HB3308ham001 102ND GENERAL ASSEMBLY

Rep. Thaddeus Jones

Filed: 3/22/2021

10200HB3308ham001 LRB102 11877 BMS 24127 a

AMENDMENT TO HOUSE BILL 3308

AMENDMENT NO. ______. Amend House Bill 3308 by replacing everything after the enacting clause with the following:

"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:

"Asynchronous store and forward system" means the transmission of a patient's medical information through an electronic communications system at an originating site to a health care provider at a distant site that does not require real-time or synchronous interaction between the health care provider and the patient.

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

"E-visits" means non-face-to-face communications through an online patient portal with a health care professional. "E-visits" only include communications involving a health care professional's evaluation and management where the initial inquiry is initiated by an established patient and the cumulative duration of which is at least as long as the cumulative time ranges provided in the most currently applicable Current Procedural Terminology or Healthcare Common Procedure Coding System codes designated for e-visits.

"Facility" includes a facility that is owned or operated by a hospital under the Hospital Licensing Act or University of Illinois Hospital Act, a facility under the Nursing Home Care Act, a rural health clinic, a federally qualified health center, a local health department, a community mental health center, a behavioral health clinic, an encounter rate clinic, a skilled nursing facility, a substance use treatment program licensed by the Department of Human Services' Division of Substance Use Prevention and Recovery, a school-based health center as defined in 77 Ill. Adm. Code 641.10, a physician's office, a podiatrist's office, a supportive living program provider, a hospice provider, a facility under the ID/DD Community Care Act, a community-integrated living arrangement as defined in the Community-Integrated Living Arrangements Licensure and Certification Act, and a provider who receives reimbursement for a patient's room and board.

"Interactive telecommunications system" means an audio and video system, an audio-only telephone system (landline or cellular), or any other telecommunications system permitting 2-way, synchronous interactive communication between the patient at an originating site and the health care professional or facility at a distant site 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 health care services are provided to the patient via telehealth.

"Remote patient monitoring" means the use of digital technologies to collect medical and other health data from a patient at an originating site and electronically transmit that data to a health care professional or facility at a distant site.

"Telehealth services" means the evaluation, diagnosis, or interpretation of electronically transmitted patient-specific data between a remote location and a licensed health care professional that generates interaction or treatment recommendations. "Telehealth services" includes telemedicine and the delivery of health care services, mental health treatment, and substance use disorder treatment to a patient, regardless of his or her location, provided by way of an interactive telecommunications system, including telephone or video technology, asynchronous store and forward system, remote patient monitoring technology, e-visit, and virtual check-in delivery of covered health care services by way of an interactive telecommunications system.

"Virtual check-in" means a brief, patient-initiated communication with a health care professional that involves an interactive telecommunications system to deliver an individualized clinical diagnosis, treatment, assessment, or guidance to an established patient. "Virtual check-in" only includes communications involving medical discussions that last at least as long as the time ranges provided in the most currently applicable Current Procedural Terminology or Healthcare Common Procedure Coding System codes designated for virtual check-ins. "Virtual check-in" does not include a communication that originates from a related office visit provided within the previous 7 days, nor a communication that leads to an office visit or procedure within the next 24 hours or the soonest available appointment.

(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 in the same manner as any other benefits covered under the policy. Reimbursement to a health care provider for telehealth services for behavioral health services, including mental health treatment and substance use disorder treatment, provided through an interactive telecommunications system shall be made on the same basis, in the same manner, and at the same rate as would be applied for the same services if they had been delivered in-person and shall include reasonable compensation to a facility that serves as the originating site at the time a telehealth service is rendered. , then it must comply with the following:

(1) With respect to telehealth benefits provided in an An individual or group policy of accident or health insurance, insurers 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; .

(E) require patients to use a separate panel of health care providers to receive telehealth service coverage and reimbursement;

(F) create geographic or facility restrictions or requirements for telehealth services; procedure code modifiers may be required to document telehealth use;

(G) require patients or health care providers to prove a hardship or access barrier before the approval of telehealth services for coverage or reimbursement;

(H) negotiate different contract rates for telehealth services and in-person services for behavioral health services, including mental health treatment and substance use disorder treatment; or

(I) impose upon telehealth services utilization review requirements that are unnecessary, duplicative, or unwarranted or impose any treatment limitations, prior authorization, documentation, or recordkeeping requirements that are more stringent than the requirements applicable to the same health care service when rendered in-person.

(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. Health care providers shall determine the appropriateness of specific sites, technology platforms, and technology vendors for a telehealth service, as long as delivered services adhere to privacy laws, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 and the Mental Health and Developmental Disabilities Confidentiality Act.

(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.)".