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

HB3308ham002 102ND GENERAL ASSEMBLY

Rep. Thaddeus Jones

Filed: 4/20/2021

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 3308

2    AMENDMENT NO. ______. Amend House Bill 3308, AS AMENDED,
3by replacing everything after the enacting clause with the
4following:
 
5    "Section 5. The Illinois Insurance Code is amended by
6changing Section 356z.22 and adding Section 356z.43 as
7follows:
 
8    (215 ILCS 5/356z.22)
9    Sec. 356z.22. Coverage for telehealth services.
10    (a) For purposes of this Section:
11    "Asynchronous store and forward system" means the
12transmission of a patient's medical information through an
13electronic communications system at an originating site to a
14health care provider at a distant site that does not require
15real-time or synchronous interaction between the health care
16provider and the patient.

 

 

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1    "Distant site" means the location at which the health care
2provider rendering the telehealth service is located.
3    "E-visits" means patient-initiated, non-face-to-face
4communications through an online patient portal with a health
5care professional.
6    "Interactive telecommunications system" means an audio and
7video system, an audio-only telephone system (landline or
8cellular), or any other telecommunications system permitting
92-way, synchronous interactive communication between the
10patient at an originating site and the health care
11professional or facility at a distant site permitting 2-way,
12live interactive communication between the patient and the
13distant site health care provider.
14    "Originating site" means the location at which the patient
15is located at the time health care services are provided to the
16patient via telehealth.
17    "Remote patient monitoring" means the use of digital
18technologies and mobile medical devices to collect medical and
19other health data from a patient at an originating site and
20electronically transmit that data to a health care
21professional or facility at a distant site for assessment and
22intervention to allow for ongoing monitoring and management of
23chronic and acute conditions.
24    "Telehealth" means the evaluation, diagnosis, or
25interpretation of electronically transmitted patient-specific
26data between a remote location and a licensed health care

 

 

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1professional that generates interaction or treatment
2recommendations. "Telehealth" includes telemedicine and the
3delivery of health care services, including mental health
4treatment and substance use disorder treatment, provided by
5way of an interactive telecommunications system, asynchronous
6store and forward system, remote patient monitoring
7technologies, e-visits, or virtual check-ins.
8    "Telehealth services" means the delivery of covered health
9care services by way of an interactive telecommunications
10system.
11    "Virtual check-in" means a brief, patient-initiated
12communication with a health care professional that involves an
13interactive telecommunications system to deliver an
14individualized clinical diagnosis, treatment, assessment, or
15guidance to an established patient. "Virtual check-in" only
16includes communications involving medical discussions that
17last at least as long as the time ranges provided in the most
18currently applicable Current Procedural Terminology or
19Healthcare Common Procedure Coding System codes designated for
20virtual check-ins. "Virtual check-in" does not include a
21communication that originates from a related office visit
22provided within the previous 7 days, nor a communication that
23leads to an office visit or procedure within the next 24 hours
24or the soonest available appointment.
25    (b) Health care services that are covered under If an
26individual or group policy of accident or health insurance

 

 

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1must be covered when delivered via provides coverage for
2telehealth when clinically appropriate in the same manner as
3any other benefits covered under the policy. Coverage required
4under this Section shall comply with all of services, then it
5must comply with the following:
6        (1) An individual or group policy of accident or
7    health insurance providing telehealth services may not:
8            (A) require that in-person contact occur between a
9        health care provider and a patient;
10            (B) require the health care provider to document a
11        barrier to an in-person consultation for coverage of
12        services to be provided through telehealth;
13            (C) require the use of telehealth when the health
14        care provider has determined that it is not
15        appropriate; or
16            (D) require the use of telehealth when a patient
17        chooses an in-person consultation or require patients
18        to use a separate panel of health care providers to
19        receive telehealth service coverage and
20        reimbursement; .
21            (E) create geographic or facility restrictions or
22        requirements for telehealth services;
23            (F) require covered individuals or health care
24        providers to prove a hardship or access barrier before
25        the approval of telehealth services for coverage or
26        reimbursement;

 

 

