Full Text of HB3308 102nd General Assembly
HB3308sam001 102ND GENERAL ASSEMBLY | Sen. Napoleon Harris, III Filed: 5/25/2021
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| 1 | | AMENDMENT TO HOUSE BILL 3308
| 2 | | AMENDMENT NO. ______. Amend House Bill 3308 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Administrative Procedure Act is | 5 | | amended by adding Section 5-45.8 as follows: | 6 | | (5 ILCS 100/5-45.8 new) | 7 | | Sec. 5-45.8. Emergency rulemaking; Illinois Insurance | 8 | | Code. To provide for the expeditious and timely implementation | 9 | | of changes made to the Illinois Insurance Code by this | 10 | | amendatory Act of the 102nd General Assembly, emergency rules | 11 | | implementing the changes made to the Illinois Insurance Code | 12 | | by this amendatory Act of the 102nd General Assembly may be | 13 | | adopted in accordance with Section 5-45 by the Department of | 14 | | Insurance. The adoption of emergency rules authorized by | 15 | | Section 5-45 and this Section is deemed to be necessary for the | 16 | | public interest, safety, and welfare. This Section is repealed |
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| 1 | | on January 1, 2022. | 2 | | Section 10. The Illinois Insurance Code is amended by | 3 | | changing Section 356z.22 as follows: | 4 | | (215 ILCS 5/356z.22) | 5 | | Sec. 356z.22. Coverage for telehealth services. | 6 | | (a) For purposes of this Section: | 7 | | "Asynchronous store and forward system" has the meaning | 8 | | given to that term in Section 5 of the Telehealth Act. | 9 | | "Distant site" has the meaning given to that term in | 10 | | Section 5 of the Telehealth Act means the location at which the | 11 | | health care provider rendering the telehealth service is | 12 | | located . | 13 | | "E-visits" has the meaning given to that term in Section 5 | 14 | | of the Telehealth Act. | 15 | | "Facility" means any hospital facility licensed under the | 16 | | Hospital Licensing Act or the University of Illinois Hospital | 17 | | Act, a federally qualified health center, a community mental | 18 | | health center, a behavioral health clinic, a substance use | 19 | | disorder treatment program licensed by the Division of | 20 | | Substance Use Prevention and Recovery of the Department of | 21 | | Human Services, or other building, place, or institution that | 22 | | is owned or operated by a person that is licensed or otherwise | 23 | | authorized to deliver health care services. | 24 | | "Health care professional" has the meaning given to that |
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| 1 | | term in Section 5 of the Telehealth Act. | 2 | | "Interactive telecommunications system" has the meaning | 3 | | given to that term in Section 5 of the Telehealth Act. As used | 4 | | in this Section, "interactive telecommunications system" does | 5 | | not include virtual check-ins means an audio and video system | 6 | | permitting 2-way, live interactive communication between the | 7 | | patient and the distant site health care provider . | 8 | | "Originating site" has the meaning given to that term in | 9 | | Section 5 of the Telehealth Act. | 10 | | "Telehealth services" has the meaning given to that term | 11 | | in Section 5 of the Telehealth Act. As used in this Section, | 12 | | "telehealth services" do not include asynchronous store and | 13 | | forward systems, remote patient monitoring technologies, | 14 | | e-visits, or virtual check-ins means the delivery of covered | 15 | | health care services by way of an interactive | 16 | | telecommunications system . | 17 | | "Virtual check-in" has the meaning given to that term in | 18 | | Section 5 of the Telehealth Act. | 19 | | (b) An If an individual or group policy of accident or | 20 | | health insurance that is amended, delivered, issued, or | 21 | | renewed on or after the effective date of this amendatory Act | 22 | | of the 102nd General Assembly shall cover telehealth services, | 23 | | e-visits, and virtual check-ins rendered by a health care | 24 | | professional when clinically appropriate and medically | 25 | | necessary to insureds, enrollees, and members in the same | 26 | | manner as any other benefits covered under the policy. An |
