101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB5079

 

Introduced 2/18/2020, by Rep. Nathan D. Reitz

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Illinois Insurance Code. In provisions concerning coverage for telehealth services, provides that certain health benefit policies or plans may not exclude from coverage a medically necessary health care service or procedure delivered by certain providers solely because the health care service or procedure is provided through telehealth (rather than requiring certain policies to meet specified criteria if they provide coverage for telehealth services). Provides the requirements of coverage for telehealth services. Provides that an individual or group policy of accident or health insurance that provides coverage for telehealth services delivered by contracted licensed dietitian nutritionists and contracted certified diabetes educators must also provide coverage for in-home services for senior diabetes patients (rather than requiring an individual or group policy of accident or health insurance that provides coverage for telehealth services to provide coverage for licensed dietitian nutritionists and certified diabetes educators who counsel senior diabetes patients in the patients' homes). Amends the Illinois Public Aid Code. Provides payment, reimbursement, and service requirements for telehealth services provided under the State's fee-for-service or managed care medical assistance programs. Provides that "telehealth" includes telepsychiatry. Provides that the Department of Healthcare and Family Services shall implement the new provisions 60 days after the effective date of the amendatory Act. Repeals a provision requiring the Department to reimburse psychiatrists and federally qualified health centers for mental health services provided by psychiatrists to medical assistance recipients through telepsychiatry. Makes other changes.


LRB101 17247 BMS 66651 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB5079LRB101 17247 BMS 66651 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 356z.22 as follows:
 
6    (215 ILCS 5/356z.22)
7    Sec. 356z.22. Coverage for telehealth services.
8    (a) For purposes of this Section:
9    "Distant site" means the location at which the health care
10provider rendering the telehealth service is located.
11    "Health care provider" means a health care professional
12licensed in Illinois, including a physician assistant.
13    "Interactive telecommunication system" means multimedia
14communications equipment that includes, at a minimum, audio and
15video equipment permitting 2-way, real-time interactive
16communication between the patient and the distant site
17provider. "Interactive telecommunication system" does not
18include a facsimile machine.
19    "Originating site" means the location at which the patient
20receiving the service is located.
21    "Telehealth" means the use of telecommunications services
22to encompass 4 modalities: store and forward technologies,
23remote monitoring, live consultation, and mobile health; and

 

 

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1which shall include, but not be limited to, real-time video
2conferencing-based communication, secure interactive and
3non-interactive web-based communication, and secure
4asynchronous information exchange, to transmit patient medical
5information, including diagnostic-quality digital images and
6laboratory results for medical interpretation and diagnosis,
7for the purpose of delivering enhanced health care services and
8information while a patient is at an originating site and the
9health care provider is at a distant site. "Telehealth"
10includes telepsychiatry and telemedicine. "Telehealth"
11includes psychiatric services, as well as services provided by
12all other professional disciplines delivered through
13telecommunication systems. "Telehealth" does not include a
14facsimile transmission. If the fee-for-service or managed care
15medical assistance programs under Article V of the Illinois
16Public Aid Code or health insurer does not offer a service as a
17covered benefit or a supplemental service for in-person or
18online care, nothing in this definition of "telehealth"
19mandates that the fee-for-service or managed care medical
20assistance programs under Article V of the Illinois Public Aid
21Code or health insurer pay for services delivered through
22telehealth.
23    "Interactive telecommunications system" means an audio and
24video system permitting 2-way, live interactive communication
25between the patient and the distant site health care provider.
26    "Telehealth services" means the delivery of covered health

 

 

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1care services by way of an interactive telecommunications
2system.
3    (b) This Section applies to an individual or group policy
4of insurance issued, amended, renewed, delivered, continued,
5or executed on or after the effective date of this amendatory
6Act of the 101st General Assembly that pays health benefits,
7including, but not limited to, such health benefit policies or
8plans as:
9        (1) the fee-for-service and managed care medical
10    assistance programs under Article V of the Illinois Public
11    Aid Code;
12        (2) accident, health, or sickness coverage plans and
13    policies;
14        (3) mutual benefit society plans and policies;
15        (4) automobile medical benefits plans and policies;
16        (5) third-party administrator plans and policies;
17        (6) travel insurance medical benefits plans and
18    policies;
19        (7) supplemental insurance plans and policies;
20        (8) life care contracts, plans, and policies;
21        (9) accident-only plans and policies;
22        (10) specified disease plans and policies;
23        (11) hospital plans and policies providing fixed daily
24    benefits only;
25        (12) Medicare supplemental plans and policies;
26        (13) long-term care plans and policies;

 

 