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1            (G) impose upon telehealth services utilization
2        review requirements that are unnecessary, duplicative,
3        or unwarranted or impose any treatment limitations,
4        prior authorization, documentation, or recordkeeping
5        requirements that are more stringent than the
6        requirements applicable to the same health care
7        service when rendered in-person; or
8            (H) require prior authorization for telehealth
9        services related to COVID-19 delivered by a network
10        provider.
11        (2) Patient cost-sharing may be no more than if the
12    health care service were delivered in person. Deductibles,
13    copayments, or coinsurance applicable to services provided
14    through telehealth shall not exceed the deductibles,
15    copayments, or coinsurance required by the individual or
16    group policy of accident or health insurance for the same
17    services provided through in-person consultation.
18        (3) Subject to all terms and conditions of the policy,
19    a health insurer shall reimburse a network provider for
20    behavioral health services, including mental health
21    treatment and substance use disorder treatment, delivered
22    through telehealth on at least the same basis and at the
23    same rate as would be applied for the same services if they
24    had been delivered in-person and shall include reasonable
25    compensation to a facility that serves as the originating
26    site at the time a telehealth service is rendered.

 

 

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1    (b-5) If an individual or group policy of accident or
2health insurance provides coverage for telehealth services, it
3must provide coverage for licensed dietitian nutritionists and
4certified diabetes educators who counsel senior diabetes
5patients in the senior diabetes patients' homes to remove the
6hurdle of transportation for senior diabetes patients to
7receive treatment.
8    (c) Nothing in this Section shall be deemed as precluding
9a health insurer from providing benefits for other services,
10including, but not limited to, services provided through an
11asynchronous store and forward system, e-visits, remote
12patient monitoring services, virtual check-ins remote
13monitoring services, other monitoring services, or oral
14communications otherwise covered under the policy. Health care
15providers shall determine the appropriateness of specific
16sites, technology platforms, and technology vendors for a
17telehealth service, as long as delivered services adhere to
18privacy laws, including, but not limited to, the Health
19Insurance Portability and Accountability Act of 1996 and the
20Mental Health and Developmental Disabilities Confidentiality
21Act.
22    (d) A health insurer may establish reasonable requirements
23and parameters for telehealth services, including with respect
24to document and recordkeeping, to the extent consistent with
25this Section, the Telehealth Act, or any company bulletin
26issued by the Department under Executive Order 2020-09. Health

 

 

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1insurers shall notify health care providers of any
2instructions necessary to facilitate billing for telehealth
3services.
4    (e) Notwithstanding Section 352b of this Code, an excepted
5benefit policy is subject to this Section if the policy covers
6the patient's use of health care services, whether on an
7expense-incurred or a per capita prepaid basis or otherwise.
8This Section does not apply to an excepted benefit policy with
9respect to lump sum or periodic payments that the policy
10covers based on the occurrence of a diagnosis with a specified
11disease, an accident, or other qualifying health condition,
12nor does this Section apply to lump sum or periodic payments
13for expenses other than health care services. However, no
14policy may deny or reduce any benefit to a patient based on the
15use of clinically appropriate telehealth services in the
16course of satisfying the policy's benefit criteria.
17(Source: P.A. 100-1009, eff. 1-1-19.)
 
18    (215 ILCS 5/356z.43 new)
19    Sec. 356z.43. Telehealth Payment Parity Task Force.
20    (a) The Telehealth Payment Parity Task Force is created to
21review and study the use of telehealth services in this State
22with respect to payment and reimbursement parity for health
23care providers providing such services. The task force shall
24be comprised of the following members:
25        (1) two members representing the Department of

 

 

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1    Insurance appointed by the Director of Insurance;
2        (2) one member representing the Department of Public
3    Health appointed by the Director of Public Health;
4        (3) two members representing the Department of
5    Healthcare and Family Services appointed by the Director
6    of Healthcare and Family Services;
7        (4) two members representing hospitals nominated by
8    the head of a statewide organization representing the
9    interests of hospitals in Illinois and appointed by the
10    Director of Public Health;
11        (5) one member representing physicians nominated by
12    the head of a statewide organization representing the
13    interests of physicians in Illinois and appointed by the
14    Director of Public Health;
15        (6) two members representing the insurance industry
16    nominated by the head of a statewide organization
17    representing the interests of insurers in Illinois and
18    appointed by the Director of Public Health;
19        (7) one member of the General Assembly appointed by
20    the Speaker of the House of Representatives;
21        (8) one member of the General Assembly appointed by
22    the President of the Senate;
23        (9) one member of the General Assembly appointed by
24    the Minority Leader of the House of Representatives; and
25        (10) one member of the General Assembly appointed by
26    the Minority Leader of the Senate.

