HB2896 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB2896

 

Introduced 2/19/2021, by Rep. Deb Conroy

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Early Intervention Services System Act. Permits an early intervention provider to deliver via telehealth any type of early intervention services authorized under the Act to the extent of his or her scope of practice as established in his or her respective licensing Act consistent with the standards of care for in-person services. Requires parents to be informed of the availability of early intervention services provided through telehealth. Amends the Illinois Insurance Code. Provides that a policy of accident and health insurance that provides coverage for early intervention services must also provide coverage for early intervention services delivered via telehealth by providers listed under the Early Intervention Services System Act, subject to any restriction or limitation under a provider's respective licensing Act on the delivery of early intervention services via telehealth. Amends the Telehealth Act. Expands the definition of "telehealth" to include the delivery of early intervention services provided by way of an interactive telecommunications system. Expands the definition of "health professional" to include certain professional personnel who are authorized by State law to provide behavioral health services or early intervention services (rather than mental health services). Provides that a health care professional, including any early intervention provider, may engage in the practice of telehealth in Illinois to the extent of his or her scope of practice as established in his or her respective licensing Act consistent with the standards of care for in-person services. Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to reimburse early intervention providers who deliver early intervention services to medical assistance recipients via telehealth.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning early intervention services.
 
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 367m as follows:
 
6    (215 ILCS 5/367m)
7    Sec. 367m. Early intervention services. A policy of
8accident and health insurance that provides coverage for early
9intervention services must also provide coverage for early
10intervention services delivered via telehealth by providers
11listed in paragraph (8) of subsection (e) of Section 3 of the
12Early Intervention Services System Act, subject to any
13restriction or limitation under a provider's respective
14licensing Act on the delivery of early intervention services
15via telehealth. A policy of accident and health insurance that
16provides coverage for early intervention services must conform
17to the following criteria:
18        (1) The use of private health insurance to pay for
19    early intervention services under Part C of the federal
20    Individuals with Disabilities Education Act may not count
21    towards or result in a loss of benefits due to annual or
22    lifetime insurance caps for an infant or toddler with a
23    disability, the infant's or toddler's parent, or the

 

 

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1    infant's or toddler's family members who are covered under
2    that health insurance policy.
3        (2) The use of private health insurance to pay for
4    early intervention services under Part C of the federal
5    Individuals with Disabilities Education Act may not
6    negatively affect the availability of health insurance to
7    an infant or toddler with a disability, the infant's or
8    toddler's parent, or the infant's or toddler's family
9    members who are covered under that health insurance
10    policy, and health insurance coverage may not be
11    discontinued for these individuals due to the use of the
12    health insurance to pay for services under Part C of the
13    federal Individuals with Disabilities Education Act.
14        (3) The use of private health insurance to pay for
15    early intervention services under Part C of the federal
16    Individuals with Disabilities Education Act may not be the
17    basis for increasing the health insurance premiums of an
18    infant or toddler with a disability, the infant's or
19    toddler's parent, or the infant's or toddler's family
20    members covered under that health insurance policy.
21    For the purposes of this Section, "early intervention
22services" has the same meaning as in the Early Intervention
23Services System Act.
24(Source: P.A. 98-41, eff. 6-28-13.)
 
25    Section 10. The Telehealth Act is amended by changing

 

 

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1Sections 5 and 15 as follows:
 
2    (225 ILCS 150/5)
3    Sec. 5. Definitions. As used in this Act:
4    "Early intervention services" means any of the services
5outlined in subsection (e) of Section 3 of the Early
6Intervention Services System Act.
7    "Health care professional" includes physicians, physician
8assistants, optometrists, advanced practice registered nurses,
9clinical psychologists licensed in Illinois, prescribing
10psychologists licensed in Illinois, dentists, occupational
11therapists, pharmacists, physical therapists, clinical social
12workers, speech-language pathologists, audiologists, hearing
13instrument dispensers, and mental health professionals and
14clinicians authorized by Illinois law to provide behavioral
15health services or early intervention services mental health
16services.
17    "Telehealth" means the evaluation, diagnosis, or
18interpretation of electronically transmitted patient-specific
19data between a remote location and a licensed health care
20professional that generates interaction or treatment
21recommendations. "Telehealth" includes telemedicine and the
22delivery of health care services provided by way of an
23interactive telecommunications system, as defined in
24subsection (a) of Section 356z.22 of the Illinois Insurance
25Code. "Telehealth" includes the delivery of early intervention

 

 

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1services provided by way of an interactive telecommunications
2system.
3(Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19;
4100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff.
57-19-19.)
 
