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

HB3498ham001 102ND GENERAL ASSEMBLY

Rep. Deb Conroy

Filed: 4/20/2021

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 3498

2    AMENDMENT NO. ______. Amend House Bill 3498 by replacing
3everything after the enacting clause with the following:
 
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.

 

 

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1    This Section is repealed on January 1, 2026.
 
2    (5 ILCS 100/5-45.9 new)
3    Sec. 5-45.9. Emergency rulemaking; Illinois Public Aid
4Code. To provide for the expeditious and timely implementation
5of changes made to the Illinois Public Aid Code by this
6amendatory Act of the 102nd General Assembly, emergency rules
7implementing the changes made to the Illinois Public Aid Code
8by this amendatory Act of the 102nd General Assembly may be
9adopted in accordance with Section 5-45 by the Department of
10Healthcare and Family Services. The adoption of emergency
11rules authorized by Section 5-45 and this Section is deemed to
12be necessary for the public interest, safety, and welfare.
13    This Section is repealed on January 1, 2026.
 
14    Section 10. The Illinois Insurance Code is amended by
15changing Section 356z.22 as follows:
 
16    (215 ILCS 5/356z.22)
17    Sec. 356z.22. Coverage for telehealth services.
18    (a) For purposes of this Section:
19    "Asynchronous store and forward system" means the
20transmission of a patient's medical information through an
21electronic communications system at an originating site to a
22health care professional or facility at a distant site that
23does not require real-time or synchronous interaction between

 

 

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1the health care professional and the patient.
2    "Distant site" means the location at which the health care
3professional provider rendering the telehealth service is
4located.
5    "Established patient" means a patient with a relationship
6with a health care professional in which there is an exchange
7of an individual's protected health information for the
8purpose of providing patient care treatment or services.
9    "E-visit" means a patient-initiated non-face-to-face
10communication through an online patient portal with a health
11care professional. "E-visit" only includes communications
12where the initial inquiry is initiated by an established
13patient.
14    "Facility" includes a facility that is owned or operated
15by a hospital under the Hospital Licensing Act or University
16of Illinois Hospital Act, a facility under the Nursing Home
17Care Act, a rural health clinic, a federally qualified health
18center, a local health department, a community mental health
19center, a behavioral health clinic, an encounter rate clinic,
20a skilled nursing facility, a substance use treatment program
21licensed by the Department of Human Services' Division of
22Substance Use Prevention and Recovery, a school-based health
23center as defined in 77 Ill. Adm. Code 641.10, a physician's
24office, a podiatrist's office, a supportive living program
25provider, a hospice provider, a facility under the ID/DD
26Community Care Act, community-integrated living arrangements

 

 

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1as defined in the Community-Integrated Living Arrangements
2Licensure and Certification Act, and a provider who receives
3reimbursement for a patient's room and board.
4    "Health care professional" has the meaning ascribed to
5that term in Section 5 of the Telehealth Act.
6    "Interactive telecommunications system" means an audio and
7video system, an audio-only telephone system (landline or
8cellular), or any other telecommunications system permitting
92-way, synchronous interactive communication between a patient
10at an originating site and a health care professional or
11facility at a distant site permitting 2-way, live interactive
12communication between the patient and the distant site health
13care provider. "Interactive telecommunications system" does
14not include a facsimile machine, electronic mail messaging, or
15text messaging.
16    "Originating site" means the location at which the patient
17is located at the time telehealth services are provided to the
18patient via telehealth.
19    "Remote patient monitoring" means the use of connected
20digital technologies or mobile medical devices to collect
21medical and other health data from a patient at one location
22and electronically transmit that data to a health care
23professional or facility at a different location for
24collection and interpretation.
25    "Telehealth services" has the meaning ascribed to that
26term in Section 5 of the Telehealth Act means the delivery of

 

 

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1covered health care services by way of an interactive
2telecommunications system.
3    "Virtual check-in" means a brief patient-initiated
4communication using a technology-based service, excluding
5facsimile, with a health care professional. "Virtual check-in"
6only includes communications where the initial inquiry is
7initiated by an established patient. "Virtual check-in" does
8not include communications from a related office visit
9provided within the previous 7 days, nor communications that
10lead to an office visit or procedure within the next 24 hours
11or soonest available appointment.
12    (b) An If an individual or group policy of accident or
13health insurance or a managed care plan that is amended,
14delivered, issued, or renewed on or after the effective date
15of this amendatory Act of the 102nd General Assembly shall
16cover all telehealth services rendered by a health care
17professional to deliver any clinically appropriate, medically
18necessary covered services and treatments to insureds,
19enrollees, and members in the same manner as any other
20benefits covered under the policy. Reimbursement to a health
21care professional for telehealth services provided through an
22interactive telecommunications system, excluding virtual
23check-ins, shall be made on the same basis, in the same manner,
24and at the same rate as would be applied for the same services
25if they had been delivered in person. An individual or group
26policy of accident or health insurance or a managed care plan

