Illinois General Assembly - Full Text of HB3498
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Full Text of HB3498  102nd General Assembly




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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 and 5-45.9 as follows:
6    (5 ILCS 100/5-45.8 new)
7    Sec. 5-45.8. Emergency rulemaking; Illinois Insurance
8Code. To provide for the expeditious and timely implementation
9of changes made to the Illinois Insurance Code by this
10amendatory Act of the 102nd General Assembly, emergency rules
11implementing the changes made to the Illinois Insurance Code
12by this amendatory Act of the 102nd General Assembly may be
13adopted in accordance with Section 5-45 by the Department of
14Insurance. The adoption of emergency rules authorized by
15Section 5-45 and this Section is deemed to be necessary for the
16public interest, safety, and welfare.
17    This Section is repealed on January 1, 2022.
18    (5 ILCS 100/5-45.9 new)
19    Sec. 5-45.9. Emergency rulemaking; Illinois Public Aid
20Code. To provide for the expeditious and timely implementation
21of changes made to the Illinois Public Aid Code by this
22amendatory Act of the 102nd General Assembly, emergency rules



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1implementing the changes made to the Illinois Public Aid Code
2by this amendatory Act of the 102nd General Assembly may be
3adopted in accordance with Section 5-45 by the Department of
4Healthcare and Family Services. The adoption of emergency
5rules authorized by Section 5-45 and this Section is deemed to
6be necessary for the public interest, safety, and welfare.
7    This Section is repealed on January 1, 2022.
8    Section 10. The Illinois Insurance Code is amended by
9changing Section 356z.22 as follows:
10    (215 ILCS 5/356z.22)
11    Sec. 356z.22. Coverage for telehealth services.
12    (a) For purposes of this Section:
13    "Asynchronous store and forward system" means the
14transmission of a patient's medical information through an
15electronic communications system at an originating site to a
16health care professional or facility at a distant site that
17does not require real-time or synchronous interaction between
18the health care professional and the patient.
19    "Distant site" means the location at which the health care
20professional provider rendering the telehealth service is
22    "Established patient" means a patient with a relationship
23with a health care professional in which there is an exchange
24of an individual's protected health information for the



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1purpose of providing patient care treatment or services.
2    "E-visit" means a patient-initiated non-face-to-face
3communication through an online patient portal with a health
4care professional. "E-visit" only includes communications
5where the initial inquiry is initiated by an established
7    "Facility" includes a facility that is owned or operated
8by a hospital under the Hospital Licensing Act or University
9of Illinois Hospital Act, a facility under the Nursing Home
10Care Act, a rural health clinic, a federally qualified health
11center, a local health department, a community mental health
12center, a behavioral health clinic, an encounter rate clinic,
13a skilled nursing facility, a substance use treatment program
14licensed by the Department of Human Services' Division of
15Substance Use Prevention and Recovery, a school-based health
16center as defined in 77 Ill. Adm. Code 641.10, a physician's
17office, a podiatrist's office, a supportive living program
18provider, a hospice provider, a facility under the ID/DD
19Community Care Act, community-integrated living arrangements
20as defined in the Community-Integrated Living Arrangements
21Licensure and Certification Act, and a provider who receives
22reimbursement for a patient's room and board.
23    "Health care professional" has the meaning ascribed to
24that term in Section 5 of the Telehealth Act.
25    "Interactive telecommunications system" means an audio and
26video system, an audio-only telephone system (landline or



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1cellular), or any other telecommunications system permitting
22-way, synchronous interactive communication between a patient
3at an originating site and a health care professional or
4facility at a distant site permitting 2-way, live interactive
5communication between the patient and the distant site health
6care provider. "Interactive telecommunications system" does
7not include a facsimile machine, electronic mail messaging, or
8text messaging.
9    "Originating site" means the location at which the patient
10is located at the time telehealth services are provided to the
11patient via telehealth.
12    "Remote patient monitoring" means the use of connected
13digital technologies or mobile medical devices to collect
14medical and other health data from a patient at one location
15and electronically transmit that data to a health care
16professional or facility at a different location for
17collection and interpretation.
18    "Telehealth services" has the meaning ascribed to that
19term in Section 5 of the Telehealth Act means the delivery of
20covered health care services by way of an interactive
21telecommunications system.
22    "Virtual check-in" means a brief patient-initiated
23communication using a technology-based service, excluding
24facsimile, with a health care professional. "Virtual check-in"
25only includes communications where the initial inquiry is
26initiated by an established patient. "Virtual check-in" does



