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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | adding Section 5-47 as follows: | ||||||
6 | (305 ILCS 5/5-47 new) | ||||||
7 | Sec. 5-47. Coverage for mental health and substance use | ||||||
8 | disorder telehealth services. | ||||||
9 | (a) As used in this Section: | ||||||
10 | "Behavioral health care professional" has the meaning | ||||||
11 | given to "health care professional" in Section 5 of the | ||||||
12 | Telehealth Act, but only with respect to professionals | ||||||
13 | licensed or certified by the Division of Mental Health or | ||||||
14 | Division of Substance Use Prevention and Recovery of the | ||||||
15 | Department of Human Services engaged in the delivery of mental | ||||||
16 | health or substance use disorder treatment or services. | ||||||
17 | "Behavioral health facility" means a community mental | ||||||
18 | health center, a behavioral health clinic, a substance use | ||||||
19 | disorder treatment program, or a facility or provider licensed | ||||||
20 | or certified by the Division of Mental Health or Division of | ||||||
21 | Substance Use Prevention and Recovery of the Department of | ||||||
22 | Human Services. | ||||||
23 | "Behavioral telehealth services" has the meaning given to |
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1 | the term "telehealth services" in Section 5 of the Telehealth | ||||||
2 | Act, but limited solely to mental health and substance use | ||||||
3 | disorder treatment or services to a patient, regardless of | ||||||
4 | patient location. | ||||||
5 | "Distant site" has the meaning given to that term in | ||||||
6 | Section 5 of the Telehealth Act. | ||||||
7 | "Originating site" has the meaning given to that term in | ||||||
8 | Section 5 of the Telehealth Act. | ||||||
9 | (b) The Department and any managed care plans under | ||||||
10 | contract with the Department for the medical assistance | ||||||
11 | program shall provide for coverage of mental health and | ||||||
12 | substance use disorder treatment or services delivered as | ||||||
13 | behavioral telehealth services as specified in this Section. | ||||||
14 | The Department and any managed care plans under contract with | ||||||
15 | the Department for the medical assistance program may also | ||||||
16 | provide reimbursement to a behavioral health facility that | ||||||
17 | serves as the originating site at the time a behavioral | ||||||
18 | telehealth service is rendered. | ||||||
19 | (c) To ensure behavioral telehealth services are equitably | ||||||
20 | provided, coverage required under this Section shall comply | ||||||
21 | with all of the following: | ||||||
22 | (1) The Department and any managed care plans under | ||||||
23 | contract with the Department for the medical assistance | ||||||
24 | program shall not: | ||||||
25 | (A) require that in-person contact occur between
a | ||||||
26 | behavioral health care professional and a patient |
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1 | before the provision of a behavioral telehealth | ||||||
2 | service; | ||||||
3 | (B) require patients, behavioral health care | ||||||
4 | professionals,
or behavioral health facilities to | ||||||
5 | prove or document a hardship or access barrier to an | ||||||
6 | in-person consultation for coverage and reimbursement | ||||||
7 | of behavioral telehealth services; | ||||||
8 | (C) require the use of behavioral telehealth | ||||||
9 | services when the behavioral health care professional | ||||||
10 | has determined that it is not appropriate; | ||||||
11 | (D) require the use of behavioral telehealth | ||||||
12 | services when
a patient chooses an in-person | ||||||
13 | consultation; | ||||||
14 | (E) require a behavioral health care professional | ||||||
15 | to be
physically present in the same room as the | ||||||
16 | patient at the originating site, unless deemed | ||||||
17 | medically necessary by the behavioral health care | ||||||
18 | professional providing the behavioral telehealth | ||||||
19 | service; | ||||||
20 | (F) create geographic or facility restrictions or | ||||||
21 | requirements for behavioral telehealth services; | ||||||
22 | (G) require behavioral health care professionals | ||||||
23 | or behavioral health facilities to offer or provide | ||||||
24 | behavioral telehealth services; | ||||||
25 | (H) require patients to use behavioral telehealth | ||||||
26 | services or require patients to use a separate panel |
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1 | of behavioral health care professionals or behavioral | ||||||
2 | health facilities to receive behavioral telehealth | ||||||
3 | services; or | ||||||
4 | (I) impose upon behavioral telehealth services | ||||||
5 | utilization review requirements that are unnecessary, | ||||||
6 | duplicative, or unwarranted or impose any treatment | ||||||
7 | limitations, prior authorization, documentation, or | ||||||
8 | recordkeeping requirements that are more stringent | ||||||
9 | than the requirements applicable to the same | ||||||
10 | behavioral health care service when rendered | ||||||
11 | in-person, except that procedure code modifiers may be | ||||||
12 | required to document behavioral telehealth. | ||||||
13 | (2) Any cost sharing applicable to services provided | ||||||
14 | through behavioral telehealth shall not exceed the cost | ||||||
15 | sharing required by the medical assistance program for the | ||||||
16 | same services provided through in-person consultation. | ||||||
17 | (3) The Department and any managed care plans under | ||||||
18 | contract with the Department for the medical assistance | ||||||
19 | program shall notify behavioral health care professionals | ||||||
20 | and behavioral health facilities of any instructions | ||||||
21 | necessary to facilitate billing for behavioral telehealth | ||||||
22 | services. | ||||||
23 | (d) For purposes of reimbursement, the Department and any | ||||||
24 | managed care plans under contract with the Department for the | ||||||
25 | medical assistance program shall reimburse a behavioral health | ||||||
26 | care professional or behavioral health facility for behavioral |
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1 | telehealth services on the same basis, in the same manner, and | ||||||
2 | at the same reimbursement rate that would apply to the | ||||||
3 | services if the services had been delivered via an in-person | ||||||
4 | encounter by a behavioral health care professional or | ||||||
5 | behavioral health facility. This subsection applies only to | ||||||
6 | those services provided by behavioral telehealth that may | ||||||
7 | otherwise be billed as an in-person service. | ||||||
8 | (e) Behavioral health care professionals and behavioral | ||||||
9 | health facilities shall determine the appropriateness of | ||||||
10 | specific sites, technology platforms, and technology vendors | ||||||
11 | for a behavioral telehealth service, as long as delivered | ||||||
12 | services adhere to all federal and State privacy, security, | ||||||
13 | and confidentiality laws, rules, or regulations, including, | ||||||
14 | but not limited to, the Health Insurance Portability and | ||||||
15 | Accountability Act of 1996, 42 CFR Part 2, and the Mental | ||||||
16 | Health and Developmental Disabilities Confidentiality Act. | ||||||
17 | (f) Nothing in this Section shall be deemed as precluding | ||||||
18 | the Department and any managed care plans under contract with | ||||||
19 | the Department for the medical assistance program from | ||||||
20 | providing benefits for other telehealth services. | ||||||
21 | (g) There shall be no restrictions on originating site | ||||||
22 | requirements for behavioral telehealth coverage or | ||||||
23 | reimbursement to the distant site under this Section other | ||||||
24 | than requiring the behavioral telehealth services to be | ||||||
25 | medically necessary and clinically appropriate. | ||||||
26 | (h) Nothing in this Section shall be deemed as precluding |
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1 | the Department and any managed care plans under contract with | ||||||
2 | the Department for the medical assistance program from | ||||||
3 | establishing limits on the use of telehealth for a particular | ||||||
4 | behavioral health service when the limits are consistent with | ||||||
5 | generally accepted standards of mental, emotional, nervous, or | ||||||
6 | substance use disorder or condition care. | ||||||
7 | (i) The Department may adopt rules to implement the | ||||||
8 | provisions of this Section.
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