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.


LRB102 17010 SPS 22432 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB3498LRB102 17010 SPS 22432 b

1    AN ACT concerning health care.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Administrative Procedure Act is
5amended by adding Sections 5-45.8, 5-45.9, and 5-45.10 as
6follows:
 
7    (5 ILCS 100/5-45.8 new)
8    Sec. 5-45.8. Emergency rulemaking; Illinois Insurance
9Code. To provide for the expeditious and timely implementation
10of changes made to the Illinois Insurance Code by this
11amendatory Act of the 102nd General Assembly, emergency rules
12implementing the changes made to the Illinois Insurance Code
13by this amendatory Act of the 102nd General Assembly may be
14adopted in accordance with Section 5-45 by the Department of
15Insurance. The adoption of emergency rules authorized by
16Section 5-45 and this Section is deemed to be necessary for the
17public interest, safety, and welfare.
18    This Section is repealed on January 1, 2026.
 
19    (5 ILCS 100/5-45.9 new)
20    Sec. 5-45.9. Emergency rulemaking; Telehealth Act. To
21provide for the expeditious and timely implementation of
22changes made to the Telehealth Act by this amendatory Act of

 

 

HB3498- 2 -LRB102 17010 SPS 22432 b

1the 102nd General Assembly, emergency rules implementing the
2changes made to the Telehealth Act by this amendatory Act of
3the 102nd General Assembly may be adopted in accordance with
4Section 5-45 by the Department of Financial and Professional
5Regulation. The adoption of emergency rules authorized by
6Section 5-45 and this Section is deemed to be necessary for the
7public interest, safety, and welfare.
8    This Section is repealed on January 1, 2026.
 
9    (5 ILCS 100/5-45.10 new)
10    Sec. 5-45.10. Emergency rulemaking; Illinois Public Aid
11Code. To provide for the expeditious and timely implementation
12of changes made to the Illinois Public Aid Code by this
13amendatory Act of the 102nd General Assembly, emergency rules
14implementing the changes made to the Illinois Public Aid Code
15by this amendatory Act of the 102nd General Assembly may be
16adopted in accordance with Section 5-45 by the Department of
17Healthcare and Family Services. The adoption of emergency
18rules authorized by Section 5-45 and this Section is deemed to
19be necessary for the public interest, safety, and welfare.
20    This Section is repealed on January 1, 2026.
 
21    Section 10. The Illinois Insurance Code is amended by
22changing Section 356z.22 as follows:
 
23    (215 ILCS 5/356z.22)

 

 

HB3498- 3 -LRB102 17010 SPS 22432 b

1    Sec. 356z.22. Coverage for telehealth services.
2    (a) For purposes of this Section:
3    "Distant site" means the location at which the health care
4provider rendering the telehealth service is located.
5    "Interactive telecommunications system" means an audio and
6video system permitting 2-way, live interactive communication
7between the patient and the distant site health care provider.
8    "Telehealth services" has the meaning ascribed to the term
9"telehealth service" in the Telehealth Act means the delivery
10of covered health care services by way of an interactive
11telecommunications system.
12    (b) Coverage and reimbursement for telehealth services
13delivered by health care professionals and facilities shall
14comply with the Telehealth Act. If an individual or group
15policy of accident or health insurance provides coverage for
16telehealth services, then it must comply with the following:
17        (1) An individual or group policy of accident or
18    health insurance providing telehealth services may not:
19            (A) require that in-person contact occur between a
20        health care provider and a patient;
21            (B) require the health care provider to document a
22        barrier to an in-person consultation for coverage of
23        services to be provided through telehealth;
24            (C) require the use of telehealth when the health
25        care provider has determined that it is not
26        appropriate; or

 

 

HB3498- 4 -LRB102 17010 SPS 22432 b

1            (D) require the use of telehealth when a patient
2        chooses an in-person consultation.
3        (2) Deductibles, copayments, or coinsurance applicable
4    to services provided through telehealth shall not exceed
5    the deductibles, copayments, or coinsurance required by
6    the individual or group policy of accident or health
7    insurance for the same services provided through in-person
8    consultation.
9    (b-5) If an individual or group policy of accident or
10health insurance provides coverage for telehealth services, it
11must provide coverage for licensed dietitian nutritionists and
12certified diabetes educators who counsel senior diabetes
13patients in the senior diabetes patients' homes to remove the
14hurdle of transportation for senior diabetes patients to
15receive treatment.
16    (c) Nothing in this Section shall be deemed as precluding
17a health insurer from providing benefits for other services,
18including, but not limited to, remote monitoring services,
19other monitoring services, or oral communications otherwise
20covered under the policy.
21(Source: P.A. 100-1009, eff. 1-1-19.)
 
