INS CD-ORTHOTIC COVERAGE House SponsorsRep. Kevin Joyce-Jim Durkin-LaShawn K. Ford-Lou Lang-William D. Burns and Monique D. Davis Senate Sponsors(Sen. Antonio Muņoz) 12/14/2009HousePublic Act . . . . . . . . . 96-0833 215 ILCS 5/356z.15 new215 ILCS 125/5-3from Ch. 111 1/2, par. 1411.2215 ILCS 165/10from Ch. 32, par. 604 Amends the Illinois Insurance Code, Health Maintenance Organization Act, and Voluntary Health Services Plans Act to provide coverage for prosthetic and customized orthotic devices that are no less favorable than the terms and conditions applicable to substantially all medical and surgical benefits provided under the plan or coverage. Provides that a policy or plan may require prior authorization. Provides that repairs and replacements of prosthetic and orthotic devices are also covered. Provides that a policy or plan may require that, if coverage is provided through a managed care plan, the benefits mandated pursuant to the Act shall be covered only if the prosthetic or orthotic devices are provided by a licensed provider employed by a provider service who contracts with or is designated by the carrier. Sets forth provisions concerning (i) patient access and (ii) in-network and out of network standards. Makes other changes. Contains a nonacceleration clause. Effective immediately.Fiscal Note (Financial & Professional Regulation) HB 2652 has no projected fiscal impact to the Illinois Department of Financial and Professional Regulation.Senate Committee Amendment No. 1 Deletes reference to:215 ILCS 5/356z.15 newAdds reference to:215 ILCS 5/356z.16 newProvides that the provisions shall apply to a policy, plan, or contract that provides coverage for prosthetic or custom orthotic care. Provides that covered benefits are limited to what is determined to be medically necessary (instead of the most appropriate model that adequately meets the medical needs of the patient as determined by the insured's treating physician). Deletes a provision requiring a minimum rate of reimbursement and coverage for prosthetic or orthotic devices as under the Illinois State Medicaid reimbursement schedule. Deletes the provisions concerning patient access. Provides instead that a policy or plan or contract shall also meet adequacy requirements as established by the Health Care Reimbursement Reform Act of 1985 of the Illinois Insurance Code.Senate Floor Amendment No. 4 Deletes reference to:215 ILCS 5/356z.15 newAdds reference to:215 ILCS 5/356z.15215 ILCS 5/356z.17215 ILCS 5/356z.18 new215 ILCS 125/5-3from Ch. 111 1/2, par. 1411.2215 ILCS 165/10from Ch. 32, par. 604Replaces everything after the enacting clause. Amends the Illinois Insurance Code, Health Maintenance Organization Act, and Voluntary Health Services Plans Act to provide that a group or individual major medical policy of accident or health insurance or managed care plan or medical, health, or hospital service corporation contract that provides coverage for prosthetic or custom orthotic care and is amended, delivered, issued, or renewed 6 months after the effective date of the amendatory Act must provide coverage for prosthetic and orthotic devices in accordance with specified provisions. Provides that the required coverage shall be subject to the other general exclusions, limitations, and financial requirements of the policy, including coordination of benefits, participating provider requirements, utilization review of health care services, including review of medical necessity, case management, and experimental and investigational treatments, and other managed care provisions under terms and conditions that are no less favorable than the terms and conditions that apply to substantially all medical and surgical benefits provided under the plan or coverage. Provides that repairs and replacements of prosthetic and orthotic devices are also covered. Provides that a policy or plan may require that, if coverage is provided through a managed care plan, the benefits mandated pursuant to the Act shall be covered only if the prosthetic or orthotic devices are provided by a licensed provider employed by a provider service who contracts with or is designated by the carrier. Makes revisory changes. Makes other changes. 