SB0458sam001 100TH GENERAL ASSEMBLY

Sen. Andy Manar

Filed: 4/24/2018

10000SB0458sam001 LRB100 05002 SMS 38600 a

AMENDMENT TO SENATE BILL 458

AMENDMENT NO. ______. Amend Senate Bill 458 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:

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

"Health care provider" means a health care provider licensed in Illinois.

"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. "Interactive telecommunication system" does not include a telephone, facsimile machine, or electronic mail system. an audio and video system 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 receiving the service is located.

"Telehealth" means the use of telecommunications services to encompass 4 modalities: store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include, but not be limited to, real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site. "Telehealth" includes telepsychiatry and telemedicine. "Telehealth" does not include a standard telephone contact, facsimile transmission, or e-mail text, in combination or by itself.

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

"Telepsychiatry" means the use of a telecommunication system to provide psychiatric services for the purpose of evaluation and treatment when the patient is at one medical provider location and the rendering provider is at another location.

(b) This Section applies to an individual or group policy of insurance issued, amended, renewed, delivered, continued, or executed on or after the effective date of this amendatory Act of the 100th General Assembly that pays health benefits, including, but not limited to, such health benefit policies or plans as:

(1) the fee-for-service and managed care medical assistance programs under Article V of the Illinois Public Aid Code;

(2) professional liability coverage plans and policies;

(3) accident, health, or sickness coverage plans and policies;

(4) mutual benefit society plans and policies;

(5) automobile medical benefits plans and policies;

(6) plans and policies subject to the federal Employee Retirement Income Security Act of 1974;

(7) third-party administrator plans and policies;

(8) travel insurance medical benefits plans and policies;

(9) supplemental insurance plans and policies;

(10) life care contracts, plans, and policies;

(11) accident-only plans and policies;

(12) specified disease plans and policies;

(13) hospital plans and policies providing fixed daily benefits only;

(14) Medicare supplemental plans and policies;

(15) long-term care plans and policies;

(16) short-term major medical plans and policies of 6 months' duration or less;

(17) hospital indemnity plans or policies; and

(18) any other supplemental health plan or policy.

(c) Any payment or reimbursement made to a health benefit policy or plan for a service delivered through telehealth or telepsychiatry, as provided under this Section, shall be made on the same basis and at the same rate as established for similar services that are not delivered through telehealth.

(d) All telehealth services provided under this Section shall meet the following requirements:

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

(2) The interactive telecommunication system must, at a minimum, have the capability of allowing the consulting distant site provider to examine the patient sufficiently to allow proper diagnosis of the involved body system when necessary and appropriate. 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, when necessary and appropriate.

(3) An in-person visit between a patient and a health care provider prior to the delivery of telehealth services shall not be required.

(4) No patient shall be required to give his or her consent or informed consent before the delivery of services through telehealth.

(5) A telepresenter shall not be required to be present with the patient unless medically necessary.

(e) Benefits for a service provided through telehealth required by this Section may be made subject to a deductible, copayment, or coinsurance as long as the deductible, copayment, or coinsurance required does not exceed the deductible, copayment, or coinsurance requirement of the policy or health benefit plan for the same service provided through in-person care.

(f) Record for telehealth services shall meet the following requirements:

(1) Medical records documenting the telehealth services provided must be maintained by the originating site. No originating and distant site shall be required to maintain or present as a condition of payment any additional medical records to document the telehealth services provided other than what is required under applicable State or federal law.

(2) Appropriate steps must be taken by the originating and distant site staff to ensure patient confidentiality, based on technical advances in compliance with all federal and State privacy and confidentiality laws.

(3) The billing records related to the use of the telecommunication system shall be maintained.

(g) Nothing in this Section precludes a health benefit policy or plan from undertaking utilization review to determine the appropriateness of telehealth as a means of delivering a health care service, provided that the determination is made in the same manner as those regarding the same service when it is delivered in person.

(h) Notwithstanding any other provision of law, this Section does not authorize a health benefit policy or plan to require the use of telehealth when the health care provider has determined that telehealth is not appropriate. In addition, no health care provider shall be required to use telehealth when the health care provider has deemed the use of telehealth to be inappropriate for a patient, nor shall a patient be required to use telehealth when the patient chooses in-person care.

(b) 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.

(i) (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. 98-1091, eff. 1-1-15.)

Section 10. The Illinois Public Aid Code is amended by adding Section 5-5.25a as follows:

(305 ILCS 5/5-5.25a new)

Sec. 5-5.25a. Telehealth services.

(a) Definitions. As used in this Section:

"Asynchronous store and forward technology" means the transmission of a patient's medical information from an originating site to the provider at the distant site. The provider at the distant site can review the medical case without the patient being present. An asynchronous telecommunication system in single media format does not include telephone calls, images transmitted through facsimile machines, and text messages without visualization of the patient (electronic mail). Photographs visualized by a telecommunication system must be specific to the patient's medical condition and adequate for furnishing or confirming a diagnosis or treatment plan. Dermatological photographs (for example, a photograph of a skin lesion) may be considered to meet the requirement of a single media format under this Section.

