Full Text of SB0458 100th General Assembly
SB0458sam002 100TH GENERAL ASSEMBLY | Sen. Andy Manar Filed: 11/7/2018
| | 10000SB0458sam002 | | LRB100 05002 SMS 43212 a |
|
| 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 | | (Text of Section before amendment by P.A. 100-1009 ) | 8 | | Sec. 356z.22. Coverage for telehealth services. | 9 | | (a) For purposes of this Section: | 10 | | "Distant site" means the location at which the health care | 11 | | provider rendering the telehealth service is located. | 12 | | "Health care provider" means a health care professional | 13 | | licensed in 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 |
| | | 10000SB0458sam002 | - 2 - | LRB100 05002 SMS 43212 a |
|
| 1 | | communication between the patient and the distant site | 2 | | provider. "Interactive telecommunication system" does not | 3 | | include a facsimile machine. | 4 | | "Originating site" means the location at which the patient | 5 | | receiving the service is located. | 6 | | "Telehealth" means the use of telecommunications services | 7 | | to encompass 4
modalities: store and forward technologies,
| 8 | | remote monitoring, live consultation, and mobile health; and | 9 | | which shall include, but not be limited to, real-time video | 10 | | conferencing-based communication, secure interactive and | 11 | | non-interactive web-based communication, and secure | 12 | | asynchronous information exchange, to transmit patient medical | 13 | | information, including diagnostic-quality digital images and | 14 | | laboratory results for medical interpretation and diagnosis, | 15 | | for the purpose of delivering enhanced health care services and | 16 | | information while a patient is at an originating site and the | 17 | | health care provider is at a distant site. "Telehealth" | 18 | | includes telepsychiatry and telemedicine. "Telehealth" | 19 | | includes psychiatric services, as well as services provided by | 20 | | all other professional disciplines delivered through | 21 | | telecommunication systems. "Telehealth" does not include a | 22 | | facsimile transmission. | 23 | | "Interactive telecommunications system" means an audio and | 24 | | video system permitting 2-way, live interactive communication | 25 | | between the patient and the distant site health care provider. | 26 | | "Telehealth services" means the delivery of covered health |
| | | 10000SB0458sam002 | - 3 - | LRB100 05002 SMS 43212 a |
|
| 1 | | care services by way of an interactive telecommunications | 2 | | system. | 3 | | (b) This Section applies to an individual or group policy | 4 | | of insurance issued, amended, renewed, delivered, continued, | 5 | | or executed on or after the effective date of this amendatory | 6 | | Act of the 100th General Assembly that pays health benefits, | 7 | | including, but not limited to, such health benefit policies or | 8 | | plans as: | 9 | | (1) the fee-for-service and managed care medical | 10 | | assistance programs under Article V of the Illinois Public | 11 | | Aid Code; | 12 | | (2) accident, health, or sickness coverage plans and | 13 | | policies; | 14 | | (3) mutual benefit society plans and policies; | 15 | | (4) automobile medical benefits plans and policies; | 16 | | (5) plans and policies subject to the federal Employee | 17 | | Retirement Income Security Act of 1974; | 18 | | (6) third-party administrator plans and policies; | 19 | | (7) travel insurance medical benefits plans and | 20 | | policies; | 21 | | (8) supplemental insurance plans and policies; | 22 | | (9) life care contracts, plans, and policies; | 23 | | (10) accident-only plans and policies; | 24 | | (11) specified disease plans and policies; | 25 | | (12) hospital plans and policies providing fixed daily | 26 | | benefits only; |
| | | 10000SB0458sam002 | - 4 - | LRB100 05002 SMS 43212 a |
|
| 1 | | (13) Medicare supplemental plans and policies; | 2 | | (14) long-term care plans and policies; | 3 | | (15) short-term major medical plans and policies of 6 | 4 | | months' duration or less; | 5 | | (16) hospital indemnity plans or policies; and | 6 | | (17) any other supplemental health plan or policy. | 7 | | (c) A health benefit policy or plan shall provide coverage | 8 | | for the cost of health care services provided through | 9 | | telehealth, as provided under this Section, on the same basis | 10 | | and at the same rate that the health insurer is responsible for | 11 | | coverage for providing the same service through in-person | 12 | | treatment or consultation. Health benefit policies or plans | 13 | | shall not exclude a service for coverage solely because the | 14 | | service is provided through telehealth services. | 15 | | (d) All telehealth services provided under this Section | 16 | | shall meet the following requirements: | 17 | | (1) Medical data may be exchanged through an | 18 | | interactive telecommunication system. | 19 | | (2) 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 interactive | 24 | | telecommunication system must also be capable of | 25 | | transmitting clearly audible heart tones and lung sounds, | 26 | | as well as clear video images of the patient and any |