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| 1 | | individual or group policy of accident or health insurance may | 2 | | provide reimbursement to a facility that serves as the | 3 | | originating site at the time a telehealth service is rendered. | 4 | | provides coverage for telehealth services, then it must comply | 5 | | with the following: | 6 | | (c) To ensure telehealth service, e-visit, and virtual | 7 | | check-in access is equitable for all patients in receipt of | 8 | | health care services under this Section and health care | 9 | | professionals and facilities are able to deliver medically | 10 | | necessary services that can be appropriately delivered via | 11 | | telehealth within the scope of their licensure or | 12 | | certification, coverage required under this Section shall | 13 | | comply with all of the following: | 14 | | (1) An individual or group policy of accident or | 15 | | health insurance shall providing telehealth services may | 16 | | not: | 17 | | (A) require that in-person contact occur between a | 18 | | health care professional provider and a patient before | 19 | | the provision of a telehealth service ; | 20 | | (B) require patients, the health care | 21 | | professionals, or facilities provider to prove or | 22 | | document a hardship or access barrier to an in-person | 23 | | consultation for coverage and reimbursement of | 24 | | telehealth services , e-visits, or virtual check-ins to | 25 | | be provided through telehealth ; | 26 | | (C) require the use of telehealth services, |
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| 1 | | e-visits, or virtual check-ins when the health care | 2 | | professional provider has determined that it is not | 3 | | appropriate; or | 4 | | (D) require the use of telehealth services when a | 5 | | patient chooses an in-person consultation ; . | 6 | | (E) require a health care professional to be | 7 | | physically present in the same room as the patient at | 8 | | the originating site, unless deemed medically | 9 | | necessary by the health care professional providing | 10 | | the telehealth service; | 11 | | (F) create geographic or facility restrictions or
| 12 | | requirements for telehealth services, e-visits, or | 13 | | virtual check-ins; | 14 | | (G) require health care professionals or | 15 | | facilities to offer or provide telehealth services, | 16 | | e-visits, or virtual check-ins; | 17 | | (H) require patients to use telehealth services, | 18 | | e-visits, or virtual check-ins, or require patients to | 19 | | use a separate panel of health care professionals or | 20 | | facilities to receive telehealth service, e-visit, or | 21 | | virtual check-in coverage and reimbursement; or | 22 | | (I) impose upon telehealth services, e-visits, or | 23 | | virtual check-ins utilization
review requirements that | 24 | | are unnecessary, duplicative,
or unwarranted or impose | 25 | | any treatment limitations,
prior authorization, | 26 | | documentation, or recordkeeping
requirements that are |
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| 1 | | more stringent than the
requirements applicable to the | 2 | | same health care
service when rendered in-person, | 3 | | except procedure code modifiers may be required to | 4 | | document telehealth. | 5 | | (2) Deductibles, copayments, or coinsurance , or any | 6 | | other cost-sharing applicable to services provided through | 7 | | telehealth shall not exceed the deductibles, copayments, | 8 | | or coinsurance , or any other cost-sharing required by the | 9 | | individual or group policy of accident or health insurance | 10 | | for the same services provided through in-person | 11 | | consultation. | 12 | | (3) An individual or group policy of accident or | 13 | | health insurance shall notify health care professionals | 14 | | and facilities of any instructions necessary to facilitate | 15 | | billing for telehealth services, e-visits, and virtual | 16 | | check-ins. | 17 | | (d) For purposes of reimbursement, an individual or group | 18 | | policy of accident or health insurance that is amended, | 19 | | delivered, issued, or renewed on or after the effective date | 20 | | of this amendatory Act of the 102nd General Assembly shall | 21 | | reimburse an in-network health care professional or facility, | 22 | | including a health care professional or facility in a tiered | 23 | | network, for telehealth services provided through an | 24 | | interactive telecommunications system on the same basis, in | 25 | | the same manner, and at the same reimbursement rate that would | 26 | | apply to the services if the services had been delivered via an |
