Illinois General Assembly - Full Text of HB3308
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Full Text of HB3308  102nd General Assembly

HB3308ham001 102ND GENERAL ASSEMBLY

Rep. Thaddeus Jones

Filed: 3/22/2021

 

 


 

 


 
10200HB3308ham001LRB102 11877 BMS 24127 a

1
AMENDMENT TO HOUSE BILL 3308

2    AMENDMENT NO. ______. Amend House Bill 3308 by replacing
3everything after the enacting clause with the following:
 
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    "Asynchronous store and forward system" means the
10transmission of a patient's medical information through an
11electronic communications system at an originating site to a
12health care provider at a distant site that does not require
13real-time or synchronous interaction between the health care
14provider and the patient.
15    "Distant site" means the location at which the health care
16provider rendering the telehealth service is located.

 

 

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1    "E-visits" means non-face-to-face communications through
2an online patient portal with a health care professional.
3"E-visits" only include communications involving a health care
4professional's evaluation and management where the initial
5inquiry is initiated by an established patient and the
6cumulative duration of which is at least as long as the
7cumulative time ranges provided in the most currently
8applicable Current Procedural Terminology or Healthcare Common
9Procedure Coding System codes designated for e-visits.
10    "Facility" includes a facility that is owned or operated
11by a hospital under the Hospital Licensing Act or University
12of Illinois Hospital Act, a facility under the Nursing Home
13Care Act, a rural health clinic, a federally qualified health
14center, a local health department, a community mental health
15center, a behavioral health clinic, an encounter rate clinic,
16a skilled nursing facility, a substance use treatment program
17licensed by the Department of Human Services' Division of
18Substance Use Prevention and Recovery, a school-based health
19center as defined in 77 Ill. Adm. Code 641.10, a physician's
20office, a podiatrist's office, a supportive living program
21provider, a hospice provider, a facility under the ID/DD
22Community Care Act, a community-integrated living arrangement
23as defined in the Community-Integrated Living Arrangements
24Licensure and Certification Act, and a provider who receives
25reimbursement for a patient's room and board.
26    "Interactive telecommunications system" means an audio and

 

 

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1video system, an audio-only telephone system (landline or
2cellular), or any other telecommunications system permitting
32-way, synchronous interactive communication between the
4patient at an originating site and the health care
5professional or facility at a distant site permitting 2-way,
6live interactive communication between the patient and the
7distant site health care provider.
8    "Originating site" means the location at which the patient
9is located at the time health care services are provided to the
10patient via telehealth.
11    "Remote patient monitoring" means the use of digital
12technologies to collect medical and other health data from a
13patient at an originating site and electronically transmit
14that data to a health care professional or facility at a
15distant site.
16    "Telehealth services" 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 services" includes telemedicine
21and the delivery of health care services, mental health
22treatment, and substance use disorder treatment to a patient,
23regardless of his or her location, provided by way of an
24interactive telecommunications system, including telephone or
25video technology, asynchronous store and forward system,
26remote patient monitoring technology, e-visit, and virtual

 

 

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1check-in delivery of covered health care services by way of an
2interactive telecommunications system.
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 services when clinically appropriate in the same
21manner as any other benefits covered under the policy.
22Reimbursement to a health care provider for telehealth
23services for behavioral health services, including mental
24health treatment and substance use disorder treatment,
25provided through an interactive telecommunications system
26shall be made on the same basis, in the same manner, and at the

 

 

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1same rate as would be applied for the same services if they had
2been delivered in-person and shall include reasonable
3compensation to a facility that serves as the originating site
4at the time a telehealth service is rendered. , then it must
5comply with the following:
6        (1) With respect to telehealth benefits provided in an
7    An individual or group policy of accident or health
8    insurance, insurers providing telehealth services may not:
9            (A) require that in-person contact occur between a
10        health care provider and a patient;
11            (B) require the health care provider to document a
12        barrier to an in-person consultation for coverage of
13        services to be provided through telehealth;
14            (C) require the use of telehealth when the health
15        care provider has determined that it is not
16        appropriate; or
17            (D) require the use of telehealth when a patient
18        chooses an in-person consultation; .
19            (E) require patients to use a separate panel of
20        health care providers to receive telehealth service
21        coverage and reimbursement;
22            (F) create geographic or facility restrictions or
23        requirements for telehealth services; procedure code
24        modifiers may be required to document telehealth use;
25            (G) require patients or health care providers to
26        prove a hardship or access barrier before the approval

 

 

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1        of telehealth services for coverage or reimbursement;
2            (H) negotiate different contract rates for
3        telehealth services and in-person services for
4        behavioral health services, including mental health
5        treatment and substance use disorder treatment; or
6            (I) impose upon telehealth services utilization
7        review requirements that are unnecessary, duplicative,
8        or unwarranted or impose any treatment limitations,
9        prior authorization, documentation, or recordkeeping
10        requirements that are more stringent than the
11        requirements applicable to the same health care
12        service when rendered in-person.
13        (2) Patient cost-sharing may be no more than if the
14    health care service were delivered in person. Deductibles,
15    copayments, or coinsurance applicable to services provided
16    through telehealth shall not exceed the deductibles,
17    copayments, or coinsurance required by the individual or
18    group policy of accident or health insurance for the same
19    services provided through in-person consultation.
20    (b-5) If an individual or group policy of accident or
21health insurance provides coverage for telehealth services, it
22must provide coverage for licensed dietitian nutritionists and
23certified diabetes educators who counsel senior diabetes
24patients in the senior diabetes patients' homes to remove the
25hurdle of transportation for senior diabetes patients to
26receive treatment.

 

 

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1    (c) Nothing in this Section shall be deemed as precluding
2a health insurer from providing benefits for other services,
3including, but not limited to, remote monitoring services,
4other monitoring services, or oral communications otherwise
5covered under the policy. Health care providers shall
6determine the appropriateness of specific sites, technology
7platforms, and technology vendors for a telehealth service, as
8long as delivered services adhere to privacy laws, including,
9but not limited to, the Health Insurance Portability and
10Accountability Act of 1996 and the Mental Health and
11Developmental Disabilities Confidentiality Act.
12    (d) Notwithstanding Section 352b of this Code, an excepted
13benefit policy is subject to this Section if the policy covers
14the patient's use of health care services, whether on an
15expense-incurred or a per capita prepaid basis or otherwise.
16This Section does not apply to an excepted benefit policy with
17respect to lump sum or periodic payments that the policy
18covers based on the occurrence of a diagnosis with a specified
19disease, an accident, or other qualifying health condition,
20nor does this Section apply to lump sum or periodic payments
21for expenses other than health care services. However, no
22policy may deny or reduce any benefit to a patient based on the
23use of clinically appropriate telehealth services in the
24course of satisfying the policy's benefit criteria.
25(Source: P.A. 100-1009, eff. 1-1-19.)".