Full Text of HB3308 102nd General Assembly
HB3308eng 102ND GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 356z.22 and adding Section 356z.43 as | 6 | | follows: | 7 | | (215 ILCS 5/356z.22) | 8 | | Sec. 356z.22. Coverage for telehealth services. | 9 | | (a) For purposes of this Section: | 10 | | "Asynchronous store and forward system" means the | 11 | | transmission of a patient's medical information through an | 12 | | electronic communications system at an originating site to a | 13 | | health care provider at a distant site that does not require | 14 | | real-time or synchronous interaction between the health care | 15 | | provider and the patient. | 16 | | "Distant site" means the location at which the health care | 17 | | provider rendering the telehealth service is located. | 18 | | "E-visits" means patient-initiated, non-face-to-face | 19 | | communications through an online patient portal with a health | 20 | | care professional. | 21 | | "Interactive telecommunications system" means an audio and | 22 | | video system , an audio-only telephone system (landline or | 23 | | cellular), or any other telecommunications system permitting |
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| 1 | | 2-way, synchronous interactive communication between the | 2 | | patient at an originating site and the health care | 3 | | professional or facility at a distant site permitting 2-way, | 4 | | live interactive communication between the patient and the | 5 | | distant site health care provider . | 6 | | "Originating site" means the location at which the patient | 7 | | is located at the time health care services are provided to the | 8 | | patient via telehealth. | 9 | | "Remote patient monitoring" means the use of digital | 10 | | technologies and mobile medical devices to collect medical and | 11 | | other health data from a patient at an originating site and | 12 | | electronically transmit that data to a health care | 13 | | professional or facility at a distant site for assessment and | 14 | | intervention to allow for ongoing monitoring and management of | 15 | | chronic and acute conditions. | 16 | | "Telehealth" means the evaluation, diagnosis, or | 17 | | interpretation of electronically transmitted patient-specific | 18 | | data between a remote location and a licensed health care | 19 | | professional that generates interaction or treatment | 20 | | recommendations. "Telehealth" includes telemedicine and the | 21 | | delivery of health care services, including mental health | 22 | | treatment and substance use disorder treatment, provided by | 23 | | way of an interactive telecommunications system, asynchronous | 24 | | store and forward system, remote patient monitoring | 25 | | technologies, e-visits, or virtual check-ins. | 26 | | "Telehealth services" means the delivery of covered health |
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| 1 | | care services by way of an interactive telecommunications | 2 | | system. | 3 | | "Virtual check-in" means a brief, patient-initiated | 4 | | communication with a health care professional that involves an | 5 | | interactive telecommunications system to deliver an | 6 | | individualized clinical diagnosis, treatment, assessment, or | 7 | | guidance to an established patient. "Virtual check-in" only | 8 | | includes communications involving medical discussions that | 9 | | last at least as long as the time ranges provided in the most | 10 | | currently applicable Current Procedural Terminology or | 11 | | Healthcare Common Procedure Coding System codes designated for | 12 | | virtual check-ins. "Virtual check-in" does not include a | 13 | | communication that originates from a related office visit | 14 | | provided within the previous 7 days, nor a communication that | 15 | | leads to an office visit or procedure within the next 24 hours | 16 | | or the soonest available appointment. | 17 | | (b) Health care services that are covered under If an | 18 | | individual or group policy of accident or health insurance | 19 | | must be covered when delivered via provides coverage for | 20 | | telehealth when clinically appropriate in the same manner as | 21 | | any other benefits covered under the policy. Coverage required | 22 | | under this Section shall comply with all of services, then it | 23 | | must comply with the following: | 24 | | (1) An individual or group policy of accident or | 25 | | health insurance providing telehealth services may not: | 26 | | (A) require that in-person contact occur between a |
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| 1 | | health care provider and a patient; | 2 | | (B) require the health care provider to document a | 3 | | barrier to an in-person consultation for coverage of | 4 | | services to be provided through telehealth; | 5 | | (C) require the use of telehealth when the health | 6 | | care provider has determined that it is not | 7 | | appropriate; or | 8 | | (D) require the use of telehealth when a patient | 9 | | chooses an in-person consultation or require patients | 10 | | to use a separate panel of