 

 

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1shall provide reasonable compensation to a facility that
2serves as the originating site at the time a telehealth
3service is rendered. Nothing in this Section shall be deemed
4as precluding a health insurer from providing a higher rate of
5reimbursement for telehealth services. provides coverage for
6telehealth services, then it must comply with the following:
7        (1) To ensure telehealth service access is equitable
8    for all patients in receipt of health care services under
9    this Section and health care professionals and facilities
10    are able to deliver services within the scope of their
11    licensure or certification, an An individual or group
12    policy of accident or health insurance or a managed care
13    plan that is amended, delivered, issued or renewed on or
14    after the effective date of this amendatory Act of the
15    102nd General Assembly shall providing telehealth services
16    may not:
17            (A) require that in-person contact occur between a
18        health care professional provider and a patient,
19        except before an initial e-visit or virtual check-in
20        in order to establish a patient relationship;
21            (B) require patients, the health care
22        professionals, or facilities provider to prove or
23        document a hardship or access barrier to an in-person
24        consultation for coverage and reimbursement of
25        telehealth services to be provided through telehealth;
26            (C) require the use of telehealth when the health

 

 

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1        care professional provider has determined that it is
2        not appropriate; or
3            (D) require the use of telehealth when a patient
4        chooses an in-person consultation; .
5            (E) require a physician or other health care
6        professional to be physically present in the same room
7        as the patient at the originating site, unless deemed
8        medically necessary by the health care professional
9        providing the telehealth service;
10            (F) create geographic or facility restrictions or
11        requirements for telehealth services;
12            (G) negotiate different contract rates for
13        telehealth services provided through an interactive
14        telecommunications system and in-person services,
15        excluding virtual check-ins;
16            (H) require health care professionals or
17        facilities to offer or provide telehealth services;
18            (I) require patients to use telehealth services or
19        require patients to use a separate panel of health
20        care professionals or facilities to receive telehealth
21        service coverage and reimbursement; or
22            (J) impose upon telehealth services utilization
23        review requirements that are unnecessary, duplicative,
24        or unwarranted, or impose any treatment limitations,
25        prior authorization, documentation, or recordkeeping
26        requirements that are more stringent than the

 

 

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1        requirements applicable to the same health care
2        service when rendered in-person, except procedure code
3        modifiers may be required to document telehealth; an
4        individual or group policy of accident or health
5        insurance or a managed care plan shall notify health
6        care providers of any instructions necessary to
7        facilitate billing for telehealth services.
8        (2) Deductibles, copayments, or coinsurance, or any
9    other cost-sharing applicable to services provided through
10    telehealth shall not exceed the deductibles, copayments,
11    or coinsurance, or any other cost-sharing required by the
12    individual or group policy of accident or health insurance
13    for the same services provided through in-person
14    consultation.
15    (b-5) An If an individual or group policy of accident or
16health insurance or a managed care plan that is amended,
17delivered, issued, or renewed on or after the effective date
18of this amendatory Act of the 102nd General Assembly shall
19provide provides coverage for telehealth services, it must
20provide coverage for licensed dietitian nutritionists and
21certified diabetes educators who counsel senior diabetes
22patients in the senior diabetes patients' homes to remove the
23hurdle of transportation for senior diabetes patients to
24receive treatment.
25    (c) Any policy, contract, or certificate of health
26insurance coverage that does not distinguish between

 

 

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1in-network and out-of-network providers shall be subject to
2this Section as though all providers were in-network.
3    (d) Services provided by telehealth pursuant to this
4Section shall be consistent with all federal and State
5privacy, security, and confidentiality laws.
6    (e) Health care professionals and facilities shall
7determine the appropriateness of specific sites, technology
8platforms, and technology vendors for a telehealth service, as
9long as delivered services adhere to privacy laws, including,
10but not limited to, the Health Insurance Portability and
11Accountability Act of 1996 and the Mental Health and
12Developmental Disabilities Confidentiality Act.
13    (f) (c) Nothing in this Section shall be deemed as
14precluding a health insurer from providing benefits for other
15telehealth services, including, but not limited to, remote
16monitoring services, other monitoring services, or oral
17communications otherwise covered under the policy.
18    (g) There shall be no restrictions on originating site
19requirements for telehealth coverage or reimbursement to the
20distant site under this Section.
21    (h) The Department may adopt rules, including emergency
22rules in accordance with the Illinois Administrative Procedure
23Act, to implement the provisions of this Section.
24(Source: P.A. 100-1009, eff. 1-1-19.)
 
