101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB4963

 

Introduced 2/18/2020, by Rep. Daniel Didech

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.22
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. Requires individual or group policies of accident and health insurance that provides coverage for telehealth services to provide coverage for: telehealth services at the same rate as in-person services; reimbursement for a telehealth originating site facility fee; and telehealth services from an originating site that is a facility licensed under the Nursing Home Care Act. Amends the Medical Assistance Article of the Illinois Public Aid Code to provide that the medical assistance program is required to comply with the provisions of the Illinois Insurance Code regarding telehealth services.


LRB101 17110 BMS 66510 b

 

 

A BILL FOR

 

HB4963LRB101 17110 BMS 66510 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 356z.22 as follows:
 
6    (215 ILCS 5/356z.22)
7    Sec. 356z.22. Coverage for telehealth services.
8    (a) For purposes of this Section:
9    "Distant site" means the location at which the health care
10provider rendering the telehealth service is located. "Distant
11site" includes a location outside of this State.
12    "Interactive telecommunications system" means an audio and
13video system permitting 2-way, live interactive communication
14between the patient and the distant site health care provider.
15    "Telehealth services" means the delivery of covered health
16care services by way of an interactive telecommunications
17system.
18    (b) If an individual or group policy of accident or health
19insurance provides coverage for telehealth services, then it
20must comply with the following:
21        (1) An individual or group policy of accident or health
22    insurance providing telehealth services may not:
23            (A) require that in-person contact occur between a

 

 

HB4963- 2 -LRB101 17110 BMS 66510 b

1        health care provider and a patient;
2            (B) require the health care provider to document a
3        barrier to an in-person consultation for coverage of
4        services to be provided through telehealth;
5            (C) require the use of telehealth when the health
6        care provider has determined that it is not
7        appropriate; or
8            (D) require the use of telehealth when a patient
9        chooses an in-person consultation.
10        (2) Deductibles, copayments, or coinsurance applicable
11    to services provided through telehealth shall not exceed
12    the deductibles, copayments, or coinsurance required by
13    the individual or group policy of accident or health
14    insurance for the same services provided through in-person
15    consultation.
16    (b-5) If an individual or group policy of accident or
17health insurance provides coverage for telehealth services, it
18must provide coverage for licensed dietitian nutritionists and
19certified diabetes educators who counsel senior diabetes
20patients in the senior diabetes patients' homes to remove the
21hurdle of transportation for senior diabetes patients to
22receive treatment.
23    (c) Nothing in this Section shall be deemed as precluding a
24health insurer from providing benefits for other services,
25including, but not limited to, remote monitoring services,
26other monitoring services, or oral communications otherwise

 

 

HB4963- 3 -LRB101 17110 BMS 66510 b

1covered under the policy.
2    (d) If an individual or group policy of accident or health
3insurance provides coverage for telehealth services, it must
4provide coverage for telehealth services at the same rate as
5in-person services.
6    (e) If an individual or group policy of accident or health
7insurance provides coverage for telehealth services, it must
8provide coverage for reimbursement for a telehealth
9originating site facility fee.
10    (e) If an individual or group policy of accident or health
11insurance provides coverage for telehealth services, it must
12provide coverage for telehealth services from an originating
13site that is a facility licensed under the Nursing Home Care
14Act.
15(Source: P.A. 100-1009, eff. 1-1-19.)
 
16    Section 10. The Illinois Public Aid Code is amended by
17changing Section 5-16.8 as follows:
 
18    (305 ILCS 5/5-16.8)
19    Sec. 5-16.8. Required health benefits. The medical
20assistance program shall (i) provide the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.22,
24356z.26, 356z.29, and 356z.32, and 356z.33, 356z.34, 356z.35,

 

 

HB4963- 4 -LRB101 17110 BMS 66510 b

1and 356z.39 of the Illinois Insurance Code and (ii) be subject
2to the provisions of Sections 356z.19, 364.01, 370c, and 370c.1
3of the Illinois Insurance Code.
4    On and after July 1, 2012, the Department shall reduce any
5rate of reimbursement for services or other payments or alter
6any methodologies authorized by this Code to reduce any rate of
7reimbursement for services or other payments in accordance with
8Section 5-5e.
9    To ensure full access to the benefits set forth in this
10Section, on and after January 1, 2016, the Department shall
11ensure that provider and hospital reimbursement for
12post-mastectomy care benefits required under this Section are
13no lower than the Medicare reimbursement rate.
14(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
15100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
167-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
17eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)