After overwhelmingly being supported in both Houses of the Illinois Legislature, on December 12th, Governor Blagojevich signed SB0934 into law. As written, the “autism insurance” law went into effect as soon as it was signed by the Governor. The legislation is also known as "Brianni's Law" for Brianni DiCianni. She was diagnosed with autism in 2006 and was denied coverage by her family's health insurance company. Brianni’s father, Pete, worked tirelessly with State Senator James DiLeo on this insurance law.

“Brianni’s Law” made changes to a number of statutes covering insurance policies. The State Employees Group Insurance Act was amended so the autism coverage would include State employees. The Counties Code and Municipal Code were changed to cover insurance policies of county and municipal employees. The School Code was changed so insurance policies cover autism diagnosis and treatment for the children of school district employees. A great deal of families affected by autism will be covered through changes to the Illinois Insurance Code and the Health Maintenance Organization Act.

Group, individual health insurance or managed care plans that are amended, delivered, issued, or renewed after December 12th must provide individuals under 21 years of age coverage for the diagnosis and treatment of autism spectrum disorders to the extent that the diagnosis and treatment of autism spectrum disorders are not already covered by the policy of accident and health insurance or managed care plan.

Coverage provided under the law is subject to a maximum benefit of $36,000 per year. The law is not limited on the number of visits to a service provider. After December 30, 2009, the maximum benefit will be adjusted for inflation.

Coverage under this autism insurance act is still subject to copayments, deductibles, and coinsurance provisions like other medical services covered by insurance policies.

Under the new law, an insurer may not deny or refuse to provide covered services, or refuse to renew, refuse to reissue, or otherwise terminate or restrict coverage to an individual because the individual or their dependent is diagnosed with an autism spectrum disorder or due to the individual utilizing benefits provided by law.

Upon request by an insurance company, a provider of treatment for autism spectrum disorders will provide documentation substantiating that initial or continued medical treatment is medically necessary and that the treatment is resulting in improved clinical status. When treatment is anticipated to require continued services to achieve progress, the insurer may request a treatment plan.

When making a determination of medical necessity for a treatment for autism spectrum disorders, an insurer must make the determination in the same way used to make that determination with respect to other diseases or illnesses covered under the insurance policy. This includes an appeals process. During the appeals process, any challenge to medical necessity will be viewed as reasonable only if the review includes a physician with expertise in the most current and effective treatment modalities for autism spectrum disorders.

The definition of medically necessary is fairly broad. The law defines medically necessary as any care, treatment, intervention, service or item which will or is reasonably expected to prevent the onset of an illness, condition, injury, disease or disability; reduce or ameliorate the physical, mental or developmental effects of an illness, condition, injury, disease or disability; assist to achieve or maintain maximum functional activity in performing daily activities.

Treatment for autism spectrum disorders includes psychiatric care, meaning direct, consultative, or diagnostic services provided by a licensed psychiatrist. Also covered is psychological care, either direct or consultative services provided by a licensed psychologist. Habilitative or rehabilitative care, meaning professional, counseling, and guidance services and treatment programs, including applied behavior analysis, meant to develop, maintain, and restore the functioning of an individual.

Therapies are provided for in the law. Covered therapies include behavioral, speech, occupational, and physical therapies that provide treatment in the areas of self care and feeding, pragmatic, receptive, and expressive language, cognitive functioning, applied behavior analysis, intervention, and modification, motor planning, and sensory processing.

Click on the link below to read and understand more about the bill
http://www.autismillinois.org/sb%20934.pdf