 

 

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1    (b) The task force shall elect a chairperson from its
2membership and shall have the authority to determine its
3meeting schedule, hearing schedule, and agendas. Task force
4members shall serve without compensation. The Department of
5Public Health shall provide administrative support to the task
6force.
7    (c) Appointments shall be made 90 days after the effective
8date of this amendatory Act of the 102nd General Assembly.
9    (d) The task force shall review existing plans and
10policies issued, delivered, and offered in this State with
11respect to coverage and reimbursement for telehealth services,
12relevant data on payment parity for telehealth services, and
13payment parity statutes in other states and provide
14recommendations on the economic feasibility and cost
15effectiveness of requiring payment parity for health care
16services provided via telehealth, including recommendations
17for possible legislation.
18    (e) The task force shall submit its findings and
19recommendations to the Governor and the General Assembly by
20December 31, 2021.
21    (f) The task force is dissolved and this Section is
22repealed on January 1, 2023.
 
23    Section 10. The Telehealth Act is amended by changing
24Sections 5 and 15 as follows:
 

 

 

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1    (225 ILCS 150/5)
2    Sec. 5. Definitions. As used in this Act:
3    "Health care professional" includes physicians, physician
4assistants, optometrists, advanced practice registered nurses,
5clinical psychologists licensed in Illinois, prescribing
6psychologists licensed in Illinois, dentists, occupational
7therapists, pharmacists, physical therapists, clinical social
8workers, speech-language pathologists, audiologists, hearing
9instrument dispensers, and mental health and substance use
10disorder treatment professionals and clinicians authorized by
11Illinois law to provide mental health and substance use
12disorder treatment services, and qualified providers listed
13under paragraph (8) of subsection(e) of Section 3 of the Early
14Intervention Services System Act.
15    "Telehealth" means the evaluation, diagnosis, or
16interpretation of electronically transmitted patient-specific
17data between a remote location and a licensed health care
18professional that generates interaction or treatment
19recommendations. "Telehealth" includes telemedicine and the
20delivery of health care services, including mental health
21treatment and substance use disorder treatment, provided by
22way of an interactive telecommunications system, asynchronous
23store and forward system, remote patient monitoring
24technologies, e-visits, or virtual check-ins as defined in
25subsection (a) of Section 356z.22 of the Illinois Insurance
26Code.

 

 

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1(Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19;
2100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff.
37-19-19.)
 
4    (225 ILCS 150/15)
5    Sec. 15. Use of telehealth.
6    (a) A health care professional may engage in the practice
7of telehealth in Illinois to the extent of his or her scope of
8practice as established in his or her respective licensing Act
9consistent with the standards of care for in-person services.
10This Act shall not be construed to alter the scope of practice
11of any health care professional or authorize the delivery of
12health care services in a setting or in a manner not otherwise
13authorized by the laws of this State.
14    (b) Services provided by telehealth pursuant to this
15Section shall be consistent with all federal and State
16privacy, security, and confidentiality laws.
17    (c) Health care professionals shall determine the
18appropriateness of specific sites, technology platforms, and
19technology vendors for a telehealth service, as long as
20delivered services adhere to privacy laws, including, but not
21limited to, the Health Insurance Portability and
22Accountability Act of 1996 and the Mental Health and
23Developmental Disabilities Confidentiality Act.
24    (d) Health care professionals shall maintain documentation
25and recordkeeping in accordance with subsection (d) of 89 Ill.

 

 

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1Adm. Code 140.403.
2(Source: P.A. 100-317, eff. 1-1-18.)
 
