HB3308 EngrossedLRB102 11877 BMS 17213 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 and adding Section 356z.43 as
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
11transmission of a patient's medical information through an
12electronic communications system at an originating site to a
13health care provider at a distant site that does not require
14real-time or synchronous interaction between the health care
15provider and the patient.
16    "Distant site" means the location at which the health care
17provider rendering the telehealth service is located.
18    "E-visits" means patient-initiated, non-face-to-face
19communications through an online patient portal with a health
20care professional.
21    "Interactive telecommunications system" means an audio and
22video system, an audio-only telephone system (landline or
23cellular), or any other telecommunications system permitting



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12-way, synchronous interactive communication between the
2patient at an originating site and the health care
3professional or facility at a distant site permitting 2-way,
4live interactive communication between the patient and the
5distant site health care provider.
6    "Originating site" means the location at which the patient
7is located at the time health care services are provided to the
8patient via telehealth.
9    "Remote patient monitoring" means the use of digital
10technologies and mobile medical devices to collect medical and
11other health data from a patient at an originating site and
12electronically transmit that data to a health care
13professional or facility at a distant site for assessment and
14intervention to allow for ongoing monitoring and management of
15chronic and acute conditions.
16    "Telehealth" means the evaluation, diagnosis, or
17interpretation of electronically transmitted patient-specific
18data between a remote location and a licensed health care
19professional that generates interaction or treatment
20recommendations. "Telehealth" includes telemedicine and the
21delivery of health care services, including mental health
22treatment and substance use disorder treatment, provided by
23way of an interactive telecommunications system, asynchronous
24store and forward system, remote patient monitoring
25technologies, e-visits, or virtual check-ins.
26    "Telehealth services" means the delivery of covered health



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1care services by way of an interactive telecommunications
3    "Virtual check-in" means a brief, patient-initiated
4communication with a health care professional that involves an
5interactive telecommunications system to deliver an
6individualized clinical diagnosis, treatment, assessment, or
7guidance to an established patient. "Virtual check-in" only
8includes communications involving medical discussions that
9last at least as long as the time ranges provided in the most
10currently applicable Current Procedural Terminology or
11Healthcare Common Procedure Coding System codes designated for
12virtual check-ins. "Virtual check-in" does not include a
13communication that originates from a related office visit
14provided within the previous 7 days, nor a communication that
15leads to an office visit or procedure within the next 24 hours
16or the soonest available appointment.
17    (b) Health care services that are covered under If an
18individual or group policy of accident or health insurance
19must be covered when delivered via provides coverage for
20telehealth when clinically appropriate in the same manner as
21any other benefits covered under the policy. Coverage required
22under this Section shall comply with all of services, then it
23must 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
20health insurance provides coverage for telehealth services, it
21must provide coverage for licensed dietitian nutritionists and
22certified diabetes educators who counsel senior diabetes
23patients in the senior diabetes patients' homes to remove the
24hurdle of transportation for senior diabetes patients to
25receive treatment.
26    (c) Nothing in this Section shall be deemed as precluding



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1a health insurer from providing benefits for other services,
2including, but not limited to, services provided through an
3asynchronous store and forward system, e-visits, remote
4patient monitoring services, virtual check-ins remote
5monitoring services, other monitoring services, or oral
6communications otherwise covered under the policy. Health care
7providers shall determine the appropriateness of specific
8sites, technology platforms, and technology vendors for a
9telehealth service, as long as delivered services adhere to
10privacy laws, including, but not limited to, the Health
11Insurance Portability and Accountability Act of 1996 and the
12Mental Health and Developmental Disabilities Confidentiality
14    (d) A health insurer may establish reasonable requirements
15and parameters for telehealth services, including with respect
16to document and recordkeeping, to the extent consistent with
17this Section, the Telehealth Act, or any company bulletin
18issued by the Department under Executive Order 2020-09. Health
19insurers shall notify health care providers of any
20instructions necessary to facilitate billing for telehealth
22    (e) Notwithstanding Section 352b of this Code, an excepted
23benefit policy is subject to this Section if the policy covers
24the patient's use of health care services, whether on an
25expense-incurred or a per capita prepaid basis or otherwise.
26This Section does not apply to an excepted benefit policy with



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1respect to lump sum or periodic payments that the policy
2covers based on the occurrence of a diagnosis with a specified
3disease, an accident, or other qualifying health condition,
4nor does this Section apply to lump sum or periodic payments
5for expenses other than health care services. However, no
6policy may deny or reduce any benefit to a patient based on the
7use of clinically appropriate telehealth services in the
8course 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
13review and study the use of telehealth services in this State
14with respect to payment and reimbursement parity for health
15care providers providing such services. The task force shall
16be 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
20membership and shall have the authority to determine its
21meeting schedule, hearing schedule, and agendas. Task force
22members shall serve without compensation. The Department of
23Public Health shall provide administrative support to the task
25    (c) Appointments shall be made 90 days after the effective
26date of this amendatory Act of the 102nd General Assembly.



