Illinois 2023-2024 Regular Session

Illinois House Bill HB3036 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3036 Introduced , by Rep. Will Guzzardi SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.18 Amends the Accident and Health Article of the Illinois Insurance Code. Provides that with respect to an enrollee at any age, in addition to coverage of a prosthetic or custom orthotic device, benefits shall be provided for a prosthetic or custom orthotic device determined by the enrollee's provider to be the most appropriate model that is medically necessary for the enrollee to perform physical activities, as applicable, such as running, biking, swimming, and lifting weights, and to maximize the enrollee's whole body health and strengthen the lower and upper limb function. Provides that the requirements of the provisions do not constitute an addition to the State's essential health benefits that requires defrayal of costs by the State pursuant to specified federal law. LRB103 28477 BMS 54858 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3036 Introduced , by Rep. Will Guzzardi SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.18 215 ILCS 5/356z.18 Amends the Accident and Health Article of the Illinois Insurance Code. Provides that with respect to an enrollee at any age, in addition to coverage of a prosthetic or custom orthotic device, benefits shall be provided for a prosthetic or custom orthotic device determined by the enrollee's provider to be the most appropriate model that is medically necessary for the enrollee to perform physical activities, as applicable, such as running, biking, swimming, and lifting weights, and to maximize the enrollee's whole body health and strengthen the lower and upper limb function. Provides that the requirements of the provisions do not constitute an addition to the State's essential health benefits that requires defrayal of costs by the State pursuant to specified federal law. LRB103 28477 BMS 54858 b LRB103 28477 BMS 54858 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3036 Introduced , by Rep. Will Guzzardi SYNOPSIS AS INTRODUCED:
3	3	215 ILCS 5/356z.18 215 ILCS 5/356z.18
4	4	215 ILCS 5/356z.18
5	5	Amends the Accident and Health Article of the Illinois Insurance Code. Provides that with respect to an enrollee at any age, in addition to coverage of a prosthetic or custom orthotic device, benefits shall be provided for a prosthetic or custom orthotic device determined by the enrollee's provider to be the most appropriate model that is medically necessary for the enrollee to perform physical activities, as applicable, such as running, biking, swimming, and lifting weights, and to maximize the enrollee's whole body health and strengthen the lower and upper limb function. Provides that the requirements of the provisions do not constitute an addition to the State's essential health benefits that requires defrayal of costs by the State pursuant to specified federal law.
6	6	LRB103 28477 BMS 54858 b LRB103 28477 BMS 54858 b
7	7	LRB103 28477 BMS 54858 b
8	8	A BILL FOR
9	9	HB3036LRB103 28477 BMS 54858 b HB3036 LRB103 28477 BMS 54858 b
10	10	HB3036 LRB103 28477 BMS 54858 b
11	11	1 AN ACT concerning regulation.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The Illinois Insurance Code is amended by
15	15	5 changing Section 356z.18 as follows:
16	16	6 (215 ILCS 5/356z.18)
17	17	7 Sec. 356z.18. Prosthetic and customized orthotic devices.
18	18	8 (a) For the purposes of this Section:
19	19	9 "Customized orthotic device" means a supportive device for
20	20	10 the body or a part of the body, the head, neck, or extremities,
21	21	11 and includes the replacement or repair of the device based on
22	22	12 the patient's physical condition as medically necessary,
23	23	13 excluding foot orthotics defined as an in-shoe device designed
24	24	14 to support the structural components of the foot during
25	25	15 weight-bearing activities.
26	26	16 "Licensed provider" means a prosthetist, orthotist, or
27	27	17 pedorthist licensed to practice in this State.
28	28	18 "Prosthetic device" means an artificial device to replace,
29	29	19 in whole or in part, an arm or leg and includes accessories
30	30	20 essential to the effective use of the device and the
31	31	21 replacement or repair of the device based on the patient's
32	32	22 physical condition as medically necessary.
33	33	23 (b) This amendatory Act of the 96th General Assembly shall
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37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3036 Introduced , by Rep. Will Guzzardi SYNOPSIS AS INTRODUCED:
38	38	215 ILCS 5/356z.18 215 ILCS 5/356z.18
39	39	215 ILCS 5/356z.18
40	40	Amends the Accident and Health Article of the Illinois Insurance Code. Provides that with respect to an enrollee at any age, in addition to coverage of a prosthetic or custom orthotic device, benefits shall be provided for a prosthetic or custom orthotic device determined by the enrollee's provider to be the most appropriate model that is medically necessary for the enrollee to perform physical activities, as applicable, such as running, biking, swimming, and lifting weights, and to maximize the enrollee's whole body health and strengthen the lower and upper limb function. Provides that the requirements of the provisions do not constitute an addition to the State's essential health benefits that requires defrayal of costs by the State pursuant to specified federal law.