6    (225 ILCS 150/15)
7    Sec. 15. Use of telehealth. A health care professional,
8including any early intervention provider listed in paragraph
9(8) of subsection (e) of Section 3 of the Early Intervention
10Services System Act, may engage in the practice of telehealth
11in Illinois to the extent of his or her scope of practice as
12established in his or her respective licensing Act consistent
13with the standards of care for in-person services. This Act
14shall not be construed to alter the scope of practice of any
15health care professional or early intervention provider or
16authorize the delivery of health care services or early
17intervention services in a setting or in a manner not
18otherwise authorized by the laws of this State.
19(Source: P.A. 100-317, eff. 1-1-18.)
 
20    Section 15. The Illinois Public Aid Code is amended by
21changing Section 5-5.25 as follows:
 
22    (305 ILCS 5/5-5.25)
23    Sec. 5-5.25. Access to behavioral health and medical

 

 

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1services.
2    (a) The General Assembly finds that providing access to
3behavioral health and medical services in a timely manner will
4improve the quality of life for persons suffering from illness
5and will contain health care costs by avoiding the need for
6more costly inpatient hospitalization.
7    (b) The Department of Healthcare and Family Services shall
8reimburse psychiatrists, federally qualified health centers as
9defined in Section 1905(l)(2)(B) of the federal Social
10Security Act, clinical psychologists, clinical social workers,
11advanced practice registered nurses certified in psychiatric
12and mental health nursing, and mental health professionals and
13clinicians authorized by Illinois law to provide behavioral
14health services to recipients via telehealth. The Department,
15by rule, shall establish: (i) criteria for such services to be
16reimbursed, including appropriate facilities and equipment to
17be used at both sites and requirements for a physician or other
18licensed health care professional to be present at the site
19where the patient is located; however, the Department shall
20not require that a physician or other licensed health care
21professional be physically present in the same room as the
22patient for the entire time during which the patient is
23receiving telehealth services; and (ii) a method to reimburse
24providers for mental health services provided by telehealth.
25    (b-5) The Department of Healthcare and Family Services
26shall reimburse early intervention providers who deliver early

 

 

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1intervention services to recipients via telehealth. The
2providers and services outlined in subsection (e) of Section 3
3of the Early Intervention Services System Act shall be
4eligible for reimbursement under this subsection, subject to
5any restriction or limitation under a provider's respective
6licensing Act on the delivery of early intervention services
7via telehealth. The Department, by rule, shall establish a
8method to reimburse providers for early intervention services
9delivered via telehealth.
10    (c) The Department shall reimburse any Medicaid certified
11eligible facility or provider organization that acts as the
12location of the patient at the time a telehealth service is
13rendered, including substance abuse centers licensed by the
14Department of Human Services' Division of Alcoholism and
15Substance Abuse.
16    (d) On and after July 1, 2012, the Department shall reduce
17any rate of reimbursement for services or other payments or
18alter any methodologies authorized by this Code to reduce any
19rate of reimbursement for services or other payments in
20accordance with Section 5-5e.
21(Source: P.A. 100-385, eff. 1-1-18; 100-790, eff. 8-10-18;
22100-1019, eff. 1-1-19; 101-81, eff. 7-12-19.)
 
