HB0823sam002 101ST GENERAL ASSEMBLY

Sen. Mattie Hunter

Filed: 5/23/2020

10100HB0823sam002 LRB101 04579 KTG 72472 a

AMENDMENT TO HOUSE BILL 823

AMENDMENT NO. ______. Amend House Bill 823, AS AMENDED, by replacing Section 1 with the following:

"Article 1. Sickle Cell Prevention,

Care, and Treatment Program

Section 1-1. Short title. This Act may be cited as the Sickle Cell Prevention, Care, and Treatment Program Act.

References in this Article to "this Act" mean this Article."; and

by renumbering Sections 5, 10, 15, 20, 25, 30, and 90 as Sections 1-5, 1-10, 1-15, 1-20, 1-25, 1-30, and 1-90; and

by inserting at the end of the bill the following:

"Article 15. Telehealth During the COVID-19 Pandemic Act

Section 15-1. Short title. This Article may be cited as the Telehealth During the COVID-19 Pandemic Act. References in this Article to "this Act" mean this Article.

Section 15-5. Applicability. This Act applies to any health insurance coverage other than excepted benefits as defined in 45 CFR 146.145(b) and 45 CFR 148.220. Any policy, contract, or certificate of health insurance coverage that does not distinguish between in-network and out-of-network providers shall be subject to this Act as though all providers were in-network.

Section 15-10. Definitions. As used in this Act:

"Health insurance coverage" has the meaning given to that term in Section 5 of the Illinois Health Insurance Portability and Accountability Act.

"Health insurance issuer" has the meaning given to that term in Section 5 of the Illinois Health Insurance Portability and Accountability Act.

"Telehealth services" means the provision of health care, psychiatry, mental health treatment, substance use disorder treatment, and related services to a patient, regardless of his or her location, through electronic or telephonic methods, such as telephone (landline or cellular), video technology commonly available on smart phones and other devices, and videoconferencing, as well as any method within the meaning of telehealth services under Section 356z.22 of the Illinois Insurance Code.

Section 15-15. Coverage for telehealth services during the COVID-19 pandemic.

(a) In order to protect the public's health, to permit expedited treatment of health conditions during the COVID-19 pandemic, and to mitigate its impact upon the residents of the State of Illinois, all health insurance issuers regulated by the Department of Insurance shall cover the costs of all telehealth services rendered by in-network providers to deliver any clinically appropriate, medically necessary covered services and treatments to insureds, enrollees, and members under each policy, contract, or certificate of health insurance coverage.

(b) Health insurance issuers may establish reasonable requirements and parameters for telehealth services, including with respect to documentation and recordkeeping, to the extent consistent with this Act or any company bulletin issued by the Department of Insurance under Executive Order 2020-09. A health insurance issuer's requirements and parameters may not be more restrictive or less favorable toward providers, insureds, enrollees, or members than those contained in the emergency rulemaking undertaken by the Department of Healthcare and Family Services at 89 Ill. Adm. Code 140.403(e). Health insurance issuers shall notify providers of any instructions necessary to facilitate billing for telehealth services.

Section 15-20. Prior authorization and utilization review requirements.

(a) In order to ensure that health care is quickly and efficiently provided to the public, health insurance issuers shall not impose upon telehealth services utilization review requirements that are unnecessary, duplicative, or unwarranted nor impose any treatment limitations that are more stringent than the requirements applicable to the same health care service when rendered in-person.

(b) For telehealth services that relate to COVID-19 delivered by in-network providers, health insurance issuers shall not impose any prior authorization requirements.

Section 15-25. Cost-sharing prohibited. Health insurance issuers shall not impose any cost-sharing (copayments, deductibles, or coinsurance) for telehealth services provided by in-network providers. However, in accordance with the standards and definitions in 26 U.S.C. 223, if an enrollee in a high-deductible health plan has not met the applicable deductible under the terms of his or her coverage, the requirements of this Section do not require an issuer to pay for a charge for telehealth services unless the associated health care service for that particular charge is deemed preventive care by the United States Department of the Treasury. The federal Internal Revenue Service has recognized that services for testing, treatment, and any potential vaccination for COVID-19 fall within the scope of preventive care.