41	41	LRB103 28477 BMS 54858 b LRB103 28477 BMS 54858 b
42	42	LRB103 28477 BMS 54858 b
43	43	A BILL FOR
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49	49	215 ILCS 5/356z.18
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67	67	HB3036 - 2 - LRB103 28477 BMS 54858 b
68	68	1 provide benefits to any person covered thereunder for expenses
69	69	2 incurred in obtaining a prosthetic or custom orthotic device
70	70	3 from any Illinois licensed prosthetist, licensed orthotist, or
71	71	4 licensed pedorthist as required under the Orthotics,
72	72	5 Prosthetics, and Pedorthics Practice Act.
73	73	6 (c) A group or individual major medical policy of accident
74	74	7 or health insurance or managed care plan or medical, health,
75	75	8 or hospital service corporation contract that provides
76	76	9 coverage for prosthetic or custom orthotic care and is
77	77	10 amended, delivered, issued, or renewed 6 months after the
78	78	11 effective date of this amendatory Act of the 96th General
79	79	12 Assembly must provide coverage for prosthetic and orthotic
80	80	13 devices in accordance with this subsection (c). The coverage
81	81	14 required under this Section shall be subject to the other
82	82	15 general exclusions, limitations, and financial requirements of
83	83	16 the policy, including coordination of benefits, participating
84	84	17 provider requirements, utilization review of health care
85	85	18 services, including review of medical necessity, case
86	86	19 management, and experimental and investigational treatments,
87	87	20 and other managed care provisions under terms and conditions
88	88	21 that are no less favorable than the terms and conditions that
89	89	22 apply to substantially all medical and surgical benefits
90	90	23 provided under the plan or coverage.
91	91	24 (d) With respect to an enrollee at any age, in addition to
92	92	25 coverage of a prosthetic or custom orthotic device required by
93	93	26 this Section, benefits shall be provided for a prosthetic or
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104	104	1 custom orthotic device determined by the enrollee's provider
105	105	2 to be the most appropriate model that is medically necessary
106	106	3 for the enrollee to perform physical activities, as
107	107	4 applicable, such as running, biking, swimming, and lifting
108	108	5 weights, and to maximize the enrollee's whole body health and
109	109	6 strengthen the lower and upper limb function.
110	110	7 (e) The requirements of this Section do not constitute an
111	111	8 addition to this State's essential health benefits that
112	112	9 requires defrayal of costs by this State pursuant to 42 U.S.C.
113	113	10 18031(d)(3)(B).
114	114	11 (f) (d) The policy or plan or contract may require prior
115	115	12 authorization for the prosthetic or orthotic devices in the
116	116	13 same manner that prior authorization is required for any other
117	117	14 covered benefit.
118	118	15 (g) (e) Repairs and replacements of prosthetic and
119	119	16 orthotic devices are also covered, subject to the co-payments
120	120	17 and deductibles, unless necessitated by misuse or loss.
121	121	18 (h) (f) A policy or plan or contract may require that, if
122	122	19 coverage is provided through a managed care plan, the benefits
123	123	20 mandated pursuant to this Section shall be covered benefits
124	124	21 only if the prosthetic or orthotic devices are provided by a
125	125	22 licensed provider employed by a provider service who contracts
126	126	23 with or is designated by the carrier, to the extent that the
127	127	24 carrier provides in-network and out-of-network service, the
128	128	25 coverage for the prosthetic or orthotic device shall be
129	129	26 offered no less extensively.
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140	140	1 (i) (g) The policy or plan or contract shall also meet
141	141	2 adequacy requirements as established by the Health Care
142	142	3 Reimbursement Reform Act of 1985 of the Illinois Insurance
143	143	4 Code.
144	144	5 (j) (h) This Section shall not apply to accident only,
145	145	6 specified disease, short-term hospital or medical, hospital
146	146	7 confinement indemnity, credit, dental, vision, Medicare
147	147	8 supplement, long-term care, basic hospital and
148	148	9 medical-surgical expense coverage, disability income insurance
149	149	10 coverage, coverage issued as a supplement to liability
150	150	11 insurance, workers' compensation insurance, or automobile
151	151	12 medical payment insurance.
152	152	13 (Source: P.A. 96-833, eff. 6-1-10.)
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