22    Section 15. The Telehealth Act is amended by changing
23Sections 5, 10, and 15 and by adding Sections 20, 25, 30, and
2435 as follows:
 

 

 

HB3498- 5 -LRB102 17010 SPS 22432 b

1    (225 ILCS 150/5)
2    Sec. 5. Definitions. As used in this Act:
3    "Asynchronous store and forward system" means the
4transmission of a patient's medical information through an
5electronic communications system at an originating site to a
6health care professional or facility at a distant site that
7does not require real-time or synchronous interaction between
8the health care professional and the patient.
9    "Distant site" means the location at which the health care
10provider rendering the telehealth service is located.
11    "E-visits" means non—face-to-face communications through
12an online patient portal with a health care professional.
13    "Facility" includes a facility that is owned or operated
14by a hospital under the Hospital Licensing Act or University
15of Illinois Hospital Act, a facility under the Nursing Home
16Care Act, a rural health clinic, a federally qualified health
17center, a local health department, a community mental health
18center, a behavioral health clinic, an encounter rate clinic,
19a skilled nursing facility, a substance use treatment program
20licensed by the Department of Human Services' Division of
21Substance Use Prevention and Recovery, a school-based health
22center as defined in 77 Ill. Adm. Code 641.10, a physician's
23office, a podiatrist's office, a supportive living program
24providers a hospice provider, a facility under the ID/DD
25Community Care Act, community-integrated living arrangements
26as defined in the Community-Integrated Living Arrangements

 

 

HB3498- 6 -LRB102 17010 SPS 22432 b

1Licensure and Certification Act, and a provider who receives
2reimbursement for a patient's room and board.
3    "Health care professional" includes physicians, physician
4assistants, optometrists, advanced practice registered nurses,
5clinical psychologists licensed in Illinois, prescribing
6psychologists licensed in Illinois, dentists, occupational
7therapists, pharmacists, physical therapists, clinical social
8workers, speech-language pathologists, audiologists, hearing
9instrument dispensers, and mental health professionals and
10clinicians authorized by Illinois law to provide mental health
11services. For billing and reimbursement purposes, a "health
12care professional" means any individual licensed, registered,
13certified, or authorized to provide health care services in
14Illinois, including health care professionals billed and
15reimbursed through a facility bill or claim.
16    "Health insurance coverage" means benefits consisting of
17medical care (provided directly, through insurance or
18reimbursement, or otherwise and including items and services
19paid for as medical care, including, without limitation,
20behavioral health care) under any hospital or medical service
21policy or certificate, hospital or medical service plan
22contract, health maintenance organization contract offered by
23a health insurance issuer, or under the medical assistance
24program authorized under the Illinois Public Aid Code.
25    "Health insurance issuer" means any insurance company,
26insurance service, or insurance organization, including,

 

 

HB3498- 7 -LRB102 17010 SPS 22432 b

1without limitation, a health maintenance organization,
2licensed to engage in the business of insurance in a state and
3licensed in the State.
4    "Interactive telecommunications system" means an audio and
5video system, an audio-only telephone system (landline or
6cellular), or any other telecommunications system permitting
72-way, synchronous interactive communication between the
8patient at an originating site and the health care
9professional or facility at a distant site.
10    "Originating site" means the location at which the patient
11is located at the time health care services are provided to the
12patient via telehealth.
13    "Remote patient monitoring" means the use of digital
14technologies to collect medical and other health data from a
15patient at an originating site and electronically transmit
16that data to a health care professional or facility at a
17distant site.
18    "Telehealth services" means the evaluation, diagnosis, or
19interpretation of electronically transmitted patient-specific
20data between a remote location and a licensed health care
21professional that generates interaction or treatment
22recommendations. "Telehealth services" includes telemedicine
23and the delivery of health care services, mental health
24treatment, and substance use disorder treatment to a patient,
25regardless of his or her location, provided by way of an
26interactive telecommunications system, including telephone or