23    Section 20. The Early Intervention Services System Act is
24amended by changing Sections 3 and 11 and by adding Section 3b
25as follows:
 

 

 

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1    (325 ILCS 20/3)  (from Ch. 23, par. 4153)
2    Sec. 3. Definitions. As used in this Act:
3    (a) "Eligible infants and toddlers" means infants and
4toddlers under 36 months of age with any of the following
5conditions:
6        (1) Developmental delays.
7        (2) A physical or mental condition which typically
8    results in developmental delay.
9        (3) Being at risk of having substantial developmental
10    delays based on informed clinical opinion.
11        (4) Either (A) having entered the program under any of
12    the circumstances listed in paragraphs (1) through (3) of
13    this subsection but no longer meeting the current
14    eligibility criteria under those paragraphs, and
15    continuing to have any measurable delay, or (B) not having
16    attained a level of development in each area, including
17    (i) cognitive, (ii) physical (including vision and
18    hearing), (iii) language, speech, and communication, (iv)
19    social or emotional, or (v) adaptive, that is at least at
20    the mean of the child's age equivalent peers; and, in
21    addition to either item (A) or item (B), (C) having been
22    determined by the multidisciplinary individualized family
23    service plan team to require the continuation of early
24    intervention services in order to support continuing
25    developmental progress, pursuant to the child's needs and

 

 

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1    provided in an appropriate developmental manner. The type,
2    frequency, and intensity of services shall differ from the
3    initial individualized family services plan because of the
4    child's developmental progress, and may consist of only
5    service coordination, evaluation, and assessments.
6    (b) "Developmental delay" means a delay in one or more of
7the following areas of childhood development as measured by
8appropriate diagnostic instruments and standard procedures:
9cognitive; physical, including vision and hearing; language,
10speech and communication; social or emotional; or adaptive.
11The term means a delay of 30% or more below the mean in
12function in one or more of those areas.
13    (c) "Physical or mental condition which typically results
14in developmental delay" means:
15        (1) a diagnosed medical disorder or exposure to a
16    toxic substance bearing a relatively well known expectancy
17    for developmental outcomes within varying ranges of
18    developmental disabilities; or
19        (2) a history of prenatal, perinatal, neonatal or
20    early developmental events suggestive of biological
21    insults to the developing central nervous system and which
22    either singly or collectively increase the probability of
23    developing a disability or delay based on a medical
24    history.
25    (d) "Informed clinical opinion" means both clinical
26observations and parental participation to determine

 

 

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1eligibility by a consensus of a multidisciplinary team of 2 or
2more members based on their professional experience and
3expertise.
4    (e) "Early intervention services" means services which:
5        (1) are designed to meet the developmental needs of
6    each child eligible under this Act and the needs of his or
7    her family;
8        (2) are selected in collaboration with the child's
9    family;
10        (3) are provided under public supervision;
11        (4) are provided at no cost except where a schedule of
12    sliding scale fees or other system of payments by families
13    has been adopted in accordance with State and federal law;
14        (5) are designed to meet an infant's or toddler's
15    developmental needs in any of the following areas:
16            (A) physical development, including vision and
17        hearing,
18            (B) cognitive development,
19            (C) communication development,
20            (D) social or emotional development, or
21            (E) adaptive development;
22        (6) meet the standards of the State, including the
23    requirements of this Act;
24        (7) include one or more of the following:
25            (A) family training,
26            (B) social work services, including counseling,

 

 

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1        and home visits,
2            (C) special instruction,
3            (D) speech, language pathology and audiology,
4            (E) occupational therapy,
5            (F) physical therapy,
6            (G) psychological services,
7            (H) service coordination services,
8            (I) medical services only for diagnostic or
9        evaluation purposes,
10            (J) early identification, screening, and
11        assessment services,
12            (K) health services specified by the lead agency
13        as necessary to enable the infant or toddler to
14        benefit from the other early intervention services,
15            (L) vision services,
16            (M) transportation,
17            (N) assistive technology devices and services,
18            (O) nursing services,
19            (P) nutrition services, and
20            (Q) sign language and cued language services;
21        (8) are provided by qualified personnel, including but
22    not limited to:
23            (A) child development specialists or special
24        educators, including teachers of children with hearing
25        impairments (including deafness) and teachers of
26        children with vision impairments (including

 

 