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| 1 | | in-person encounter by an in-network or tiered network health | 2 | | care professional or facility. This subsection applies only to | 3 | | those services provided by telehealth that may otherwise be | 4 | | billed as an in-person service. This subsection is inoperative | 5 | | on and after January 1, 2028, except that this subsection is | 6 | | operative after that date with respect to mental health and | 7 | | substance use disorder telehealth services. | 8 | | (e) The Department and the Department of Public Health | 9 | | shall commission a report to the General Assembly administered | 10 | | by an established medical college in this State wherein | 11 | | supervised clinical training takes place at an affiliated | 12 | | institution that uses telehealth services, subject to | 13 | | appropriation. The report shall study the telehealth coverage | 14 | | and reimbursement policies established in subsections (b) and | 15 | | (d) of this Section, to determine if the policies improve | 16 | | access to care, reduce health disparities, promote health | 17 | | equity, have an impact on utilization and cost-avoidance, | 18 | | including direct or indirect cost savings to the patient, and | 19 | | to provide any recommendations for telehealth access expansion | 20 | | in the future. An individual or group policy of accident or | 21 | | health insurance shall provide data necessary to carry out the | 22 | | requirements of this subsection upon request of the | 23 | | Department. The Department and the Department of Public Health | 24 | | shall submit the report by December 31, 2026. The established | 25 | | medical college may utilize subject matter expertise to | 26 | | complete any necessary actuarial analysis. |
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| 1 | | (f) Nothing in this Section is intended to limit the | 2 | | ability of an individual or group policy of accident or health | 3 | | insurance and a health care professional or facility to | 4 | | voluntarily negotiate alternate reimbursement rates for | 5 | | telehealth services. Such voluntary negotiations shall take | 6 | | into consideration the ongoing investment necessary to ensure | 7 | | these telehealth platforms may be continuously maintained, | 8 | | seamlessly updated, and integrated with a patient's electronic | 9 | | medical records. | 10 | | (g) An (b-5) If an individual or group policy of accident | 11 | | or health insurance that is amended, delivered, issued, or | 12 | | renewed on or after the effective date of this amendatory Act | 13 | | of the 102nd General Assembly shall provide provides coverage | 14 | | for telehealth services , it must provide coverage for licensed | 15 | | dietitian nutritionists and certified diabetes educators who | 16 | | counsel senior diabetes patients in the senior diabetes | 17 | | patients' homes to remove the hurdle of transportation for | 18 | | senior diabetes patients to receive treatment , in accordance | 19 | | with the Dietitian Nutritionist Practice Act . | 20 | | (h) Any policy, contract, or certificate of health | 21 | | insurance coverage that does not distinguish between | 22 | | in-network and out-of-network health care professionals and | 23 | | facilities shall be subject to this Section as though all | 24 | | health care professionals and facilities were in-network. | 25 | | (i) Health care professionals and facilities shall | 26 | | determine the appropriateness of specific sites, technology |
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| 1 | | platforms, and technology vendors for a telehealth service, as | 2 | | long as delivered services adhere to all federal and State | 3 | | privacy, security, and confidentiality laws, rules, or | 4 | | regulations, including, but not limited to, the Health | 5 | | Insurance Portability and Accountability Act of 1996 and the | 6 | | Mental Health and Developmental Disabilities Confidentiality | 7 | | Act. | 8 | | (j) (c) Nothing in this Section shall be deemed as | 9 | | precluding a health insurer from providing benefits for other | 10 | | telehealth services, including, but not limited to, services | 11 | | not required for coverage provided through an asynchronous | 12 | | store and forward system, remote patient monitoring services, | 13 | | remote monitoring services, other monitoring services, or oral | 14 | | communications otherwise covered under the policy.
| 15 | | (k) There shall be no restrictions on originating site | 16 | | requirements for telehealth coverage or reimbursement to the | 17 | | distant site under this Section other than requiring the | 18 | | telehealth services to be medically necessary and clinically | 19 | | appropriate. | 20 | | (l) The Department may adopt rules, including emergency | 21 | | rules subject to the provisions of Section 5-45 of the | 22 | | Illinois Administrative Procedure Act, to implement the | 23 | | provisions of this Section. | 24 | | (Source: P.A. 100-1009, eff. 1-1-19 .)