25    Section 15. The Telehealth Act is amended by changing

 

 

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1Sections 5, 10, and 15 as follows:
 
2    (225 ILCS 150/5)
3    Sec. 5. Definitions. As used in this Act:
4    "Health care professional" includes, but is not limited
5to, physicians, physician assistants, optometrists, advanced
6practice registered nurses, clinical psychologists licensed in
7Illinois, prescribing psychologists licensed in Illinois,
8dentists, occupational therapists, pharmacists, physical
9therapists, clinical social workers, speech-language
10pathologists, audiologists, hearing instrument dispensers,
11licensed certified substance use disorder treatment providers
12and clinicians, and mental health professionals and clinicians
13authorized by Illinois law to provide mental health services,
14qualified providers listed under paragraph (8) of subsection
15(e) of Section 3 of the Early Intervention Services System
16Act, dietitian nutritionists licensed in Illinois, and health
17care professionals associated with a facility.
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 and services to
25a patient, regardless of his or her location, provided by way

 

 

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1of an interactive telecommunications system, as defined in
2subsection (a) of Section 356z.22 of the Illinois Insurance
3Code.
4(Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19;
5100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff.
67-19-19.)
 
7    (225 ILCS 150/10)
8    Sec. 10. Practice authority. A health care professional
9treating a patient located in this State through telehealth
10services must be licensed or authorized to practice in
11Illinois.
12(Source: P.A. 100-317, eff. 1-1-18.)
 
13    (225 ILCS 150/15)
14    Sec. 15. Use of telehealth services. A health care
15professional may engage in the practice of telehealth services
16in Illinois to the extent of his or her scope of practice as
17established in his or her respective licensing Act consistent
18with the standards of care for in-person services. This Act
19shall not be construed to alter the scope of practice of any
20health care professional or authorize the delivery of health
21care services in a setting or in a manner not otherwise
22authorized by the laws of this State.
23(Source: P.A. 100-317, eff. 1-1-18.)
 

 

 

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1    Section 20. The Illinois Public Aid Code is amended by
2changing Section 5-5.25 as follows:
 
3    (305 ILCS 5/5-5.25)
4    Sec. 5-5.25. Access to behavioral health and medical
5services.
6    (a) The Department and Medicaid managed care organizations
7shall comply with the requirements under Section 356z.22 of
8the Illinois Insurance Code regardless of whether a recipient
9of medical assistance under this Article is enrolled in the
10fee for service or managed care medical assistance program.
11    (b) The Department may adopt rules, including emergency
12rules, in accordance with the Illinois Administrative
13Procedure Act to implement the provisions of this Section.
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
25clinicians authorized by Illinois law to provide behavioral

 

 

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1health services to recipients via telehealth. The Department,
2by rule, shall establish: (i) criteria for such services to be
3reimbursed, including appropriate facilities and equipment to
4be used at both sites and requirements for a physician or other
5licensed health care professional to be present at the site
6where the patient is located; however, the Department shall
7not require that a physician or other licensed health care
8professional be physically present in the same room as the
9patient for the entire time during which the patient is
10receiving telehealth services; and (ii) a method to reimburse
11providers for mental health services provided by telehealth.
12    (c) The Department shall reimburse any Medicaid certified
13eligible facility or provider organization that acts as the
14location of the patient at the time a telehealth service is
15rendered, including substance abuse centers licensed by the
16Department of Human Services' Division of Alcoholism and
17Substance Abuse.
18    (d) On and after July 1, 2012, the Department shall reduce
19any rate of reimbursement for services or other payments or
20alter any methodologies authorized by this Code to reduce any
21rate of reimbursement for services or other payments in
22accordance with Section 5-5e.
23(Source: P.A. 100-385, eff. 1-1-18; 100-790, eff. 8-10-18;
24100-1019, eff. 1-1-19; 101-81, eff. 7-12-19.)
 
25    Section 99. Effective date. This Act takes effect upon

 

 

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1becoming law.".