TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.403 TELEHEALTH SERVICES


 

Section 140.403  Telehealth Services

 

a)         Definitions

 

1)         "Asynchronous Store and Forward Technology" means the transmission of a patient's medical information from an originating site to the provider at the distant site.  The provider at the distant site can review the medical case without the patient being present.  An asynchronous telecommunication system in single media format does not include telephone calls, images transmitted via facsimile machines and text messages without visualization of the patient (electronic mail).  Photographs visualized by a telecommunication system must be specific to the patient' s medical condition and adequate for furnishing or confirming a diagnosis and/or treatment plan.  Dermatological photographs (for example, a photograph of a skin lesion) may be considered to meet the requirement of a single media format under this provision.

 

2)         "Distant Site" means the location at which the provider rendering the service is located.

 

3)         "Encounter Clinic" means a Federally Qualified Health Center, Rural Health Clinic or Encounter Rate Clinic, as defined in 89 Ill. Adm. Code 140.461.

 

4)         "Facility Fee" means the reimbursement made to the following originating sites for the telehealth service:  physician's office, podiatrist's office, local health departments, community mental health centers, licensed hospital outpatient departments as defined in 89 Ill. Adm. Code 148.25(d) and substance abuse treatment centers licensed by the Department of Human Services-Division of Alcoholism and Substance Abuse (DASA).

 

5)         "Interactive Telecommunication System" means multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and the distant site provider.  Telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunication system.

 

6)         "Originating Site" means the location at which the participant receiving the service is located.

 

7)         "Telecommunication System" means an asynchronous store and forward technology and/or an interactive telecommunication system that is used to transmit data between the originating and distant sites.

 

8)         "Telehealth" means services provided via a telecommunication system.

 

9)         "Telemedicine" means the use of a telecommunication system to provide medical services for the purpose of evaluation and treatment when the patient is at one medical provider location and the rendering provider is at another location.

 

10)         "Telepsychiatry" means the use of a telecommunication system to provide psychiatric services for the purpose of evaluation and treatment when the patient is at one medical provider location and the rendering provider is at another location.

 

b)         Requirements for Telehealth Services

 

1)         Telemedicine

 

A)        A physician or other licensed health care professional must be present at all times with the patient at the originating site.

 

B)        The distant site provider must be a physician, physician assistant, podiatrist or advanced practice nurse who is licensed by the State of Illinois or by the state where the patient is located.

 

C)        The originating and distant site provider must not be terminated, suspended or barred from the Department's medical programs.

 

D)        Medical data may be exchanged through a telecommunication system.

 

E)        The interactive telecommunication system must, at a minimum, have the capability of allowing the consulting distant site provider to examine the patient sufficiently to allow proper diagnosis of the involved body system.  The system must also be capable of transmitting clearly audible heart tones and lung sounds, as well as clear video images of the patient and any diagnostic tools, such as radiographs.

 

2)         Telepsychiatry

 

A)        A physician, licensed health care professional or other licensed clinician, mental health professional (MHP), or qualified mental health professional (QMHP), as defined in 59 Ill. Adm. Code 132.25, must be present at all times with the patient at the originating site.

 

B)        The distant site provider must be a physician licensed by the State of Illinois or by the state where the patient is located and must have completed an accredited general psychiatry residency program or an accredited child and adolescent psychiatry residency program.

 

C)        The originating and distant site provider must not be terminated, suspended or barred from the Department's medical programs.

 

D)        The distant site provider must personally render the telepsychiatry service.

 

E)        Telepsychiatry services must be rendered using an interactive telecommunication system.

 

F)         Group psychotherapy is not a covered telepsychiatry service.

 

c)         Reimbursement for Telehealth Services

 

1)         Originating Site Reimbursement

 

A)        A facility fee shall be paid to providers as defined in subsection (a)(4) of this Section.

 

B)        Local education agencies may submit telehealth services as a certified expenditure.

 

C)        Providers who receive reimbursement for a patient's room and board are not eligible for reimbursement as an originating site.

 

D)        Clinics reimbursed under the prospective payment system shall be eligible for a medical encounter as set forth in subsection (c)(3) of this Section.

 

2)         Reimbursement for Rendering Provider at the Distant Site

 

A)        Participating providers shall be reimbursed for the appropriate AMA Current Procedural Terminology (CPT) code for the telehealth service rendered.

 

B)        Nonparticipating providers may be reimbursed by the originating site provider, but will not be eligible for reimbursement from the Department.

 

3)         Clinic Reimbursement

 

A)        An encounter clinic serving as the originating site shall be reimbursed for its medical encounter as defined in Section 140.462.  The clinic is responsible for reimbursement to the distant site provider.

 

B)        An encounter clinic serving as the distant site shall be reimbursed as follows: 

 

i)          If the originating site is another encounter clinic, the distant site encounter clinic shall receive no reimbursement from the Department.  The originating site encounter clinic is responsible for reimbursement to the distant site encounter clinic; and

 

ii)         If the originating site is not an encounter clinic, the distant site encounter clinic shall be reimbursed for its medical encounter.  The originating site provider will receive a facility fee as defined in subsection (a)(4) of this Section.

 

d)         Record Requirements for Telehealth Services

 

1)         Medical records documenting the telehealth services provided must be maintained by the originating and distant sites and shall include, but not be limited to, the following:

 

A)        The records required in Section 140.28;

 

B)        The name and license number of the licensed health care professional or other licensed clinician present with the patient at the originating site;

 

C)        The name and license number of the provider at the distant site and, if the service involves telepsychiatry, documentation that the physician has completed an approved general psychiatry residency program or an approved child and adolescent psychiatry residency program;

 

D)        The locations of the originating and distant sites;

 

E)        The date and the beginning and ending times of the telehealth service; and

 

F)         The medical necessity for the telehealth service.

 

2)         When the originating site is an encounter clinic, records from the distant site must also be maintained.

 

3)         Appropriate steps must be taken by the originating and distant site staff to assure patient confidentiality, based on technical advances in compliance with all federal and state privacy and confidentiality laws.

 

4)         The type of interactive telecommunication system utilized at the originating and distant sites shall be documented.

 

5)         The billing records related to the use of the telecommunication system shall be maintained as provided in Section 140.28.

 

(Source:  Added at 34 Ill. Reg. 903, effective January 29, 2010)