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1        blindness),
2            (B) speech and language pathologists and
3        audiologists,
4            (C) occupational therapists,
5            (D) physical therapists,
6            (E) social workers,
7            (F) nurses,
8            (G) dietitian nutritionists,
9            (H) vision specialists, including ophthalmologists
10        and optometrists,
11            (I) psychologists, and
12            (J) physicians;
13        (9) are provided in conformity with an Individualized
14    Family Service Plan;
15        (10) are provided throughout the year; and
16        (11) are provided in natural environments, to the
17    maximum extent appropriate, which may include the home and
18    community settings, unless justification is provided
19    consistent with federal regulations adopted under Sections
20    1431 through 1444 of Title 20 of the United States Code.
21    (f) "Individualized Family Service Plan" or "Plan" means a
22written plan for providing early intervention services to a
23child eligible under this Act and the child's family, as set
24forth in Section 11.
25    (g) "Local interagency agreement" means an agreement
26entered into by local community and State and regional

 

 

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1agencies receiving early intervention funds directly from the
2State and made in accordance with State interagency agreements
3providing for the delivery of early intervention services
4within a local community area.
5    (h) "Council" means the Illinois Interagency Council on
6Early Intervention established under Section 4.
7    (i) "Lead agency" means the State agency responsible for
8administering this Act and receiving and disbursing public
9funds received in accordance with State and federal law and
10rules.
11    (i-5) "Central billing office" means the central billing
12office created by the lead agency under Section 13.
13    (j) "Child find" means a service which identifies eligible
14infants and toddlers.
15    (k) "Regional intake entity" means the lead agency's
16designated entity responsible for implementation of the Early
17Intervention Services System within its designated geographic
18area.
19    (l) "Early intervention provider" means an individual who
20is qualified, as defined by the lead agency, to provide one or
21more types of early intervention services, and who has
22enrolled as a provider in the early intervention program.
23    (m) "Fully credentialed early intervention provider" means
24an individual who has met the standards in the State
25applicable to the relevant profession, and has met such other
26qualifications as the lead agency has determined are suitable

 

 

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1for personnel providing early intervention services, including
2pediatric experience, education, and continuing education. The
3lead agency shall establish these qualifications by rule filed
4no later than 180 days after the effective date of this
5amendatory Act of the 92nd General Assembly.
6    (n) "Telehealth" has the meaning ascribed to that term in
7Section 5 of the Telehealth Act.
8(Source: P.A. 101-10, eff. 6-5-19.)
 
9    (325 ILCS 20/3b new)
10    Sec. 3b. Services delivered by telehealth. An early
11intervention provider may deliver via telehealth any type of
12early intervention service outlined in subsection (e) of
13Section 3 to the extent of his or her scope of practice as
14established in his or her respective licensing Act consistent
15with the standards of care for in-person services. This
16Section shall not be construed to alter the scope of practice
17of any early intervention provider or authorize the delivery
18of early intervention services in a setting or in a manner not
19otherwise authorized by the laws of this State.
 
20    (325 ILCS 20/11)  (from Ch. 23, par. 4161)
21    Sec. 11. Individualized Family Service Plans.
22    (a) Each eligible infant or toddler and that infant's or
23toddler's family shall receive:
24        (1) timely, comprehensive, multidisciplinary

 

 

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1    assessment of the unique strengths and needs of each
2    eligible infant and toddler, and assessment of the
3    concerns and priorities of the families to appropriately
4    assist them in meeting their needs and identify supports
5    and services to meet those needs; and
6        (2) a written Individualized Family Service Plan
7    developed by a multidisciplinary team which includes the
8    parent or guardian. The individualized family service plan
9    shall be based on the multidisciplinary team's assessment
10    of the resources, priorities, and concerns of the family
11    and its identification of the supports and services
12    necessary to enhance the family's capacity to meet the
13    developmental needs of the infant or toddler, and shall
14    include the identification of services appropriate to meet
15    those needs, including the frequency, intensity, and
16    method of delivering services. During and as part of the
17    initial development of the individualized family services
18    plan, and any periodic reviews of the plan, the
19    multidisciplinary team may seek consultation from the lead
20    agency's designated experts, if any, to help determine
21    appropriate services and the frequency and intensity of
22    those services. All services in the individualized family
23    services plan must be justified by the multidisciplinary
24    assessment of the unique strengths and needs of the infant
25    or toddler and must be appropriate to meet those needs. At
26    the periodic reviews, the team shall determine whether

