Illinois General Assembly - Full Text of HB2896
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Full Text of HB2896  102nd General Assembly


Rep. Deb Conroy

Filed: 3/11/2021





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2    AMENDMENT NO. ______. Amend House Bill 2896 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Insurance Code is amended by
5changing Section 367m as follows:
6    (215 ILCS 5/367m)
7    Sec. 367m. Early intervention services. A policy of
8accident and health insurance that provides coverage for early
9intervention services must also provide coverage for early
10intervention services delivered via telehealth by providers
11listed in paragraph (8) of subsection (e) of Section 3 of the
12Early Intervention Services System Act, subject to any
13restriction or limitation under a provider's respective
14licensing Act on the delivery of early intervention services
15via telehealth. A policy of accident and health insurance that
16provides coverage for early intervention services must conform



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1to the following criteria:
2        (1) The use of private health insurance to pay for
3    early intervention services under Part C of the federal
4    Individuals with Disabilities Education Act may not count
5    towards or result in a loss of benefits due to annual or
6    lifetime insurance caps for an infant or toddler with a
7    disability, the infant's or toddler's parent, or the
8    infant's or toddler's family members who are covered under
9    that health insurance policy.
10        (2) The use of private health insurance to pay for
11    early intervention services under Part C of the federal
12    Individuals with Disabilities Education Act may not
13    negatively affect the availability of health insurance to
14    an infant or toddler with a disability, the infant's or
15    toddler's parent, or the infant's or toddler's family
16    members who are covered under that health insurance
17    policy, and health insurance coverage may not be
18    discontinued for these individuals due to the use of the
19    health insurance to pay for services under Part C of the
20    federal Individuals with Disabilities Education Act.
21        (3) The use of private health insurance to pay for
22    early intervention services under Part C of the federal
23    Individuals with Disabilities Education Act may not be the
24    basis for increasing the health insurance premiums of an
25    infant or toddler with a disability, the infant's or
26    toddler's parent, or the infant's or toddler's family



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1    members covered under that health insurance policy.
2    For the purposes of this Section, "early intervention
3services" has the same meaning as in the Early Intervention
4Services System Act.
5(Source: P.A. 98-41, eff. 6-28-13.)
6    Section 10. The Telehealth Act is amended by changing
7Section 5 as follows:
8    (225 ILCS 150/5)
9    Sec. 5. Definitions. As used in this Act:
10    "Health care professional" includes physicians, physician
11assistants, optometrists, advanced practice registered nurses,
12clinical psychologists licensed in Illinois, prescribing
13psychologists licensed in Illinois, dentists, occupational
14therapists, pharmacists, physical therapists, clinical social
15workers, speech-language pathologists, audiologists, hearing
16instrument dispensers, and mental health professionals and
17clinicians authorized by Illinois law to provide mental health
18services and qualified providers listed under paragraph (8) of
19subsection (e) of Section 3 of the Early Intervention Services
20System Act.
21    "Telehealth" means the evaluation, diagnosis, or
22interpretation of electronically transmitted patient-specific
23data between a remote location and a licensed health care
24professional that generates interaction or treatment



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1recommendations. "Telehealth" includes telemedicine and the
2delivery of health care services provided by way of an
3interactive telecommunications system, as defined in
4subsection (a) of Section 356z.22 of the Illinois Insurance
6(Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19;
7100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff.
9    Section 15. The Illinois Public Aid Code is amended by
10changing Section 5-5.25 as follows:
11    (305 ILCS 5/5-5.25)
12    Sec. 5-5.25. Access to behavioral health and medical
14    (a) The General Assembly finds that providing access to
15behavioral health and medical services in a timely manner will
16improve the quality of life for persons suffering from illness
17and will contain health care costs by avoiding the need for
18more costly inpatient hospitalization.
19    (b) The Department of Healthcare and Family Services shall
20reimburse psychiatrists, federally qualified health centers as
21defined in Section 1905(l)(2)(B) of the federal Social
22Security Act, clinical psychologists, clinical social workers,
23advanced practice registered nurses certified in psychiatric
24and mental health nursing, and mental health professionals and



