Full Text of SB0458 100th General Assembly
SB0458sam001 100TH GENERAL ASSEMBLY | Sen. Andy Manar Filed: 4/24/2018
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| 1 | | AMENDMENT TO SENATE BILL 458
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 458 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing 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 | 10 | | provider rendering the telehealth service is located. | 11 | | "Health care provider" means a health care provider | 12 | | licensed in Illinois. | 13 | | "Interactive telecommunications system" means multimedia | 14 | | communications equipment that includes, at a minimum, audio and | 15 | | video equipment permitting 2-way, real-time interactive | 16 | | communication between the patient and the distant site |
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| 1 | | provider. "Interactive telecommunication system" does not | 2 | | include a telephone, facsimile machine, or electronic mail | 3 | | system. an audio and video system permitting 2-way, live | 4 | | interactive communication between the patient and the distant | 5 | | site health care provider. | 6 | | "Originating site" means the location at which the patient | 7 | | receiving the service is located. | 8 | | "Telehealth" means the use of telecommunications services | 9 | | to encompass 4
modalities: store and forward technologies,
| 10 | | remote monitoring, live consultation, and mobile health; and | 11 | | which shall include, but not be limited to, real-time video | 12 | | conferencing-based communication, secure interactive and | 13 | | non-interactive web-based communication, and secure | 14 | | asynchronous information exchange, to transmit patient medical | 15 | | information, including diagnostic-quality digital images and | 16 | | laboratory results for medical interpretation and diagnosis, | 17 | | for the purpose of delivering enhanced health care services and | 18 | | information while a patient is at an originating site and the | 19 | | health care provider is at a distant site. "Telehealth" | 20 | | includes telepsychiatry and telemedicine. "Telehealth" does | 21 | | not include a standard telephone contact, facsimile | 22 | | transmission, or e-mail text, in combination or by itself. | 23 | | "Telehealth services" means the delivery of covered health | 24 | | care services by way of an interactive telecommunications | 25 | | system. | 26 | | "Telepsychiatry" means the use of a telecommunication |
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| 1 | | system to provide psychiatric services for the purpose of | 2 | | evaluation and treatment when the patient is at one medical | 3 | | provider location and the rendering provider is at another | 4 | | location. | 5 | | (b) This Section applies to an individual or group policy | 6 | | of insurance issued, amended, renewed, delivered, continued, | 7 | | or executed on or after the effective date of this amendatory | 8 | | Act of the 100th General Assembly that pays health benefits, | 9 | | including, but not limited to, such health benefit policies or | 10 | | plans as: | 11 | | (1) the fee-for-service and managed care medical | 12 | | assistance programs under Article V of the Illinois Public | 13 | | Aid Code; | 14 | | (2) professional liability coverage plans and | 15 | | policies; | 16 | | (3) accident, health, or sickness coverage plans and | 17 | | policies; | 18 | | (4) mutual benefit society plans and policies; | 19 | | (5) automobile medical benefits plans and policies; | 20 | | (6) plans and policies subject to the federal Employee | 21 | | Retirement Income Security Act of 1974; | 22 | | (7) third-party administrator plans and policies; | 23 | | (8) travel insurance medical benefits plans and | 24 | | policies; | 25 | | (9) supplemental insurance plans and policies; | 26 | | (10) life care contracts, plans, and policies; |
