Sen. Mattie Hunter

Filed: 5/23/2020





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2    AMENDMENT NO. ______. Amend House Bill 823, AS AMENDED, by
3replacing Section 1 with the following:
"Article 1. Sickle Cell Prevention,
Care, and Treatment Program

6    Section 1-1. Short title. This Act may be cited as the
7Sickle Cell Prevention, Care, and Treatment Program Act.
8References in this Article to "this Act" mean this Article.";
10by renumbering Sections 5, 10, 15, 20, 25, 30, and 90 as
11Sections 1-5, 1-10, 1-15, 1-20, 1-25, 1-30, and 1-90; and
12by inserting at the end of the bill the following:
"Article 15. Telehealth During the COVID-19 Pandemic Act




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1    Section 15-1. Short title. This Article may be cited as the
2Telehealth During the COVID-19 Pandemic Act. References in this
3Article to "this Act" mean this Article.
4    Section 15-5. Applicability. This Act applies to any health
5insurance coverage other than excepted benefits as defined in
645 CFR 146.145(b) and 45 CFR 148.220. Any policy, contract, or
7certificate of health insurance coverage that does not
8distinguish between in-network and out-of-network providers
9shall be subject to this Act as though all providers were
11    Section 15-10. Definitions. As used in this Act:
12    "Health insurance coverage" has the meaning given to that
13term in Section 5 of the Illinois Health Insurance Portability
14and Accountability Act.
15    "Health insurance issuer" has the meaning given to that
16term in Section 5 of the Illinois Health Insurance Portability
17and Accountability Act.
18    "Telehealth services" means the provision of health care,
19psychiatry, mental health treatment, substance use disorder
20treatment, and related services to a patient, regardless of his
21or her location, through electronic or telephonic methods, such
22as telephone (landline or cellular), video technology commonly
23available on smart phones and other devices, and



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1videoconferencing, as well as any method within the meaning of
2telehealth services under Section 356z.22 of the Illinois
3Insurance Code.
4    Section 15-15. Coverage for telehealth services during the
5COVID-19 pandemic.
6    (a) In order to protect the public's health, to permit
7expedited treatment of health conditions during the COVID-19
8pandemic, and to mitigate its impact upon the residents of the
9State of Illinois, all health insurance issuers regulated by
10the Department of Insurance shall cover the costs of all
11telehealth services rendered by in-network providers to
12deliver any clinically appropriate, medically necessary
13covered services and treatments to insureds, enrollees, and
14members under each policy, contract, or certificate of health
15insurance coverage.
16    (b) Health insurance issuers may establish reasonable
17requirements and parameters for telehealth services, including
18with respect to documentation and recordkeeping, to the extent
19consistent with this Act or any company bulletin issued by the
20Department of Insurance under Executive Order 2020-09. A health
21insurance issuer's requirements and parameters may not be more
22restrictive or less favorable toward providers, insureds,
23enrollees, or members than those contained in the emergency
24rulemaking undertaken by the Department of Healthcare and
25Family Services at 89 Ill. Adm. Code 140.403(e). Health



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1insurance issuers shall notify providers of any instructions
2necessary to facilitate billing for telehealth services.
3    Section 15-20. Prior authorization and utilization review
5    (a) In order to ensure that health care is quickly and
6efficiently provided to the public, health insurance issuers
7shall not impose upon telehealth services utilization review
8requirements that are unnecessary, duplicative, or unwarranted
9nor impose any treatment limitations that are more stringent
10than the requirements applicable to the same health care
11service when rendered in-person.
12    (b) For telehealth services that relate to COVID-19
13delivered by in-network providers, health insurance issuers
14shall not impose any prior authorization requirements.
15    Section 15-25. Cost-sharing prohibited. Health insurance
16issuers shall not impose any cost-sharing (copayments,
17deductibles, or coinsurance) for telehealth services provided
18by in-network providers. However, in accordance with the
19standards and definitions in 26 U.S.C. 223, if an enrollee in a
20high-deductible health plan has not met the applicable
21deductible under the terms of his or her coverage, the
22requirements of this Section do not require an issuer to pay
23for a charge for telehealth services unless the associated
24health care service for that particular charge is deemed