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1not include communications from a related office visit
2provided within the previous 7 days, nor communications that
3lead to an office visit or procedure within the next 24 hours
4or soonest available appointment.
5    (b) An If an individual or group policy of accident or
6health insurance or a managed care plan that is amended,
7delivered, issued, or renewed on or after the effective date
8of this amendatory Act of the 102nd General Assembly shall
9cover all telehealth services rendered by a health care
10professional to deliver any clinically appropriate, medically
11necessary covered services and treatments to insureds,
12enrollees, and members in the same manner as any other
13benefits covered under the policy. Reimbursement to a health
14care professional for telehealth services provided through an
15interactive telecommunications system, excluding virtual
16check-ins, shall be made on the same basis, in the same manner,
17and at the same rate as would be applied for the same services
18if they had been delivered in person. An individual or group
19policy of accident or health insurance or a managed care plan
20shall provide reasonable compensation to a facility that
21serves as the originating site at the time a telehealth
22service is rendered. Nothing in this Section shall be deemed
23as precluding a health insurer from providing a higher rate of
24reimbursement for telehealth services. provides coverage for
25telehealth services, then it must comply with the following:
26        (1) To ensure telehealth service access is equitable



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1    for all patients in receipt of health care services under
2    this Section and health care professionals and facilities
3    are able to deliver services within the scope of their
4    licensure or certification, an An individual or group
5    policy of accident or health insurance or a managed care
6    plan that is amended, delivered, issued or renewed on or
7    after the effective date of this amendatory Act of the
8    102nd General Assembly shall providing telehealth services
9    may not:
10            (A) require that in-person contact occur between a
11        health care professional provider and a patient;
12            (B) require patients, the health care
13        professionals, or facilities provider to prove or
14        document a hardship or access barrier to an in-person
15        consultation for coverage and reimbursement of
16        telehealth services to be provided through telehealth;
17            (C) require the use of telehealth when the health
18        care professional provider has determined that it is
19        not appropriate; or
20            (D) require the use of telehealth when a patient
21        chooses an in-person consultation; .
22            (E) require a physician or other health care
23        professional to be physically present in the same room
24        as the patient at the originating site, unless deemed
25        medically necessary by the health care professional
26        providing the telehealth service;



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1            (F) create geographic or facility restrictions or
2        requirements for telehealth services;
3            (G) negotiate different contract rates for
4        telehealth services provided through an interactive
5        telecommunications system and in-person services,
6        excluding virtual check-ins;
7            (H) require health care professionals or
8        facilities to offer or provide telehealth services;
9            (I) require patients to use telehealth services or
10        require patients to use a separate panel of health
11        care professionals or facilities to receive telehealth
12        service coverage and reimbursement; or
13            (J) impose upon telehealth services utilization
14        review requirements that are unnecessary, duplicative,
15        or unwarranted, or impose any treatment limitations,
16        prior authorization, documentation, or recordkeeping
17        requirements that are more stringent than the
18        requirements applicable to the same health care
19        service when rendered in-person, except procedure code
20        modifiers may be required to document telehealth; an
21        individual or group policy of accident or health
22        insurance or a managed care plan shall notify health
23        care providers of any instructions necessary to
24        facilitate billing for telehealth services.
25        (2) Deductibles, copayments, or coinsurance, or any
26    other cost-sharing applicable to services provided through



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1    telehealth shall not exceed the deductibles, copayments,
2    or coinsurance, or any other cost-sharing required by the
3    individual or group policy of accident or health insurance
4    for the same services provided through in-person
5    consultation.
6    (b-5) An If an individual or group policy of accident or
7health insurance or a managed care plan that is amended,
8delivered, issued, or renewed on or after the effective date
9of this amendatory Act of the 102nd General Assembly shall
10provide provides coverage for telehealth services, it must
11provide 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) 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 Section as though all providers were in-network.
20    (d) Services provided by telehealth pursuant to this
21Section shall be consistent with all federal and State
22privacy, security, and confidentiality laws.
23    (e) Health care professionals and facilities shall
24determine the appropriateness of specific sites, technology
25platforms, and technology vendors for a telehealth service, as
26long as delivered services adhere to privacy laws, including,