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| 1 | | (11) accident-only plans and policies; | 2 | | (12) specified disease plans and policies; | 3 | | (13) hospital plans and policies providing fixed daily | 4 | | benefits only; | 5 | | (14) Medicare supplemental plans and policies; | 6 | | (15) long-term care plans and policies; | 7 | | (16) short-term major medical plans and policies of 6 | 8 | | months' duration or less; | 9 | | (17) hospital indemnity plans or policies; and | 10 | | (18) any other supplemental health plan or policy. | 11 | | (c) Any payment or reimbursement made to a health benefit | 12 | | policy or plan for a service delivered through telehealth or | 13 | | telepsychiatry, as provided under this Section, shall be made | 14 | | on the same basis and at the same rate as established for | 15 | | similar services that are not delivered through telehealth. | 16 | | (d) All telehealth services provided under this Section | 17 | | shall meet the following requirements: | 18 | | (1) Medical data may be exchanged through a | 19 | | telecommunication system. | 20 | | (2) The interactive telecommunication system must, at | 21 | | a minimum, have the capability of allowing the consulting | 22 | | distant site provider to examine the patient sufficiently | 23 | | to allow proper diagnosis of the involved body system when | 24 | | necessary and appropriate. The system must also be capable | 25 | | of transmitting clearly audible heart tones and lung | 26 | | sounds, as well as clear video images of the patient and |
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| 1 | | any diagnostic tools, such as radiographs, when necessary | 2 | | and appropriate. | 3 | | (3) An in-person visit between a patient and a health | 4 | | care provider prior to the delivery of telehealth services | 5 | | shall not be required. | 6 | | (4) No patient shall be required to give his or her | 7 | | consent or informed consent before the delivery of services | 8 | | through telehealth. | 9 | | (5) A telepresenter shall not be required to be
present | 10 | | with the patient unless medically necessary. | 11 | | (e) Benefits for a service provided through telehealth | 12 | | required by this Section may be made subject to a deductible, | 13 | | copayment, or coinsurance as long as the deductible, copayment, | 14 | | or coinsurance required does not exceed the deductible, | 15 | | copayment, or coinsurance requirement of the policy or health | 16 | | benefit plan for the same service provided through in-person | 17 | | care. | 18 | | (f) Record for telehealth services shall meet the following | 19 | | requirements: | 20 | | (1) Medical records documenting the telehealth | 21 | | services provided must be maintained by the originating | 22 | | site. No originating and distant site shall be required to | 23 | | maintain or present as a condition of payment any | 24 | | additional medical records to document the telehealth | 25 | | services provided other than what is required under | 26 | | applicable State or federal law. |
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| 1 | | (2) Appropriate steps must be taken by the originating | 2 | | and distant site staff to ensure patient confidentiality, | 3 | | based on technical advances in compliance with all federal | 4 | | and State privacy and confidentiality laws. | 5 | | (3) The billing records related to the use of the | 6 | | telecommunication system shall be maintained. | 7 | | (g) Nothing in this Section precludes a health benefit | 8 | | policy or plan from undertaking utilization review to determine | 9 | | the appropriateness of telehealth as a means of delivering a | 10 | | health care service, provided that the determination is made in | 11 | | the same manner as those regarding the same service when it is | 12 | | delivered in person. | 13 | | (h) Notwithstanding any other provision of law, this | 14 | | Section does not authorize a health benefit policy or plan to | 15 | | require the use of telehealth when the health care provider has | 16 | | determined that telehealth is not appropriate. In addition, no | 17 | | health care provider shall be required to use telehealth when | 18 | | the health care provider has deemed the use of telehealth to be | 19 | | inappropriate for a patient, nor shall a patient be required to | 20 | | use telehealth when the patient chooses in-person care. | 21 | | (b) If an individual or group policy of accident or health | 22 | | insurance provides coverage for telehealth services, then it | 23 | | must comply with the following: | 24 | | (1) An individual or group policy of accident or health | 25 | | insurance providing telehealth services may not: | 26 | | (A) require that in-person contact occur between a |
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| 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 | | (i) (c) Nothing in this Section shall be deemed as | 17 | | precluding a health insurer from providing benefits for other | 18 | | services, including, but not limited to, remote monitoring | 19 | | services, other monitoring services, or oral communications | 20 | | otherwise covered under the policy.
