SB2366 98TH GENERAL ASSEMBLY

LRB098 07932 RPM 38020 b

98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
SB2366

Introduced 2/15/2013, by Sen. Don Harmon

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.22 new

Amends the Illinois Insurance Code. Sets forth the General Assembly's findings and declarations concerning telehealth. Sets forth provisions concerning definitions and applicability. Provides that an entity subject to the provision concerning telehealth (1) shall provide coverage under a health insurance policy or contract for health care services appropriately delivered through telehealth, (2) may not exclude from coverage a health care service solely because it is provided through telehealth and is not provided through an in-person consultation or contact between a health care provider and a patient, and (3) shall not require that in-person contact occur between a health care provider and a patient before payment is made for the covered services appropriately provided through telehealth. Sets forth provisions concerning reimbursement, teleophthalmology, the requirements for telehealth and telepsychiatry services, and medical records documenting the telehealth services.

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 adding Section 356z.22 as follows:

(215 ILCS 5/356z.22 new)

Sec. 356z.22. Telehealth.

(a) The General Assembly finds and declares the following:

(1) Lack of primary care providers, specialty providers, and transportation continue to be significant barriers to access to health services in medically underserved rural and urban areas.

(2) Parts of Illinois have difficulty attracting and retaining health professionals, as well as supporting local health facilities to provide a continuum of health care.

(3) Individuals in rural areas are much less likely to have access to the specialty health services they need, due to major distance and time barriers, transportation limitations, or mobility limitations, all of which lead to disparities in access to care.

(4) Hospital emergency rooms have become the default provider of health care to patients with acute crises and for whom no appropriate alternatives are available, and the majority of emergency rooms do not have reliable, ready consultative access to psychiatrists or other medical specialties.

(5) Telehealth has been shown to be an effective medium through which to deliver physical health and mental health care.

(6) Key findings from the Illinois Rural Health Association's Mental Health Access Forum Report recommend the increased use of telehealth and technology to improve access to care, increase training opportunities, and evaluate quality of care.

(7) The State of Illinois has already recognized, and currently reimburses providers for, telepsychiatry services to patients receiving State public aid.

(8) Telehealth is a mode of delivering health care services of a personal, family, and public health nature through utilizing information and communication technologies to enable the examination, diagnosis, consultation, treatment, education, care management, and self-management of patients at a distance from health care providers.

(9) The use of information and telecommunication technologies to deliver health services has the potential to reduce costs, improve quality, change the conditions of practice, and improve access to health care, particularly in rural and other medically underserved areas, as well as in emergency rooms in large urban areas where the wait for specialty care can be lengthy.

(10) Telehealth will assist in maintaining or improving the physical and economic health of medically underserved communities by keeping the source of medical care in the local area by assisting primary care physicians, strengthening the health infrastructure, and preserving health care-related jobs.

(11) Consumers of health care will benefit from telehealth in many ways, including expanded access to providers, faster and more convenient treatment, better continuity of care, reduction of lost work time and travel costs, and the ability to remain with support networks.

(12) It is the intent of the General Assembly that the fundamental health care provider-patient relationship not only be preserved, but also be augmented and enhanced, through the use of telehealth as a tool to be integrated into practices.

(13) Without the assurance of payment and the resolution of legal and policy barriers, the full potential of telehealth will not be realized.

The purpose of this Section is to require certain insurers, nonprofit health service plans, managed care organizations, and health maintenance organizations to provide coverage for health care services delivered through telehealth in a certain manner; prohibit certain insurers, nonprofit health service plans, health maintenance organizations and managed care organizations from excluding a health care service from coverage solely because it is delivered by telehealth and not in another manner; require certain insurers, nonprofit health service plans, and health maintenance organizations to reimburse health care providers for certain services under certain circumstances; authorize the imposition of a deductible, copayment, coinsurance amount, or annual dollar maximum for certain services; prohibit the imposition of a lifetime dollar maximum for certain services; prohibit a health insurance policy or contract from distinguishing between patients in rural or urban locations in providing certain coverage; and provide for the application of this Code.

(b) For the purposes of this Section:

"Asynchronous store and forward" means the transmission of a patient's medical information from an originating site to the health care provider at a distant site without the presence of the patient.

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

"Facility fee" means the reimbursement made to the following originating sites for the telehealth service: physician's office, local health departments, community mental health centers, outpatient hospitals, and substance abuse treatment centers licensed by the Division of Alcoholism and Substance Abuse of the Department of Human Services.

"Interactive telecommunications system" means multimedia communications equipment that includes, at a minimum, audio and video equipment permitting 2-way, real-time interactive communication between the patient and the distant site provider. Telephones, facsimile machines, and electronic mail systems do not meet the definition of "interactive telecommunications system".

"Originating site" means the location at which the participant receiving the service is located.

"Synchronous interaction" means a real-time interaction between a patient and a health care provider located at a distant site.

"Telecommunication system" means an asynchronous store and forward technology or an interactive telecommunications system, or both, that is used to transmit data between the originating and distant sites.

"Telehealth" means (1) the provision of services and the mode of delivering health care services and public health via information and communication technologies to facilitate the examination, diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the health care provider is at a distant site; telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers and (2) as it relates to the delivery of health care, mental health care, and public health services, the use of interactive audio, video, or other telecommunications or electronic technology by a licensed health care provider to deliver a health care service within the scope of practice of the health care provider from the distant site to the originating site at which the patient is located; telehealth is the provision of services via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the health care provider is at a distant site; telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers. "Telehealth" does not include:

(A) an audio-only telephone conversation between a health care provider and a patient;

(B) an electronic mail message between a health care provider and a patient; or

(C) a facsimile transmission between a health care provider and a patient.