health care providers to | 11 | | receive telehealth service
coverage and | 12 | | reimbursement; . | 13 | | (E) create geographic or facility restrictions or
| 14 | | requirements for telehealth services; | 15 | | (F) require covered individuals or health care | 16 | | providers to
prove a hardship or access barrier before | 17 | | the approval
of telehealth services for coverage or | 18 | | reimbursement; | 19 | | (G) impose upon telehealth services utilization
| 20 | | review requirements that are unnecessary, duplicative,
| 21 | | or unwarranted or impose any treatment limitations,
| 22 | | prior authorization, documentation, or recordkeeping
| 23 | | requirements that are more stringent than the
| 24 | | requirements applicable to the same health care
| 25 | | service when rendered in-person; or | 26 | | (H) require prior authorization for telehealth |
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| 1 | | services related to COVID-19 delivered by a network | 2 | | provider. | 3 | | (2) Patient cost-sharing may be no more than if the | 4 | | health care service were delivered in person. Deductibles, | 5 | | copayments, or coinsurance applicable to services provided | 6 | | through telehealth shall not exceed the deductibles, | 7 | | copayments, or coinsurance required by the individual or | 8 | | group policy of accident or health insurance for the same | 9 | | services provided through in-person consultation. | 10 | | (3) Subject to all terms and conditions of the policy, | 11 | | a health insurer shall reimburse a network provider for | 12 | | behavioral health services, including mental health | 13 | | treatment and substance use disorder treatment, delivered | 14 | | through telehealth on at least the same basis and at the | 15 | | same rate as would be applied for the same services if they | 16 | | had been delivered in-person and shall include reasonable | 17 | | compensation to a facility that serves as the originating | 18 | | site at the time a telehealth service is rendered. | 19 | | (b-5) If an individual or group policy of accident or | 20 | | health insurance provides coverage for telehealth services, it | 21 | | must provide coverage for licensed dietitian nutritionists and | 22 | | certified diabetes educators who counsel senior diabetes | 23 | | patients in the senior diabetes patients' homes to remove the | 24 | | hurdle of transportation for senior diabetes patients to | 25 | | receive treatment. | 26 | | (c) Nothing in this Section shall be deemed as precluding |
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| 1 | | a health insurer from providing benefits for other services, | 2 | | including, but not limited to, services provided through an | 3 | | asynchronous store and forward system, e-visits, remote | 4 | | patient monitoring services, virtual check-ins remote | 5 | | monitoring services, other monitoring services , or oral | 6 | | communications otherwise covered under the policy. Health care | 7 | | providers shall determine the appropriateness of specific | 8 | | sites, technology platforms, and technology vendors for a | 9 | | telehealth service, as long as delivered services adhere to | 10 | | privacy laws, including, but not limited to, the Health | 11 | | Insurance Portability and Accountability Act of 1996 and the | 12 | | Mental Health and Developmental Disabilities Confidentiality | 13 | | Act.
| 14 | | (d) A health insurer may establish reasonable requirements | 15 | | and parameters for telehealth services, including with respect | 16 | | to document and recordkeeping, to the extent consistent with | 17 | | this Section, the Telehealth Act, or any company bulletin | 18 | | issued by the Department under Executive Order 2020-09. Health | 19 | | insurers shall notify health care providers of any | 20 | | instructions necessary to facilitate billing for telehealth | 21 | | services. | 22 | | (e) Notwithstanding Section 352b of this Code, an excepted | 23 | | benefit policy is subject to this Section if the policy covers | 24 | | the patient's use of health care services, whether on an | 25 | | expense-incurred or a per capita prepaid basis or otherwise. | 26 | | This Section does not apply to an excepted benefit policy with |
