101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB2561

 

Introduced 1/29/2020, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.22
305 ILCS 5/5-5.25

    Amends the Illinois Insurance Code. Requires an individual or group policy of accident and health insurance that provides telehealth services to provide reimbursement for such services at the same rate that such services are reimbursed for an in-person consultation and to reimburse a facility fee to the originating site. Allows the Director of Insurance to alter the dollar amount of this facility fee, and requires the Director to review the amount of the fee at least once every 5 years. Defines "originating site". Amends the Illinois Public Aid Code. Provides that services provided through telehealth shall be reimbursed at the same rate that such services are reimbursed for an in-person consultation. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB2561LRB101 15400 BMS 64650 b

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 Insurance Code is amended by
5changing Section 356z.22 as follows:
 
6    (215 ILCS 5/356z.22)
7    Sec. 356z.22. Coverage for telehealth services.
8    (a) For purposes of this Section:
9    "Distant site" means the location at which the health care
10provider rendering the telehealth service is located.
11    "Interactive telecommunications system" means an audio and
12video system permitting 2-way, live interactive communication
13between the patient and the distant site health care provider.
14    "Originating site" means the location at which the patient
15is located at the time that health care services are provided
16to the patient by means of telehealth.
17    "Telehealth services" means the delivery of covered health
18care services by way of an interactive telecommunications
19system.
20    (b) If an individual or group policy of accident or health
21insurance provides coverage for telehealth services, then it
22must comply with the following:
23        (1) An individual or group policy of accident or health

 

 

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1    insurance providing telehealth services may not:
2            (A) require that in-person contact occur between a
3        health care provider and a patient;
4            (B) require the health care provider to document a
5        barrier to an in-person consultation for coverage of
6        services to be provided through telehealth;
7            (C) require the use of telehealth when the health
8        care provider has determined that it is not
9        appropriate; or
10            (D) require the use of telehealth when a patient
11        chooses an in-person consultation.
12        (2) Deductibles, copayments, or coinsurance applicable
13    to services provided through telehealth shall not exceed
14    the deductibles, copayments, or coinsurance required by
15    the individual or group policy of accident or health
16    insurance for the same services provided through in-person
17    consultation.
18        (3) An individual or group policy of accident or health
19    insurance providing telehealth services shall reimburse
20    telehealth services at the same rate that such services are
21    reimbursed for an in-person consultation.
22        (4) An individual or group policy of accident or health
23    insurance providing telehealth services shall reimburse
24    the originating site a facility fee of $25 per telehealth
25    service. The Director shall have the power to increase or
26    decrease the dollar amount of this facility fee as the

 

 

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1    Director deems appropriate and shall review the amount of
2    the fee at least once every 5 years.
3    (b-5) If an individual or group policy of accident or
4health insurance provides coverage for telehealth services, it
5must provide coverage for licensed dietitian nutritionists and
6certified diabetes educators who counsel senior diabetes
7patients in the senior diabetes patients' homes to remove the
8hurdle of transportation for senior diabetes patients to
9receive treatment.
10    (c) Nothing in this Section shall be deemed as precluding a
11health insurer from providing benefits for other services,
12including, but not limited to, remote monitoring services,
13other monitoring services, or oral communications otherwise
14covered under the policy.
15(Source: P.A. 100-1009, eff. 1-1-19.)
 
16    Section 10. The Illinois Public Aid Code is amended by
17changing Section 5-5.25 as follows:
 
18    (305 ILCS 5/5-5.25)
19    Sec. 5-5.25. Access to behavioral health and medical
20services.
21    (a) The General Assembly finds that providing access to
22behavioral health and medical services in a timely manner will
23improve the quality of life for persons suffering from illness
24and will contain health care costs by avoiding the need for

 

 

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1more costly inpatient hospitalization.
2    (b) The Department of Healthcare and Family Services shall
3reimburse psychiatrists, federally qualified health centers as
4defined in Section 1905(l)(2)(B) of the federal Social Security
5Act, clinical psychologists, clinical social workers, advanced
6practice registered nurses certified in psychiatric and mental
7health nursing, and mental health professionals and clinicians
8authorized by Illinois law to provide behavioral health
9services to recipients via telehealth. The Department, by rule,
10shall establish: (i) criteria for such services to be
11reimbursed, including appropriate facilities and equipment to
12be used at both sites and requirements for a physician or other
13licensed health care professional to be present at the site
14where the patient is located; however, the Department shall not
15require that a physician or other licensed health care
16professional be physically present in the same room as the
17patient for the entire time during which the patient is
18receiving telehealth services; and (ii) a method to reimburse
19providers for mental health services provided by telehealth.
20Services provided through telehealth shall be reimbursed at the
21same rate that such services are reimbursed for an in-person
22consultation.
23    (c) The Department shall reimburse any Medicaid certified
24eligible facility or provider organization that acts as the
25location of the patient at the time a telehealth service is
26rendered, including substance abuse centers licensed by the

 

 

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1Department of Human Services' Division of Alcoholism and
2Substance Abuse.
3    (d) On and after July 1, 2012, the Department shall reduce
4any rate of reimbursement for services or other payments or
5alter any methodologies authorized by this Code to reduce any
6rate of reimbursement for services or other payments in
7accordance with Section 5-5e.
8(Source: P.A. 100-385, eff. 1-1-18; 100-790, eff. 8-10-18;
9100-1019, eff. 1-1-19; 101-81, eff. 7-12-19.)
 
10    Section 99. Effective date. This Act takes effect upon
11becoming law.