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Full Text of SB2899

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SB2899 - 104th General Assembly

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Senate Amendment 001

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SB2899 Enrolled
LRB104 16346 BAB 29733 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Illinois Insurance Code is amended by
5
changing Section 356z.15 as follows:

6

(215 ILCS 5/356z.15)
7

Sec. 356z.15.
Habilitative services for children.
8

(a) As used in this Section, "habilitative services" means
9
occupational therapy, physical therapy, speech therapy, and
10
other services prescribed by the insured's treating physician
11
pursuant to a treatment plan to enhance the ability of a child
12
to function with a congenital, genetic, or early acquired
13
disorder. A congenital or genetic disorder includes, but is
14
not limited to, hereditary disorders. An early acquired
15
disorder refers to a disorder resulting from illness, trauma,
16
injury, or some other event or condition suffered by a child
17
prior to that child developing functional life skills such as,
18
but not limited to, walking, talking, or self-help skills.
19
Congenital, genetic, and early acquired disorders may include,
20
but are not limited to, autism or an autism spectrum disorder,
21
cerebral palsy, and other disorders resulting from early
22
childhood illness, trauma, or injury.
23

(b) A group or individual policy of accident and health

SB2899 Enrolled
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LRB104 16346 BAB 29733 b
1
insurance or managed care plan amended, delivered, issued, or
2
renewed after the effective date of this amendatory Act of the
3
95th General Assembly must provide coverage for habilitative
4
services for children under 19 years of age with a congenital,
5
genetic, or early acquired disorder so long as all of the
6
following conditions are met:
7

(1) A physician licensed to practice medicine in all
8

its branches has diagnosed the child's congenital,
9

genetic, or early acquired disorder.
10

(2) The treatment is administered by a licensed
11

speech-language pathologist, licensed audiologist,
12

licensed occupational therapist, licensed physical
13

therapist, licensed physician, licensed nurse, licensed
14

optometrist, licensed nutritionist, licensed social
15

worker, or licensed psychologist upon the referral of a
16

physician licensed to practice medicine in all its
17

branches.
18

(3) The initial or continued treatment must be
19

medically necessary and therapeutic and not experimental
20

or investigational.
21

(b-5) For any child under 19 years of age with an early
22
acquired disorder that is diagnosed as a speech-language
23
disorder, including stuttering, the coverage required under
24
this Section shall include rehabilitative services in addition
25
to habilitative services. As used in this subsection,
26
"rehabilitative services" means speech therapy that helps a

SB2899 Enrolled
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LRB104 16346 BAB 29733 b
1
child restore or improve skills and functions for daily living
2
that have been lost or impaired.

3

(c) The coverage required by this Section shall be subject
4
to other general exclusions and limitations of the policy,
5
including coordination of benefits, participating provider
6
requirements, restrictions on services provided by family or
7
household members, utilization review of health care services,
8
including review of medical necessity, case management,
9
experimental, and investigational treatments, and other
10
managed care provisions.
11

(d) Coverage under this Section does not apply to those
12
services that are solely educational in nature or otherwise
13
paid under State or federal law for purely educational
14
services. Nothing in this subsection (d) relieves an insurer
15
or similar third party from an otherwise valid obligation to
16
provide or to pay for services provided to a child with a
17
disability.
18

(e) Coverage under this Section for children under age 19
19
shall not apply to treatment of mental or emotional disorders
20
or illnesses as covered under Section 370 of this Code as well
21
as any other benefit based upon a specific diagnosis that may
22
be otherwise required by law.
23

(f) The provisions of this Section do not apply to
24
short-term travel, accident-only, limited, or specific disease
25
policies.
26

(g) Any denial of care for habilitative services shall be

SB2899 Enrolled
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LRB104 16346 BAB 29733 b
1
subject to appeal and external independent review procedures
2
as provided by Section 45 of the Managed Care Reform and
3
Patient Rights Act.
4

