Chicago City Wire

Lindsey LaPointe introduced HB1770 in the Illinois House on Jan. 27, 2025, during the general assembly session 104, according to the Illinois General Assembly.

According to the Illinois General Assembly site, the legislature summarized the bill's official text as follows: "Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section."

The following is our breakdown, based on the actual bill text, and may include interpretation to clarify its provisions.

In essence, this bill amends the Illinois Insurance Code to require insurance policies issued, amended, delivered, or renewed in Illinois after the effective date to cover medically necessary treatments for genetic, rare, and unique conditions, such as Ehlers-Danlos syndrome and altered drug metabolism. It mandates coverage for prescription drugs to include opioid alternatives, drugs from the WHO Model List of Essential Medicines, custom-made medications, and medical food. The bill specifies that policies limiting medication quantities must waive pre-approval for patients with rare metabolism conditions needing higher doses. Insurers cannot place the burden of proving medical necessity on the insured in cases of claim rejections, preauthorization requests, and related appeals.

Lindsey LaPointe has proposed another three bills since the beginning of the 104th session.

LaPointe graduated from Grinnell College in 2004 with a BA.

Lindsey LaPointe is currently serving in the Illinois State House, representing the state's 19th House District. She replaced previous state representative Robert Martwick in 2019.

Bills in Illinois follow a multi-step legislative process, beginning with introduction in either the House or Senate, followed by committee review, floor debates, and votes in both chambers before reaching the governor for approval or veto. The General Assembly operates on a biennial schedule, and while typically thousands of bills are introduced each session, only a fraction successfully pass through the process to become law.

You can read more about bills and other measures here.

Bill Number	Date Introduced	Short Description
HB1770	01/27/2025	Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section.
HB1784	01/27/2025	Amends the Medical Assistance Article of the Illinois Public Aid Code. Expands the classes of persons eligible for medical assistance to include, beginning January 1, 2027 and subject to any federal waivers or approvals necessary for implementation, persons licensed under the Clinical Psychologist Licensing Act, the Clinical Social Work and Social Work Practice Act, the Illinois Dental Practice Act, the Medical Practice Act of 1987, the Licensed Certified Professional Midwife Practice Act, the Nurse Practice Act, the Physician Assistant Practice Act of 1987, or the Registered Surgical Assistant and Registered Surgical Technologist Title Protection Act. Permits such licensed persons to apply for medical assistance by submitting an application to the Department of Healthcare and Family Services between January 1 and March 31. Requires the Director of Healthcare and Family Services to determine the form and manner of submitting an application. Requires the Department to post application instructions on its website. Requires an eligible person who satisfies all application requirements to pay a premium for medical assistance coverage that shall be no higher than 5% of the person's annual income. Provides that any premiums paid shall be automatically allocated to the Department's medical assistance budget for the next fiscal year. Requires the Department to adopt rules.
HB1588	01/22/2025	Appropriates $7,500,000 to the Illinois Student Assistance Commission for the Human Services Professional Loan Repayment Program. Effective July 1, 2025.
HB1555	01/21/2025	Amends the Environmental Barriers Act. Requires the Attorney General to provide, by January 31, 2026 and every January 31 thereafter (rather than by July 31, 2020 and every July 31 thereafter), data on the Attorney General's website about annual enforcement efforts performed under the Act. Effective immediately.
HB1085	01/09/2025	Amends the Illinois Insurance Code. Establishes reimbursement rates for mental health and substance use disorder treatment services for all group or individual policies of accident and health insurance or managed care plans that are amended, delivered, issued, or renewed on or after January 1, 2027 or for any contracted third party administering the behavioral health benefits for the insurer. Requires a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 or any contracted third party administering the behavioral health benefits for the insurer to cover certain medically necessary mental health and substance use disorder treatment services. Provides that, if the Department of Insurance determines that an insurer or a contracted third party administering the behavioral health benefits for the insurer has violated a provision concerning mental health and substance use parity, the Department shall by order assess a civil penalty of $1,000 for each violation. Excludes certain health care plans serving Medicaid populations who are enrolled under the Illinois Public Aid Code or under the Children's Health Insurance Program Act from provisions concerning mental health and substance use parity. Requires the Department to review the impact of the proposed mental health and substance abuse mandate on network adequacy for mental health and substance use disorder treatment and access to affordable mental health and substance use care. Permits the Department to examine out-of-network utilization and out-of-pocket costs for insureds for mental health and substance use treatment and services for all plans to compare with in-network utilization. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code to require coverage under those provisions. Effective immediately.