103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB2684

 

Introduced 1/10/2024, by Sen. Laura M. Murphy

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.24a new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to adopt rules permitting reimbursement under the fee-for-service and managed care medical assistance programs for remote ultrasound procedures and remote fetal nonstress tests, utilizing established Current Procedural Terminology codes, as published by the American Medical Association, for these procedures when the patient is in a residence or other off-site location from the patient's provider and the same standard of care is met as would be present during an in-person visit. Provides that remote ultrasounds and remote fetal nonstress tests are only eligible for reimbursement when the provider uses digital technology that meets certain criteria. Provides which fetal nonstress test requires a place of service modifier for at-home monitoring in order to qualify for reimbursement. Requires the Department to issue guidance to implement the provisions of the amendatory Act.


LRB103 35787 KTG 65870 b

 

 

A BILL FOR

 

SB2684LRB103 35787 KTG 65870 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5adding Section 5-5.24a as follows:
 
6    (305 ILCS 5/5-5.24a new)
7    Sec. 5-5.24a. Remote ultrasounds and remote fetal
8nonstress tests; reimbursement.
9    (a) As used in this Section, "CPT code" means the medical
10billing code set contained in the most recent version of the
11Current Procedural Terminology code book published by the
12American Medical Association.
13    (b) The Department shall adopt rules permitting
14reimbursement under the fee-for-service and managed care
15medical assistance programs for remote ultrasound procedures
16and remote fetal nonstress tests, utilizing established CPT
17codes for these procedures, when the patient is in a residence
18or other off-site location from the patient's provider and the
19same standard of care is met as would be present during an
20in-person visit.
21    (c) Remote ultrasounds and remote fetal nonstress tests
22are only eligible for reimbursement when the provider uses
23digital technology:

 

 

SB2684- 2 -LRB103 35787 KTG 65870 b

1        (1) to collect medical and other forms of health data
2    from a patient and to electronically transmit that
3    information securely to a healthcare provider in a
4    different location for interpretation and recommendation;
5        (2) that is compliant with the federal Health
6    Insurance Portability and Accountability Act of 1996; and
7        (3) that is approved by the U.S. Food and Drug
8    Administration.
9    (d) A fetal nonstress test under CPT code 59025 is only
10eligible for reimbursement with a place of service modifier
11for at-home monitoring with remote monitoring solutions that
12are cleared by the U.S. Food and Drug Administration for
13on-label use for monitoring fetal heart rate, maternal heart
14rate, and uterine activity.
15    (e) The Department shall issue guidance to implement the
16provisions of this Section.