| | | 10000SB0458sam002 | - 5 - | LRB100 05002 SMS 43212 a |
|
| 1 | | diagnostic tools, such as radiographs, when necessary and | 2 | | 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) Other than consents required for treatment for | 7 | | in-person care, no informed or other consents shall be | 8 | | required for the patient to receive care through | 9 | | telehealth. | 10 | | (5) A telepresenter shall not be required to be
present | 11 | | with the patient unless medically necessary. | 12 | | (e) Email systems and text messaging may be used as | 13 | | interactive telecommunication systems for existing patients. | 14 | | (f) Benefits for a service provided through telehealth | 15 | | required by this Section may be made subject to a deductible, | 16 | | copayment, or coinsurance as long as the deductible, copayment, | 17 | | or coinsurance required does not exceed the deductible, | 18 | | copayment, or coinsurance requirement of the policy or health | 19 | | benefit plan for the same service provided through in-person | 20 | | care. | 21 | | (g) Records for telehealth services shall meet the | 22 | | following requirements: | 23 | | (1) The originating and distant sites shall not 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 |
| | | 10000SB0458sam002 | - 6 - | LRB100 05002 SMS 43212 a |
|
| 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 following | 7 | | through the use of the telecommunication system shall be | 8 | | maintained: | 9 | | (A) Current Procedural Terminology codes or any | 10 | | successor codes; | 11 | | (B) Healthcare Common Procedure Coding System | 12 | | services or any successor services; and | 13 | | (C) Level 1 technical component facility fees or | 14 | | any successor fees. | 15 | | (h) Originating sites shall have no restrictions with | 16 | | respect to geographic location or other restrictions that limit | 17 | | the type and location or originating sites. | 18 | | (i) Nothing in this Section precludes a health benefit | 19 | | policy or plan from undertaking utilization review to determine | 20 | | the appropriateness of telehealth as a means of delivering a | 21 | | health care service, provided that the determination is made in | 22 | | the same manner as those regarding the same service when it is | 23 | | delivered in person. | 24 | | (j) Notwithstanding any other provision of law, this | 25 | | Section does not authorize a health benefit policy or plan to | 26 | | require the use of telehealth. A health care provider is not |
| | | 10000SB0458sam002 | - 7 - | LRB100 05002 SMS 43212 a |
|
| 1 | | required to use telehealth. A patient is not required to use | 2 | | telehealth if the patient chooses in-person care. | 3 | | (b) If an individual or group policy of accident or health | 4 | | insurance provides coverage for telehealth services, then it | 5 | | must comply with the following: | 6 | | (1) An individual or group policy of accident or health | 7 | | insurance providing telehealth services may not: | 8 | | (A) require that in-person contact occur between a | 9 | | health care provider and a patient; | 10 | | (B) require the health care provider to document a | 11 | | barrier to an in-person consultation for coverage of | 12 | | services to be provided through telehealth; | 13 | | (C) require the use of telehealth when the health | 14 | | care provider has determined that it is not | 15 | | appropriate; or | 16 | | (D) require the use of telehealth when a patient | 17 | | chooses an in-person consultation. | 18 | | (2) Deductibles, copayments, or coinsurance applicable | 19 | | to services provided through telehealth shall not exceed | 20 | | the deductibles, copayments, or coinsurance required by | 21 | | the individual or group policy of accident or health | 22 | | insurance for the same services provided through in-person | 23 | | consultation. | 24 | | (l) (c) Nothing in this Section precludes shall be deemed | 25 | | as precluding a health insurer from providing benefits for | 26 | | other services, including, but not limited to, email, text |
| | | 10000SB0458sam002 | - 8 - | LRB100 05002 SMS 43212 a |
|
| 1 | | messaging, the use of mobile applications, remote monitoring | 2 | | services, other monitoring services, or oral communications | 3 | | otherwise covered under the policy.