| 25 | | Section 15. The Telehealth Act is amended by changing |
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| 1 | | Sections 5, 10, and 15 as follows: | 2 | | (225 ILCS 150/5)
| 3 | | Sec. 5. Definitions. As used in this Act: | 4 | | "Asynchronous store and forward system" means the | 5 | | transmission of a patient's medical information through an | 6 | | electronic communications system at an originating site to a | 7 | | health care professional or facility at a distant site that | 8 | | does not require real-time or synchronous interaction between | 9 | | the health care professional and the patient. | 10 | | "Distant site" means the location at which the health care | 11 | | professional rendering the telehealth service is located. | 12 | | "Established patient" means a patient with a relationship | 13 | | with a health care professional in which there has been an | 14 | | exchange of an individual's protected health information for | 15 | | the purpose of providing patient care, treatment, or services. | 16 | | "E-visit" means a patient-initiated non-face-to-face | 17 | | communication through an online patient portal between an | 18 | | established patient and a health care professional. | 19 | | "Facility" includes a facility that is owned or operated | 20 | | by a hospital under the Hospital Licensing Act or University | 21 | | of Illinois Hospital Act, a facility under the Nursing Home | 22 | | Care Act, a rural health clinic, a federally qualified health | 23 | | center, a local health department, a community mental health | 24 | | center, a behavioral health clinic as defined in 89 Ill. Adm. | 25 | | Code 140.453, an encounter rate clinic, a skilled nursing |
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| 1 | | facility, a substance use treatment program licensed by the | 2 | | Division of Substance Use Prevention and Recovery of the | 3 | | Department of Human Services, a school-based health center as | 4 | | defined in 77 Ill. Adm. Code 641.10, a physician's office, a | 5 | | podiatrist's office, a supportive living program provider, a | 6 | | hospice provider, home health agency, or home nursing agency | 7 | | under the Home Health, Home Services, and Home Nursing Agency | 8 | | Licensing Act, a facility under the ID/DD Community Care Act, | 9 | | community-integrated living arrangements as defined in the | 10 | | Community-Integrated Living Arrangements Licensure and | 11 | | Certification Act, and a provider who receives reimbursement | 12 | | for a patient's room and board. | 13 | | "Health care professional" includes , but is not limited | 14 | | to, physicians, physician assistants, optometrists, advanced | 15 | | practice registered nurses, clinical psychologists licensed in | 16 | | Illinois, prescribing psychologists licensed in Illinois, | 17 | | dentists, occupational therapists, pharmacists, physical | 18 | | therapists, clinical social workers, speech-language | 19 | | pathologists, audiologists, hearing instrument dispensers, | 20 | | licensed certified substance use disorder treatment providers | 21 | | and clinicians, and mental health professionals and clinicians | 22 | | authorized by Illinois law to provide mental health services , | 23 | | and qualified providers listed under paragraph (8)
of | 24 | | subsection (e) of Section 3 of the Early Intervention
Services | 25 | | System Act, dietitian nutritionists licensed in Illinois, and | 26 | | health care professionals associated with a facility .
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| 1 | | "Interactive telecommunications system" means an audio and | 2 | | video system, an audio-only telephone system (landline or | 3 | | cellular), or any other telecommunications system permitting | 4 | | 2-way, synchronous interactive communication between a patient | 5 | | at an originating site and a health care professional or | 6 | | facility at a distant site. "Interactive telecommunications | 7 | | system" does not include a facsimile machine, electronic mail | 8 | | messaging, or text messaging. | 9 | | "Originating site" means the location at which the patient | 10 | | is located at the time telehealth services are provided to the | 11 | | patient via telehealth. | 12 | | "Remote patient monitoring" means the use of connected | 13 | | digital technologies or mobile medical devices to collect | 14 | | medical and other health data from a patient at one location | 15 | | and electronically transmit that data to a health care | 16 | | professional or facility at a different location for | 17 | | collection and interpretation. | 18 | | "Telehealth services " means the evaluation, diagnosis, or | 19 | | interpretation of electronically transmitted patient-specific | 20 | | data between a remote location and a licensed health care | 21 | | professional that generates interaction or treatment | 22 | | recommendations. "Telehealth services " includes telemedicine | 23 | | and the delivery of health care services , including mental | 24 | | health treatment and substance use disorder treatment and | 25 | | services to a patient, regardless of patient location, | 26 | | provided by way of an interactive telecommunications system, |
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| 1 | | asynchronous store and forward system, remote patient | 2 | | monitoring technologies, e-visits, or virtual check-ins as | 3 | | defined in subsection (a) of Section 356z.22 of the Illinois | 4 | | Insurance Code .
| 5 | | "Virtual check-in" means a brief patient-initiated | 6 | | communication using a technology-based service, excluding | 7 | | facsimile, between an established patient and a health care | 8 | | professional. "Virtual check-in" does not include | 9 | | communications from a related office visit provided within the | 10 | | previous 7 days, nor communications that lead to an office | 11 | | visit or procedure within the next 24 hours or soonest | 12 | | available appointment. | 13 | | (Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19; | 14 | | 100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff. | 15 | | 7-19-19.) | 16 | | (225 ILCS 150/10)
| 17 | | Sec. 10. Practice authority. A health care professional | 18 | | treating a patient located in this State through telehealth | 19 | | services must be licensed or authorized to practice in | 20 | | Illinois.