3    Section 15. The Early Intervention Services System Act is
4amended by changing Sections 3 and 11 and by adding Section 3b
5as follows:
 
6    (325 ILCS 20/3)  (from Ch. 23, par. 4153)
7    Sec. 3. Definitions. As used in this Act:
8    (a) "Eligible infants and toddlers" means infants and
9toddlers under 36 months of age with any of the following
10conditions:
11        (1) Developmental delays.
12        (2) A physical or mental condition which typically
13    results in developmental delay.
14        (3) Being at risk of having substantial developmental
15    delays based on informed clinical opinion.
16        (4) Either (A) having entered the program under any of
17    the circumstances listed in paragraphs (1) through (3) of
18    this subsection but no longer meeting the current
19    eligibility criteria under those paragraphs, and
20    continuing to have any measurable delay, or (B) not having
21    attained a level of development in each area, including
22    (i) cognitive, (ii) physical (including vision and
23    hearing), (iii) language, speech, and communication, (iv)
24    social or emotional, or (v) adaptive, that is at least at

 

 

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1    the mean of the child's age equivalent peers; and, in
2    addition to either item (A) or item (B), (C) having been
3    determined by the multidisciplinary individualized family
4    service plan team to require the continuation of early
5    intervention services in order to support continuing
6    developmental progress, pursuant to the child's needs and
7    provided in an appropriate developmental manner. The type,
8    frequency, and intensity of services shall differ from the
9    initial individualized family services plan because of the
10    child's developmental progress, and may consist of only
11    service coordination, evaluation, and assessments.
12    (b) "Developmental delay" means a delay in one or more of
13the following areas of childhood development as measured by
14appropriate diagnostic instruments and standard procedures:
15cognitive; physical, including vision and hearing; language,
16speech and communication; social or emotional; or adaptive.
17The term means a delay of 30% or more below the mean in
18function in one or more of those areas.
19    (c) "Physical or mental condition which typically results
20in developmental delay" means:
21        (1) a diagnosed medical disorder or exposure to a
22    toxic substance bearing a relatively well known expectancy
23    for developmental outcomes within varying ranges of
24    developmental disabilities; or
25        (2) a history of prenatal, perinatal, neonatal or
26    early developmental events suggestive of biological

 

 

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1    insults to the developing central nervous system and which
2    either singly or collectively increase the probability of
3    developing a disability or delay based on a medical
4    history.
5    (d) "Informed clinical opinion" means both clinical
6observations and parental participation to determine
7eligibility by a consensus of a multidisciplinary team of 2 or
8more members based on their professional experience and
9expertise.
10    (e) "Early intervention services" means services which:
11        (1) are designed to meet the developmental needs of
12    each child eligible under this Act and the needs of his or
13    her family;
14        (2) are selected in collaboration with the child's
15    family;
16        (3) are provided under public supervision;
17        (4) are provided at no cost except where a schedule of
18    sliding scale fees or other system of payments by families
19    has been adopted in accordance with State and federal law;
20        (5) are designed to meet an infant's or toddler's
21    developmental needs in any of the following areas:
22            (A) physical development, including vision and
23        hearing,
24            (B) cognitive development,
25            (C) communication development,
26            (D) social or emotional development, or

 

 

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1            (E) adaptive development;
2        (6) meet the standards of the State, including the
3    requirements of this Act;
4        (7) include one or more of the following:
5            (A) family training,
6            (B) social work services, including counseling,
7        and home visits,
8            (C) special instruction,
9            (D) speech, language pathology and audiology,
10            (E) occupational therapy,
11            (F) physical therapy,
12            (G) psychological services,
13            (H) service coordination services,
14            (I) medical services only for diagnostic or
15        evaluation purposes,
16            (J) early identification, screening, and
17        assessment services,
18            (K) health services specified by the lead agency
19        as necessary to enable the infant or toddler to
20        benefit from the other early intervention services,
21            (L) vision services,
22            (M) transportation,
23            (N) assistive technology devices and services,
24            (O) nursing services,
25            (P) nutrition services, and
26            (Q) sign language and cued language services;

 

 

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1        (8) are provided by qualified personnel, including but
2    not limited to:
3            (A) child development specialists or special
4        educators, including teachers of children with hearing
5        impairments (including deafness) and teachers of
6        children with vision impairments (including
7        blindness),
8            (B) speech and language pathologists and
9        audiologists,
10            (C) occupational therapists,
11            (D) physical therapists,
12            (E) social workers,
13            (F) nurses,
14            (G) dietitian nutritionists,
15            (H) vision specialists, including ophthalmologists
16        and optometrists,
17            (I) psychologists, and
18            (J) physicians;
19        (9) are provided in conformity with an Individualized
20    Family Service Plan;
21        (10) are provided throughout the year; and
22        (11) are provided in natural environments, to the
23    maximum extent appropriate, which may include the home and
24    community settings, unless justification is provided
25    consistent with federal regulations adopted under Sections
26    1431 through 1444 of Title 20 of the United States Code.

