HB 2845

Abstract

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that a Medicaid managed care plan amended, delivered, issued, or renewed after the effective date of the amendatory Act must provide individuals under 21 years of age coverage for the diagnosis of autism spectrum disorders and for the treatment of autism spectrum disorders to the extent that the diagnosis and treatment of autism spectrum disorders are not already covered by the Medicaid managed care plan. Provides that the coverage provided for the treatment of autism spectrum disorders shall not be subject to any limits on the number of visits to a service provider, but shall be subject to copayment, deductible, and coinsurance provisions of a Medicaid managed care plan to the extent that other medical services covered by the Medicaid managed care plan are subject to these provisions. Provides that the provisions of the amendatory Act shall not be construed as limiting benefits that are otherwise available to an individual under a Medicaid managed care plan and benefits provided under the amendatory Act may not be subject to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable to the insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally. Requires a provider of treatment for autism spectrum disorders to furnish, upon request to the reimbursing managed care organization, medical records, clinical notes, or other necessary data that substantiate that initial or continued medical treatment is medically necessary and is resulting in improved clinical status. Defines terms. Makes other changes.