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1clinicians authorized by Illinois law to provide behavioral
2health services to recipients via telehealth. The Department,
3by rule, shall establish: (i) criteria for such services to be
4reimbursed, including appropriate facilities and equipment to
5be used at both sites and requirements for a physician or other
6licensed health care professional to be present at the site
7where the patient is located; however, the Department shall
8not require that a physician or other licensed health care
9professional be physically present in the same room as the
10patient for the entire time during which the patient is
11receiving telehealth services; and (ii) a method to reimburse
12providers for mental health services provided by telehealth.
13    (b-5) The Department of Healthcare and Family Services
14shall reimburse qualified providers listed under paragraph (8)
15of subsection (e) of Section 3 of the Early Intervention
16Services System Act who deliver early intervention services to
17recipients via telehealth. Such qualified providers shall be
18eligible for reimbursement under this subsection, subject to
19any restriction or limitation under a provider's respective
20licensing Act on the delivery of early intervention services
21via telehealth. The Department, by rule, shall establish a
22method to reimburse such qualified providers for early
23intervention services delivered via telehealth.
24    (c) The Department shall reimburse any Medicaid certified
25eligible facility or provider organization that acts as the
26location of the patient at the time a telehealth service is



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1rendered, including substance abuse centers licensed by the
2Department of Human Services' Division of Alcoholism and
3Substance Abuse.
4    (d) On and after July 1, 2012, the Department shall reduce
5any rate of reimbursement for services or other payments or
6alter any methodologies authorized by this Code to reduce any
7rate of reimbursement for services or other payments in
8accordance with Section 5-5e.
9(Source: P.A. 100-385, eff. 1-1-18; 100-790, eff. 8-10-18;
10100-1019, eff. 1-1-19; 101-81, eff. 7-12-19.)
11    Section 20. The Early Intervention Services System Act is
12amended by changing Sections 3 and 11 and by adding Section 3b
13as follows:
14    (325 ILCS 20/3)  (from Ch. 23, par. 4153)
15    Sec. 3. Definitions. As used in this Act:
16    (a) "Eligible infants and toddlers" means infants and
17toddlers under 36 months of age with any of the following
19        (1) Developmental delays.
20        (2) A physical or mental condition which typically
21    results in developmental delay.
22        (3) Being at risk of having substantial developmental
23    delays based on informed clinical opinion.
24        (4) Either (A) having entered the program under any of



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1    the circumstances listed in paragraphs (1) through (3) of
2    this subsection but no longer meeting the current
3    eligibility criteria under those paragraphs, and
4    continuing to have any measurable delay, or (B) not having
5    attained a level of development in each area, including
6    (i) cognitive, (ii) physical (including vision and
7    hearing), (iii) language, speech, and communication, (iv)
8    social or emotional, or (v) adaptive, that is at least at
9    the mean of the child's age equivalent peers; and, in
10    addition to either item (A) or item (B), (C) having been
11    determined by the multidisciplinary individualized family
12    service plan team to require the continuation of early
13    intervention services in order to support continuing
14    developmental progress, pursuant to the child's needs and
15    provided in an appropriate developmental manner. The type,
16    frequency, and intensity of services shall differ from the
17    initial individualized family services plan because of the
18    child's developmental progress, and may consist of only
19    service coordination, evaluation, and assessments.
20    (b) "Developmental delay" means a delay in one or more of
21the following areas of childhood development as measured by
22appropriate diagnostic instruments and standard procedures:
23cognitive; physical, including vision and hearing; language,
24speech and communication; social or emotional; or adaptive.
25The term means a delay of 30% or more below the mean in
26function in one or more of those areas.



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1    (c) "Physical or mental condition which typically results
2in developmental delay" means:
3        (1) a diagnosed medical disorder or exposure to a
4    toxic substance bearing a relatively well known expectancy
5    for developmental outcomes within varying ranges of
6    developmental disabilities; or
7        (2) a history of prenatal, perinatal, neonatal or
8    early developmental events suggestive of biological
9    insults to the developing central nervous system and which
10    either singly or collectively increase the probability of
11    developing a disability or delay based on a medical
12    history.
13    (d) "Informed clinical opinion" means both clinical
14observations and parental participation to determine
15eligibility by a consensus of a multidisciplinary team of 2 or
16more members based on their professional experience and
18    (e) "Early intervention services" means services which:
19        (1) are designed to meet the developmental needs of
20    each child eligible under this Act and the needs of his or
21    her family;
22        (2) are selected in collaboration with the child's
23    family;
24        (3) are provided under public supervision;
25        (4) are provided at no cost except where a schedule of
26    sliding scale fees or other system of payments by families



