Illinois 2023-2024 Regular Session

Illinois House Bill HB3229 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 HB3229 Introduced , by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.61 new Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section. LRB103 29512 BMS 55907 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3229 Introduced , by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.61 new 215 ILCS 5/356z.61 new Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section. LRB103 29512 BMS 55907 b LRB103 29512 BMS 55907 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3229 Introduced , by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED:
3	3	215 ILCS 5/356z.61 new 215 ILCS 5/356z.61 new
4	4	215 ILCS 5/356z.61 new
5	5	Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section.
6	6	LRB103 29512 BMS 55907 b LRB103 29512 BMS 55907 b
7	7	LRB103 29512 BMS 55907 b
8	8	A BILL FOR
9	9	HB3229LRB103 29512 BMS 55907 b HB3229 LRB103 29512 BMS 55907 b
10	10	HB3229 LRB103 29512 BMS 55907 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 adding Section 356z.61 as follows:
16	16	6 (215 ILCS 5/356z.61 new)
17	17	7 Sec. 356z.61. Genetic, rare, and unique conditions;
18	18	8 medically necessary treatment.
19	19	9 (a) An insurance policy amended, delivered, issued, or
20	20	10 renewed in this State on or after the effective date of this
21	21	11 amendatory Act of the 103rd General Assembly shall provide
22	22	12 coverage for medically necessary treatments for genetic, rare,
23	23	13 unknown or unnamed, and unique conditions, including
24	24	14 Ehlers-Danlos syndrome and altered drug metabolism.
25	25	15 (b) For an insurance policy that provides coverage for
26	26	16 prescription drugs, the coverage required under subsection (a)
27	27	17 shall include coverage for opioid alternatives, coverage for
28	28	18 medicines included in the most recent Model List of Essential
29	29	19 Medicines published by the World Health Organization, and
30	30	20 coverage for custom-made medications and medical food.
31	31	21 (c) An insurance policy that limits the quantity of a
32	32	22 medication in accordance with applicable State and federal law
33	33	23 shall not require pre-approval for the treatment of patients
34	34
35	35
36	36
37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3229 Introduced , by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED:
38	38	215 ILCS 5/356z.61 new 215 ILCS 5/356z.61 new
39	39	215 ILCS 5/356z.61 new
40	40	Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section.
41	41	LRB103 29512 BMS 55907 b LRB103 29512 BMS 55907 b
42	42	LRB103 29512 BMS 55907 b
43	43	A BILL FOR
44	44
45	45
46	46
47	47
48	48
49	49	215 ILCS 5/356z.61 new
50	50
51	51
52	52
53	53	LRB103 29512 BMS 55907 b
54	54
55	55
56	56
57	57
58	58
59	59
60	60
61	61
62	62
63	63	HB3229 LRB103 29512 BMS 55907 b
64	64
65	65
66	66	HB3229- 2 -LRB103 29512 BMS 55907 b HB3229 - 2 - LRB103 29512 BMS 55907 b
67	67	HB3229 - 2 - LRB103 29512 BMS 55907 b
68	68	1 with rare metabolism conditions that may need a higher dose of
69	69	2 medication than what is otherwise allowed within a time frame
70	70	3 or prescription schedule.
71	71	4 (d) The burden of proving that treatment is medically
72	72	5 necessary shall not lie with the insured in cases of
73	73	6 rejections for filing claims, preauthorization requests, and
74	74	7 appeals related to coverage required under this Section.
75	75
76	76
77	77
78	78
79	79
80	80	HB3229 - 2 - LRB103 29512 BMS 55907 b