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| 1 | AN ACT concerning insurance.
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| 2 | Be it enacted by the People of the State of Illinois,
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| 3 | represented in the General Assembly:
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| 4 | Section 5. The Illinois Insurance Code is amended by | ||||||
| 5 | adding Section 356z.61 as follows: | ||||||
| 6 | (215 ILCS 5/356z.61 new) | ||||||
| 7 | Sec. 356z.61. Proton beam
therapy. | ||||||
| 8 | (a) As used in this Section: | ||||||
| 9 | "Medically necessary" has the meaning given to that term | ||||||
| 10 | in the Prior Authorization Reform Act. | ||||||
| 11 | "Proton beam therapy" means a type of radiation
therapy | ||||||
| 12 | treatment that utilizes protons as the radiation delivery | ||||||
| 13 | method for the
treatment of tumors and cancerous cells. | ||||||
| 14 | "Radiation therapy treatment"
means the delivery of | ||||||
| 15 | biological effective doses with proton therapy,
intensity | ||||||
| 16 | modulated radiation therapy, brachytherapy,
stereotactic body | ||||||
| 17 | radiation therapy, three-dimensional conformal
radiation | ||||||
| 18 | therapy, or other forms of therapy using radiation. | ||||||
| 19 | (b) A group or individual policy of accident and health | ||||||
| 20 | insurance or managed care plan that is amended, delivered, | ||||||
| 21 | issued, or renewed on or after January 1, 2025 that provides | ||||||
| 22 | coverage for the treatment of cancer shall not apply a
higher | ||||||
| 23 | standard of clinical evidence for the coverage of proton beam
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| 1 | therapy than the insurer applies for the coverage of any other | ||||||
| 2 | form of
radiation therapy treatment. | ||||||
| 3 | (c) A group or individual policy of accident and health | ||||||
| 4 | insurance or managed care plan that is amended, delivered, | ||||||
| 5 | issued, or renewed on or after January 1, 2025 that provides | ||||||
| 6 | coverage or benefits to any resident
of this State for | ||||||
| 7 | radiation oncology shall include coverage or benefits
for | ||||||
| 8 | medically necessary proton beam therapy for the treatment of
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| 9 | cancer. | ||||||
| 10 | Section 10. The Illinois Public Aid Code is amended by | ||||||
| 11 | adding Section 5-47 as follows: | ||||||
| 12 | (305 ILCS 5/5-47 new) | ||||||
| 13 | Sec. 5-47. Proton beam therapy; managed care. | ||||||
| 14 | Notwithstanding any
other provision of this Article, a managed | ||||||
| 15 | care organization under
contract with the Department to | ||||||
| 16 | provide services to recipients of
medical assistance shall | ||||||
| 17 | provide coverage for proton beam therapy. As
used in this | ||||||
| 18 | Section, "proton beam therapy" means a type of radiation
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| 19 | therapy treatment that utilizes protons as the radiation | ||||||
| 20 | delivery method for the
treatment of tumors and cancerous | ||||||
| 21 | cells. "Radiation therapy treatment"
means the delivery of | ||||||
| 22 | biological effective doses with proton therapy,
intensity | ||||||
| 23 | modulated radiation therapy, brachytherapy,
stereotactic body | ||||||
| 24 | radiation therapy, three-dimensional conformal
radiation | ||||||
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| 1 | therapy, or other forms of therapy using radiation.
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| 2 | Section 99. Effective date. This Act takes effect January | ||||||
| 3 | 1, 2024. | ||||||