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1        (14) short-term major medical plans and policies of 6
2    months' duration or less;
3        (15) hospital indemnity plans or policies; and
4        (16) any other supplemental health plan or policy.
5    (c) A health benefit policy or plan may not exclude from
6coverage a medically necessary health care service or procedure
7delivered by a contracted health care professional or
8contracted health care provider solely because the health care
9service or procedure is provided through telehealth. Such
10coverage shall be on the same basis and at the same rate that
11the health insurer is responsible for coverage for providing
12the same service through in-person treatment or consultations
13to contracted health care providers if the service is a covered
14benefit or supplemental service provided to enrollees.
15    (d) All telehealth services provided under this Section
16shall meet the following requirements:
17        (1) Medical data may be exchanged through an
18    interactive telecommunication system.
19        (2) The interactive telecommunication system must, at
20    a minimum, have the capability of allowing the consulting
21    distant site provider to examine the patient sufficiently
22    to allow proper diagnosis of the involved body system when
23    necessary and appropriate. The interactive
24    telecommunication system must also be capable of
25    transmitting clearly audible heart tones and lung sounds,
26    as well as clear video images of the patient and any

 

 

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1    diagnostic tools, such as radiographs, when necessary and
2    appropriate.
3        (3) An in-person visit between a patient and a health
4    care provider prior to the delivery of telehealth services
5    shall not be required unless medically necessary as
6    determined by the health care provider offering the
7    service.
8        (4) Other than consents required for treatment for
9    in-person care, no informed or other consents shall be
10    required for the patient to receive care through
11    telehealth.
12        (5) A telepresenter shall not be required to be present
13    with the patient unless medically necessary.
14    (e) Email systems and text messaging may be used as
15interactive telecommunication systems for existing patients
16but are included in telehealth and are subject to payment only
17if a covered service or supplemental benefit is offered by the
18fee-for-service or managed care medical assistance programs
19under Article V of the Illinois Public Aid Code or health
20insurer.
21    (f) Benefits for a service provided through telehealth
22required by this Section may be made subject to a deductible,
23copayment, or coinsurance as long as the deductible, copayment,
24or coinsurance required does not exceed the deductible,
25copayment, or coinsurance requirement of the policy or health
26benefit plan for the same service provided through in-person

 

 

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1care.
2    (g) Records for telehealth services shall meet the
3following requirements:
4        (1) The originating and distant sites shall not be
5    required to maintain or present as a condition of payment
6    any additional medical records to document the telehealth
7    services provided other than what is required under
8    applicable State or federal law.
9        (2) Appropriate steps must be taken by the originating
10    and distant site staff to ensure patient confidentiality,
11    based on technical advances in compliance with all federal
12    and State privacy and confidentiality laws.
13        (3) The billing records related to the following
14    through the use of the telecommunication system shall be
15    maintained:
16            (A) Current Procedural Terminology codes or any
17        successor codes;
18            (B) Healthcare Common Procedure Coding System
19        services or any successor services; and
20            (C) Level 1 technical component facility fees or
21        any successor fees.
22    (h) Originating sites shall have no restrictions with
23respect to geographic location or other restrictions that limit
24the type and location or originating sites.
25    (i) Nothing in this Section precludes a health benefit
26policy or plan from undertaking utilization review to determine

 

 

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1the appropriateness of telehealth as a means of delivering a
2health care service, provided that the determination is made in
3the same manner as those regarding the same service when it is
4delivered in person.
5    (j) Notwithstanding any other provision of law, nothing in
6this Section authorizes a health benefit policy or plan to
7require the use of telehealth by a health care professional,
8health care provider, or a covered individual.
9    (b) If an individual or group policy of accident or health
10insurance provides coverage for telehealth services, then it
11must comply with the following:
12        (1) An individual or group policy of accident or health
13    insurance providing telehealth services may not:
14            (A) require that in-person contact occur between a
15        health care provider and a patient;
16            (B) require the health care provider to document a
17        barrier to an in-person consultation for coverage of
18        services to be provided through telehealth;
19            (C) require the use of telehealth when the health
20        care provider has determined that it is not
21        appropriate; or
22            (D) require the use of telehealth when a patient
23        chooses an in-person consultation.
24        (2) Deductibles, copayments, or coinsurance applicable
25    to services provided through telehealth shall not exceed
26    the deductibles, copayments, or coinsurance required by

 

 