| 21 | | (Source: P.A. 98-1091, eff. 1-1-15 .) | 22 | | Section 10. The Illinois Public Aid Code is amended by | 23 | | adding Section 5-5.25a as follows: | 24 | | (305 ILCS 5/5-5.25a new) |
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| 1 | | Sec. 5-5.25a. Telehealth services. | 2 | | (a) Definitions. As used in this Section: | 3 | | "Asynchronous store and forward technology" means the | 4 | | transmission of a patient's medical information from an | 5 | | originating site to the provider at the distant site. The | 6 | | provider at the distant site can review the medical case | 7 | | without the patient being present. An asynchronous | 8 | | telecommunication system in single media format does not | 9 | | include telephone calls, images transmitted through facsimile | 10 | | machines, and text messages without visualization of the | 11 | | patient (electronic mail). Photographs visualized by a | 12 | | telecommunication system must be specific to the patient's | 13 | | medical condition and adequate for furnishing or confirming a | 14 | | diagnosis or treatment plan. Dermatological photographs (for | 15 | | example, a photograph of a skin lesion) may be considered to | 16 | | meet the requirement of a single media format under this | 17 | | Section. | 18 | | "Distant site" means the location at which the provider | 19 | | rendering the telehealth service is located. | 20 | | "Encounter clinic" means a federally qualified health | 21 | | center, rural health clinic, or encounter rate clinic, as | 22 | | defined in 89 Ill. Adm. Code 140.461. | 23 | | "Facility fee" means the reimbursement made to any Illinois | 24 | | Medicaid participating health care organization or Illinois | 25 | | Medicaid participating provider as originating sites. | 26 | | "Illinois Medicaid participating provider" means any |
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| 1 | | health care provider, including a licensed clinical social | 2 | | worker, a licensed clinical psychologist, a licensed advanced | 3 | | practice registered nurse with psychiatric specialty, a | 4 | | licensed nutritionist, or any other certified nutrition | 5 | | professional, who is eligible to participate in the State's | 6 | | fee-for-service or managed care medical assistance program and | 7 | | who is employed by an Illinois Medicaid participating health | 8 | | care organization. | 9 | | "Illinois Medicaid participating health care organization" | 10 | | means any health care organization that is eligible to | 11 | | participate in the State's fee-for-service or managed care | 12 | | medical assistance program and that has a corporate office | 13 | | located in the State of Illinois. | 14 | | "Interactive telecommunication system" means multimedia | 15 | | communications equipment that includes, at a minimum, audio and | 16 | | video equipment permitting 2-way, real-time interactive | 17 | | communication between the patient and the distant site | 18 | | provider. "Interactive telecommunication system" does not | 19 | | include a telephone, facsimile machine, or electronic mail | 20 | | system. | 21 | | "Originating site" means the location at which the patient | 22 | | receiving the service is located. | 23 | | "Telecommunication system" means an asynchronous store and | 24 | | forward technology or an interactive telecommunication system | 25 | | that is used to transmit data between the originating and | 26 | | distant sites. |
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| 1 | | "Telehealth" means the use of telecommunications services | 2 | | to encompass 4
modalities: store and forward technologies,
| 3 | | remote monitoring, live consultation, and mobile health; and | 4 | | which shall include, but not be limited to, real-time video | 5 | | conferencing-based communication, secure interactive and | 6 | | non-interactive web-based communication, and secure | 7 | | asynchronous information exchange, to transmit patient medical | 8 | | information, including diagnostic-quality digital images and | 9 | | laboratory results for medical interpretation and diagnosis, | 10 | | for the purpose of delivering enhanced health care services and | 11 | | information while a patient is at an originating site and the | 12 | | health care provider is at a distant site. "Telehealth" | 13 | | includes telepsychiatry and telemedicine. "Telehealth" does | 14 | | not include a standard telephone contact, facsimile | 15 | | transmission, or e-mail text, in combination or by itself. | 16 | | "Telemedicine" means the use of a telecommunication system | 17 | | to provide medical services for the purpose of evaluation and | 18 | | treatment when the patient is at one provider location and the | 19 | | rendering provider is at another location. | 20 | | "Telepsychiatry" means the use of a telecommunication | 21 | | system to provide psychiatric services for the purpose of | 22 | | evaluation and treatment when the patient is at one medical | 23 | | provider location and the rendering provider is at another | 24 | | location. | 25 | | (b) Payment. Any payment or reimbursement made under the | 26 | | fee-for-service or managed care medical assistance program for |