 

 

HB3498- 8 -LRB102 17010 SPS 22432 b

1video technology, asynchronous store and forward system,
2remote patient monitoring technologies, e-visits, and virtual
3check-ins as defined in subsection (a) of Section 356z.22 of
4the Illinois Insurance Code.
5    "Virtual check-in" means a brief communication using a
6technology-based service by a health care professional.
7"Virtual check-in" shall not originate from a related office
8visit provided within the previous 7 days, nor lead to an
9office visit or procedure within the next 24 hours or soonest
10available appointment.
11(Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19;
12100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff.
137-19-19.)
 
14    (225 ILCS 150/10)
15    Sec. 10. Practice authority. A health care professional
16treating a patient located in this State through telehealth
17services must be licensed or authorized to practice in
18Illinois.
19(Source: P.A. 100-317, eff. 1-1-18.)
 
20    (225 ILCS 150/15)
21    Sec. 15. Use of telehealth services. A health care
22professional may engage in the practice of telehealth services
23in Illinois to the extent of his or her scope of practice as
24established in his or her respective licensing Act consistent

 

 

HB3498- 9 -LRB102 17010 SPS 22432 b

1with the standards of care for in-person services. This Act
2shall not be construed to alter the scope of practice of any
3health care professional or authorize the delivery of health
4care services in a setting or in a manner not otherwise
5authorized by the laws of this State.
6(Source: P.A. 100-317, eff. 1-1-18.)
 
7    (225 ILCS 150/20 new)
8    Sec. 20. Applicability.
9    (a) This Act applies to all health insurance coverage
10offered by health insurance issuers regulated by the
11Department of Insurance or the Department of Healthcare and
12Family Services and the medical assistance program authorized
13under the Illinois Public Aid Code that is amended, delivered,
14issued, or renewed on or after the effective date of this
15amendatory Act of the 102nd General Assembly.
16    (b) Any policy, contract, or certificate of health
17insurance coverage that does not distinguish between
18in-network and out-of-network providers shall be subject to
19this Act as though all providers were in-network.
 
20    (225 ILCS 150/25 new)
21    Sec. 25. Coverage for telehealth services.
22    (a) Health insurance issuers shall cover all telehealth
23services rendered by a health care professional to deliver any
24clinically appropriate, medically necessary covered services

 

 

HB3498- 10 -LRB102 17010 SPS 22432 b

1and treatments to insureds, enrollees, and members under each
2policy, contract, or certificate of health insurance coverage
3in the same manner as any other benefits covered under the
4policy. Reimbursement to a health care provider for telehealth
5services provided through an interactive telecommunications
6system shall be made on the same basis, in the same manner, and
7at the same rate as would be applied for the same services if
8they had been delivered in-person. Health insurance issuers
9shall include reasonable compensation to a facility that
10serves as the originating site at the time a telehealth
11service is rendered.
12    (b) To ensure telehealth service access is equitable for
13all patients in receipt of health care services under this Act
14and healthcare professionals and facilities are able to
15deliver services within the scope of their licensure or
16certification, health insurance issuers shall not:
17        (1) create geographic or facility restrictions or
18    requirements for telehealth services; procedure code
19    modifiers may be required to document telehealth use;
20        (2) require patients, health care professionals, or
21    facilities to prove a hardship or access barrier prior to
22    the approval of telehealth services for coverage or
23    reimbursement;
24        (3) negotiate different contract rates for telehealth
25    services and in-person services;
26        (4) require health care professionals or facilities to

 

 

HB3498- 11 -LRB102 17010 SPS 22432 b

1    offer or provide telehealth services;
2        (5) require patients to use telehealth services or
3    require patients to use a separate panel of health care
4    professionals or facilities to receive telehealth service
5    coverage and reimbursement; and
6        (6) impose upon telehealth services utilization review
7    requirements that are unnecessary, duplicative, or
8    unwarranted, nor impose any treatment limitations, prior
9    authorization, documentation, or recordkeeping
10    requirements that are more stringent than the requirements
11    applicable to the same health care service when rendered
12    in-person.
13    (c) There shall be no restrictions on originating site
14requirements for telehealth coverage or reimbursement to the
15distant site under this Act.
16    (d) Services provided by telehealth pursuant to this
17Section shall be consistent with all federal and State
18privacy, security, and confidentiality laws.
19    (e) Nothing in this Section shall be deemed as precluding
20a health insurer from providing benefits for other telehealth
21services, including, but not limited to, other monitoring
22services and oral communications otherwise covered under the
23policy.
 