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1    the individual or group policy of accident or health
2    insurance for the same services provided through in-person
3    consultation.
4    (k) An individual or group policy of accident or health
5insurance that provides coverage for telehealth services
6delivered by contracted licensed dietitian nutritionists and
7certified diabetes educators must also provide coverage for
8in-home services delivered by contracted licensed dietitian
9nutritionists and certified diabetes educators and physician
10assistants for senior diabetes patients. (b-5) If an individual
11or group policy of accident or health insurance provides
12coverage for telehealth services, it must provide coverage for
13licensed dietitian nutritionists and certified diabetes
14educators who counsel senior diabetes patients in the senior
15diabetes patients' homes to remove the hurdle of transportation
16for senior diabetes patients to receive treatment.
17    (l) (c) Nothing in this Section precludes shall be deemed
18as precluding a health insurer from providing benefits or
19requires a health insurer to provide benefits for other
20services, including, but not limited to, email, text messaging,
21the use of mobile applications, remote monitoring services,
22other monitoring services, or oral communications otherwise
23covered under the policy.
24(Source: P.A. 100-1009, eff. 1-1-19.)
 
25    Section 10. The Illinois Public Aid Code is amended by

 

 

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1adding Section 5-5.25a as follows:
 
2    (305 ILCS 5/5-5.25a new)
3    Sec. 5-5.25a. Telehealth services.
4    (a) Definitions. As used in this Section:
5    "Asynchronous store and forward technology" means the
6transmission of a patient's medical information from an
7originating site to the provider at the distant site. The
8provider at the distant site can review the medical case
9without the patient being present. An asynchronous
10telecommunication system in single media format does not
11include telephone calls, images transmitted through facsimile
12machines, and text messages without visualization of the
13patient (email). Photographs visualized by a telecommunication
14system must be specific to the patient's medical condition and
15adequate for furnishing or confirming a diagnosis or treatment
16plan. Dermatological photographs (for example, a photograph of
17a skin lesion) may be considered to meet the requirement of a
18single media format under this Section. Nothing in this
19definition of "asynchronous store and forward technology"
20shall require an insurer to pay for asynchronous store and
21forward technology unless that service is a covered benefit or
22supplemental service.
23    "Distant site" means the location at which the provider
24rendering the telehealth service is located.
25    "Facility fee" means the reimbursement made to any Illinois

 

 

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1Medicaid participating health care organization or Illinois
2Medicaid participating provider as originating sites.
3    "Illinois Medicaid participating health care organization"
4means any health care organization that is eligible to
5participate in the State's fee-for-service or managed care
6medical assistance program and that has an office or is
7affiliated with an organization that has an office located in
8the State of Illinois.
9    "Illinois Medicaid participating provider" means any
10health care provider, including a practitioner described in
11Section 5-8, a licensed clinical social worker, a licensed
12clinical psychologist, a licensed advanced practice registered
13nurse certified in a psychiatric specialty, a licensed
14nutritionist or any other certified nutrition professional,
15and a physician assistant who is eligible to participate in the
16State's fee-for-service or managed medical assistance program
17and who is employed by an Illinois Medicaid participating
18organization.
19    "Interactive telecommunication system" means multimedia
20communications equipment that includes, at a minimum, audio and
21video equipment permitting 2-way, real-time interactive
22communication between the patient and the distant site
23provider. "Interactive telecommunication system" does not
24include a facsimile machine.
25    "Originating site" means the location at which the patient
26receiving the service is located.

 

 

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1    "Telecommunication system" means an asynchronous store and
2forward technology or an interactive telecommunication system
3that is used to transmit data between the originating and
4distant sites.
5    "Telehealth" means the use of telecommunications services
6to encompass 4 modalities: store and forward technologies,
7remote monitoring, live consultation, and mobile health; and
8which shall include, but not be limited to, real-time video
9conferencing-based communication, secure interactive and
10non-interactive web-based communication, and secure
11asynchronous information exchange, to transmit patient medical
12information, including diagnostic-quality digital images and
13laboratory results for medical interpretation and diagnosis,
14for the purpose of delivering enhanced health care services and
15information while a patient is at an originating site and the
16health care provider is at a distant site. "Telehealth"
17includes telepsychiatry and telemedicine. "Telehealth"
18includes psychiatric services, as well as services provided by
19all other professional disciplines delivered through
20telecommunication systems. "Telehealth" does not include a
21facsimile transmission. Nothing in this definition of
22"telehealth" mandates that the State's fee-for-service or
23managed care medical assistance program or a health insurer pay
24for services delivered through telehealth if the service is not
25a covered benefit or supplemental service.
26    (b) Payment. Any fee-for-service or managed care medical

 

 