2/20/2009HouseFiled with the Clerk by Rep. Kevin Joyce 2/20/2009HouseFirst Reading 2/20/2009HouseReferred to Rules Committee 2/25/2009HouseAssigned to Insurance Committee 3/3/2009HouseAdded Chief Co-Sponsor Rep. Jim Durkin 3/4/2009HouseAdded Chief Co-Sponsor Rep. LaShawn K. Ford 3/6/2009HouseAdded Chief Co-Sponsor Rep. Lou Lang 3/10/2009HouseDo Pass / Short Debate Insurance Committee; 023-000-000 3/11/2009HousePlaced on Calendar 2nd Reading - Short Debate 3/13/2009HouseAdded Co-Sponsor Rep. Monique D. Davis 3/25/2009HouseFiscal Note Filed 4/1/2009HouseSecond Reading - Short Debate 4/1/2009HouseHeld on Calendar Order of Second Reading - Short Debate 4/2/2009HousePlaced on Calendar Order of 3rd Reading - Short Debate 4/2/2009HouseThird Reading - Short Debate - Passed 106-011-000 4/15/2009SenateArrive in Senate 4/15/2009SenatePlaced on Calendar Order of First Reading 4/15/2009SenateChief Senate Sponsor Sen. Antonio Muņoz 4/15/2009SenateFirst Reading 4/15/2009SenateReferred to Assignments 4/22/2009SenateAssigned to Insurance 4/30/2009SenatePostponed - Insurance 5/5/2009SenateSenate Committee Amendment No. 1 Filed with Secretary by Sen. Antonio Muņoz 5/5/2009SenateSenate Committee Amendment No. 1 Referred to Assignments 5/5/2009SenateSenate Committee Amendment No. 1 Assignments Refers to Insurance 5/6/2009SenateSenate Committee Amendment No. 1 Adopted 5/7/2009SenateDo Pass as Amended Insurance; 011-000-000 5/7/2009SenatePlaced on Calendar Order of 2nd Reading May 12, 2009 5/21/2009SenateSenate Floor Amendment No. 2 Filed with Secretary by Sen. Antonio Muņoz 5/21/2009SenateSenate Floor Amendment No. 2 Referred to Assignments 5/27/2009SenateSenate Floor Amendment No. 2 Assignments Refers to Insurance 5/27/2009SenateRule 2-10 Third Reading Deadline Established As May 31, 2009 5/28/2009SenateSenate Floor Amendment No. 2 Postponed - Insurance 8/15/2009SenateSenate Floor Amendment No. 2 Re-referred to Assignments; Pursuant to Senate Rule 3-9(b). 8/15/2009SenatePursuant to Senate Rule 3-9(b) / Referred to Assignments 10/15/2009SenateApproved for Consideration Assignments 10/15/2009SenatePlaced on Calendar Order of 2nd Reading October 16, 2009 10/15/2009SenateSenate Floor Amendment No. 2 Assignments Refers to Insurance 10/15/2009SenateRule 2-10 Third Reading Deadline Established As December 31, 2009 10/28/2009SenateSecond Reading 10/28/2009SenatePlaced on Calendar Order of 3rd Reading October 29, 2009 10/29/2009SenateSenate Floor Amendment No. 3 Filed with Secretary by Sen. Antonio Muņoz 10/29/2009SenateSenate Floor Amendment No. 3 Referred to Assignments 10/29/2009SenateSenate Floor Amendment No. 4 Filed with Secretary by Sen. Antonio Muņoz 10/29/2009SenateSenate Floor Amendment No. 4 Referred to Assignments 10/29/2009SenateSenate Floor Amendment No. 4 Assignments Refers to Executive 10/29/2009SenateSenate Floor Amendment No. 4 Recommend Do Adopt Executive; 011-000-002 10/29/2009SenateRecalled to Second Reading 10/29/2009SenateSenate Floor Amendment No. 4 Adopted; Munoz 10/29/2009SenatePlaced on Calendar Order of 3rd Reading 10/29/2009SenateThird Reading - Passed; 047-005-000 10/29/2009SenateSenate Floor Amendment No. 2 Tabled Pursuant to Rule 5-4(a) 10/29/2009SenateSenate Floor Amendment No. 3 Tabled Pursuant to Rule 5-4(a) 10/29/2009HouseArrived in House 10/29/2009HousePlaced on Calendar Order of Concurrence Senate Amendment(s) 1, 4 10/29/2009HouseSenate Committee Amendment No. 1 Motion Filed Concur Rep. Kevin Joyce 10/29/2009HouseSenate Floor Amendment No. 4 Motion Filed Concur Rep. Kevin Joyce 10/29/2009HouseSenate Committee Amendment No. 1 Motion to Concur Referred to Rules Committee 10/29/2009HouseSenate Floor Amendment No. 4 Motion to Concur Referred to Rules Committee 10/30/2009HouseSenate Committee Amendment No. 1 Motion to Concur Rules Referred to Health Care Availability and Accessibility Committee 10/30/2009HouseSenate Floor Amendment No. 4 Motion to Concur Rules Referred to Health Care Availability and Accessibility Committee 10/30/2009HouseSenate Committee Amendment No. 1 Motion to Concur Recommends Be Adopted Health Care Availability and Accessibility Committee; 012-000-000 10/30/2009HouseSenate Floor Amendment No. 4 Motion to Concur Recommends Be Adopted Health Care Availability and Accessibility Committee; 012-000-000 10/30/2009HouseAdded Chief Co-Sponsor Rep. William D. Burns 10/30/2009HouseSenate Committee Amendment No. 1 House Concurs 113-000-000 10/30/2009HouseSenate Floor Amendment No. 4 House Concurs 113-000-000 10/30/2009HousePassed Both Houses 11/25/2009HouseSent to the Governor 12/14/2009HouseGovernor Approved 12/14/2009HouseEffective Date June 1, 2010 12/14/2009HousePublic Act . . . . . . . . . 96-0833