SB1913eng 103RD GENERAL ASSEMBLY

  
  
  

 


 
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1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-47 as follows:
 
6    (305 ILCS 5/5-47 new)
7    Sec. 5-47. Coverage for mental health and substance use
8disorder telehealth services.
9    (a) As used in this Section:
10    "Behavioral health care professional" has the meaning
11given to "health care professional" in Section 5 of the
12Telehealth Act, but only with respect to professionals
13licensed or certified by the Division of Mental Health or
14Division of Substance Use Prevention and Recovery of the
15Department of Human Services engaged in the delivery of mental
16health or substance use disorder treatment or services.
17    "Behavioral health facility" means a community mental
18health center, a behavioral health clinic, a substance use
19disorder treatment program, or a facility or provider licensed
20or certified by the Division of Mental Health or Division of
21Substance Use Prevention and Recovery of the Department of
22Human Services.
23    "Behavioral telehealth services" has the meaning given to

 

 

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1the term "telehealth services" in Section 5 of the Telehealth
2Act, but limited solely to mental health and substance use
3disorder treatment or services to a patient, regardless of
4patient location.
5    "Distant site" has the meaning given to that term in
6Section 5 of the Telehealth Act.
7    "Originating site" has the meaning given to that term in
8Section 5 of the Telehealth Act.
9    (b) The Department and any managed care plans under
10contract with the Department for the medical assistance
11program shall provide for coverage of mental health and
12substance use disorder treatment or services delivered as
13behavioral telehealth services as specified in this Section.
14The Department and any managed care plans under contract with
15the Department for the medical assistance program may also
16provide reimbursement to a behavioral health facility that
17serves as the originating site at the time a behavioral
18telehealth service is rendered.
19    (c) To ensure behavioral telehealth services are equitably
20provided, coverage required under this Section shall comply
21with all of the following:
22        (1) The Department and any managed care plans under
23    contract with the Department for the medical assistance
24    program shall not:
25            (A) require that in-person contact occur between a
26        behavioral health care professional and a patient

 

 

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1        before the provision of a behavioral telehealth
2        service;
3            (B) require patients, behavioral health care
4        professionals, or behavioral health facilities to
5        prove or document a hardship or access barrier to an
6        in-person consultation for coverage and reimbursement
7        of behavioral telehealth services;
8            (C) require the use of behavioral telehealth
9        services when the behavioral health care professional
10        has determined that it is not appropriate;
11            (D) require the use of behavioral telehealth
12        services when a patient chooses an in-person
13        consultation;
14            (E) require a behavioral health care professional
15        to be physically present in the same room as the
16        patient at the originating site, unless deemed
17        medically necessary by the behavioral health care
18        professional providing the behavioral telehealth
19        service;
20            (F) create geographic or facility restrictions or
21        requirements for behavioral telehealth services;
22            (G) require behavioral health care professionals
23        or behavioral health facilities to offer or provide
24        behavioral telehealth services;
25            (H) require patients to use behavioral telehealth
26        services or require patients to use a separate panel

 

 

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1        of behavioral health care professionals or behavioral
2        health facilities to receive behavioral telehealth
3        services; or
4            (I) impose upon behavioral telehealth services
5        utilization review requirements that are unnecessary,
6        duplicative, or unwarranted or impose any treatment
7        limitations, prior authorization, documentation, or
8        recordkeeping requirements that are more stringent
9        than the requirements applicable to the same
10        behavioral health care service when rendered
11        in-person, except that procedure code modifiers may be
12        required to document behavioral telehealth.
13        (2) Any cost sharing applicable to services provided
14    through behavioral telehealth shall not exceed the cost
15    sharing required by the medical assistance program for the
16    same services provided through in-person consultation.
17        (3) The Department and any managed care plans under
18    contract with the Department for the medical assistance
19    program shall notify behavioral health care professionals
20    and behavioral health facilities of any instructions
21    necessary to facilitate billing for behavioral telehealth
22    services.
23    (d) For purposes of reimbursement, the Department and any
24managed care plans under contract with the Department for the
25medical assistance program shall reimburse a behavioral health
26care professional or behavioral health facility for behavioral

 

 

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1telehealth services on the same basis, in the same manner, and
2at the same reimbursement rate that would apply to the
3services if the services had been delivered via an in-person
4encounter by a behavioral health care professional or
5behavioral health facility. This subsection applies only to
6those services provided by behavioral telehealth that may
7otherwise be billed as an in-person service.
8    (e) Behavioral health care professionals and behavioral
9health facilities shall determine the appropriateness of
10specific sites, technology platforms, and technology vendors
11for a behavioral telehealth service, as long as delivered
12services adhere to all federal and State privacy, security,
13and confidentiality laws, rules, or regulations, including,
14but not limited to, the Health Insurance Portability and
15Accountability Act of 1996, 42 CFR Part 2, and the Mental
16Health and Developmental Disabilities Confidentiality Act.
17    (f) Nothing in this Section shall be deemed as precluding
18the Department and any managed care plans under contract with
19the Department for the medical assistance program from
20providing benefits for other telehealth services.
21    (g) There shall be no restrictions on originating site
22requirements for behavioral telehealth coverage or
23reimbursement to the distant site under this Section other
24than requiring the behavioral telehealth services to be
25medically necessary and clinically appropriate.
26    (h) Nothing in this Section shall be deemed as precluding

 

 

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1the Department and any managed care plans under contract with
2the Department for the medical assistance program from
3establishing limits on the use of telehealth for a particular
4behavioral health service when the limits are consistent with
5generally accepted standards of mental, emotional, nervous, or
6substance use disorder or condition care.
7    (i) The Department may adopt rules to implement the
8provisions of this Section.