SB2561 101ST GENERAL ASSEMBLY

LRB101 15400 BMS 64650 b

101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB2561

Introduced 1/29/2020, by Sen. Laura Fine

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.22
305 ILCS 5/5-5.25

Amends the Illinois Insurance Code. Requires an individual or group policy of accident and health insurance that provides telehealth services to provide reimbursement for such services at the same rate that such services are reimbursed for an in-person consultation and to reimburse a facility fee to the originating site. Allows the Director of Insurance to alter the dollar amount of this facility fee, and requires the Director to review the amount of the fee at least once every 5 years. Defines "originating site". Amends the Illinois Public Aid Code. Provides that services provided through telehealth shall be reimbursed at the same rate that such services are reimbursed for an in-person consultation. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning regulation.

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

Section 5. The Illinois Insurance Code is amended by changing Section 356z.22 as follows:

(215 ILCS 5/356z.22)

Sec. 356z.22. Coverage for telehealth services.

(a) For purposes of this Section:

"Distant site" means the location at which the health care provider rendering the telehealth service is located.

"Interactive telecommunications system" means an audio and video system permitting 2-way, live interactive communication between the patient and the distant site health care provider.

"Originating site" means the location at which the patient is located at the time that health care services are provided to the patient by means of telehealth.

"Telehealth services" means the delivery of covered health care services by way of an interactive telecommunications system.

(b) If an individual or group policy of accident or health insurance provides coverage for telehealth services, then it must comply with the following:

(1) An individual or group policy of accident or health insurance providing telehealth services may not:

(A) require that in-person contact occur between a health care provider and a patient;

(B) require the health care provider to document a barrier to an in-person consultation for coverage of services to be provided through telehealth;

(C) require the use of telehealth when the health care provider has determined that it is not appropriate; or

(D) require the use of telehealth when a patient chooses an in-person consultation.

(2) Deductibles, copayments, or coinsurance applicable to services provided through telehealth shall not exceed the deductibles, copayments, or coinsurance required by the individual or group policy of accident or health insurance for the same services provided through in-person consultation.

(3) An individual or group policy of accident or health insurance providing telehealth services shall reimburse telehealth services at the same rate that such services are reimbursed for an in-person consultation.

(4) An individual or group policy of accident or health insurance providing telehealth services shall reimburse the originating site a facility fee of $25 per telehealth service. The Director shall have the power to increase or decrease the dollar amount of this facility fee as the Director deems appropriate and shall review the amount of the fee at least once every 5 years.

(b-5) If an individual or group policy of accident or health insurance provides coverage for telehealth services, it must provide coverage for licensed dietitian nutritionists and certified diabetes educators who counsel senior diabetes patients in the senior diabetes patients' homes to remove the hurdle of transportation for senior diabetes patients to receive treatment.

(c) Nothing in this Section shall be deemed as precluding a health insurer from providing benefits for other services, including, but not limited to, remote monitoring services, other monitoring services, or oral communications otherwise covered under the policy.

(Source: P.A. 100-1009, eff. 1-1-19.)

Section 10. The Illinois Public Aid Code is amended by changing Section 5-5.25 as follows:

(305 ILCS 5/5-5.25)

Sec. 5-5.25. Access to behavioral health and medical services.

(a) The General Assembly finds that providing access to behavioral health and medical services in a timely manner will improve the quality of life for persons suffering from illness and will contain health care costs by avoiding the need for more costly inpatient hospitalization.

(b) The Department of Healthcare and Family Services shall reimburse psychiatrists, federally qualified health centers as defined in Section 1905(l)(2)(B) of the federal Social Security Act, clinical psychologists, clinical social workers, advanced practice registered nurses certified in psychiatric and mental health nursing, and mental health professionals and clinicians authorized by Illinois law to provide behavioral health services to recipients via telehealth. The Department, by rule, shall establish: (i) criteria for such services to be reimbursed, including appropriate facilities and equipment to be used at both sites and requirements for a physician or other licensed health care professional to be present at the site where the patient is located; however, the Department shall not require that a physician or other licensed health care professional be physically present in the same room as the patient for the entire time during which the patient is receiving telehealth services; and (ii) a method to reimburse providers for mental health services provided by telehealth. Services provided through telehealth shall be reimbursed at the same rate that such services are reimbursed for an in-person consultation.

(c) The Department shall reimburse any Medicaid certified eligible facility or provider organization that acts as the location of the patient at the time a telehealth service is rendered, including substance abuse centers licensed by the Department of Human Services' Division of Alcoholism and Substance Abuse.

(d) On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e.

(Source: P.A. 100-385, eff. 1-1-18; 100-790, eff. 8-10-18; 100-1019, eff. 1-1-19; 101-81, eff. 7-12-19.)

Section 99. Effective date. This Act takes effect upon becoming law.