HB3498 102ND GENERAL ASSEMBLY

LRB102 17010 SPS 22432 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3498

Introduced 2/22/2021, by Rep. Deb Conroy - Greg Harris - Norine K. Hammond - Ryan Spain - Bob Morgan

SYNOPSIS AS INTRODUCED:

See Index

Amends the Telehealth Act. Provides that the Act applies to all health insurance coverage offered by health insurance issuers regulated by the Department of Insurance or the Department of Healthcare and Family Services and the medical assistance program authorized under the Illinois Public Aid Code. Provides that any policy, contract, or certificate of health insurance coverage that does not distinguish between in-network and out-of-network providers shall be subject to the Act as though all providers were in-network. Provides that health insurance issuers shall cover all telehealth services rendered by a health care professional to deliver any clinically appropriate, medically necessary covered services. Restricts health insurance issuers from engaging in specified activities. Provides that health care professionals and facilities 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. Changes the term "telehealth" to "telehealth services". Makes corresponding changes. Defines terms. Amends the Illinois Insurance Code. In provisions concerning coverage for telehealth services, makes changes to definitions. Provides that coverage and reimbursement for telehealth services delivered by health care professionals and facilities shall comply with the Telehealth Act. Makes other changes. Amends the Illinois Public Aid Code. Provides that the Department and managed care organizations shall comply with the Telehealth Act and removes provisions concerning behavioral health and medical services via telehealth. Makes other changes. Amends the Illinois Administrative Procedure Act to provide for emergency rulemaking. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning health care.

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

Section 5. The Illinois Administrative Procedure Act is amended by adding Sections 5-45.8, 5-45.9, and 5-45.10 as follows:

(5 ILCS 100/5-45.8 new)

Sec. 5-45.8. Emergency rulemaking; Illinois Insurance Code. To provide for the expeditious and timely implementation of changes made to the Illinois Insurance Code by this amendatory Act of the 102nd General Assembly, emergency rules implementing the changes made to the Illinois Insurance Code by this amendatory Act of the 102nd General Assembly may be adopted in accordance with Section 5-45 by the Department of Insurance. The adoption of emergency rules authorized by Section 5-45 and this Section is deemed to be necessary for the public interest, safety, and welfare.

This Section is repealed on January 1, 2026.

(5 ILCS 100/5-45.9 new)

Sec. 5-45.9. Emergency rulemaking; Telehealth Act. To provide for the expeditious and timely implementation of changes made to the Telehealth Act by this amendatory Act of the 102nd General Assembly, emergency rules implementing the changes made to the Telehealth Act by this amendatory Act of the 102nd General Assembly may be adopted in accordance with Section 5-45 by the Department of Financial and Professional Regulation. The adoption of emergency rules authorized by Section 5-45 and this Section is deemed to be necessary for the public interest, safety, and welfare.

This Section is repealed on January 1, 2026.

(5 ILCS 100/5-45.10 new)

Sec. 5-45.10. Emergency rulemaking; Illinois Public Aid Code. To provide for the expeditious and timely implementation of changes made to the Illinois Public Aid Code by this amendatory Act of the 102nd General Assembly, emergency rules implementing the changes made to the Illinois Public Aid Code by this amendatory Act of the 102nd General Assembly may be adopted in accordance with Section 5-45 by the Department of Healthcare and Family Services. The adoption of emergency rules authorized by Section 5-45 and this Section is deemed to be necessary for the public interest, safety, and welfare.

This Section is repealed on January 1, 2026.

Section 10. 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" has the meaning ascribed to the term "telehealth service" in the Telehealth Act means the delivery of covered health care services by way of an interactive telecommunications system.

(b) Coverage and reimbursement for telehealth services delivered by health care professionals and facilities shall comply with the Telehealth Act. 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.

(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 15. The Telehealth Act is amended by changing Sections 5, 10, and 15 and by adding Sections 20, 25, 30, and 35 as follows:

(225 ILCS 150/5)

Sec. 5. Definitions. As used in this Act:

"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 professional or facility at a distant site that does not require real-time or synchronous interaction between the health care professional 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.

"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 providers a hospice provider, a facility under the ID/DD Community Care Act, community-integrated living arrangements 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.