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| 1 | | respect to lump sum or periodic payments that the policy | 2 | | covers based on the occurrence of a diagnosis with a specified | 3 | | disease, an accident, or other qualifying health condition, | 4 | | nor does this Section apply to lump sum or periodic payments | 5 | | for expenses other than health care services. However, no | 6 | | policy may deny or reduce any benefit to a patient based on the | 7 | | use of clinically appropriate telehealth services in the | 8 | | course of satisfying the policy's benefit criteria. | 9 | | (Source: P.A. 100-1009, eff. 1-1-19 .) | 10 | | (215 ILCS 5/356z.43 new) | 11 | | Sec. 356z.43. Telehealth Payment Parity Task Force. | 12 | | (a) The Telehealth Payment Parity Task Force is created to | 13 | | review and study the use of telehealth services in this State | 14 | | with respect to payment and reimbursement parity for health | 15 | | care providers providing such services. The task force shall | 16 | | be comprised of the following members: | 17 | | (1) two members representing the Department of | 18 | | Insurance appointed by the Director of Insurance; | 19 | | (2) one member representing the Department of Public | 20 | | Health appointed by the Director of Public Health; | 21 | | (3) two members representing the Department of | 22 | | Healthcare and Family Services appointed by the Director | 23 | | of Healthcare and Family Services; | 24 | | (4) two members representing hospitals nominated by | 25 | | the head of a statewide organization representing the |
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| 1 | | interests of hospitals in Illinois and appointed by the | 2 | | Director of Public Health; | 3 | | (5) one member representing physicians nominated by | 4 | | the head of a statewide organization representing the | 5 | | interests of physicians in Illinois and appointed by the | 6 | | Director of Public Health; | 7 | | (6) two members representing the insurance industry | 8 | | nominated by the head of a statewide organization | 9 | | representing the interests of insurers in Illinois and | 10 | | appointed by the Director of Public Health; | 11 | | (7) one member of the General Assembly appointed by | 12 | | the Speaker of the House of Representatives; | 13 | | (8) one member of the General Assembly appointed by | 14 | | the President of the Senate; | 15 | | (9) one member of the General Assembly appointed by | 16 | | the Minority Leader of the House of Representatives; and | 17 | | (10) one member of the General Assembly appointed by | 18 | | the Minority Leader of the Senate. | 19 | | (b) The task force shall elect a chairperson from its | 20 | | membership and shall have the authority to determine its | 21 | | meeting schedule, hearing schedule, and agendas. Task force | 22 | | members shall serve without compensation. The Department of | 23 | | Public Health shall provide administrative support to the task | 24 | | force. | 25 | | (c) Appointments shall be made 90 days after the effective | 26 | | date of this amendatory Act of the 102nd General Assembly. |
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| 1 | | (d) The task force shall review existing plans and | 2 | | policies issued, delivered, and offered in this State with | 3 | | respect to coverage and reimbursement for telehealth services, | 4 | | relevant data on payment parity for telehealth services, and | 5 | | payment parity statutes in other states and provide | 6 | | recommendations on the economic feasibility and cost | 7 | | effectiveness of requiring payment parity for health care | 8 | | services provided via telehealth, including recommendations | 9 | | for possible legislation. | 10 | | (e) The task force shall submit its findings and | 11 | | recommendations to the Governor and the General Assembly by | 12 | | December 31, 2021. | 13 | | (f) The task force is dissolved and this Section is | 14 | | repealed on January 1, 2023.
| 15 | | Section 10. The Telehealth Act is amended by changing | 16 | | Sections 5 and 15 as follows: | 17 | | (225 ILCS 150/5)
| 18 | | Sec. 5. Definitions. As used in this Act: | 19 | | "Health care professional" includes physicians, physician | 20 | | assistants, optometrists, advanced practice registered nurses, | 21 | | clinical psychologists licensed in Illinois, prescribing | 22 | | psychologists licensed in Illinois, dentists, occupational | 23 | | therapists, pharmacists, physical therapists, clinical social | 24 | | workers, speech-language pathologists, audiologists, hearing |
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| 1 | | instrument dispensers, and mental health and substance use | 2 | | disorder treatment professionals and clinicians authorized by | 3 | | Illinois law to provide mental health and substance use | 4 | | disorder treatment services , and qualified providers listed | 5 | | under paragraph (8)
of subsection(e) of Section 3 of the Early | 6 | | Intervention
Services System Act .
| 7 | | "Telehealth" means the evaluation, diagnosis, or | 8 | | interpretation of electronically transmitted patient-specific | 9 | | data between a remote location and a licensed health care | 10 | | professional that generates interaction or treatment | 11 | | recommendations. "Telehealth" includes telemedicine and the | 12 | | delivery of health care services , including mental health | 13 | | treatment and substance use disorder treatment, provided by | 14 | | way of an interactive telecommunications system, asynchronous | 15 | | store and forward system, remote patient monitoring | 16 | | technologies, e-visits, or virtual check-ins as defined in | 17 | | subsection (a) of Section 356z.22 of the Illinois Insurance | 18 | | Code.