 

 

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1    (f) "Individualized Family Service Plan" or "Plan" means a
2written plan for providing early intervention services to a
3child eligible under this Act and the child's family, as set
4forth in Section 11.
5    (g) "Local interagency agreement" means an agreement
6entered into by local community and State and regional
7agencies receiving early intervention funds directly from the
8State and made in accordance with State interagency agreements
9providing for the delivery of early intervention services
10within a local community area.
11    (h) "Council" means the Illinois Interagency Council on
12Early Intervention established under Section 4.
13    (i) "Lead agency" means the State agency responsible for
14administering this Act and receiving and disbursing public
15funds received in accordance with State and federal law and
16rules.
17    (i-5) "Central billing office" means the central billing
18office created by the lead agency under Section 13.
19    (j) "Child find" means a service which identifies eligible
20infants and toddlers.
21    (k) "Regional intake entity" means the lead agency's
22designated entity responsible for implementation of the Early
23Intervention Services System within its designated geographic
24area.
25    (l) "Early intervention provider" means an individual who
26is qualified, as defined by the lead agency, to provide one or

 

 

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1more types of early intervention services, and who has
2enrolled as a provider in the early intervention program.
3    (m) "Fully credentialed early intervention provider" means
4an individual who has met the standards in the State
5applicable to the relevant profession, and has met such other
6qualifications as the lead agency has determined are suitable
7for personnel providing early intervention services, including
8pediatric experience, education, and continuing education. The
9lead agency shall establish these qualifications by rule filed
10no later than 180 days after the effective date of this
11amendatory Act of the 92nd General Assembly.
12    (n) "Telehealth" has the meaning ascribed to that term in
13Section 5 of the Telehealth Act.
14(Source: P.A. 101-10, eff. 6-5-19.)
 
15    (325 ILCS 20/3b new)
16    Sec. 3b. Services delivered by telehealth. An early
17intervention provider may deliver via telehealth any type of
18early intervention service outlined in subsection (e) of
19Section 3 to the extent of his or her scope of practice as
20established in his or her respective licensing Act consistent
21with the standards of care for in-person services. This
22Section shall not be construed to alter the scope of practice
23of any early intervention provider or authorize the delivery
24of early intervention services in a setting or in a manner not
25otherwise authorized by the laws of this State.
 

 

 

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1    (325 ILCS 20/11)  (from Ch. 23, par. 4161)
2    Sec. 11. Individualized Family Service Plans.
3    (a) Each eligible infant or toddler and that infant's or
4toddler's family shall receive:
5        (1) timely, comprehensive, multidisciplinary
6    assessment of the unique strengths and needs of each
7    eligible infant and toddler, and assessment of the
8    concerns and priorities of the families to appropriately
9    assist them in meeting their needs and identify supports
10    and services to meet those needs; and
11        (2) a written Individualized Family Service Plan
12    developed by a multidisciplinary team which includes the
13    parent or guardian. The individualized family service plan
14    shall be based on the multidisciplinary team's assessment
15    of the resources, priorities, and concerns of the family
16    and its identification of the supports and services
17    necessary to enhance the family's capacity to meet the
18    developmental needs of the infant or toddler, and shall
19    include the identification of services appropriate to meet
20    those needs, including the frequency, intensity, and
21    method of delivering services. During and as part of the
22    initial development of the individualized family services
23    plan, and any periodic reviews of the plan, the
24    multidisciplinary team may seek consultation from the lead
25    agency's designated experts, if any, to help determine

 

 

