SB2684 103RD GENERAL ASSEMBLY

LRB103 35787 KTG 65870 b

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.

A BILL FOR

AN ACT concerning public aid.

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 5-5.24a as follows:

(305 ILCS 5/5-5.24a new)

Sec. 5-5.24a. Remote ultrasounds and remote fetal nonstress tests; reimbursement.

(a) As used in this Section, "CPT code" means the medical billing code set contained in the most recent version of the Current Procedural Terminology code book published by the American Medical Association.

(b) The Department shall 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 CPT codes 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.

(c) Remote ultrasounds and remote fetal nonstress tests are only eligible for reimbursement when the provider uses digital technology:

(1) to collect medical and other forms of health data from a patient and to electronically transmit that information securely to a healthcare provider in a different location for interpretation and recommendation;

(2) that is compliant with the federal Health Insurance Portability and Accountability Act of 1996; and

(3) that is approved by the U.S. Food and Drug Administration.

(d) A fetal nonstress test under CPT code 59025 is only eligible for reimbursement with a place of service modifier for at-home monitoring with remote monitoring solutions that are cleared by the U.S. Food and Drug Administration for on-label use for monitoring fetal heart rate, maternal heart rate, and uterine activity.

(e) The Department shall issue guidance to implement the provisions of this Section.