| 19 | | (Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19; | 20 | | 100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff. | 21 | | 7-19-19.) | 22 | | (225 ILCS 150/15)
| 23 | | Sec. 15. Use of telehealth. | 24 | | (a) A health care professional may engage in the practice | 25 | | of telehealth in Illinois to the extent of his or her scope of |
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| 1 | | practice as established in his or her respective licensing Act | 2 | | consistent with the standards of care for in-person services. | 3 | | This Act shall not be construed to alter the scope of practice | 4 | | of any health care professional or authorize the delivery of | 5 | | health care services in a setting or in a manner not otherwise | 6 | | authorized by the laws of this State.
| 7 | | (b) Services provided by telehealth pursuant to this | 8 | | Section shall be consistent with all federal and State | 9 | | privacy, security, and confidentiality laws. | 10 | | (c) Health care professionals shall determine the | 11 | | appropriateness of specific sites, technology platforms, and | 12 | | technology vendors for a telehealth service, as long as | 13 | | delivered services adhere to privacy laws, including, but not | 14 | | limited to, the Health Insurance Portability and | 15 | | Accountability Act of 1996 and the Mental Health and | 16 | | Developmental Disabilities Confidentiality Act. | 17 | | (d) Health care professionals shall maintain documentation | 18 | | and recordkeeping in accordance with subsection (d) of 89 Ill. | 19 | | Adm. Code 140.403. | 20 | | (Source: P.A. 100-317, eff. 1-1-18 .) | 21 | | Section 15. The Early Intervention Services System Act is | 22 | | amended by changing Sections 3 and 11 and by adding Section 3b | 23 | | as follows:
| 24 | | (325 ILCS 20/3) (from Ch. 23, par. 4153)
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| 1 | | Sec. 3. Definitions. As used in this Act:
| 2 | | (a) "Eligible infants and toddlers" means infants and | 3 | | toddlers
under 36 months of age with any of the following | 4 | | conditions:
| 5 | | (1) Developmental delays.
| 6 | | (2) A physical or mental condition which typically | 7 | | results in
developmental delay.
| 8 | | (3) Being at risk of having substantial developmental | 9 | | delays
based on informed clinical opinion.
| 10 | | (4) Either (A) having entered the program under any of
| 11 | | the circumstances listed in paragraphs (1) through (3) of | 12 | | this
subsection
but no
longer meeting
the current | 13 | | eligibility criteria under those paragraphs,
and | 14 | | continuing to have any measurable delay, or (B) not
having | 15 | | attained a level of development in each area,
including
| 16 | | (i) cognitive, (ii) physical (including vision and | 17 | | hearing), (iii)
language,
speech, and communication, (iv) | 18 | | social or emotional, or (v) adaptive, that
is at least at | 19 | | the mean of the child's age equivalent peers;
and,
in | 20 | | addition to either item (A) or item (B), (C)
having
been | 21 | | determined by the multidisciplinary individualized
family | 22 | | service plan
team to require the continuation of early | 23 | | intervention services in order to
support
continuing
| 24 | | developmental progress, pursuant to the child's needs and | 25 | | provided in an
appropriate
developmental manner. The type, | 26 | | frequency, and intensity of services shall
differ from
the |
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| 1 | | initial individualized family services plan because of the | 2 | | child's
developmental
progress, and may consist of only | 3 | | service coordination, evaluation, and
assessments.
| 4 | | (b) "Developmental delay" means a delay in one or more of | 5 | | the following
areas of childhood development as measured by | 6 | | appropriate diagnostic
instruments and standard procedures: | 7 | | cognitive; physical, including vision
and hearing; language, | 8 | | speech and communication; social or emotional;
or adaptive. | 9 | | The term means a delay of 30% or more below the mean in
| 10 | | function in one or more of those areas.
| 11 | | (c) "Physical or mental condition which typically results | 12 | | in developmental
delay" means:
| 13 | | (1) a diagnosed medical disorder or exposure to a | 14 | | toxic substance bearing a relatively well known
expectancy | 15 | | for developmental outcomes within varying ranges of | 16 | | developmental
disabilities; or
| 17 | | (2) a history of prenatal, perinatal, neonatal or | 18 | | early developmental
events suggestive of biological | 19 | | insults to the developing central nervous
system and which | 20 | | either singly or collectively increase the probability of
| 21 | | developing a disability or delay based on a medical | 22 | | history.
| 23 | | (d) "Informed clinical opinion" means both clinical | 24 | | observations and
parental participation to determine | 25 | | eligibility by a consensus of a
multidisciplinary team of 2 or | 26 | | more members based on their professional
experience and |
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| 1 | | expertise.