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1    has been adopted in accordance with State and federal law;
2        (5) are designed to meet an infant's or toddler's
3    developmental needs in any of the following areas:
4            (A) physical development, including vision and
5        hearing,
6            (B) cognitive development,
7            (C) communication development,
8            (D) social or emotional development, or
9            (E) adaptive development;
10        (6) meet the standards of the State, including the
11    requirements of this Act;
12        (7) include one or more of the following:
13            (A) family training,
14            (B) social work services, including counseling,
15        and home visits,
16            (C) special instruction,
17            (D) speech, language pathology and audiology,
18            (E) occupational therapy,
19            (F) physical therapy,
20            (G) psychological services,
21            (H) service coordination services,
22            (I) medical services only for diagnostic or
23        evaluation purposes,
24            (J) early identification, screening, and
25        assessment services,
26            (K) health services specified by the lead agency



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1        as necessary to enable the infant or toddler to
2        benefit from the other early intervention services,
3            (L) vision services,
4            (M) transportation,
5            (N) assistive technology devices and services,
6            (O) nursing services,
7            (P) nutrition services, and
8            (Q) sign language and cued language services;
9        (8) are provided by qualified personnel, including but
10    not limited to:
11            (A) child development specialists or special
12        educators, including teachers of children with hearing
13        impairments (including deafness) and teachers of
14        children with vision impairments (including
15        blindness),
16            (B) speech and language pathologists and
17        audiologists,
18            (C) occupational therapists,
19            (D) physical therapists,
20            (E) social workers,
21            (F) nurses,
22            (G) dietitian nutritionists,
23            (H) vision specialists, including ophthalmologists
24        and optometrists,
25            (I) psychologists, and
26            (J) physicians;



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1        (9) are provided in conformity with an Individualized
2    Family Service Plan;
3        (10) are provided throughout the year; and
4        (11) are provided in natural environments, to the
5    maximum extent appropriate, which may include the home and
6    community settings, unless justification is provided
7    consistent with federal regulations adopted under Sections
8    1431 through 1444 of Title 20 of the United States Code.
9    (f) "Individualized Family Service Plan" or "Plan" means a
10written plan for providing early intervention services to a
11child eligible under this Act and the child's family, as set
12forth in Section 11.
13    (g) "Local interagency agreement" means an agreement
14entered into by local community and State and regional
15agencies receiving early intervention funds directly from the
16State and made in accordance with State interagency agreements
17providing for the delivery of early intervention services
18within a local community area.
19    (h) "Council" means the Illinois Interagency Council on
20Early Intervention established under Section 4.
21    (i) "Lead agency" means the State agency responsible for
22administering this Act and receiving and disbursing public
23funds received in accordance with State and federal law and
25    (i-5) "Central billing office" means the central billing
26office created by the lead agency under Section 13.



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1    (j) "Child find" means a service which identifies eligible
2infants and toddlers.
3    (k) "Regional intake entity" means the lead agency's
4designated entity responsible for implementation of the Early
5Intervention Services System within its designated geographic
7    (l) "Early intervention provider" means an individual who
8is qualified, as defined by the lead agency, to provide one or
9more types of early intervention services, and who has
10enrolled as a provider in the early intervention program.
11    (m) "Fully credentialed early intervention provider" means
12an individual who has met the standards in the State
13applicable to the relevant profession, and has met such other
14qualifications as the lead agency has determined are suitable
15for personnel providing early intervention services, including
16pediatric experience, education, and continuing education. The
17lead agency shall establish these qualifications by rule filed
18no later than 180 days after the effective date of this
19amendatory Act of the 92nd General Assembly.
20    (n) "Telehealth" has the meaning ascribed to that term in
21Section 5 of the Telehealth Act.
22(Source: P.A. 101-10, eff. 6-5-19.)
23    (325 ILCS 20/3b new)
24    Sec. 3b. Services delivered by telehealth. An early
25intervention provider may deliver via telehealth any type of



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1early intervention service outlined in subsection (e) of
2Section 3 to the extent of his or her scope of practice as
3established in his or her respective licensing Act consistent
4with the standards of care for in-person services. This
5Section shall not be construed to alter the scope of practice
6of any early intervention provider or authorize the delivery
7of early intervention services in a setting or in a manner not
8otherwise authorized by the laws of this State.
9    (325 ILCS 20/11)  (from Ch. 23, par. 4161)
10    Sec. 11. Individualized Family Service Plans.
11    (a) Each eligible infant or toddler and that infant's or
12toddler's family shall receive:
13        (1) timely, comprehensive, multidisciplinary
14    assessment of the unique strengths and needs of each
15    eligible infant and toddler, and assessment of the
16    concerns and priorities of the families to appropriately
17    assist them in meeting their needs and identify supports
18    and services to meet those needs; and
19        (2) a written Individualized Family Service Plan
20    developed by a multidisciplinary team which includes the
21    parent or guardian. The individualized family service plan
22    shall be based on the multidisciplinary team's assessment
23    of the resources, priorities, and concerns of the family
24    and its identification of the supports and services
25    necessary to enhance the family's capacity to meet the



