Sen. Laura Fine

Filed: 3/29/2023

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 1913

2    AMENDMENT NO. ______. Amend Senate Bill 1913 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-47 as follows:
 
6    (305 ILCS 5/5-47 new)
7    Sec. 5-47. Coverage for mental health and substance use
8disorder telehealth services.
9    (a) As used in this Section:
10    "Behavioral health care professional" has the meaning
11given to "health care professional" in Section 5 of the
12Telehealth Act, but only with respect to professionals
13licensed or certified by the Division of Mental Health or
14Division of Substance Use Prevention and Recovery of the
15Department of Human Services engaged in the delivery of mental
16health or substance use disorder treatment or services.

 

 

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1    "Behavioral health facility" means a community mental
2health center, a behavioral health clinic, a substance use
3disorder treatment program, or a facility or provider licensed
4or certified by the Division of Mental Health or Division of
5Substance Use Prevention and Recovery of the Department of
6Human Services.
7    "Behavioral telehealth services" has the meaning given to
8the term "telehealth services" in Section 5 of the Telehealth
9Act, but limited solely to mental health and substance use
10disorder treatment or services to a patient, regardless of
11patient location.
12    "Distant site" has the meaning given to that term in
13Section 5 of the Telehealth Act.
14    "Originating site" has the meaning given to that term in
15Section 5 of the Telehealth Act.
16    (b) The Department and any managed care plans under
17contract with the Department for the medical assistance
18program shall provide for coverage of mental health and
19substance use disorder treatment or services delivered as
20behavioral telehealth services as specified in this Section.
21The Department and any managed care plans under contract with
22the Department for the medical assistance program may also
23provide reimbursement to a behavioral health facility that
24serves as the originating site at the time a behavioral
25telehealth service is rendered.
26    (c) To ensure behavioral telehealth services are equitably

 

 

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1provided, coverage required under this Section shall comply
2with all of the following:
3        (1) The Department and any managed care plans under
4    contract with the Department for the medical assistance
5    program shall not:
6            (A) require that in-person contact occur between a
7        behavioral health care professional and a patient
8        before the provision of a behavioral telehealth
9        service;
10            (B) require patients, behavioral health care
11        professionals, or behavioral health facilities to
12        prove or document a hardship or access barrier to an
13        in-person consultation for coverage and reimbursement
14        of behavioral telehealth services;
15            (C) require the use of behavioral telehealth
16        services when the behavioral health care professional
17        has determined that it is not appropriate;
18            (D) require the use of behavioral telehealth
19        services when a patient chooses an in-person
20        consultation;
21            (E) require a behavioral health care professional
22        to be physically present in the same room as the
23        patient at the originating site, unless deemed
24        medically necessary by the behavioral health care
25        professional providing the behavioral telehealth
26        service;

 

 

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1            (F) create geographic or facility restrictions or
2        requirements for behavioral telehealth services;
3            (G) require behavioral health care professionals
4        or behavioral health facilities to offer or provide
5        behavioral telehealth services;
6            (H) require patients to use behavioral telehealth
7        services or require patients to use a separate panel
8        of behavioral health care professionals or behavioral
9        health facilities to receive behavioral telehealth
10        services; or
11            (I) impose upon behavioral telehealth services
12        utilization review requirements that are unnecessary,
13        duplicative, or unwarranted or impose any treatment
14        limitations, prior authorization, documentation, or
15        recordkeeping requirements that are more stringent
16        than the requirements applicable to the same
17        behavioral health care service when rendered
18        in-person, except that procedure code modifiers may be
19        required to document behavioral telehealth.
20        (2) Any cost sharing applicable to services provided
21    through behavioral telehealth shall not exceed the cost
22    sharing required by the medical assistance program for the
23    same services provided through in-person consultation.
24        (3) The Department and any managed care plans under
25    contract with the Department for the medical assistance
26    program shall notify behavioral health care professionals

 

 

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1    and behavioral health facilities of any instructions
2    necessary to facilitate billing for behavioral telehealth
3    services.
4    (d) For purposes of reimbursement, the Department and any
5managed care plans under contract with the Department for the
6medical assistance program shall reimburse a behavioral health
7care professional or behavioral health facility for behavioral
8telehealth services on the same basis, in the same manner, and
9at the same reimbursement rate that would apply to the
10services if the services had been delivered via an in-person
11encounter by a behavioral health care professional or
12behavioral health facility. This subsection applies only to
13those services provided by behavioral telehealth that may
14otherwise be billed as an in-person service.
15    (e) Behavioral health care professionals and behavioral
16health facilities shall determine the appropriateness of
17specific sites, technology platforms, and technology vendors
18for a behavioral telehealth service, as long as delivered
19services adhere to all federal and State privacy, security,
20and confidentiality laws, rules, or regulations, including,
21but not limited to, the Health Insurance Portability and
22Accountability Act of 1996, 42 CFR Part 2, and the Mental
23Health and Developmental Disabilities Confidentiality Act.
24    (f) Nothing in this Section shall be deemed as precluding
25the Department and any managed care plans under contract with
26the Department for the medical assistance program from

 

 

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1providing benefits for other telehealth services.
2    (g) There shall be no restrictions on originating site
3requirements for behavioral telehealth coverage or
4reimbursement to the distant site under this Section other
5than requiring the behavioral telehealth services to be
6medically necessary and clinically appropriate.
7    (h) Nothing in this Section shall be deemed as precluding
8the Department and any managed care plans under contract with
9the Department for the medical assistance program from
10establishing limits on the use of telehealth for a particular
11behavioral health service when the limits are consistent with
12generally accepted standards of mental, emotional, nervous, or
13substance use disorder or condition care.
14    (i) The Department may adopt rules to implement the
15provisions of this Section.".