| 2 | | (e) "Early intervention services" means services which:
| 3 | | (1) are designed to meet the developmental needs of | 4 | | each child
eligible under this Act and the needs of his or | 5 | | her family;
| 6 | | (2) are selected in collaboration with the child's | 7 | | family;
| 8 | | (3) are provided under public supervision;
| 9 | | (4) are provided at no cost except where a schedule of | 10 | | sliding scale
fees or other system of payments by families | 11 | | has been adopted in accordance
with State and federal law;
| 12 | | (5) are designed to meet an infant's or toddler's | 13 | | developmental needs in
any of the following areas:
| 14 | | (A) physical development, including vision and | 15 | | hearing,
| 16 | | (B) cognitive development,
| 17 | | (C) communication development,
| 18 | | (D) social or emotional development, or
| 19 | | (E) adaptive development;
| 20 | | (6) meet the standards of the State, including the | 21 | | requirements of this Act;
| 22 | | (7) include one or more of the following:
| 23 | | (A) family training,
| 24 | | (B) social work services, including counseling, | 25 | | and home visits,
| 26 | | (C) special instruction,
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| 1 | | (D) speech, language pathology and audiology,
| 2 | | (E) occupational therapy,
| 3 | | (F) physical therapy,
| 4 | | (G) psychological services,
| 5 | | (H) service coordination services,
| 6 | | (I) medical services only for diagnostic or | 7 | | evaluation purposes,
| 8 | | (J) early identification, screening, and | 9 | | assessment services,
| 10 | | (K) health services specified by the lead agency | 11 | | as necessary to
enable the infant or toddler to | 12 | | benefit from the other early intervention
services,
| 13 | | (L) vision services,
| 14 | | (M) transportation,
| 15 | | (N) assistive technology devices and services,
| 16 | | (O) nursing services, | 17 | | (P) nutrition services, and | 18 | | (Q) sign language and cued language services;
| 19 | | (8) are provided by qualified personnel, including but | 20 | | not limited to:
| 21 | | (A) child development specialists or special | 22 | | educators, including teachers of children with hearing | 23 | | impairments (including deafness) and teachers of | 24 | | children with vision impairments (including | 25 | | blindness),
| 26 | | (B) speech and language pathologists and |
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| 1 | | audiologists,
| 2 | | (C) occupational therapists,
| 3 | | (D) physical therapists,
| 4 | | (E) social workers,
| 5 | | (F) nurses,
| 6 | | (G) dietitian nutritionists,
| 7 | | (H) vision specialists, including ophthalmologists | 8 | | and optometrists,
| 9 | | (I) psychologists, and
| 10 | | (J) physicians;
| 11 | | (9) are provided in conformity with an Individualized | 12 | | Family Service Plan;
| 13 | | (10) are provided throughout the year; and
| 14 | | (11) are provided in natural
environments, to the | 15 | | maximum extent appropriate, which may include the home and | 16 | | community settings, unless justification is provided | 17 | | consistent with federal regulations adopted under Sections | 18 | | 1431 through 1444 of Title 20 of the United States Code.
| 19 | | (f) "Individualized Family Service Plan" or "Plan" means a | 20 | | written plan for
providing early intervention services to a | 21 | | child eligible under this Act
and the child's family, as set | 22 | | forth in Section 11.
| 23 | | (g) "Local interagency agreement" means an agreement | 24 | | entered into by
local community and State and regional | 25 | | agencies receiving early
intervention funds directly from the | 26 | | State and made in accordance with
State interagency agreements |
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| 1 | | providing for the delivery of early
intervention services | 2 | | within a local community area.
| 3 | | (h) "Council" means the Illinois Interagency Council on | 4 | | Early
Intervention established under Section 4.
| 5 | | (i) "Lead agency" means the State agency
responsible for | 6 | | administering this Act and
receiving and disbursing public | 7 | | funds received in accordance with State and
federal law and | 8 | | rules.
| 9 | | (i-5) "Central billing office" means the central billing | 10 | | office created by
the lead agency under Section 13.
| 11 | | (j) "Child find" means a service which identifies eligible | 12 | | infants and
toddlers.
| 13 | | (k) "Regional intake entity" means the lead agency's | 14 | | designated entity
responsible for implementation of the Early | 15 | | Intervention Services System within
its designated geographic | 16 | | area.