 

 

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1    modification or revision of the outcomes or services is
2    necessary.
3    (b) The Individualized Family Service Plan shall be
4evaluated once a year and the family shall be provided a review
5of the Plan at 6 month intervals or more often where
6appropriate based on infant or toddler and family needs. The
7lead agency shall create a quality review process regarding
8Individualized Family Service Plan development and changes
9thereto, to monitor and help assure that resources are being
10used to provide appropriate early intervention services.
11    (c) The initial evaluation and initial assessment and
12initial Plan meeting must be held within 45 days after the
13initial contact with the early intervention services system.
14The 45-day timeline does not apply for any period when the
15child or parent is unavailable to complete the initial
16evaluation, the initial assessments of the child and family,
17or the initial Plan meeting, due to exceptional family
18circumstances that are documented in the child's early
19intervention records, or when the parent has not provided
20consent for the initial evaluation or the initial assessment
21of the child despite documented, repeated attempts to obtain
22parental consent. As soon as exceptional family circumstances
23no longer exist or parental consent has been obtained, the
24initial evaluation, the initial assessment, and the initial
25Plan meeting must be completed as soon as possible. With
26parental consent, early intervention services may commence

 

 

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1before the completion of the comprehensive assessment and
2development of the Plan.
3    (d) Parents must be informed that early intervention
4services shall be provided to each eligible infant and
5toddler, to the maximum extent appropriate, in the natural
6environment, which may include the home or other community
7settings. Parents must also be informed of the availability of
8early intervention services provided through telehealth.
9Parents shall make the final decision to accept or decline
10early intervention services. A decision to decline such
11services shall not be a basis for administrative determination
12of parental fitness, or other findings or sanctions against
13the parents. Parameters of the Plan shall be set forth in
14rules.
15    (e) The regional intake offices shall explain to each
16family, orally and in writing, all of the following:
17        (1) That the early intervention program will pay for
18    all early intervention services set forth in the
19    individualized family service plan that are not covered or
20    paid under the family's public or private insurance plan
21    or policy and not eligible for payment through any other
22    third party payor.
23        (2) That services will not be delayed due to any rules
24    or restrictions under the family's insurance plan or
25    policy.
26        (3) That the family may request, with appropriate

 

 

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1    documentation supporting the request, a determination of
2    an exemption from private insurance use under Section
3    13.25.
4        (4) That responsibility for co-payments or
5    co-insurance under a family's private insurance plan or
6    policy will be transferred to the lead agency's central
7    billing office.
8        (5) That families will be responsible for payments of
9    family fees, which will be based on a sliding scale
10    according to the State's definition of ability to pay
11    which is comparing household size and income to the
12    sliding scale and considering out-of-pocket medical or
13    disaster expenses, and that these fees are payable to the
14    central billing office. Families who fail to provide
15    income information shall be charged the maximum amount on
16    the sliding scale.
17    (f) The individualized family service plan must state
18whether the family has private insurance coverage and, if the
19family has such coverage, must have attached to it a copy of
20the family's insurance identification card or otherwise
21include all of the following information:
22        (1) The name, address, and telephone number of the
23    insurance carrier.
24        (2) The contract number and policy number of the
25    insurance plan.
26        (3) The name, address, and social security number of

 

 

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1    the primary insured.
2        (4) The beginning date of the insurance benefit year.
3    (g) A copy of the individualized family service plan must
4be provided to each enrolled provider who is providing early
5intervention services to the child who is the subject of that
6plan.
7    (h) Children receiving services under this Act shall
8receive a smooth and effective transition by their third
9birthday consistent with federal regulations adopted pursuant
10to Sections 1431 through 1444 of Title 20 of the United States
11Code.
12(Source: P.A. 97-902, eff. 8-6-12; 98-41, eff. 6-28-13.)

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    215 ILCS 5/367m
4    225 ILCS 150/5
5    225 ILCS 150/15
6    305 ILCS 5/5-5.25
7    325 ILCS 20/3from Ch. 23, par. 4153
8    325 ILCS 20/3b new
9    325 ILCS 20/11from Ch. 23, par. 4161