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1assistance program shall provide coverage for the cost of
2health care services provided through telehealth, as provided
3under this Section, on the same basis and at the same
4contracted rate as established for coverage for providing the
5same service through in-person treatment or consultation.
6Fee-for-service or managed care medical assistance programs
7shall not exclude a service for coverage solely because the
8service is provided through telehealth services if the service
9is a covered benefit or supplemental service. This Section
10applies to any plan that is issued, amended, renewed,
11delivered, continued, or executed in the State of Illinois.
12    (c) Telehealth services requirements. All telehealth
13services provided under this Section shall meet the following
14requirements:
15        (1) The distant site provider must be an eligible
16    Illinois Medicaid participating provider or Illinois
17    Medicaid participating health care organization
18        (2) The originating and distant site provider must not
19    be terminated, suspended, or barred from the State's
20    fee-for-service or managed care medical assistance
21    program.
22        (3) Medical data may be exchanged through an
23    interactive telecommunication system.
24        (4) The interactive telecommunication system must, at
25    a minimum, have the capability of allowing the consulting
26    distant site provider to examine the patient sufficiently

 

 

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1    to allow proper diagnosis of the involved body system when
2    necessary and appropriate. The interactive
3    telecommunication system must also be capable of
4    transmitting clearly audible heart tones and lung sounds,
5    as well as clear video images of the patient and any
6    diagnostic tools, such as radiographs, when necessary and
7    appropriate.
8    (d) Telehealth service prohibitions.
9        (1) An in-person visit between a patient and a health
10    care provider prior to the delivery of telehealth services
11    shall not be required for medical assistance coverage under
12    the State's fee-for-service or managed care medical
13    assistance program unless medically necessary as
14    determined by the health care provider offering the
15    service.
16        (2) Other than consents required for treatment for
17    in-person care, no informed or other consents shall be
18    required for the patient to receive care through
19    telehealth.
20        (3) A telepresenter shall not be required to be present
21    with the patient unless medically necessary.
22    (e) Email systems and text messaging may be used as
23interactive telecommunication systems for existing patients.
24    (f) Reimbursement for telehealth services.
25        (1) Originating site reimbursement.
26            (A) A facility fee shall be paid to providers as

 

 

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1        defined in subsection (a) of this Section.
2            (B) Local education agencies may submit telehealth
3        services as a certified expenditure.
4            (C) All Illinois Medicaid participating health
5        care organizations and providers that receive
6        reimbursement for a patient's room and board shall also
7        receive the facility fee.
8        (2) Reimbursement for rendering provider at the
9    distant site.
10            (A) Participating providers shall be reimbursed
11        for the appropriate Current Procedural Terminology
12        code for the telehealth service rendered.
13            (B) Nonparticipating providers may be reimbursed
14        by the originating site provider but shall not be
15        eligible for reimbursement from the Department or its
16        managed care contracted insurers.
17    (g) Copayments. Benefits for a service provided through
18telehealth as required under this Section may be made subject
19to a deductible, copayment, or coinsurance as long as the
20deductible, copayment, or coinsurance required does not exceed
21any deductible, copayment, or coinsurance established under
22the fee-for-service or managed care medical assistance program
23for the same service provided during an in-person visit.
24    (h) Record requirements for telehealth services.
25        (1) Medical records documenting the telehealth
26    services provided must be maintained by the originating

 

 

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1    site in accordance with the requirements under 89 Ill. Adm.
2    Code. 140.28. The originating and distant sites shall not
3    be required to maintain or present as a condition of
4    payment any additional medical records to document the
5    telehealth services provided other than what is required
6    for in-person care under applicable State or federal law.
7        (2) Appropriate steps must be taken by the originating
8    and distant site staff to ensure patient confidentiality,
9    based on technical advances in compliance with all federal
10    and State privacy and confidentiality laws.
11        (3) The billing records related to the following
12    through the use of the telecommunication system shall be
13    maintained as provided in 89 Ill. Adm. Code 140.28:
14            (A) Current Procedural Terminology codes or any
15        successor codes;
16            (B) Healthcare Common Procedure Coding System
17        services or any successor services; and
18            (C) Level 1 technical component facility fees or
19        any successor fees.
20    (i) Originating sites shall have no restrictions with
21respect to geographic location or other restrictions that limit
22the type and location of originating sites.
23    (j) Implementation. The Department shall implement the
24provisions of this Section 60 days after the effective date of
25this amendatory Act of the 101st General Assembly.
 

 

 

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1    (305 ILCS 5/5-5.25 rep.)
2    Section 15. The Illinois Public Aid Code is amended by
3repealing Section 5-5.25.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    215 ILCS 5/356z.22
4    305 ILCS 5/5-5.25a new
5    305 ILCS 5/5-5.25 rep.