| 17 | | (l) "Early intervention provider" means an individual who | 18 | | is qualified, as
defined by the lead agency, to provide one or | 19 | | more types of early intervention
services, and who has | 20 | | enrolled as a provider in the early intervention program.
| 21 | | (m) "Fully credentialed early intervention provider" means | 22 | | an individual who
has met the standards in the State | 23 | | applicable to the relevant
profession, and has met such other | 24 | | qualifications as the lead agency has
determined are suitable | 25 | | for personnel providing early intervention services,
including | 26 | | pediatric experience, education, and continuing education. The |
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| 1 | | lead
agency shall establish these qualifications by rule filed | 2 | | no later than 180
days
after the effective date of this | 3 | | amendatory Act of the 92nd General Assembly.
| 4 | | (n) "Telehealth" has the meaning ascribed to that term in | 5 | | Section 5 of the Telehealth Act. | 6 | | (Source: P.A. 101-10, eff. 6-5-19.)
| 7 | | (325 ILCS 20/3b new) | 8 | | Sec. 3b. Services delivered by telehealth. An early | 9 | | intervention provider may deliver via telehealth any type of | 10 | | early intervention service outlined in subsection (e) of | 11 | | Section 3 to the extent of his or her scope of practice as | 12 | | established in his or her respective licensing Act consistent | 13 | | with the standards of care for in-person services. This | 14 | | Section shall not be construed to alter the scope of practice | 15 | | of any early intervention provider or authorize the delivery | 16 | | of early intervention services in a setting or in a manner not | 17 | | otherwise authorized by the laws of this State.
| 18 | | (325 ILCS 20/11) (from Ch. 23, par. 4161)
| 19 | | Sec. 11. Individualized Family Service Plans.
| 20 | | (a) Each eligible infant or toddler and that infant's or | 21 | | toddler's family
shall receive:
| 22 | | (1) timely, comprehensive, multidisciplinary | 23 | | assessment of the unique
strengths and needs of each | 24 | | eligible infant and toddler, and assessment of the |
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| 1 | | concerns
and priorities of the families to appropriately | 2 | | assist them in meeting
their needs and identify supports | 3 | | and services to meet those needs; and
| 4 | | (2) a written Individualized Family Service Plan | 5 | | developed by a
multidisciplinary team which includes the | 6 | | parent or guardian. The
individualized family service plan | 7 | | shall be based on the
multidisciplinary team's assessment | 8 | | of the resources, priorities,
and concerns of the family | 9 | | and its identification of the supports
and services | 10 | | necessary to enhance the family's capacity to meet the
| 11 | | developmental needs of the infant or toddler, and shall | 12 | | include the
identification of services appropriate to meet | 13 | | those needs, including the
frequency, intensity, and | 14 | | method of delivering services. During and as part of
the | 15 | | initial development of the individualized family services | 16 | | plan, and any
periodic reviews of the plan, the | 17 | | multidisciplinary team may seek consultation from the lead
| 18 | | agency's designated experts, if any, to help
determine | 19 | | appropriate services and the frequency and intensity of | 20 | | those
services. All services in the individualized family | 21 | | services plan must be
justified by the multidisciplinary | 22 | | assessment of the unique strengths and
needs of the infant | 23 | | or toddler and must be appropriate to meet those needs.
At | 24 | | the periodic reviews, the team shall determine whether | 25 | | modification or
revision of the outcomes or services is | 26 | | necessary.
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| 1 | | (b) The Individualized Family Service Plan shall be | 2 | | evaluated once a year
and the family shall be provided a review | 3 | | of the Plan at 6 month intervals or
more often where | 4 | | appropriate based on infant or toddler and family needs.
The | 5 | | lead agency shall create a quality review process regarding | 6 | | Individualized
Family Service Plan development and changes | 7 | | thereto, to monitor
and help assure that resources are being | 8 | | used to provide appropriate early
intervention services.
| 9 | | (c) The initial evaluation and initial assessment and | 10 | | initial
Plan meeting must be held within 45 days after the | 11 | | initial
contact with the early intervention services system. | 12 | | The 45-day timeline does not apply for any period when the | 13 | | child or parent is unavailable to complete the initial | 14 | | evaluation, the initial assessments of the child and family, | 15 | | or the initial Plan meeting, due to exceptional family | 16 | | circumstances that are documented in the child's early | 17 | | intervention records, or when the parent has not provided | 18 | | consent for the initial evaluation or the initial assessment | 19 | | of the child despite documented, repeated attempts to obtain | 20 | | parental consent. As soon as exceptional family circumstances | 21 | | no longer exist or parental consent has been obtained, the | 22 | | initial evaluation, the initial assessment, and the initial | 23 | | Plan meeting must be completed as soon as possible. With | 24 | | parental consent,
early intervention services may commence | 25 | | before the completion of the
comprehensive assessment and | 26 | | development of the Plan.