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

"Encounter clinic" means a federally qualified health center, rural health clinic, or encounter rate clinic, as defined in 89 Ill. Adm. Code 140.461.

"Facility fee" means the reimbursement made to any Illinois Medicaid participating health care organization or Illinois Medicaid participating provider as originating sites.

"Illinois Medicaid participating provider" means any health care provider, including a licensed clinical social worker, a licensed clinical psychologist, a licensed advanced practice registered nurse with psychiatric specialty, a licensed nutritionist, or any other certified nutrition professional, who is eligible to participate in the State's fee-for-service or managed care medical assistance program and who is employed by an Illinois Medicaid participating health care organization.

"Illinois Medicaid participating health care organization" means any health care organization that is eligible to participate in the State's fee-for-service or managed care medical assistance program and that has a corporate office located in the State of Illinois.

"Interactive telecommunication 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. "Interactive telecommunication system" does not include a telephone, facsimile machine, or electronic mail system.

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

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

"Telehealth" means the use of telecommunications services to encompass 4 modalities: store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include, but not be limited to, real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site. "Telehealth" includes telepsychiatry and telemedicine. "Telehealth" does not include a standard telephone contact, facsimile transmission, or e-mail text, in combination or by itself.

"Telemedicine" means the use of a telecommunication system to provide medical services for the purpose of evaluation and treatment when the patient is at one provider location and the rendering provider is at another location.

"Telepsychiatry" means the use of a telecommunication system to provide psychiatric services for the purpose of evaluation and treatment when the patient is at one medical provider location and the rendering provider is at another location.

(b) Payment. Any payment or reimbursement made under the fee-for-service or managed care medical assistance program for a service delivered through telehealth or telepsychiatry, as provided under this Section, shall be made on the same basis and at the same rate as established for similar services that are not delivered through telehealth. All Medicaid managed care plans issued, amended, renewed, delivered, continued, or executed shall comply with the provisions of this Section.

(c) Telehealth services requirements. All telehealth services provided under this Section shall meet the following requirements:

(1) The distant site provider must be an eligible Illinois Medicaid participating provider or Illinois Medicaid participating health care organization

(2) The originating and distant site provider must not be terminated, suspended, or barred from the State's fee-for-service or managed care medical assistance program.

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

(4) The interactive telecommunication system must, at a minimum, have the capability of allowing the consulting distant site provider to examine the patient sufficiently to allow proper diagnosis of the involved body system when necessary and appropriate. 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, when necessary and appropriate.

(d) Telehealth service prohibitions.

(1) An in-person visit between a patient and a health care provider prior to the delivery of telehealth services shall not be required for medical assistance coverage under the State's fee-for-service or managed care medical assistance program.

(2) No patient shall be required to give his or her consent or informed consent before the delivery of services through telehealth.

(3) A telepresenter shall not be required to be present with the patient unless medically necessary.

(e) Reimbursement for telehealth services.

(1) Originating site reimbursement.

(A) A facility fee shall be paid to providers as defined in subsection (a) of this Section.

(B) Local education agencies may submit telehealth services as a certified expenditure.

(C) All Illinois Medicaid participating health care organizations and providers that receive reimbursement for a patient's room and board shall also receive the facility fee.

(2) Reimbursement for encounter clinics. An encounter clinic serving as the originating site shall be reimbursed for its medical encounter on the same basis and at the same rate as established for Illinois Medicaid participating providers and Illinois Medicaid participating health care organizations for the delivery of telehealth services as provided under this Section.

(3) Reimbursement for rendering provider at the distant site.

(A) Participating providers shall be reimbursed for the appropriate Current Procedural Terminology code for the telehealth service rendered.

(B) Nonparticipating providers may be reimbursed by the originating site provider but shall not be eligible for reimbursement from the Department.

(f) Copayments. Benefits for a service provided through telehealth as required under this Section may be made subject to a deductible, copayment, or coinsurance as long as the deductible, copayment, or coinsurance required does not exceed any deductible, copayment, or coinsurance established under the fee-for-service or managed care medical assistance program for the same service provided during an in-person visit.

(g) Record requirements for telehealth services.

(1) Medical records documenting the telehealth services provided must be maintained by the originating site in accordance with the requirements under 89 Ill. Adm. Code. 140.28. No originating and distant site shall be required to maintain or present as a condition of payment any additional medical records to document the telehealth services provided other than what is required under applicable State or federal law.

(2) Appropriate steps must be taken by the originating and distant site staff to ensure patient confidentiality, based on technical advances in compliance with all federal and State privacy and confidentiality laws.

(3) The billing records related to the use of the telecommunication system shall be maintained as provided in 89 Ill. Adm. Code 140.28.

(h) Implementation. The Department shall apply for any federal waivers or approvals necessary to implement the provisions of this Section. Implementation of this Section shall be contingent on the receipt of all necessary federal waivers or approvals. Upon receipt of all necessary federal waivers or approvals, the Department shall implement the provisions of this Section 60 days after the date federal approval is received or 60 days after the effective date of this amendatory Act of the 100th General Assembly, whichever is later.

(305 ILCS 5/5-5.25 rep.)

Section 15. The Illinois Public Aid Code is amended by repealing Section 5-5.25.".