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1preventive care by the United States Department of the
2Treasury. The federal Internal Revenue Service has recognized
3that services for testing, treatment, and any potential
4vaccination for COVID-19 fall within the scope of preventive
6    Section 15-30. Eligible services. Services eligible under
7this Act include services provided by any professional,
8practitioner, clinician, or other provider who is licensed,
9certified, registered, or otherwise authorized to practice in
10the State where the patient receives treatment, subject to the
11provisions of the Telehealth Act for any health care
12professional, as defined in the Telehealth Act, who delivers
13treatment through telehealth to a patient located in this
14State, and substance use disorder professionals and clinicians
15authorized by Illinois law to provide substance use disorder
17    Section 15-35. Mental Health and Developmental
18Disabilities Confidentiality Act. A covered health care
19provider or covered entity subject to the requirements of the
20Mental Health and Developmental Disabilities Confidentiality
21Act that uses audio or video communication technology to
22provide telehealth services to mental health and developmental
23disability patients may use any non-public facing remote
24communication product in accordance with this Act to the extent



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1allowed by the U.S. Department of Health and Human Services
2under the federal Health Insurance Portability and
3Accountability Act of 1996 for the duration of the
4Gubernatorial Disaster Proclamation issued by the Governor on
5March 9, 2020 concerning COVID-19 and any subsequent
6Gubernatorial Disaster Proclamation issued by the Governor
7concerning COVID-19. Providers and covered entities shall, to
8the extent feasible, notify patients that third-party
9applications potentially introduce privacy risks. Providers
10shall enable all available encryption and privacy modes when
11using such applications. A public facing video communication
12application may not be used in the provision of telehealth
13services by covered health care providers or covered entities.
14    Section 15-40. Rulemaking authority. The Department of
15Insurance may adopt rules to implement the provisions of this
17    Section 15-90. Repeal. This Act is repealed on December 31,
19    Section 15-95. The Illinois Insurance Code is amended by
20changing Section 356z.22 as follows:
21    (215 ILCS 5/356z.22)
22    Sec. 356z.22. Coverage for telehealth services.



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1    (a) For purposes of this Section:
2    "Distant site" means the location at which the health care
3provider rendering the telehealth service is located.
4    "Interactive telecommunications system" means an audio and
5video system permitting 2-way, live interactive communication
6between the patient and the distant site health care provider.
7    "Originating site" means the location at which the patient
8is located at the time that health care services are provided
9to the patient by means of telehealth. "Originating site"
10includes only the sites described in 42 U.S.C.
12    "Telehealth services" means the delivery of covered health
13care services by way of an interactive telecommunications
14system, through electronic means, or through telephonic means
15(landline or cellular).
16    (b) If an individual or group policy of accident or health
17insurance provides coverage for telehealth services, then it
18must comply with the following:
19        (1) An individual or group policy of accident or health
20    insurance providing telehealth services may not:
21            (A) require that in-person contact occur between a
22        health care provider and a patient;
23            (B) require the health care provider to document a
24        barrier to an in-person consultation for coverage of
25        services to be provided through telehealth;
26            (C) require the use of telehealth when the health



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1        care provider has determined that it is not
2        appropriate; or
3            (D) require the use of telehealth when a patient
4        chooses an in-person consultation.
5        (2) Deductibles, copayments, or coinsurance applicable
6    to services provided through telehealth shall not exceed
7    the deductibles, copayments, or coinsurance required by
8    the individual or group policy of accident or health
9    insurance for the same services provided through in-person
10    consultation.
11        (3) An individual or group policy of accident or health
12    insurance may not exclude from coverage a medically
13    necessary health care service or procedure delivered by a
14    contracted health care professional or contracted health
15    care provider solely because the service or procedure is
16    provided through telehealth.
17        (4) Nothing in this Act shall prohibit an insurer from
18    entering a contract for telehealth services in which the
19    terms and reimbursement, including the facility fee, are
20    subject to negotiation. However, no facility fee shall be
21    paid with respect to the home of an individual other than
22    the home of a health care provider when used as his or her
23    office for providing health care services.
24    (b-5) If an individual or group policy of accident or
25health insurance provides coverage for telehealth services, it
26must provide coverage for licensed dietitian nutritionists and



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1certified diabetes educators who counsel senior diabetes
2patients in the senior diabetes patients' homes to remove the
3hurdle of transportation for senior diabetes patients to
4receive treatment.
5    (c) Nothing in this Section shall be deemed as precluding a
6health insurer from providing benefits for other services,
7including, but not limited to, remote monitoring services,
8other monitoring services, or oral communications otherwise
9covered under the policy.
10(Source: P.A. 100-1009, eff. 1-1-19.)
Article 99. Effective Date

12    Section 99-99. Effective date. Article 15 and this Article
13take effect upon becoming law.".