Full Text of HB0823 101st General Assembly
HB0823sam002 101ST GENERAL ASSEMBLY | Sen. Mattie Hunter Filed: 5/23/2020
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| 1 | | AMENDMENT TO HOUSE BILL 823
| 2 | | AMENDMENT NO. ______. Amend House Bill 823, AS AMENDED, by | 3 | | replacing Section 1 with the following:
| 4 | | "Article 1. Sickle Cell Prevention, | 5 | | Care, and Treatment Program | 6 | | Section 1-1. Short title. This Act may be cited as the | 7 | | Sickle Cell Prevention, Care, and Treatment Program Act. | 8 | | References in this Article to "this Act" mean this Article."; | 9 | | and | 10 | | by renumbering Sections 5, 10, 15, 20, 25, 30, and 90 as | 11 | | Sections 1-5, 1-10, 1-15, 1-20, 1-25, 1-30, and 1-90; and | 12 | | by inserting at the end of the bill the following: | 13 | | "Article 15. Telehealth During the COVID-19 Pandemic Act |
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| 1 | | Section 15-1. Short title. This Article may be cited as the | 2 | | Telehealth During the COVID-19 Pandemic Act. References in this | 3 | | Article to "this Act" mean this Article. | 4 | | Section 15-5. Applicability. This Act applies to any health | 5 | | insurance coverage other than excepted benefits as defined in | 6 | | 45 CFR 146.145(b) and 45 CFR 148.220.
Any policy, contract, or | 7 | | certificate of health insurance coverage that does not | 8 | | distinguish between in-network and out-of-network providers | 9 | | shall be subject to this Act as though all providers were | 10 | | in-network. | 11 | | Section 15-10. Definitions. As used in this Act: | 12 | | "Health insurance coverage" has the meaning given to that | 13 | | term in Section 5 of the Illinois Health Insurance Portability | 14 | | and Accountability Act. | 15 | | "Health insurance issuer" has the meaning given to that | 16 | | term in Section 5 of the Illinois Health Insurance Portability | 17 | | and Accountability Act. | 18 | | "Telehealth services" means the provision of health care, | 19 | | psychiatry, mental health treatment, substance use disorder | 20 | | treatment, and related services to a patient, regardless of his | 21 | | or her location, through electronic or telephonic methods, such | 22 | | as telephone (landline or cellular), video technology commonly | 23 | | available on smart phones and other devices, and |
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| 1 | | videoconferencing, as well as any method within the meaning of | 2 | | telehealth services under Section 356z.22 of the Illinois | 3 | | Insurance Code. | 4 | | Section 15-15. Coverage for telehealth services during the | 5 | | COVID-19 pandemic. | 6 | | (a) In order to protect the public's health, to permit | 7 | | expedited treatment of health conditions during the COVID-19 | 8 | | pandemic, and to mitigate its impact upon the residents of the | 9 | | State of Illinois, all health insurance issuers regulated by | 10 | | the Department of Insurance shall cover the costs of all | 11 | | telehealth services rendered by in-network providers to | 12 | | deliver any clinically appropriate, medically necessary | 13 | | covered services and treatments to insureds, enrollees, and | 14 | | members under each policy, contract, or certificate of health | 15 | | insurance coverage. | 16 | | (b) Health insurance issuers may establish reasonable | 17 | | requirements and parameters for telehealth services, including | 18 | | with respect to documentation and recordkeeping, to the extent | 19 | | consistent with this Act or any company bulletin issued by the | 20 | | Department of Insurance under Executive Order 2020-09. A health | 21 | | insurance issuer's requirements and parameters may not be more | 22 | | restrictive or less favorable toward providers, insureds, | 23 | | enrollees, or members than those contained in the emergency | 24 | | rulemaking undertaken by the Department of Healthcare and | 25 | | Family Services at 89 Ill. Adm. Code 140.403(e). Health |
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| 1 | | insurance issuers shall notify providers of any instructions | 2 | | necessary to facilitate billing for telehealth services. | 3 | | Section 15-20. Prior authorization and utilization review | 4 | | requirements. | 5 | | (a) In order to ensure that health care is quickly and | 6 | | efficiently provided to the public, health insurance issuers | 7 | | shall not impose upon telehealth services utilization review | 8 | | requirements that are unnecessary, duplicative, or unwarranted | 9 | | nor impose any treatment limitations that are more stringent | 10 | | than the requirements applicable to the same health care | 11 | | service when rendered in-person. | 12 | | (b) For telehealth services that relate to COVID-19 | 13 | | delivered by in-network providers, health insurance issuers | 14 | | shall not impose any prior authorization requirements. | 15 | | Section 15-25. Cost-sharing prohibited. Health insurance | 16 | | issuers shall not impose any cost-sharing (copayments, | 17 | | deductibles, or coinsurance) for telehealth services provided | 18 | | by in-network providers. However, in accordance with the | 19 | | standards and definitions in 26 U.S.C. 223, if an enrollee in a | 20 | | high-deductible health plan has not met the applicable | 21 | | deductible under the terms of his or her coverage, the | 22 | | requirements of this Section do not require an issuer to pay | 23 | | for a charge for telehealth services unless the associated | 24 | | health care service for that particular charge is deemed |
