INS CD-PERIPHERAL ARTERY TEST

104th Regular Session Introduced by John Cabello and 27 co-sponsors

Requires Illinois health plans and public programs to cover PAD screening at least once per year for at-risk individuals, enabling early detection and reducing amputations.

Public Act . . . . . . . . . 104-0379

Main purpose

Require health insurance plans and certain public health programs in Illinois to cover screening for peripheral artery disease (PAD) — at least once every 12 months — for individuals identified as “at‑risk,” with the goal of improving early detection and reducing PAD‑related complications (e.g., amputations, heart attack, stroke, death).

Key provisions

Adds a new required benefit to the Illinois Insurance Code: group or individual accident & health plans and managed care plans that are amended, delivered, issued, or renewed after the effective date must provide coverage for a PAD screening test no less than once every 12 months for any “at‑risk individual.”

Extends this coverage requirement across a range of state programs and codes by amending:

State Employees Group Insurance Act of 1971,
Counties Code,
Illinois Municipal Code,
School Code,
Health Maintenance Organization Act,
Limited Health Service Organization Act,
Voluntary Health Services Plans Act,
Illinois Public Aid (Medicaid) Code.

Legislative findings accompanying the bill emphasize PAD’s prevalence (estimated ~21 million Americans), the disproportionate impact on minorities, the cost‑effectiveness of screening, and the potential to reduce amputations and deaths through evidence‑based PAD care.

The bill does not, in the provided excerpts, set specific reimbursement rates, detailed test specifications, or explicit statutory text defining “at‑risk individual.” Those operational details may be addressed in the full statutory language or implementing rules.

Who is affected

Private insurers offering group and individual accident & health plans and managed care plans in Illinois.

HMOs, limited health service organizations, voluntary health service plans.

State and local public employers/self‑insured entities (state employees, counties, municipalities, school districts) whose plans are governed by the amended statutes.

Illinois Medicaid (Public Aid) beneficiaries, to the extent the Public Aid Code amendment applies.

Clinicians and health systems delivering PAD screening services; patients identified as “at‑risk” for PAD.

Potential impact

Short term: increased utilization of PAD screening tests and associated insurer claim costs; administrative adjustments for plan documents and provider billing.

Long term: potential reductions in downstream costs (fewer amputations, hospitalizations, advanced care) if screening leads to earlier intervention; potential public health benefit by improving PAD detection among high‑risk populations.

Fiscal implications for state plans and Medicaid depend on screening uptake and subsequent care pathways; the bill text does not include a fiscal estimate in the excerpts provided.

Implementation notes / next steps

Consult the enacted Public Act text for the exact definition of “at‑risk individual,” the precise scope of covered tests, any cost‑sharing limitations, and transitional rules.

Regulated entities should update plan documents and compliance procedures for coverage mandates effective for plans amended/delivered/issued/renewed on or after the effective date.

Bill