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| 1 | | a service delivered through telehealth or telepsychiatry, as | 2 | | provided under this Section, shall be made on the same basis | 3 | | and at the same rate as established for similar services that | 4 | | are not delivered through telehealth. All Medicaid managed care | 5 | | plans issued, amended, renewed, delivered, continued, or | 6 | | executed shall comply with the provisions of this Section. | 7 | | (c) Telehealth services requirements. All telehealth | 8 | | services provided under this Section shall meet the following | 9 | | requirements: | 10 | | (1) The distant site provider must be an eligible | 11 | | Illinois Medicaid participating provider or Illinois | 12 | | Medicaid participating health care organization | 13 | | (2) The originating and distant site provider must not | 14 | | be terminated, suspended, or barred from the State's | 15 | | fee-for-service or managed care medical assistance | 16 | | program. | 17 | | (3) Medical data may be exchanged through a | 18 | | telecommunication system. | 19 | | (4) The interactive telecommunication system must, at | 20 | | a minimum, have the capability of allowing the consulting | 21 | | distant site provider to examine the patient sufficiently | 22 | | to allow proper diagnosis of the involved body system when | 23 | | necessary and appropriate. The system must also be capable | 24 | | of transmitting clearly audible heart tones and lung | 25 | | sounds, as well as clear video images of the patient and | 26 | | any diagnostic tools, such as radiographs, when necessary |
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| 1 | | and appropriate. | 2 | | (d) Telehealth service prohibitions. | 3 | | (1) An in-person visit between a patient and a health | 4 | | care provider prior to the delivery of telehealth services | 5 | | shall not be required for medical assistance coverage under | 6 | | the State's fee-for-service or managed care medical | 7 | | assistance program. | 8 | | (2) No patient shall be required to give his or her | 9 | | consent or informed consent before the delivery of services | 10 | | through telehealth. | 11 | | (3) A telepresenter shall not be required to be
present | 12 | | with the patient unless medically necessary. | 13 | | (e) Reimbursement for telehealth services. | 14 | | (1) Originating site reimbursement. | 15 | | (A) A facility fee shall be paid to providers as | 16 | | defined in subsection (a) of this Section. | 17 | | (B) Local education agencies may submit telehealth | 18 | | services as a certified expenditure. | 19 | | (C) All Illinois Medicaid participating health | 20 | | care organizations and providers that receive | 21 | | reimbursement for a patient's room and board shall also | 22 | | receive the facility fee. | 23 | | (2) Reimbursement for encounter clinics. An encounter | 24 | | clinic serving as the originating site shall be reimbursed | 25 | | for its medical encounter on the same basis and at the same | 26 | | rate as established for Illinois Medicaid participating |
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| 1 | | providers and Illinois Medicaid participating health care | 2 | | organizations for the delivery of telehealth services as | 3 | | provided under this Section. | 4 | | (3) Reimbursement for rendering provider at the | 5 | | distant site. | 6 | | (A) Participating providers shall be reimbursed | 7 | | for the appropriate Current Procedural Terminology | 8 | | code for the telehealth service rendered. | 9 | | (B) Nonparticipating providers may be reimbursed | 10 | | by the originating site provider but shall not be | 11 | | eligible for reimbursement from the Department. | 12 | | (f) Copayments. Benefits for a service provided through
| 13 | | telehealth as required under this Section may be made subject
| 14 | | to a deductible, copayment, or coinsurance as long as the
| 15 | | deductible, copayment, or coinsurance required does not exceed | 16 | | any deductible, copayment, or coinsurance established
under | 17 | | the fee-for-service or managed care medical assistance program | 18 | | for the same
service provided during an in-person visit. | 19 | | (g) Record requirements for telehealth services. | 20 | | (1) Medical records documenting the telehealth | 21 | | services provided must be maintained by the originating | 22 | | site in accordance with the requirements under 89 Ill. Adm. | 23 | | Code. 140.28. No originating and distant site shall be | 24 | | required to maintain or present as a condition of payment | 25 | | any additional medical records to document the telehealth | 26 | | services provided other than what is required under |
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| 1 | | applicable State or federal law. | 2 | | (2) Appropriate steps must be taken by the originating | 3 | | and distant site staff to ensure patient confidentiality, | 4 | | based on technical advances in compliance with all federal | 5 | | and State privacy and confidentiality laws. | 6 | | (3) The billing records related to the use of the | 7 | | telecommunication system shall be maintained as provided | 8 | | in 89 Ill. Adm. Code 140.28. | 9 | | (h) Implementation. The Department shall apply for any | 10 | | federal waivers or approvals necessary to implement the | 11 | | provisions of this Section. Implementation of this Section | 12 | | shall be contingent on the receipt of all necessary federal | 13 | | waivers or approvals. Upon receipt of all necessary federal | 14 | | waivers or approvals, the Department shall implement the | 15 | | provisions of this Section 60 days after the date federal | 16 | | approval is received or 60 days after the effective date of | 17 | | this amendatory Act of the 100th General Assembly, whichever is | 18 | | later. | 19 | | (305 ILCS 5/5-5.25 rep.) | 20 | | Section 15. The Illinois Public Aid Code is amended by | 21 | | repealing Section 5-5.25.".
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