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1    appropriate services and the frequency and intensity of
2    those services. All services in the individualized family
3    services plan must be justified by the multidisciplinary
4    assessment of the unique strengths and needs of the infant
5    or toddler and must be appropriate to meet those needs. At
6    the periodic reviews, the team shall determine whether
7    modification or revision of the outcomes or services is
8    necessary.
9    (b) The Individualized Family Service Plan shall be
10evaluated once a year and the family shall be provided a review
11of the Plan at 6 month intervals or more often where
12appropriate based on infant or toddler and family needs. The
13lead agency shall create a quality review process regarding
14Individualized Family Service Plan development and changes
15thereto, to monitor and help assure that resources are being
16used to provide appropriate early intervention services.
17    (c) The initial evaluation and initial assessment and
18initial Plan meeting must be held within 45 days after the
19initial contact with the early intervention services system.
20The 45-day timeline does not apply for any period when the
21child or parent is unavailable to complete the initial
22evaluation, the initial assessments of the child and family,
23or the initial Plan meeting, due to exceptional family
24circumstances that are documented in the child's early
25intervention records, or when the parent has not provided
26consent for the initial evaluation or the initial assessment

 

 

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1of the child despite documented, repeated attempts to obtain
2parental consent. As soon as exceptional family circumstances
3no longer exist or parental consent has been obtained, the
4initial evaluation, the initial assessment, and the initial
5Plan meeting must be completed as soon as possible. With
6parental consent, early intervention services may commence
7before the completion of the comprehensive assessment and
8development of the Plan.
9    (d) Parents must be informed that early intervention
10services shall be provided to each eligible infant and
11toddler, to the maximum extent appropriate, in the natural
12environment, which may include the home or other community
13settings. Parents must also be informed of the availability of
14early intervention services provided through telehealth.
15Parents shall make the final decision to accept or decline
16early intervention services, including whether accepted
17services are delivered in person or via telehealth. A decision
18to decline such services shall not be a basis for
19administrative determination of parental fitness, or other
20findings or sanctions against the parents. Parameters of the
21Plan shall be set forth in rules.
22    (e) The regional intake offices shall explain to each
23family, orally and in writing, all of the following:
24        (1) That the early intervention program will pay for
25    all early intervention services set forth in the
26    individualized family service plan that are not covered or

 

 

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1    paid under the family's public or private insurance plan
2    or policy and not eligible for payment through any other
3    third party payor.
4        (2) That services will not be delayed due to any rules
5    or restrictions under the family's insurance plan or
6    policy.
7        (3) That the family may request, with appropriate
8    documentation supporting the request, a determination of
9    an exemption from private insurance use under Section
10    13.25.
11        (4) That responsibility for co-payments or
12    co-insurance under a family's private insurance plan or
13    policy will be transferred to the lead agency's central
14    billing office.
15        (5) That families will be responsible for payments of
16    family fees, which will be based on a sliding scale
17    according to the State's definition of ability to pay
18    which is comparing household size and income to the
19    sliding scale and considering out-of-pocket medical or
20    disaster expenses, and that these fees are payable to the
21    central billing office. Families who fail to provide
22    income information shall be charged the maximum amount on
23    the sliding scale.
24    (f) The individualized family service plan must state
25whether the family has private insurance coverage and, if the
26family has such coverage, must have attached to it a copy of

 

 

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1the family's insurance identification card or otherwise
2include all of the following information:
3        (1) The name, address, and telephone number of the
4    insurance carrier.
5        (2) The contract number and policy number of the
6    insurance plan.
7        (3) The name, address, and social security number of
8    the primary insured.
9        (4) The beginning date of the insurance benefit year.
10    (g) A copy of the individualized family service plan must
11be provided to each enrolled provider who is providing early
12intervention services to the child who is the subject of that
13plan.
14    (h) Children receiving services under this Act shall
15receive a smooth and effective transition by their third
16birthday consistent with federal regulations adopted pursuant
17to Sections 1431 through 1444 of Title 20 of the United States
18Code. Beginning July 1, 2022, children who receive early
19intervention services prior to their third birthday and are
20found eligible for an individualized education program under
21the Individuals with Disabilities Education Act, 20 U.S.C.
221414(d)(1)(A), and under Section 14-8.02 of the School Code
23and whose birthday falls between May 1 and August 31 may
24continue to receive early intervention services until the
25beginning of the school year following their third birthday in
26order to minimize gaps in services, ensure better continuity

 

 

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1of care, and align practices for the enrollment of preschool
2children with special needs to the enrollment practices of
3typically developing preschool children.
4(Source: P.A. 101-654, eff. 3-8-21.)
 
5    Section 99. Effective date. This Act takes effect upon
6becoming law.".