"Teleophthalmology and teledermatology by store and forward" means an asynchronous transmission of medical information to be reviewed at a later time by a physician at a distant site who is trained in ophthalmology or dermatology or, for teleophthalmology, by an optometrist who is licensed pursuant to the Illinois Optometric Practice Act of 1987 where the physician or optometrist at the distant site reviews the medical information without the patient being present in real time.

(c) This Section applies to:

(1) insurers and nonprofit health service plans that provide hospital, medical, mental health, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies or contracts that are issued or delivered in this State; and

(2) health maintenance organizations that provide hospital, medical, mental health, or surgical benefits to individuals or groups under contracts that are issued or delivered in this State.

This Section shall not be construed to alter the scope of practice of any health care provider or authorize the delivery of health care services in a setting or in a manner not otherwise authorized by law. All laws regarding the confidentiality of health care information and a patient's rights to his or her medical information shall apply to telehealth interactions. This Section applies to a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 98th General Assembly.

(d) An entity subject to this Section:

(1) shall provide coverage under a health insurance policy or contract for health care services appropriately delivered through telehealth;

(2) may not exclude from coverage a health care service solely because it is provided through telehealth and is not provided through an in-person consultation or contact between a health care provider and a patient; and

(3) shall not require that in-person contact occur between a health care provider and a patient before payment is made for the covered services appropriately provided through telehealth.

No health care service plan shall require the health care provider to document a barrier to an in-person visit for coverage of services to be provided via telehealth. No health care service plan shall limit the type of setting where services are provided for the patient or by the health care provider before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee or subscriber and the health care service plan and its participating providers or provider groups.

Notwithstanding any other provision, this Section shall not be interpreted to authorize a health care service plan to require the use of telehealth when the health care provider has determined that it is not appropriate.

(e) With regard to reimbursement, an entity subject to this Section:

(1) shall reimburse a health care provider for the examination, diagnosis, consultation, and treatment of an insured patient for a health care service covered under a health insurance policy or contract that can appropriately be provided through telehealth;

(2) is not required to:

(A) reimburse a health care provider for a health care service delivered in person or through telehealth that is not a covered benefit under the health insurance policy or contract; or

(B) reimburse a health care provider who is not a covered provider under the health insurance policy or contract;

(3) may impose the same deductible, copayment, or coinsurance amount on benefits for health care services that are delivered through an in-person consultation or through telehealth; and

(4) may not impose a lifetime dollar maximum.

A facility fee shall be paid to providers. Participating providers shall be reimbursed for the appropriate current procedural terminology (CPT) code for the telehealth service rendered.

(f) A patient receiving teleophthalmology and teledermatology by store and forward shall be notified of the right to receive interactive communication with the distant specialist physician or optometrist, and shall receive an interactive communication with the distant specialist physician or optometrist upon request. If requested, communication with the distant specialist physician or optometrist may occur either at the time of the consultation or within 30 days after the patient's notification of the results of the consultation. If the reviewing optometrist identifies a disease or condition requiring consultation or referral, then that consultation or referral shall be with an ophthalmologist or other appropriate physician and surgeon as required.

(g) The requirements for telehealth services are as follows:

(1) A physician or other licensed health care professional must be present at all times with the patient at the originating site.

(2) The distant site provider must be a physician or advanced practice nurse who is licensed by the State of Illinois or by the state where the patient is located.

(3) Medical data may be exchanged through a telecommunication system.

(4) The interactive telecommunications system must, at a minimum, have the capability of allowing the consulting physician to examine the patient sufficiently to allow proper diagnosis of the involved body system. The system must also be capable of transmitting clearly audible heart tones and lung sounds as well as clear video images of the patient and any diagnostic tools such as radiographs.

(h) The requirements for telepsychiatry services are as follows:

(1) A physician or other licensed clinician as defined in Section 132.25 of Title 59 of the Illinois Administrative Code must be present at all times with the patient at the originating site.

(2) The distant site provider must be a physician licensed by the State of Illinois or by the state where the patient is located and must have completed or be registered in and supervised by a physician who has completed an approved general psychiatry residency program. When treating patients age 16 and younger, the physician must have also completed an approved child and adolescent residency program or be registered in an approved general psychiatry residency program or a child and adolescent psychiatry fellowship program and supervised by a physician who has completed an approved child and adolescent psychiatry fellowship program. The distant site provider must personally render the telepsychiatry service. Telepsychiatry services must be rendered using an interactive telecommunications system.

Group psychotherapy is a covered telepsychiatry service.

(i) Medical records documenting the telehealth services provided must be maintained by the originating and distant sites and shall include, but not be limited to, the following:

(1) the record requirements as provided in Section 140.28 of Title 89 of the Illinois Administrative Code;

(2) the name and license number of the physician or other health care professional present with the patient at the originating site;

(3) the name and license number of the provider at the distant site and, if the service involves telepsychiatry, documentation that the physician has completed an approved general psychiatry residency program;

(4) the location of the originating and distant sites;

(5) the date and the beginning and ending times of the telehealth service;

(6) the medical necessity for the telehealth service; and

(7) the model or type of interactive telecommunications system utilized at the originating and distant sites.

When the originating site is a federally qualified health center, rural health center, or encounter clinic, records from the distant site must also be maintained. Appropriate steps must be taken by the originating and distant site staff to ensure patient confidentiality, based on technical advances.