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1but not limited to, the Health Insurance Portability and
2Accountability Act of 1996 and the Mental Health and
3Developmental Disabilities Confidentiality Act.
4    (f) (c) Nothing in this Section shall be deemed as
5precluding a health insurer from providing benefits for other
6telehealth services, including, but not limited to, remote
7monitoring services, other monitoring services, or oral
8communications otherwise covered under the policy.
9    (g) There shall be no restrictions on originating site
10requirements for telehealth coverage or reimbursement to the
11distant site under this Section.
12    (h) The Department may adopt rules to implement the
13provisions of this Section.
14(Source: P.A. 100-1009, eff. 1-1-19.)
15    Section 15. The Telehealth Act is amended by changing
16Sections 5, 10, and 15 as follows:
17    (225 ILCS 150/5)
18    Sec. 5. Definitions. As used in this Act:
19    "Health care professional" includes, but is not limited
20to, physicians, physician assistants, optometrists, advanced
21practice registered nurses, clinical psychologists licensed in
22Illinois, prescribing psychologists licensed in Illinois,
23dentists, occupational therapists, pharmacists, physical
24therapists, clinical social workers, speech-language



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1pathologists, audiologists, hearing instrument dispensers,
2licensed certified substance use disorder treatment providers
3and clinicians, and mental health professionals and clinicians
4authorized by Illinois law to provide mental health services,
5qualified providers listed under paragraph (8) of subsection
6(e) of Section 3 of the Early Intervention Services System
7Act, dietitian nutritionists licensed in Illinois, and health
8care professionals associated with a facility.
9    "Telehealth services" means the evaluation, diagnosis, or
10interpretation of electronically transmitted patient-specific
11data between a remote location and a licensed health care
12professional that generates interaction or treatment
13recommendations. "Telehealth services" includes telemedicine
14and the delivery of health care services, mental health
15treatment and substance use disorder treatment and services to
16a patient, regardless of his or her location, provided by way
17of an interactive telecommunications system, as defined in
18subsection (a) of Section 356z.22 of the Illinois Insurance
20(Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19;
21100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff.
23    (225 ILCS 150/10)
24    Sec. 10. Practice authority. A health care professional
25treating a patient located in this State through telehealth



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1services must be licensed or authorized to practice in
3(Source: P.A. 100-317, eff. 1-1-18.)
4    (225 ILCS 150/15)
5    Sec. 15. Use of telehealth services. A health care
6professional may engage in the practice of telehealth services
7in Illinois to the extent of his or her scope of practice as
8established in his or her respective licensing Act consistent
9with the standards of care for in-person services. This Act
10shall not be construed to alter the scope of practice of any
11health care professional or authorize the delivery of health
12care services in a setting or in a manner not otherwise
13authorized by the laws of this State.
14(Source: P.A. 100-317, eff. 1-1-18.)
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
20    (a) The Department and Medicaid managed care organizations
21shall comply with the requirements under Section 356z.22 of
22the Illinois Insurance Code regardless of whether a recipient
23of medical assistance under this Article is enrolled in the



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1fee for service or managed care medical assistance program.
2    (b) The Department may adopt rules to implement the
3provisions of this Section.
4    (a) The General Assembly finds that providing access to
5behavioral health and medical services in a timely manner will
6improve the quality of life for persons suffering from illness
7and will contain health care costs by avoiding the need for
8more costly inpatient hospitalization.
9    (b) The Department of Healthcare and Family Services shall
10reimburse psychiatrists, federally qualified health centers as
11defined in Section 1905(l)(2)(B) of the federal Social
12Security Act, clinical psychologists, clinical social workers,
13advanced practice registered nurses certified in psychiatric
14and mental health nursing, and mental health professionals and
15clinicians authorized by Illinois law to provide behavioral
16health services to recipients via telehealth. The Department,
17by rule, shall establish: (i) criteria for such services to be
18reimbursed, including appropriate facilities and equipment to
19be used at both sites and requirements for a physician or other
20licensed health care professional to be present at the site
21where the patient is located; however, the Department shall
22not require that a physician or other licensed health care
23professional be physically present in the same room as the
24patient for the entire time during which the patient is
25receiving telehealth services; and (ii) a method to reimburse
26providers for mental health services provided by telehealth.



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1    (c) The Department shall reimburse any Medicaid certified
2eligible facility or provider organization that acts as the
3location of the patient at the time a telehealth service is
4rendered, including substance abuse centers licensed by the
5Department of Human Services' Division of Alcoholism and
6Substance Abuse.
7    (d) On and after July 1, 2012, the Department shall reduce
8any rate of reimbursement for services or other payments or
9alter any methodologies authorized by this Code to reduce any
10rate of reimbursement for services or other payments in
11accordance with Section 5-5e.
12(Source: P.A. 100-385, eff. 1-1-18; 100-790, eff. 8-10-18;
13100-1019, eff. 1-1-19; 101-81, eff. 7-12-19.)
14    Section 99. Effective date. This Act takes effect upon
15becoming law.