| 4 | | (Source: P.A. 98-1091, eff. 1-1-15 .) | 5 | | (Text of Section after amendment by P.A. 100-1009 ) | 6 | | Sec. 356z.22. Coverage for telehealth services. | 7 | | (a) For purposes of this Section: | 8 | | "Distant site" means the location at which the health care | 9 | | provider rendering the telehealth service is located. | 10 | | "Health care provider" means a health care professional | 11 | | licensed in Illinois. | 12 | | "Interactive telecommunication system" means multimedia | 13 | | communications equipment that includes, at a minimum, audio and | 14 | | video equipment permitting 2-way, real-time interactive | 15 | | communication between the patient and the distant site | 16 | | provider. "Interactive telecommunication system" does not | 17 | | include a facsimile machine. | 18 | | "Originating site" means the location at which the patient | 19 | | receiving the service is located. | 20 | | "Telehealth" means the use of telecommunications services | 21 | | to encompass 4
modalities: store and forward technologies,
| 22 | | remote monitoring, live consultation, and mobile health; and | 23 | | which shall include, but not be limited to, real-time video | 24 | | conferencing-based communication, secure interactive and | 25 | | non-interactive web-based communication, and secure |
| | | 10000SB0458sam002 | - 9 - | LRB100 05002 SMS 43212 a |
|
| 1 | | asynchronous information exchange, to transmit patient medical | 2 | | information, including diagnostic-quality digital images and | 3 | | laboratory results for medical interpretation and diagnosis, | 4 | | for the purpose of delivering enhanced health care services and | 5 | | information while a patient is at an originating site and the | 6 | | health care provider is at a distant site. "Telehealth" | 7 | | includes telepsychiatry and telemedicine. "Telehealth" | 8 | | includes psychiatric services, as well as services provided by | 9 | | all other professional disciplines delivered through | 10 | | telecommunication systems. "Telehealth" does not include a | 11 | | facsimile transmission. | 12 | | "Interactive telecommunications system" means an audio and | 13 | | video system permitting 2-way, live interactive communication | 14 | | between the patient and the distant site health care provider. | 15 | | "Telehealth services" means the delivery of covered health | 16 | | care services by way of an interactive telecommunications | 17 | | system. | 18 | | (b) This Section applies to an individual or group policy | 19 | | of insurance issued, amended, renewed, delivered, continued, | 20 | | or executed on or after the effective date of this amendatory | 21 | | Act of the 100th General Assembly that pays health benefits, | 22 | | including, but not limited to, such health benefit policies or | 23 | | plans as: | 24 | | (1) the fee-for-service and managed care medical | 25 | | assistance programs under Article V of the Illinois Public | 26 | | Aid Code; |
| | | 10000SB0458sam002 | - 10 - | LRB100 05002 SMS 43212 a |
|
| 1 | | (2) accident, health, or sickness coverage plans and | 2 | | policies; | 3 | | (3) mutual benefit society plans and policies; | 4 | | (4) automobile medical benefits plans and policies; | 5 | | (5) plans and policies subject to the federal Employee | 6 | | Retirement Income Security Act of 1974; | 7 | | (6) third-party administrator plans and policies; | 8 | | (7) travel insurance medical benefits plans and | 9 | | policies; | 10 | | (8) supplemental insurance plans and policies; | 11 | | (9) life care contracts, plans, and policies; | 12 | | (10) accident-only plans and policies; | 13 | | (11) specified disease plans and policies; | 14 | | (12) hospital plans and policies providing fixed daily | 15 | | benefits only; | 16 | | (13) Medicare supplemental plans and policies; | 17 | | (14) long-term care plans and policies; | 18 | | (15) short-term major medical plans and policies of 6 | 19 | | months' duration or less; | 20 | | (16) hospital indemnity plans or policies; and | 21 | | (17) any other supplemental health plan or policy. | 22 | | (c) A health benefit policy or plan shall provide coverage | 23 | | for the cost of health care services provided through | 24 | | telehealth, as provided under this Section, on the same basis | 25 | | and at the same rate that the health insurer is responsible for | 26 | | coverage for providing the same service through in-person |