24    (225 ILCS 150/30 new)
25    Sec. 30. Permissible use of communication technologies and

 

 

HB3498- 12 -LRB102 17010 SPS 22432 b

1locations. Health care professionals and facilities shall
2determine the appropriateness of specific sites, technology
3platforms, and technology vendors for a telehealth service, as
4long as delivered services adhere to privacy laws, including,
5but not limited to, the Health Insurance Portability and
6Accountability Act of 1996 and the Mental Health and
7Developmental Disabilities Confidentiality Act.
 
8    (225 ILCS 150/35 new)
9    Sec. 35. Rulemaking authority. The Department of Financial
10and Professional Regulation, Department of Insurance, and
11Department of Healthcare and Family Services may adopt rules,
12including emergency rules in accordance with the Illinois
13Administrative Procedure Act, to implement the provisions of
14this Act.
 
15    Section 20. The Illinois Public Aid Code is amended by
16changing Section 5-5.25 as follows:
 
17    (305 ILCS 5/5-5.25)
18    Sec. 5-5.25. Access to behavioral health and medical
19services. The Department and managed care organizations shall
20comply with the Telehealth Act.
21    (a) The General Assembly finds that providing access to
22behavioral health and medical services in a timely manner will
23improve the quality of life for persons suffering from illness

 

 

HB3498- 13 -LRB102 17010 SPS 22432 b

1and will contain health care costs by avoiding the need for
2more costly inpatient hospitalization.
3    (b) The Department of Healthcare and Family Services shall
4reimburse psychiatrists, federally qualified health centers as
5defined in Section 1905(l)(2)(B) of the federal Social
6Security Act, clinical psychologists, clinical social workers,
7advanced practice registered nurses certified in psychiatric
8and mental health nursing, and mental health professionals and
9clinicians authorized by Illinois law to provide behavioral
10health services to recipients via telehealth. The Department,
11by rule, shall establish: (i) criteria for such services to be
12reimbursed, including appropriate facilities and equipment to
13be used at both sites and requirements for a physician or other
14licensed health care professional to be present at the site
15where the patient is located; however, the Department shall
16not require that a physician or other licensed health care
17professional be physically present in the same room as the
18patient for the entire time during which the patient is
19receiving telehealth services; and (ii) a method to reimburse
20providers for mental health services provided by telehealth.
21    (c) The Department shall reimburse any Medicaid certified
22eligible facility or provider organization that acts as the
23location of the patient at the time a telehealth service is
24rendered, including substance abuse centers licensed by the
25Department of Human Services' Division of Alcoholism and
26Substance Abuse.

 

 

HB3498- 14 -LRB102 17010 SPS 22432 b

1    (d) On and after July 1, 2012, the Department shall reduce
2any rate of reimbursement for services or other payments or
3alter any methodologies authorized by this Code to reduce any
4rate of reimbursement for services or other payments in
5accordance with Section 5-5e.
6(Source: P.A. 100-385, eff. 1-1-18; 100-790, eff. 8-10-18;
7100-1019, eff. 1-1-19; 101-81, eff. 7-12-19.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.

 

 

HB3498- 15 -LRB102 17010 SPS 22432 b

1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 100/5-45.8 new
4    5 ILCS 100/5-45.9 new
5    5 ILCS 100/5-45.10 new
6    215 ILCS 5/356z.22
7    225 ILCS 150/5
8    225 ILCS 150/10
9    225 ILCS 150/15
10    225 ILCS 150/20 new
11    225 ILCS 150/25 new
12    225 ILCS 150/30 new
13    225 ILCS 150/35 new
14    305 ILCS 5/5-5.25