HB3308 102ND GENERAL ASSEMBLY

LRB102 11877 BMS 17213 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3308

Introduced 2/19/2021, by Rep. Thaddeus Jones

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.22

Amends the Illinois Insurance Code. Includes the delivery of covered health care services by way of telephone usage in the definition of "telehealth services". Provides that health care services that are covered under an individual or group policy of accident or health insurance must be covered when delivered via telehealth services when clinically appropriate, subject to specified conditions (rather than requiring an individual or group policy of accident or health insurance to comply with specified conditions if it provides coverage for telehealth services). Provides that patient cost-sharing may be no more than if the health care service were delivered in person. Provides that no excepted benefit policy may deny or reduce any benefit to a patient based on the use of clinically appropriate telehealth services in the course of satisfying the policy's benefit criteria.

FISCAL NOTE ACT MAY APPLY

STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

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.

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

(b) Health care services that are covered under If an individual or group policy of accident or health insurance must be covered when delivered via provides coverage for telehealth services when clinically appropriate, subject to then it must comply with the following:

(1) Telehealth benefits provided in an 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) Patient cost-sharing may be no more than if the health care service were delivered in person. 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.

(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.

(d) Notwithstanding Section 352b of this Code, an excepted benefit policy is subject to this Section if the policy covers the patient's use of health care services, whether on an expense-incurred or a per capita prepaid basis or otherwise. This Section does not apply to an excepted benefit policy with respect to lump-sum or periodic payments that the policy covers based on the occurrence of a diagnosis with a specified disease, an accident, or other qualifying health condition, nor does this Section apply to lump sum or periodic payments for expenses other than health care services. However, no policy may deny or reduce any benefit to a patient based on the use of clinically appropriate telehealth services in the course of satisfying the policy's benefit criteria.

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