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1    (d) The task force shall review existing plans and
2policies issued, delivered, and offered in this State with
3respect to coverage and reimbursement for telehealth services,
4relevant data on payment parity for telehealth services, and
5payment parity statutes in other states and provide
6recommendations on the economic feasibility and cost
7effectiveness of requiring payment parity for health care
8services provided via telehealth, including recommendations
9for possible legislation.
10    (e) The task force shall submit its findings and
11recommendations to the Governor and the General Assembly by
12December 31, 2021.
13    (f) The task force is dissolved and this Section is
14repealed on January 1, 2023.
15    Section 10. The Telehealth Act is amended by changing
16Sections 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
20assistants, optometrists, advanced practice registered nurses,
21clinical psychologists licensed in Illinois, prescribing
22psychologists licensed in Illinois, dentists, occupational
23therapists, pharmacists, physical therapists, clinical social
24workers, speech-language pathologists, audiologists, hearing



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1instrument dispensers, and mental health and substance use
2disorder treatment professionals and clinicians authorized by
3Illinois law to provide mental health and substance use
4disorder treatment services, and qualified providers listed
5under paragraph (8) of subsection(e) of Section 3 of the Early
6Intervention Services System Act.
7    "Telehealth" means the evaluation, diagnosis, or
8interpretation of electronically transmitted patient-specific
9data between a remote location and a licensed health care
10professional that generates interaction or treatment
11recommendations. "Telehealth" includes telemedicine and the
12delivery of health care services, including mental health
13treatment and substance use disorder treatment, provided by
14way of an interactive telecommunications system, asynchronous
15store and forward system, remote patient monitoring
16technologies, e-visits, or virtual check-ins as defined in
17subsection (a) of Section 356z.22 of the Illinois Insurance
19(Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19;
20100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff.
22    (225 ILCS 150/15)
23    Sec. 15. Use of telehealth.
24    (a) A health care professional may engage in the practice
25of telehealth in Illinois to the extent of his or her scope of



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1practice as established in his or her respective licensing Act
2consistent with the standards of care for in-person services.
3This Act shall not be construed to alter the scope of practice
4of any health care professional or authorize the delivery of
5health care services in a setting or in a manner not otherwise
6authorized by the laws of this State.
7    (b) Services provided by telehealth pursuant to this
8Section shall be consistent with all federal and State
9privacy, security, and confidentiality laws.
10    (c) Health care professionals shall determine the
11appropriateness of specific sites, technology platforms, and
12technology vendors for a telehealth service, as long as
13delivered services adhere to privacy laws, including, but not
14limited to, the Health Insurance Portability and
15Accountability Act of 1996 and the Mental Health and
16Developmental Disabilities Confidentiality Act.
17    (d) Health care professionals shall maintain documentation
18and recordkeeping in accordance with subsection (d) of 89 Ill.
19Adm. Code 140.403.
20(Source: P.A. 100-317, eff. 1-1-18.)
21    Section 15. The Early Intervention Services System Act is
22amended by changing Sections 3 and 11 and by adding Section 3b
23as 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
3toddlers under 36 months of age with any of the following
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
5the following areas of childhood development as measured by
6appropriate diagnostic instruments and standard procedures:
7cognitive; physical, including vision and hearing; language,
8speech and communication; social or emotional; or adaptive.
9The term means a delay of 30% or more below the mean in
10function in one or more of those areas.
11    (c) "Physical or mental condition which typically results
12in 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
24observations and parental participation to determine
25eligibility by a consensus of a multidisciplinary team of 2 or
26more members based on their professional experience and



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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
20written plan for providing early intervention services to a
21child eligible under this Act and the child's family, as set
22forth in Section 11.
23    (g) "Local interagency agreement" means an agreement
24entered into by local community and State and regional
25agencies receiving early intervention funds directly from the
26State and made in accordance with State interagency agreements