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| 1 | | preventive care by the United States Department of the | 2 | | Treasury. The federal Internal Revenue Service has recognized | 3 | | that services for testing, treatment, and any potential | 4 | | vaccination for COVID-19 fall within the scope of preventive | 5 | | care. | 6 | | Section 15-30. Eligible services. Services eligible under | 7 | | this Act include services provided by any professional, | 8 | | practitioner, clinician, or other provider who is licensed, | 9 | | certified, registered, or otherwise authorized to practice in | 10 | | the State where the patient receives treatment, subject to the | 11 | | provisions of the Telehealth Act for any health care | 12 | | professional, as defined in the Telehealth Act, who delivers | 13 | | treatment through telehealth to a patient located in this | 14 | | State, and substance use disorder professionals and clinicians | 15 | | authorized by Illinois law to provide substance use disorder | 16 | | services. | 17 | | Section 15-35. Mental Health and Developmental | 18 | | Disabilities Confidentiality Act. A covered health care | 19 | | provider or covered entity subject to the requirements of the | 20 | | Mental Health and Developmental Disabilities Confidentiality | 21 | | Act that uses audio or video communication technology to | 22 | | provide telehealth services to mental health and developmental | 23 | | disability patients may use any non-public facing remote | 24 | | communication product in accordance with this Act to the extent |
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| 1 | | allowed by the U.S. Department of Health and Human Services | 2 | | under the federal Health Insurance Portability and | 3 | | Accountability Act of 1996 for the duration of the | 4 | | Gubernatorial Disaster Proclamation issued by the Governor on | 5 | | March 9, 2020 concerning COVID-19 and any subsequent | 6 | | Gubernatorial Disaster Proclamation issued by the Governor | 7 | | concerning COVID-19. Providers and covered entities shall, to | 8 | | the extent feasible, notify patients that third-party | 9 | | applications potentially introduce privacy risks. Providers | 10 | | shall enable all available encryption and privacy modes when | 11 | | using such applications. A public facing video communication | 12 | | application may not be used in the provision of telehealth | 13 | | services by covered health care providers or covered entities. | 14 | | Section 15-40. Rulemaking authority. The Department of | 15 | | Insurance may adopt rules to implement the provisions of this | 16 | | Act. | 17 | | Section 15-90. Repeal. This Act is repealed on December 31, | 18 | | 2020. | 19 | | Section 15-95. The Illinois Insurance Code is amended by | 20 | | changing Section 356z.22 as follows: | 21 | | (215 ILCS 5/356z.22) | 22 | | Sec. 356z.22. Coverage for telehealth services. |
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| 1 | | (a) For purposes of this Section: | 2 | | "Distant site" means the location at which the health care | 3 | | provider rendering the telehealth service is located. | 4 | | "Interactive telecommunications system" means an audio and | 5 | | video system permitting 2-way, live interactive communication | 6 | | between the patient and the distant site health care provider. | 7 | | "Originating site" means the location at which the patient | 8 | | is located at the time that health care services are provided | 9 | | to the patient by means of telehealth. "Originating site" | 10 | | includes only the sites described in 42 U.S.C. | 11 | | 1395m(m)(4)(C)(ii). | 12 | | "Telehealth services" means the delivery of covered health | 13 | | care services by way of an interactive telecommunications | 14 | | system , through electronic means, or through telephonic means | 15 | | (landline or cellular) . | 16 | | (b) If an individual or group policy of accident or health | 17 | | insurance provides coverage for telehealth services, then it | 18 | | must comply with the following: | 19 | | (1) An individual or group policy of accident or health | 20 | | insurance providing telehealth services may not: | 21 | | (A) require that in-person contact occur between a | 22 | | health care provider and a patient; | 23 | | (B) require the health care provider to document a | 24 | | barrier to an in-person consultation for coverage of | 25 | | services to be provided through telehealth; | 26 | | (C) require the use of telehealth when the health |
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| 1 | | care provider has determined that it is not | 2 | | appropriate; or | 3 | | (D) require the use of telehealth when a patient | 4 | | chooses an in-person consultation. | 5 | | (2) Deductibles, copayments, or coinsurance applicable | 6 | | to services provided through telehealth shall not exceed | 7 | | the deductibles, copayments, or coinsurance required by | 8 | | the individual or group policy of accident or health | 9 | | insurance for the same services provided through in-person | 10 | | consultation. | 11 | | (3) An individual or group policy of accident or health | 12 | | insurance may not exclude from coverage a medically | 13 | | necessary health care service or procedure delivered by a | 14 | | contracted health care professional or contracted health | 15 | | care provider solely because the service or procedure is | 16 | | provided through telehealth. | 17 | | (4) Nothing in this Act shall prohibit an insurer from | 18 | | entering a contract for telehealth services in which the | 19 | | terms and reimbursement, including the facility fee, are | 20 | | subject to negotiation. However, no facility fee shall be | 21 | | paid with respect to the home of an individual other than | 22 | | the home of a health care provider when used as his or her | 23 | | office for providing health care services. | 24 | | (b-5) If an individual or group policy of accident or | 25 | | health insurance provides coverage for telehealth services, it | 26 | | must provide coverage for licensed dietitian nutritionists and |
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| 1 | | certified diabetes educators who counsel senior diabetes | 2 | | patients in the senior diabetes patients' homes to remove the | 3 | | hurdle of transportation for senior diabetes patients to | 4 | | receive treatment. | 5 | | (c) Nothing in this Section shall be deemed as precluding a | 6 | | health insurer from providing benefits for other services, | 7 | | including, but not limited to, remote monitoring services, | 8 | | other monitoring services, or oral communications otherwise | 9 | | covered under the policy.
| 10 | | (Source: P.A. 100-1009, eff. 1-1-19 .) | 11 | | Article 99. Effective Date | 12 | | Section 99-99. Effective date. Article 15 and this Article | 13 | | take effect upon becoming law.".
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