HB3759 102ND GENERAL ASSEMBLY

LRB102 10851 BMS 22336 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3759

Introduced 2/22/2021, by Rep. Ryan Spain

SYNOPSIS AS INTRODUCED:

New Act

Creates the Telehealth Parity Act. Requires all health insurance issuers regulated by the Department of Insurance to cover the costs of all telehealth services rendered by in-network providers 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. Provides that health insurance issuers shall not impose upon telehealth services utilization review requirements that are unnecessary, duplicative, or unwarranted nor impose any treatment limitations that are more stringent than the requirements applicable to the same health care service when rendered in-person. Provides that, for telehealth services that relate to COVID-19 delivered by in-network providers, health insurance issuers shall not impose any prior authorization requirements. Contains provisions prohibiting cost-sharing for telehealth services, describing eligible services, and allowing use of non-public facing remote communication products under certain circumstances. Effective immediately.

A BILL FOR

AN ACT concerning regulation.

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

Section 1. Short title. This Act may be cited as the Telehealth Parity Act.

Section 5. Applicability.

(a) This Act applies to policies issued by a health insurance issuer as defined in Section 10 of this Act, but does not apply to excepted benefits as defined in 45 CFR 146.145(b) and 45 CFR 148.220, but does apply to limited scope dental benefits, limited scope vision benefits, long-term care benefits, coverage only for accidents, and coverage only for specified disease or illness.

(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.

Section 10. Definitions. As used in this Act:

"Health insurance coverage" has the meaning given to that term in Section 5 of the Illinois Health Insurance Portability and Accountability Act.

"Health insurance issuer" means an insurance company, insurance service, or insurance organization, including health maintenance organization, that is licensed to engage in the business of insurance in a state and that is subject to Illinois law that regulates insurance (within the meaning of Section 514(b)(2) of the Employee Retirement Income Security Act of 1974).

"Telehealth services" means the provision of health care, psychiatry, mental health treatment, substance use disorder treatment, and related services to a patient, regardless of his or her location, through electronic or telephonic methods, such as telephone (landline or cellular), video technology commonly available on smart phones and other devices, and videoconferencing, as well as any method within the meaning of telehealth services under Section 356z.22 of the Illinois Insurance Code.

Section 15. Coverage for telehealth services.

(a) All health insurance issuers regulated by the Department of Insurance shall cover the costs of all telehealth services rendered by in-network providers 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.

(b) Health insurance issuers may establish reasonable requirements and parameters for telehealth services, including with respect to documentation and recordkeeping, to the extent consistent with this Act or any company bulletin issued by the Department of Insurance under Executive Order 2020-09. A health insurance issuer's requirements and parameters may not be more restrictive or less favorable toward providers, insureds, enrollees, or members than those contained in the emergency rulemaking undertaken by the Department of Healthcare and Family Services at 89 Ill. Adm. Code 140.403(e). Health insurance issuers shall notify providers of any instructions necessary to facilitate billing for telehealth services.

Section 20. Prior authorization and utilization review requirements.

(a) In order to ensure that health care is quickly and efficiently provided to the public, health insurance issuers shall not impose upon telehealth services utilization review requirements that are unnecessary, duplicative, or unwarranted nor impose any treatment limitations that are more stringent than the requirements applicable to the same health care service when rendered in-person.

(b) For telehealth services that relate to COVID-19 delivered by in-network providers, health insurance issuers shall not impose any prior authorization requirements.

Section 25. Cost-sharing prohibited. Health insurance issuers shall not impose any cost-sharing (copayments, deductibles, or coinsurance) for telehealth services provided by in-network providers. However, in accordance with the standards and definitions in 26 U.S.C. 223, if an enrollee in a high-deductible health plan has not met the applicable deductible under the terms of his or her coverage, the requirements of this Section do not require an issuer to pay for a charge for telehealth services unless the associated health care service for that particular charge is deemed preventive care by the United States Department of the Treasury. The federal Internal Revenue Service has recognized that services for testing, treatment, and any potential vaccination for COVID-19 fall within the scope of preventive care.

Section 30. Eligible services. Services eligible under this Act include services provided by any professional, practitioner, clinician, or other provider who is licensed, certified, registered, or otherwise authorized to practice in the State where the patient receives treatment, subject to the provisions of the Telehealth Act for any health care professional, as defined in the Telehealth Act, who delivers treatment through telehealth to a patient located in this State, and substance use disorder professionals and clinicians authorized by Illinois law to provide substance use disorder services.

Section 35. Permissible use of non-public facing audio or video communication technologies. Notwithstanding the requirements of the Mental Health and Developmental Disabilities Confidentiality Act, any provider or covered entity of any licensure or area of practice subject to this Act that uses audio or video communication technology to deliver services may use any non-public facing remote communication product in accordance with this Act to the extent permitted by the U.S. Department of Health and Human Services under the federal Health Insurance Portability and Accountability Act of 1996. Providers and covered entities shall, to the extent feasible, notify patients that third-party applications potentially introduce privacy risks. Providers shall enable all available encryption and privacy modes when using such applications. A public facing video communication application may not be used in the provision of telehealth services by covered health care providers or covered entities.

Section 40. Rulemaking authority. The Department of Insurance may adopt rules to implement the provisions of this Act.

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