Public Act 103-0243
 
SB1913 EnrolledLRB103 29930 BMS 56345 b


  
    AN ACT concerning regulation.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  


 
    Section 5. The Illinois Public Aid Code is amended  by 
adding Section 5-47 as follows:
 
    (305 ILCS 5/5-47 new)
    Sec. 5-47. Coverage for mental health and substance use 
disorder telehealth services.
    (a) As used in this Section:
    "Behavioral health care professional" has the meaning 
given to "health care professional" in Section 5 of the 
Telehealth Act, but only with respect to professionals 
licensed or certified by the Division of Mental Health or 
Division of Substance Use Prevention and Recovery of the 
Department of Human Services engaged in the delivery of mental 
health or substance use disorder treatment or services.
    "Behavioral health facility" means a community mental 
health center, a behavioral health clinic, a substance use 
disorder treatment program, or a facility or provider licensed 
or certified by the Division of Mental Health or Division of 
Substance Use Prevention and Recovery of the Department of 
Human Services.
    "Behavioral telehealth services" has the meaning given to 
the term "telehealth services" in Section 5 of the Telehealth 
Act, but limited solely to mental health and substance use 
disorder treatment or services to a patient, regardless of 
patient location.
    "Distant site" has the meaning given to that term in 
Section 5 of the Telehealth Act.
    "Originating site" has the meaning given to that term in 
Section 5 of the Telehealth Act.
    (b) The Department and any managed care plans under 
contract with the Department for the medical assistance 
program shall provide for coverage of mental health and 
substance use disorder treatment or services delivered as 
behavioral telehealth services as specified in this Section. 
The Department and any managed care plans under contract with 
the Department for the medical assistance program may also 
provide reimbursement to a behavioral health facility that 
serves as the originating site at the time a behavioral 
telehealth service is rendered.
    (c) To ensure behavioral telehealth services are equitably 
provided, coverage required under this Section shall comply 
with all of the following:
        (1) The Department and any managed care plans under 
    contract with the Department for the medical assistance 
    program shall not:
            (A) require that in-person contact occur between
a 
        behavioral health care professional and a patient 
        before the provision of a behavioral telehealth 
        service;
            (B) require patients, behavioral health care 
        professionals,
or behavioral health facilities to 
        prove or document a hardship or access barrier to an 
        in-person consultation for coverage and reimbursement 
        of behavioral telehealth services;
            (C) require the use of behavioral telehealth 
        services when the behavioral health care professional 
        has determined that it is not appropriate;
            (D) require the use of behavioral telehealth 
        services when
a patient chooses an in-person 
        consultation;
            (E) require a behavioral health care professional 
        to be
physically present in the same room as the 
        patient at the originating site, unless deemed 
        medically necessary by the behavioral health care 
        professional providing the behavioral telehealth 
        service;
            (F) create geographic or facility restrictions or 
        requirements for behavioral telehealth services;
            (G) require behavioral health care professionals 
        or behavioral health facilities to offer or provide 
        behavioral telehealth services;
            (H) require patients to use behavioral telehealth 
        services or require patients to use a separate panel 
        of behavioral health care professionals or behavioral 
        health facilities to receive behavioral telehealth 
        services; or
            (I) impose upon behavioral telehealth services 
        utilization review requirements that are unnecessary, 
        duplicative, or unwarranted or impose any treatment 
        limitations, prior authorization, documentation, or 
        recordkeeping requirements that are more stringent 
        than the requirements applicable to the same 
        behavioral health care service when rendered 
        in-person, except that procedure code modifiers may be 
        required to document behavioral telehealth.
        (2) Any cost sharing applicable to services provided 
    through behavioral telehealth shall not exceed the cost 
    sharing required by the medical assistance program for the 
    same services provided through in-person consultation.
        (3) The Department and any managed care plans under 
    contract with the Department for the medical assistance 
    program shall notify behavioral health care professionals 
    and behavioral health facilities of any instructions 
    necessary to facilitate billing for behavioral telehealth 
    services.
    (d) For purposes of reimbursement, the Department and any 
managed care plans under contract with the Department for the 
medical assistance program shall reimburse a behavioral health 
care professional or behavioral health facility for behavioral 
telehealth services on the same basis, in the same manner, and 
at the same reimbursement rate that would apply to the 
services if the services had been delivered via an in-person 
encounter by a behavioral health care professional or 
behavioral health facility. This subsection applies only to 
those services provided by behavioral telehealth that may 
otherwise be billed as an in-person service.
    (e) Behavioral health care professionals and behavioral 
health facilities shall determine the appropriateness of 
specific sites, technology platforms, and technology vendors 
for a behavioral telehealth service, as long as delivered 
services adhere to all federal and State privacy, security, 
and confidentiality laws, rules, or regulations, including, 
but not limited to, the Health Insurance Portability and 
Accountability Act of 1996, 42 CFR Part 2, and the Mental 
Health and Developmental Disabilities Confidentiality Act.
    (f) Nothing in this Section shall be deemed as precluding 
the Department and any managed care plans under contract with 
the Department for the medical assistance program from 
providing benefits for other telehealth services.
    (g) There shall be no restrictions on originating site 
requirements for behavioral telehealth coverage or 
reimbursement to the distant site under this Section other 
than requiring the behavioral telehealth services to be 
medically necessary and clinically appropriate.
    (h) Nothing in this Section shall be deemed as precluding 
the Department and any managed care plans under contract with 
the Department for the medical assistance program from 
establishing limits on the use of telehealth for a particular 
behavioral health service when the limits are consistent with 
generally accepted standards of mental, emotional, nervous, or 
substance use disorder or condition care.
    (i) The Department may adopt rules to implement the 
provisions of this Section.