HB4968 104TH GENERAL ASSEMBLY

LRB104 19589 KTG 33037 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4968

Introduced , by Rep. Laura Faver Dias

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-50a new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall provide coverage under the medical assistance program for intensive outpatient services delivered via telehealth when the services: (1) are otherwise covered when provided in person; (2) are medically necessary; (3) are delivered by a provider enrolled in the medical assistance program and acting within the scope of the provider's license, certification, or authorization under State law; and (4) comply with all applicable federal and State telehealth requirements. Provides that intensive outpatient services provided via telehealth shall be subject to the same coverage requirements, utilization management, and reimbursement methodologies as intensive outpatient services provided in person. Sets forth standards for telehealth delivery of intensive outpatient services. Provides that implementation of the provisions is subject to any required federal approval. Effective immediately.

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 5-50a as follows:

(305 ILCS 5/5-50a new)

Sec. 5-50a. Telehealth delivery of intensive outpatient services.

(a) Purpose. To ensure access to medically necessary behavioral health treatment, the medical assistance program shall authorize intensive outpatient services to be provided via telehealth in a manner consistent with existing telehealth coverage under this Code.

(b) Definitions. As used in this Section:

"Intensive outpatient services" means a structured behavioral health treatment service, delivered at a minimum 3 times per week for 9 hours or more, that is more intensive than standard outpatient services and less intensive than partial hospitalization, delivered pursuant to an individualized treatment plan and consistent with Department-established criteria and generally accepted standards of care.

"Telehealth" has the meaning given to the term "telehealth services" in Section 5 of the Telehealth Act.

"Telehealth" includes the delivery of health care services using interactive telecommunications systems, including synchronous audio and video, that allow real-time communication between a patient and a provider.

(c) Coverage. Notwithstanding any other provision of law, the Department shall provide coverage under the medical assistance program for intensive outpatient services delivered via telehealth when the services:

(1) are otherwise covered when provided in person;

(2) are medically necessary;

(3) are delivered by a provider enrolled in the medical assistance program and acting within the scope of the provider's license, certification, or authorization under State law; and

(4) comply with all applicable federal and State telehealth requirements.

(d) Parity. Intensive outpatient services provided via telehealth service under this Section shall be subject to the same coverage requirements, utilization management, and reimbursement methodologies as intensive outpatient services provided in person, in accordance with Section 5-5.25 and Department rules.

(e) Standards and safeguards. Telehealth delivery of intensive outpatient services shall:

(1) meet the same standards of care as in-person services;

(2) include informed consent for the use of telehealth, as required by Department rule;

(3) ensure compliance with State and federal privacy and confidentiality laws;

(4) include protocols for emergency response, continuity of care, and referral to in-person services when clinically appropriate; and

(5) not require any in-person elements or services.

(f) Rulemaking authority. The Department may adopt rules consistent with Section 5-5.25 that are necessary to implement this Section, including rules governing clinical eligibility, documentation, quality assurance, and program integrity.

(g) Federal approval. Implementation of this Section is subject to any required federal approval.

Section 99. Effective date. This Act takes effect upon becoming law.