| | | 10000SB0458sam002 | - 11 - | LRB100 05002 SMS 43212 a |
|
| 1 | | treatment or consultation. Health benefit policies or plans | 2 | | shall not exclude a service for coverage solely because the | 3 | | service is provided through telehealth services. | 4 | | (d) All telehealth services provided under this Section | 5 | | shall meet the following requirements: | 6 | | (1) Medical data may be exchanged through an | 7 | | interactive telecommunication system. | 8 | | (2) The interactive telecommunication system must, at | 9 | | a minimum, have the capability of allowing the consulting | 10 | | distant site provider to examine the patient sufficiently | 11 | | to allow proper diagnosis of the involved body system when | 12 | | necessary and appropriate. The interactive | 13 | | telecommunication system must also be capable of | 14 | | transmitting clearly audible heart tones and lung sounds, | 15 | | as well as clear video images of the patient and any | 16 | | diagnostic tools, such as radiographs, when necessary and | 17 | | appropriate. | 18 | | (3) An in-person visit between a patient and a health | 19 | | care provider prior to the delivery of telehealth services | 20 | | shall not be required. | 21 | | (4) Other than consents required for treatment for | 22 | | in-person care, no informed or other consents shall be | 23 | | required for the patient to receive care through | 24 | | telehealth. | 25 | | (5) A telepresenter shall not be required to be
present | 26 | | with the patient unless medically necessary. |
| | | 10000SB0458sam002 | - 12 - | LRB100 05002 SMS 43212 a |
|
| 1 | | (e) Email systems and text messaging may be used as | 2 | | interactive telecommunication systems for existing patients. | 3 | | (f) Benefits for a service provided through telehealth | 4 | | required by this Section may be made subject to a deductible, | 5 | | copayment, or coinsurance as long as the deductible, copayment, | 6 | | or coinsurance required does not exceed the deductible, | 7 | | copayment, or coinsurance requirement of the policy or health | 8 | | benefit plan for the same service provided through in-person | 9 | | care. | 10 | | (g) Records for telehealth services shall meet the | 11 | | following requirements: | 12 | | (1) The originating and distant sites shall not be | 13 | | required to maintain or present as a condition of payment | 14 | | any additional medical records to document the telehealth | 15 | | services provided other than what is required under | 16 | | applicable State or federal law. | 17 | | (2) Appropriate steps must be taken by the originating | 18 | | and distant site staff to ensure patient confidentiality, | 19 | | based on technical advances in compliance with all federal | 20 | | and State privacy and confidentiality laws. | 21 | | (3) The billing records related to the following | 22 | | through the use of the telecommunication system shall be | 23 | | maintained: | 24 | | (A) Current Procedural Terminology codes or any | 25 | | successor codes; | 26 | | (B) Healthcare Common Procedure Coding System |
| | | 10000SB0458sam002 | - 13 - | LRB100 05002 SMS 43212 a |
|
| 1 | | services or any successor services; and | 2 | | (C) Level 1 technical component facility fees or | 3 | | any successor fees. | 4 | | (h) Originating sites shall have no restrictions with | 5 | | respect to geographic location or other restrictions that limit | 6 | | the type and location or originating sites. | 7 | | (i) 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 | | (j) 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. A health care provider is not | 16 | | required to use telehealth. A patient is not required to use | 17 | | telehealth if the patient chooses in-person care. | 18 | | (b) If an individual or group policy of accident or health | 19 | | insurance provides coverage for telehealth services, then it | 20 | | must 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 | 24 | | health care provider and a patient; | 25 | | (B) require the health care provider to document a | 26 | | barrier to an in-person consultation for coverage of |