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| 1 | | (d) Parents must be informed that early
intervention
| 2 | | services shall be provided to each eligible infant and | 3 | | toddler, to the maximum extent appropriate, in the natural
| 4 | | environment, which may include the home or other community | 5 | | settings. Parents must also be informed of the availability of | 6 | | early intervention services provided through telehealth. | 7 | | Parents
shall make
the final decision to accept or decline
| 8 | | early intervention services , including whether accepted | 9 | | services are delivered in person or via telehealth . A decision | 10 | | to decline such services shall
not be a basis for | 11 | | administrative determination of parental fitness, or
other | 12 | | findings or sanctions against the parents. Parameters of the | 13 | | Plan
shall be set forth in rules.
| 14 | | (e) The regional intake offices shall explain to each | 15 | | family, orally and
in
writing, all of the following:
| 16 | | (1) That the early intervention program will pay for | 17 | | all early
intervention services set forth in the | 18 | | individualized family service plan that
are not
covered or | 19 | | paid under the family's public or private insurance plan | 20 | | or policy
and not
eligible for payment through any other | 21 | | third party payor.
| 22 | | (2) That services will not be delayed due to any rules | 23 | | or restrictions
under the family's insurance plan or | 24 | | policy.
| 25 | | (3) That the family may request, with appropriate | 26 | | documentation
supporting the request, a
determination of |
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| 1 | | an exemption from private insurance use under
Section | 2 | | 13.25.
| 3 | | (4) That responsibility for co-payments or
| 4 | | co-insurance under a family's private insurance
plan or | 5 | | policy will be transferred to the lead
agency's central | 6 | | billing office.
| 7 | | (5) That families will be responsible
for payments of | 8 | | family fees,
which will be based on a sliding scale
| 9 | | according to the State's definition of ability to pay | 10 | | which is comparing household size and income to the | 11 | | sliding scale and considering out-of-pocket medical or | 12 | | disaster expenses, and that these fees
are payable to the | 13 | | central billing office. Families who fail to provide | 14 | | income information shall be charged the maximum amount on | 15 | | the sliding scale.
| 16 | | (f) The individualized family service plan must state | 17 | | whether the family
has private insurance coverage and, if the | 18 | | family has such coverage, must
have attached to it a copy of | 19 | | the family's insurance identification card or
otherwise
| 20 | | include all of the following information:
| 21 | | (1) The name, address, and telephone number of the | 22 | | insurance
carrier.
| 23 | | (2) The contract number and policy number of the | 24 | | insurance plan.
| 25 | | (3) The name, address, and social security number of | 26 | | the primary
insured.
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| 1 | | (4) The beginning date of the insurance benefit year.
| 2 | | (g) A copy of the individualized family service plan must | 3 | | be provided to
each enrolled provider who is providing early | 4 | | intervention services to the
child
who is the subject of that | 5 | | plan.
| 6 | | (h) Children receiving services under this Act shall | 7 | | receive a smooth and effective transition by their third | 8 | | birthday consistent with federal regulations adopted pursuant | 9 | | to Sections 1431 through 1444 of Title 20 of the United States | 10 | | Code. Beginning July 1, 2022, children who receive early | 11 | | intervention services prior to their third birthday and are | 12 | | found eligible for an individualized education program under | 13 | | the Individuals with Disabilities Education Act, 20 U.S.C. | 14 | | 1414(d)(1)(A), and under Section 14-8.02 of the School Code | 15 | | and whose birthday falls between May 1 and August 31 may | 16 | | continue to receive early intervention services until the | 17 | | beginning of the school year following their third birthday in | 18 | | order to minimize gaps in services, ensure better continuity | 19 | | of care, and align practices for the enrollment of preschool | 20 | | children with special needs to the enrollment practices of | 21 | | typically developing preschool children. | 22 | | (Source: P.A. 101-654, eff. 3-8-21.)
| 23 | | Section 99. Effective date. This Act takes effect upon | 24 | | becoming law. |
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