"Health care professional" includes physicians, physician assistants, optometrists, advanced practice registered nurses, clinical psychologists licensed in Illinois, prescribing psychologists licensed in Illinois, dentists, occupational therapists, pharmacists, physical therapists, clinical social workers, speech-language pathologists, audiologists, hearing instrument dispensers, and mental health professionals and clinicians authorized by Illinois law to provide mental health services. For billing and reimbursement purposes, a "health care professional" means any individual licensed, registered, certified, or authorized to provide health care services in Illinois, including health care professionals billed and reimbursed through a facility bill or claim.

"Health insurance coverage" means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, including, without limitation, behavioral health care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, health maintenance organization contract offered by a health insurance issuer, or under the medical assistance program authorized under the Illinois Public Aid Code.

"Health insurance issuer" means any insurance company, insurance service, or insurance organization, including, without limitation, a health maintenance organization, licensed to engage in the business of insurance in a state and licensed in the State.

"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.

"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 technologies, e-visits, and virtual check-ins as defined in subsection (a) of Section 356z.22 of the Illinois Insurance Code.

"Virtual check-in" means a brief communication using a technology-based service by a health care professional. "Virtual check-in" shall not originate from a related office visit provided within the previous 7 days, nor lead to an office visit or procedure within the next 24 hours or soonest available appointment.

(Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19; 100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff. 7-19-19.)

(225 ILCS 150/10)

Sec. 10. Practice authority. A health care professional treating a patient located in this State through telehealth services must be licensed or authorized to practice in Illinois.

(Source: P.A. 100-317, eff. 1-1-18.)

(225 ILCS 150/15)

Sec. 15. Use of telehealth services. A health care professional may engage in the practice of telehealth services in Illinois to the extent of his or her scope of practice as established in his or her respective licensing Act consistent with the standards of care for in-person services. This Act shall not be construed to alter the scope of practice of any health care professional or authorize the delivery of health care services in a setting or in a manner not otherwise authorized by the laws of this State.

(Source: P.A. 100-317, eff. 1-1-18.)

(225 ILCS 150/20 new)

Sec. 20. Applicability.

(a) This Act applies to all health insurance coverage offered by health insurance issuers regulated by the Department of Insurance or the Department of Healthcare and Family Services and the medical assistance program authorized under the Illinois Public Aid Code that is amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 102nd General Assembly.

(b) Any policy, contract, or certificate of health insurance coverage that does not distinguish between in-network and out-of-network providers shall be subject to this Act as though all providers were in-network.

(225 ILCS 150/25 new)

Sec. 25. Coverage for telehealth services.

(a) Health insurance issuers shall cover all telehealth services rendered by a health care professional to deliver any clinically appropriate, medically necessary covered services and treatments to insureds, enrollees, and members under each policy, contract, or certificate of health insurance coverage in the same manner as any other benefits covered under the policy. Reimbursement to a health care provider for telehealth services 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. Health insurance issuers shall include reasonable compensation to a facility that serves as the originating site at the time a telehealth service is rendered.

(b) To ensure telehealth service access is equitable for all patients in receipt of health care services under this Act and healthcare professionals and facilities are able to deliver services within the scope of their licensure or certification, health insurance issuers shall not:

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

(2) require patients, health care professionals, or facilities to prove a hardship or access barrier prior to the approval of telehealth services for coverage or reimbursement;

(3) negotiate different contract rates for telehealth services and in-person services;

(4) require health care professionals or facilities to offer or provide telehealth services;

(5) require patients to use telehealth services or require patients to use a separate panel of health care professionals or facilities to receive telehealth service coverage and reimbursement; and

(6) impose upon telehealth services utilization review requirements that are unnecessary, duplicative, or unwarranted, nor 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.

(c) There shall be no restrictions on originating site requirements for telehealth coverage or reimbursement to the distant site under this Act.

(d) Services provided by telehealth pursuant to this Section shall be consistent with all federal and State privacy, security, and confidentiality laws.

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

(225 ILCS 150/30 new)

Sec. 30. Permissible use of communication technologies and locations. Health care professionals and facilities 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.

(225 ILCS 150/35 new)

Sec. 35. Rulemaking authority. The Department of Financial and Professional Regulation, Department of Insurance, and Department of Healthcare and Family Services may adopt rules, including emergency rules in accordance with the Illinois Administrative Procedure Act, to implement the provisions of this Act.

Section 20. 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. The Department and managed care organizations shall comply with the Telehealth Act.

(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.

(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.