(h) Upon request of the reimbursing insurer, the provider
5
under whose supervision the habilitative services are being
6
provided shall furnish medical records, clinical notes, or
7
other necessary data to allow the insurer to substantiate that
8
initial or continued medical treatment is medically necessary
9
and that the patient's condition is clinically improving. When
10
the treating provider anticipates that continued treatment is
11
or will be required to permit the patient to achieve
12
demonstrable progress, the insurer may request that the
13
provider furnish a treatment plan consisting of diagnosis,
14
proposed treatment by type, frequency, anticipated duration of
15
treatment, the anticipated goals of treatment, and how
16
frequently the treatment plan will be updated.
17

(i) Rulemaking authority to implement this amendatory Act
18
of the 95th General Assembly, if any, is conditioned on the
19
rules being adopted in accordance with all provisions of the
20
Illinois Administrative Procedure Act and all rules and
21
procedures of the Joint Committee on Administrative Rules; any
22
purported rule not so adopted, for whatever reason, is
23
unauthorized.
24

(j) An insurer may not deny or refuse to provide otherwise
25
covered services under a group or individual policy of
26
accident and health insurance or a managed care plan solely

SB2899 Enrolled
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LRB104 16346 BAB 29733 b
1
because of the location wherein the clinically appropriate
2
services are provided.
3
(Source: P.A. 102-322, eff. 1-1-22
.)

4

Section 10.
The Limited Health Service Organization Act is
5
amended by changing Section 4003 as follows:

6

(215 ILCS 130/4003)

(from Ch. 73, par. 1504-3)
7

Sec. 4003.
Illinois Insurance Code provisions.
Limited
8
health service organizations shall be subject to the
9
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
10
141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
11
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
12
355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
13
356z.10,
356z.15,
356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
14
356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
15
356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
16
356z.71, 356z.73, 356z.74, 356z.75, 356z.79, 356z.80,
356z.81,
17
356z.83, 356z.84, 356z.85,
364.3, 368a, 370a, 401, 401.1, 402,
18
403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
19
IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
20
XXXIIB of the Illinois Insurance Code. Nothing in this Section
21
shall require a limited health care plan to cover any service
22
that is not a limited health service. For purposes of the
23
Illinois Insurance Code, except for Sections 444 and 444.1 and
24
Articles XIII and XIII 1/2, limited health service

SB2899 Enrolled
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LRB104 16346 BAB 29733 b
1
organizations in the following categories are deemed to be
2
domestic companies:
3

(1) a corporation under the laws of this State; or
4

(2) a corporation organized under the laws of another
5

state, 30% or more of the enrollees of which are residents
6

of this State, except a corporation subject to
7

substantially the same requirements in its state of
8

organization as is a domestic company under Article VIII
9

1/2 of the Illinois Insurance Code.
10
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
11
103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
12
1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,
13
eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
14
103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
15
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
16
eff. 8-1-25; 104-73, eff. 1-1-26; 104-98, eff. 1-1-26;
17
104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-334, eff.
18
8-15-25; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; revised
19
11-21-25.)

20

Section 15.
The Illinois Public Aid Code is amended by
21
adding Section 5-5j as follows:

22

(305 ILCS 5/5-5j new)
23

Sec. 5-5j.
Speech-language rehabilitative and habilitative
24
services.
Subject to federal approval, for services beginning

SB2899 Enrolled
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LRB104 16346 BAB 29733 b
1
on and after July 1, 2026, the medical assistance program
2
shall provide coverage for medically necessary rehabilitative
3
and habilitative services for individuals under the age of 21
4
with an early acquired disorder that is diagnosed as a
5
speech-language disorder, including stuttering. As used in
6
this Section, "rehabilitative services" means speech therapy
7
that helps an individual restore or improve skills and
8
functions for daily living that have been lost or impaired.

9

Section 99.
Effective date.
This Act takes effect July 1,
10
2026, except that Sections 5 and 10 take effect on January 1,
11
2028.

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