| | | 10000SB0458sam002 | - 14 - | LRB100 05002 SMS 43212 a |
|
| 1 | | services to be provided through telehealth; | 2 | | (C) require the use of telehealth when the health | 3 | | care provider has determined that it is not | 4 | | appropriate; or | 5 | | (D) require the use of telehealth when a patient | 6 | | chooses an in-person consultation. | 7 | | (2) Deductibles, copayments, or coinsurance applicable | 8 | | to services provided through telehealth shall not exceed | 9 | | the deductibles, copayments, or coinsurance required by | 10 | | the individual or group policy of accident or health | 11 | | insurance for the same services provided through in-person | 12 | | consultation. | 13 | | (k) (b-5) If an individual or group policy of accident or | 14 | | health insurance provides coverage for telehealth services, it | 15 | | must provide coverage for licensed dietitian nutritionists and | 16 | | certified diabetes educators who counsel senior diabetes | 17 | | patients in the senior diabetes patients' homes to remove the | 18 | | hurdle of transportation for senior diabetes patients to | 19 | | receive treatment. | 20 | | (l) (c) Nothing in this Section precludes shall be deemed | 21 | | as precluding a health insurer from providing benefits for | 22 | | other services, including, but not limited to, email, text | 23 | | messaging, the use of mobile applications, remote monitoring | 24 | | services, other monitoring services, or oral communications | 25 | | otherwise covered under the policy.
| 26 | | (Source: P.A. 100-1009, eff. 1-1-19.) |
| | | 10000SB0458sam002 | - 15 - | LRB100 05002 SMS 43212 a |
|
| 1 | | Section 10. The Illinois Public Aid Code is amended by | 2 | | adding Section 5-5.25a as follows: | 3 | | (305 ILCS 5/5-5.25a new) | 4 | | Sec. 5-5.25a. Telehealth services. | 5 | | (a) Definitions. As used in this Section: | 6 | | "Asynchronous store and forward technology" means the | 7 | | transmission of a patient's medical information from an | 8 | | originating site to the provider at the distant site. The | 9 | | provider at the distant site can review the medical case | 10 | | without the patient being present. An asynchronous | 11 | | telecommunication system in single media format does not | 12 | | include telephone calls, images transmitted through facsimile | 13 | | machines, and text messages without visualization of the | 14 | | patient (email). Photographs visualized by a telecommunication | 15 | | system must be specific to the patient's medical condition and | 16 | | adequate for furnishing or confirming a diagnosis or treatment | 17 | | plan. Dermatological photographs (for example, a photograph of | 18 | | a skin lesion) may be considered to meet the requirement of a | 19 | | single media format under this Section. | 20 | | "Distant site" means the location at which the provider | 21 | | rendering the telehealth service is located. | 22 | | "Facility fee" means the reimbursement made to any Illinois | 23 | | Medicaid participating health care organization or Illinois | 24 | | Medicaid participating provider as originating sites. |
| | | 10000SB0458sam002 | - 16 - | LRB100 05002 SMS 43212 a |
|
| 1 | | "Illinois Medicaid participating provider" means any | 2 | | health care provider, including a practitioner described in | 3 | | Section 5-8, a licensed clinical social worker, a licensed | 4 | | clinical psychologist, a licensed advanced practice registered | 5 | | nurse with psychiatric specialty, a licensed nutritionist, or | 6 | | any other certified nutrition professional, who is eligible to | 7 | | participate in the State's fee-for-service or managed care | 8 | | medical assistance program and who is employed by an Illinois | 9 | | Medicaid participating health care organization. | 10 | | "Illinois Medicaid participating health care organization" | 11 | | means any health care organization that is eligible to | 12 | | participate in the State's fee-for-service or managed care | 13 | | medical assistance program and that has an office or is | 14 | | affiliated with an organization that has an office located in | 15 | | the State of Illinois. | 16 | | "Interactive telecommunication