treatment of autism spectrum disorder through applied behavior analysis shall be covered under the medical assistance program under this Article for children with a diagnosis of autism spectrum disorder in the following instances: (1) when ordered by: (1) a physician licensed to practice medicine in all its branches and rendered by a licensed or certified health care professional with expertise in applied behavior analysis; or (2) when evaluated and treated by a behavior analyst licensed by the Department of Financial and Professional Regulation to practice applied behavior analysis in this State; or (3) 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. Treatment covered under this Section shall include, but not be limited to, the following:

(1) Psychiatric care, meaning direct, consultative, or diagnostic services provided by a licensed psychiatrist.

(2) Psychological care, meaning direct or consultative services provided by a licensed psychologist.

(3) Habilitative or rehabilitative care, meaning professional, counseling, and guidance services and treatment programs, including applied behavior analysis, that are intended to develop, maintain, and restore the functioning of an individual. As used in this subsection, "applied behavior analysis" means the design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relations between environment and behavior. Applied behavior analysis shall be covered if provided by a Board Certified Behavior Analyst who possesses at least a master's degree or higher level of education in qualifying fields and possesses certification from the Behavior Analyst Certification Board. Applied behavior analysis can also be provided and shall be covered when provided by a Registered Behavior Technician who is certified and in direct supervision of a Board Certified Behavior Analyst.

(4) Therapeutic care, including behavioral, speech, occupational, and physical therapies that provide treatment in the following areas: (i) self care and feeding; (ii) pragmatic, receptive, and expressive language; (iii) cognitive functioning; (iv) applied behavior analysis, intervention, and modification; (v) motor planning; and (vi) sensory processing.

. Such coverage may be limited to age ranges based on evidence-based best practices. Appropriate State plan amendments as well as rules regarding provision of services and providers will be submitted by September 1, 2019.

(Source: P.A. 101-10, eff. 6-5-19; 102-558, eff. 8-20-21; 102-953, eff. 5-27-22.)

Section 99. Effective date. This Act takes effect July 1, 2023.