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1providing for the delivery of early intervention services
2within a local community area.
3    (h) "Council" means the Illinois Interagency Council on
4Early Intervention established under Section 4.
5    (i) "Lead agency" means the State agency responsible for
6administering this Act and receiving and disbursing public
7funds received in accordance with State and federal law and
9    (i-5) "Central billing office" means the central billing
10office created by the lead agency under Section 13.
11    (j) "Child find" means a service which identifies eligible
12infants and toddlers.
13    (k) "Regional intake entity" means the lead agency's
14designated entity responsible for implementation of the Early
15Intervention Services System within its designated geographic
17    (l) "Early intervention provider" means an individual who
18is qualified, as defined by the lead agency, to provide one or
19more types of early intervention services, and who has
20enrolled as a provider in the early intervention program.
21    (m) "Fully credentialed early intervention provider" means
22an individual who has met the standards in the State
23applicable to the relevant profession, and has met such other
24qualifications as the lead agency has determined are suitable
25for personnel providing early intervention services, including
26pediatric experience, education, and continuing education. The



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1lead agency shall establish these qualifications by rule filed
2no later than 180 days after the effective date of this
3amendatory Act of the 92nd General Assembly.
4    (n) "Telehealth" has the meaning ascribed to that term in
5Section 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
9intervention provider may deliver via telehealth any type of
10early intervention service outlined in subsection (e) of
11Section 3 to the extent of his or her scope of practice as
12established in his or her respective licensing Act consistent
13with the standards of care for in-person services. This
14Section shall not be construed to alter the scope of practice
15of any early intervention provider or authorize the delivery
16of early intervention services in a setting or in a manner not
17otherwise 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
21toddler'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
2evaluated once a year and the family shall be provided a review
3of the Plan at 6 month intervals or more often where
4appropriate based on infant or toddler and family needs. The
5lead agency shall create a quality review process regarding
6Individualized Family Service Plan development and changes
7thereto, to monitor and help assure that resources are being
8used to provide appropriate early intervention services.
9    (c) The initial evaluation and initial assessment and
10initial Plan meeting must be held within 45 days after the
11initial contact with the early intervention services system.
12The 45-day timeline does not apply for any period when the
13child or parent is unavailable to complete the initial
14evaluation, the initial assessments of the child and family,
15or the initial Plan meeting, due to exceptional family
16circumstances that are documented in the child's early
17intervention records, or when the parent has not provided
18consent for the initial evaluation or the initial assessment
19of the child despite documented, repeated attempts to obtain
20parental consent. As soon as exceptional family circumstances
21no longer exist or parental consent has been obtained, the
22initial evaluation, the initial assessment, and the initial
23Plan meeting must be completed as soon as possible. With
24parental consent, early intervention services may commence
25before the completion of the comprehensive assessment and
26development of the Plan.



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1    (d) Parents must be informed that early intervention
2services shall be provided to each eligible infant and
3toddler, to the maximum extent appropriate, in the natural
4environment, which may include the home or other community
5settings. Parents must also be informed of the availability of
6early intervention services provided through telehealth.
7Parents shall make the final decision to accept or decline
8early intervention services, including whether accepted
9services are delivered in person or via telehealth. A decision
10to decline such services shall not be a basis for
11administrative determination of parental fitness, or other
12findings or sanctions against the parents. Parameters of the
13Plan shall be set forth in rules.
14    (e) The regional intake offices shall explain to each
15family, 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
17whether the family has private insurance coverage and, if the
18family has such coverage, must have attached to it a copy of
19the family's insurance identification card or otherwise
20include 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.



HB3308 Engrossed- 23 -LRB102 11877 BMS 17213 b

1        (4) The beginning date of the insurance benefit year.
2    (g) A copy of the individualized family service plan must
3be provided to each enrolled provider who is providing early
4intervention services to the child who is the subject of that
6    (h) Children receiving services under this Act shall
7receive a smooth and effective transition by their third
8birthday consistent with federal regulations adopted pursuant
9to Sections 1431 through 1444 of Title 20 of the United States
10Code. Beginning July 1, 2022, children who receive early
11intervention services prior to their third birthday and are
12found eligible for an individualized education program under
13the Individuals with Disabilities Education Act, 20 U.S.C.
141414(d)(1)(A), and under Section 14-8.02 of the School Code
15and whose birthday falls between May 1 and August 31 may
16continue to receive early intervention services until the
17beginning of the school year following their third birthday in
18order to minimize gaps in services, ensure better continuity
19of care, and align practices for the enrollment of preschool
20children with special needs to the enrollment practices of
21typically developing preschool children.
22(Source: P.A. 101-654, eff. 3-8-21.)
23    Section 99. Effective date. This Act takes effect upon
24becoming law.