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1    developmental needs of the infant or toddler, and shall
2    include the identification of services appropriate to meet
3    those needs, including the frequency, intensity, and
4    method of delivering services. During and as part of the
5    initial development of the individualized family services
6    plan, and any periodic reviews of the plan, the
7    multidisciplinary team may seek consultation from the lead
8    agency's designated experts, if any, to help determine
9    appropriate services and the frequency and intensity of
10    those services. All services in the individualized family
11    services plan must be justified by the multidisciplinary
12    assessment of the unique strengths and needs of the infant
13    or toddler and must be appropriate to meet those needs. At
14    the periodic reviews, the team shall determine whether
15    modification or revision of the outcomes or services is
16    necessary.
17    (b) The Individualized Family Service Plan shall be
18evaluated once a year and the family shall be provided a review
19of the Plan at 6 month intervals or more often where
20appropriate based on infant or toddler and family needs. The
21lead agency shall create a quality review process regarding
22Individualized Family Service Plan development and changes
23thereto, to monitor and help assure that resources are being
24used to provide appropriate early intervention services.
25    (c) The initial evaluation and initial assessment and
26initial Plan meeting must be held within 45 days after the



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1initial contact with the early intervention services system.
2The 45-day timeline does not apply for any period when the
3child or parent is unavailable to complete the initial
4evaluation, the initial assessments of the child and family,
5or the initial Plan meeting, due to exceptional family
6circumstances that are documented in the child's early
7intervention records, or when the parent has not provided
8consent for the initial evaluation or the initial assessment
9of the child despite documented, repeated attempts to obtain
10parental consent. As soon as exceptional family circumstances
11no longer exist or parental consent has been obtained, the
12initial evaluation, the initial assessment, and the initial
13Plan meeting must be completed as soon as possible. With
14parental consent, early intervention services may commence
15before the completion of the comprehensive assessment and
16development of the Plan.
17    (d) Parents must be informed that early intervention
18services shall be provided to each eligible infant and
19toddler, to the maximum extent appropriate, in the natural
20environment, which may include the home or other community
21settings. Parents must also be informed of the availability of
22early intervention services provided through telehealth.
23Parents shall make the final decision to accept or decline
24early intervention services, including whether accepted
25services are delivered in person or via telehealth. A decision
26to decline such services shall not be a basis for



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1administrative determination of parental fitness, or other
2findings or sanctions against the parents. Parameters of the
3Plan shall be set forth in rules.
4    (e) The regional intake offices shall explain to each
5family, orally and in writing, all of the following:
6        (1) That the early intervention program will pay for
7    all early intervention services set forth in the
8    individualized family service plan that are not covered or
9    paid under the family's public or private insurance plan
10    or policy and not eligible for payment through any other
11    third party payor.
12        (2) That services will not be delayed due to any rules
13    or restrictions under the family's insurance plan or
14    policy.
15        (3) That the family may request, with appropriate
16    documentation supporting the request, a determination of
17    an exemption from private insurance use under Section
18    13.25.
19        (4) That responsibility for co-payments or
20    co-insurance under a family's private insurance plan or
21    policy will be transferred to the lead agency's central
22    billing office.
23        (5) That families will be responsible for payments of
24    family fees, which will be based on a sliding scale
25    according to the State's definition of ability to pay
26    which is comparing household size and income to the



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1    sliding scale and considering out-of-pocket medical or
2    disaster expenses, and that these fees are payable to the
3    central billing office. Families who fail to provide
4    income information shall be charged the maximum amount on
5    the sliding scale.
6    (f) The individualized family service plan must state
7whether the family has private insurance coverage and, if the
8family has such coverage, must have attached to it a copy of
9the family's insurance identification card or otherwise
10include all of the following information:
11        (1) The name, address, and telephone number of the
12    insurance carrier.
13        (2) The contract number and policy number of the
14    insurance plan.
15        (3) The name, address, and social security number of
16    the primary insured.
17        (4) The beginning date of the insurance benefit year.
18    (g) A copy of the individualized family service plan must
19be provided to each enrolled provider who is providing early
20intervention services to the child who is the subject of that
22    (h) Children receiving services under this Act shall
23receive a smooth and effective transition by their third
24birthday consistent with federal regulations adopted pursuant
25to Sections 1431 through 1444 of Title 20 of the United States



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1(Source: P.A. 97-902, eff. 8-6-12; 98-41, eff. 6-28-13.)".