system" means multimedia | 17 | | communications equipment that includes, at a minimum, audio and | 18 | | video equipment permitting 2-way, real-time interactive | 19 | | communication between the patient and the distant site | 20 | | provider. "Interactive telecommunication system" does not | 21 | | include a facsimile machine. | 22 | | "Originating site" means the location at which the patient | 23 | | receiving the service is located. | 24 | | "Telecommunication system" means an asynchronous store and | 25 | | forward technology or an interactive telecommunication system | 26 | | that is used to transmit data between the originating and |
| | | 10000SB0458sam002 | - 17 - | LRB100 05002 SMS 43212 a |
|
| 1 | | distant sites. | 2 | | "Telehealth" means the use of telecommunications services | 3 | | to encompass 4
modalities: store and forward technologies,
| 4 | | remote monitoring, live consultation, and mobile health; and | 5 | | which shall include, but not be limited to, real-time video | 6 | | conferencing-based communication, secure interactive and | 7 | | non-interactive web-based communication, and secure | 8 | | asynchronous information exchange, to transmit patient medical | 9 | | information, including diagnostic-quality digital images and | 10 | | laboratory results for medical interpretation and diagnosis, | 11 | | for the purpose of delivering enhanced health care services and | 12 | | information while a patient is at an originating site and the | 13 | | health care provider is at a distant site. "Telehealth" | 14 | | includes telepsychiatry and telemedicine. "Telehealth" | 15 | | includes psychiatric services, as well as services provided by | 16 | | all other professional disciplines delivered through | 17 | | telecommunication systems. "Telehealth" does not include a | 18 | | facsimile transmission. | 19 | | (b) Payment. Any fee-for-service or managed care medical | 20 | | assistance program shall provide coverage for the cost of | 21 | | health care services provided through telehealth, as provided | 22 | | under this Section, on the same basis and at the same rate as | 23 | | established for coverage for providing the same service through | 24 | | in-person treatment or consultation. Fee-for-service or | 25 | | managed care medical assistance programs shall not exclude a | 26 | | service for coverage solely because the service is provided |
| | | 10000SB0458sam002 | - 18 - | LRB100 05002 SMS 43212 a |
|
| 1 | | through telehealth services. This Section applies to any plan | 2 | | that is issued, amended, renewed, delivered, continued, or | 3 | | executed in the State of Illinois. | 4 | | (c) Telehealth services requirements. All telehealth | 5 | | services provided under this Section shall meet the following | 6 | | requirements: | 7 | | (1) The distant site provider must be an eligible | 8 | | Illinois Medicaid participating provider or Illinois | 9 | | Medicaid participating health care organization | 10 | | (2) The originating and distant site provider must not | 11 | | be terminated, suspended, or barred from the State's | 12 | | fee-for-service or managed care medical assistance | 13 | | program. | 14 | | (3) Medical data may be exchanged through an | 15 | | interactive telecommunication system. | 16 | | (4) The interactive telecommunication system must, at | 17 | | a minimum, have the capability of allowing the consulting | 18 | | distant site provider to examine the patient sufficiently | 19 | | to allow proper diagnosis of the involved body system when | 20 | | necessary and appropriate. The interactive | 21 | | telecommunication system must also be capable of | 22 | | transmitting clearly audible heart tones and lung sounds, | 23 | | as well as clear video images of the patient and any | 24 | | diagnostic tools, such as radiographs, when necessary and | 25 | | appropriate. | 26 | | (d) Telehealth service prohibitions. |
| | | 10000SB0458sam002 | - 19 - | LRB100 05002 SMS 43212 a |
|