Section 15-30. Eligible services. Services eligible under this Act include services provided by any professional, practitioner, clinician, or other provider who is licensed, certified, registered, or otherwise authorized to practice in the State where the patient receives treatment, subject to the provisions of the Telehealth Act for any health care professional, as defined in the Telehealth Act, who delivers treatment through telehealth to a patient located in this State, and substance use disorder professionals and clinicians authorized by Illinois law to provide substance use disorder services.

Section 15-35. Mental Health and Developmental Disabilities Confidentiality Act. A covered health care provider or covered entity subject to the requirements of the Mental Health and Developmental Disabilities Confidentiality Act that uses audio or video communication technology to provide telehealth services to mental health and developmental disability patients may use any non-public facing remote communication product in accordance with this Act to the extent allowed by the U.S. Department of Health and Human Services under the federal Health Insurance Portability and Accountability Act of 1996 for the duration of the Gubernatorial Disaster Proclamation issued by the Governor on March 9, 2020 concerning COVID-19 and any subsequent Gubernatorial Disaster Proclamation issued by the Governor concerning COVID-19. Providers and covered entities shall, to the extent feasible, notify patients that third-party applications potentially introduce privacy risks. Providers shall enable all available encryption and privacy modes when using such applications. A public facing video communication application may not be used in the provision of telehealth services by covered health care providers or covered entities.

Section 15-40. Rulemaking authority. The Department of Insurance may adopt rules to implement the provisions of this Act.

Section 15-90. Repeal. This Act is repealed on December 31, 2020.

Section 15-95. The Illinois Insurance Code is amended by changing Section 356z.22 as follows:

(215 ILCS 5/356z.22)

Sec. 356z.22. Coverage for telehealth services.

(a) For purposes of this Section:

"Distant site" means the location at which the health care provider rendering the telehealth service is located.

"Interactive telecommunications system" means an audio and video system permitting 2-way, live interactive communication between the patient and the distant site health care provider.

"Originating site" means the location at which the patient is located at the time that health care services are provided to the patient by means of telehealth. "Originating site" includes only the sites described in 42 U.S.C. 1395m(m)(4)(C)(ii).

"Telehealth services" means the delivery of covered health care services by way of an interactive telecommunications system, through electronic means, or through telephonic means (landline or cellular).

(b) If an individual or group policy of accident or health insurance provides coverage for telehealth services, then it must comply with the following:

(1) An individual or group policy of accident or health insurance providing telehealth services may not:

(A) require that in-person contact occur between a health care provider and a patient;

(B) require the health care provider to document a barrier to an in-person consultation for coverage of services to be provided through telehealth;

(C) require the use of telehealth when the health care provider has determined that it is not appropriate; or

(D) require the use of telehealth when a patient chooses an in-person consultation.

(2) Deductibles, copayments, or coinsurance applicable to services provided through telehealth shall not exceed the deductibles, copayments, or coinsurance required by the individual or group policy of accident or health insurance for the same services provided through in-person consultation.

(3) An individual or group policy of accident or health insurance may not exclude from coverage a medically necessary health care service or procedure delivered by a contracted health care professional or contracted health care provider solely because the service or procedure is provided through telehealth.

(4) Nothing in this Act shall prohibit an insurer from entering a contract for telehealth services in which the terms and reimbursement, including the facility fee, are subject to negotiation. However, no facility fee shall be paid with respect to the home of an individual other than the home of a health care provider when used as his or her office for providing health care services.

(b-5) If an individual or group policy of accident or health insurance provides coverage for telehealth services, it must provide coverage for licensed dietitian nutritionists and certified diabetes educators who counsel senior diabetes patients in the senior diabetes patients' homes to remove the hurdle of transportation for senior diabetes patients to receive treatment.

(c) Nothing in this Section shall be deemed as precluding a health insurer from providing benefits for other services, including, but not limited to, remote monitoring services, other monitoring services, or oral communications otherwise covered under the policy.

(Source: P.A. 100-1009, eff. 1-1-19.)

Article 99. Effective Date

Section 99-99. Effective date. Article 15 and this Article take effect upon becoming law.".