102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3759

 

Introduced 2/22/2021, by Rep. Ryan Spain

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Telehealth Parity Act. Requires all health insurance issuers regulated by the Department of Insurance to 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. Provides that 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. Provides that, for telehealth services that relate to COVID-19 delivered by in-network providers, health insurance issuers shall not impose any prior authorization requirements. Contains provisions prohibiting cost-sharing for telehealth services, describing eligible services, and allowing use of non-public facing remote communication products under certain circumstances. Effective immediately.


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A BILL FOR

 

HB3759LRB102 10851 BMS 22336 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 1. Short title. This Act may be cited as the
5Telehealth Parity Act.
 
6    Section 5. Applicability.
7    (a) This Act applies to policies issued by a health
8insurance issuer as defined in Section 10 of this Act, but does
9not apply to excepted benefits as defined in 45 CFR 146.145(b)
10and 45 CFR 148.220, but does apply to limited scope dental
11benefits, limited scope vision benefits, long-term care
12benefits, coverage only for accidents, and coverage only for
13specified disease or illness.
14    (b) Any policy, contract, or certificate of health
15insurance coverage that does not distinguish between
16in-network and out-of-network providers shall be subject to
17this Act as though all providers were in-network.
 
18    Section 10. Definitions. As used in this Act:
19    "Health insurance coverage" has the meaning given to that
20term in Section 5 of the Illinois Health Insurance Portability
21and Accountability Act.
22    "Health insurance issuer" means an insurance company,

 

 

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1insurance service, or insurance organization, including health
2maintenance organization, that is licensed to engage in the
3business of insurance in a state and that is subject to
4Illinois law that regulates insurance (within the meaning of
5Section 514(b)(2) of the Employee Retirement Income Security
6Act of 1974).
7    "Telehealth services" means the provision of health care,
8psychiatry, mental health treatment, substance use disorder
9treatment, and related services to a patient, regardless of
10his or her location, through electronic or telephonic methods,
11such as telephone (landline or cellular), video technology
12commonly available on smart phones and other devices, and
13videoconferencing, as well as any method within the meaning of
14telehealth services under Section 356z.22 of the Illinois
15Insurance Code.
 
16    Section 15. Coverage for telehealth services.
17    (a) All health insurance issuers regulated by the
18Department of Insurance shall cover the costs of all
19telehealth services rendered by in-network providers to
20deliver any clinically appropriate, medically necessary
21covered services and treatments to insureds, enrollees, and
22members under each policy, contract, or certificate of health
23insurance coverage.
24    (b) Health insurance issuers may establish reasonable
25requirements and parameters for telehealth services, including

 

 

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1with respect to documentation and recordkeeping, to the extent
2consistent with this Act or any company bulletin issued by the
3Department of Insurance under Executive Order 2020-09. A
4health insurance issuer's requirements and parameters may not
5be more restrictive or less favorable toward providers,
6insureds, enrollees, or members than those contained in the
7emergency rulemaking undertaken by the Department of
8Healthcare and Family Services at 89 Ill. Adm. Code
9140.403(e). Health insurance issuers shall notify providers of
10any instructions necessary to facilitate billing for
11telehealth services.
 
12    Section 20. Prior authorization and utilization review
13requirements.
14    (a) In order to ensure that health care is quickly and
15efficiently provided to the public, health insurance issuers
16shall not impose upon telehealth services utilization review
17requirements that are unnecessary, duplicative, or unwarranted
18nor impose any treatment limitations that are more stringent
19than the requirements applicable to the same health care
20service when rendered in-person.
21    (b) For telehealth services that relate to COVID-19
22delivered by in-network providers, health insurance issuers
23shall not impose any prior authorization requirements.
 
24    Section 25. Cost-sharing prohibited. Health insurance

 

 

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1issuers shall not impose any cost-sharing (copayments,
2deductibles, or coinsurance) for telehealth services provided
3by in-network providers. However, in accordance with the
4standards and definitions in 26 U.S.C. 223, if an enrollee in a
5high-deductible health plan has not met the applicable
6deductible under the terms of his or her coverage, the
7requirements of this Section do not require an issuer to pay
8for a charge for telehealth services unless the associated
9health care service for that particular charge is deemed
10preventive care by the United States Department of the
11Treasury. The federal Internal Revenue Service has recognized
12that services for testing, treatment, and any potential
13vaccination for COVID-19 fall within the scope of preventive
14care.
 
15    Section 30. Eligible services. Services eligible under
16this Act include services provided by any professional,
17practitioner, clinician, or other provider who is licensed,
18certified, registered, or otherwise authorized to practice in
19the State where the patient receives treatment, subject to the
20provisions of the Telehealth Act for any health care
21professional, as defined in the Telehealth Act, who delivers
22treatment through telehealth to a patient located in this
23State, and substance use disorder professionals and clinicians
24authorized by Illinois law to provide substance use disorder
25services.
 

 

 

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1    Section 35. Permissible use of non-public facing audio or
2video communication technologies. Notwithstanding the
3requirements of the Mental Health and Developmental
4Disabilities Confidentiality Act, any provider or covered
5entity of any licensure or area of practice subject to this Act
6that uses audio or video communication technology to deliver
7services may use any non-public facing remote communication
8product in accordance with this Act to the extent permitted by
9the U.S. Department of Health and Human Services under the
10federal Health Insurance Portability and Accountability Act of
111996. Providers and covered entities shall, to the extent
12feasible, notify patients that third-party applications
13potentially introduce privacy risks. Providers shall enable
14all available encryption and privacy modes when using such
15applications. A public facing video communication application
16may not be used in the provision of telehealth services by
17covered health care providers or covered entities.
 
18    Section 40. Rulemaking authority. The Department of
19Insurance may adopt rules to implement the provisions of this
20Act.
 
21    Section 99. Effective date. This Act takes effect upon
22becoming law.