| 1 | | (1) An in-person visit between a patient and a health | 2 | | care provider prior to the delivery of telehealth services | 3 | | shall not be required for medical assistance coverage under | 4 | | the State's fee-for-service or managed care medical | 5 | | assistance program. | 6 | | (2) Other than consents required for treatment for | 7 | | in-person care, no informed or other consents shall be | 8 | | required for the patient to receive care through | 9 | | telehealth. | 10 | | (3) A telepresenter shall not be required to be
present | 11 | | with the patient unless medically necessary. | 12 | | (e) Email systems and text messaging may be used as | 13 | | interactive telecommunication systems for existing patients. | 14 | | (f) Reimbursement for telehealth services. | 15 | | (1) Originating site reimbursement. | 16 | | (A) A facility fee shall be paid to providers as | 17 | | defined in subsection (a) of this Section. | 18 | | (B) Local education agencies may submit telehealth | 19 | | services as a certified expenditure. | 20 | | (C) All Illinois Medicaid participating health | 21 | | care organizations and providers that receive | 22 | | reimbursement for a patient's room and board shall also | 23 | | receive the facility fee. | 24 | | (2) Reimbursement for rendering provider at the | 25 | | distant site. | 26 | | (A) Participating providers shall be reimbursed |
| | | 10000SB0458sam002 | - 20 - | LRB100 05002 SMS 43212 a |
|
| 1 | | for the appropriate Current Procedural Terminology | 2 | | code for the telehealth service rendered. | 3 | | (B) Nonparticipating providers may be reimbursed | 4 | | by the originating site provider but shall not be | 5 | | eligible for reimbursement from the Department. | 6 | | (g) Copayments. Benefits for a service provided through
| 7 | | telehealth as required under this Section may be made subject
| 8 | | to a deductible, copayment, or coinsurance as long as the
| 9 | | deductible, copayment, or coinsurance required does not exceed | 10 | | any deductible, copayment, or coinsurance established
under | 11 | | the fee-for-service or managed care medical assistance program | 12 | | for the same
service provided during an in-person visit. | 13 | | (h) Record requirements for telehealth services. | 14 | | (1) Medical records documenting the telehealth | 15 | | services provided must be maintained by the originating | 16 | | site in accordance with the requirements under 89 Ill. Adm. | 17 | | Code. 140.28. The originating and distant sites shall not | 18 | | be required to maintain or present as a condition of | 19 | | payment any additional medical records to document the | 20 | | telehealth services provided other than what is required | 21 | | for in-person care under applicable State or federal law. | 22 | | (2) Appropriate steps must be taken by the originating | 23 | | and distant site staff to ensure patient confidentiality, | 24 | | based on technical advances in compliance with all federal | 25 | | and State privacy and confidentiality laws. | 26 | | (3) The billing records related to the following |
| | | 10000SB0458sam002 | - 21 - | LRB100 05002 SMS 43212 a |
|
| 1 | | through the use of the telecommunication system shall be | 2 | | maintained as provided in 89 Ill. Adm. Code 140.28: | 3 | | (A) Current Procedural Terminology codes or any | 4 | | successor codes; | 5 | | (B) Healthcare Common Procedure Coding System | 6 | | services or any successor services; and | 7 | | (C) Level 1 technical component facility fees or | 8 | | any successor fees. | 9 | | (i) Originating sites shall have no restrictions with | 10 | | respect to geographic location or other restrictions that limit | 11 | | the type and location of originating sites. | 12 | | (j) Implementation. The Department shall implement the | 13 | | provisions of this Section 60 days after the effective date of | 14 | | this amendatory Act of the 100th General Assembly. | 15 | | (305 ILCS 5/5-5.25 rep.) | 16 | | Section 15. The Illinois Public Aid Code is amended by | 17 | | repealing Section 5-5.25.
| 18 | | Section 95. No acceleration or delay. Where this Act makes | 19 | | changes in a statute that is represented in this Act by text | 20 | | that is not yet or no longer in effect (for example, a Section | 21 | | represented by multiple versions), the use of that text does | 22 | | not accelerate or delay the taking effect of (i) the changes | 23 | | made by this Act or (ii) provisions derived from any other | 24 | | Public Act.".
|
|