| 21 | | (Source: P.A. 100-317, eff. 1-1-18 .) | 22 | | (225 ILCS 150/15)
| 23 | | Sec. 15. Use of telehealth services . | 24 | | (a) A health care professional may engage in the practice |
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| 1 | | of telehealth services in Illinois to the extent of his or her | 2 | | scope of practice as established in his or her respective | 3 | | licensing Act consistent with the standards of care for | 4 | | in-person services. This Act shall not be construed to alter | 5 | | the scope of practice of any health care professional or | 6 | | authorize the delivery of health care services in a setting or | 7 | | in a manner not otherwise authorized by the laws of this State.
| 8 | | (b) Telehealth services provided pursuant to this Section | 9 | | shall be consistent with all federal and State privacy, | 10 | | security, and confidentiality laws, rules, or regulations. | 11 | | (Source: P.A. 100-317, eff. 1-1-18 .) | 12 | | Section 20. The Early Intervention Services System Act is | 13 | | amended by changing Sections 3 and 11 and by adding Section 3b | 14 | | as follows:
| 15 | | (325 ILCS 20/3) (from Ch. 23, par. 4153)
| 16 | | Sec. 3. Definitions. As used in this Act:
| 17 | | (a) "Eligible infants and toddlers" means infants and | 18 | | toddlers
under 36 months of age with any of the following | 19 | | conditions:
| 20 | | (1) Developmental delays.
| 21 | | (2) A physical or mental condition which typically | 22 | | results in
developmental delay.
| 23 | | (3) Being at risk of having substantial developmental | 24 | | delays
based on informed clinical opinion.
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| 1 | | (4) Either (A) having entered the program under any of
| 2 | | the circumstances listed in paragraphs (1) through (3) of | 3 | | this
subsection
but no
longer meeting
the current | 4 | | eligibility criteria under those paragraphs,
and | 5 | | continuing to have any measurable delay, or (B) not
having | 6 | | attained a level of development in each area,
including
| 7 | | (i) cognitive, (ii) physical (including vision and | 8 | | hearing), (iii)
language,
speech, and communication, (iv) | 9 | | social or emotional, or (v) adaptive, that
is at least at | 10 | | the mean of the child's age equivalent peers;
and,
in | 11 | | addition to either item (A) or item (B), (C)
having
been | 12 | | determined by the multidisciplinary individualized
family | 13 | | service plan
team to require the continuation of early | 14 | | intervention services in order to
support
continuing
| 15 | | developmental progress, pursuant to the child's needs and | 16 | | provided in an
appropriate
developmental manner. The type, | 17 | | frequency, and intensity of services shall
differ from
the | 18 | | initial individualized family services plan because of the | 19 | | child's
developmental
progress, and may consist of only | 20 | | service coordination, evaluation, and
assessments.
| 21 | | (b) "Developmental delay" means a delay in one or more of | 22 | | the following
areas of childhood development as measured by | 23 | | appropriate diagnostic
instruments and standard procedures: | 24 | | cognitive; physical, including vision
and hearing; language, | 25 | | speech and communication; social or emotional;
or adaptive. | 26 | | The term means a delay of 30% or more below the mean in
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| 1 | | function in one or more of those areas.
| 2 | | (c) "Physical or mental condition which typically results | 3 | | in developmental
delay" means:
| 4 | | (1) a diagnosed medical disorder or exposure to a | 5 | | toxic substance bearing a relatively well known
expectancy | 6 | | for developmental outcomes within varying ranges of | 7 | | developmental
disabilities; or
| 8 | | (2) a history of prenatal, perinatal, neonatal or | 9 | | early developmental
events suggestive of biological | 10 | | insults to the developing central nervous
system and which | 11 | | either singly or collectively increase the probability of
| 12 | | developing a disability or delay based on a medical | 13 | | history.
| 14 | | (d) "Informed clinical opinion" means both clinical | 15 | | observations and
parental participation to determine | 16 | | eligibility by a consensus of a
multidisciplinary team of 2 or | 17 | | more members based on their professional
experience and | 18 | | expertise.
| 19 | | (e) "Early intervention services" means services which:
| 20 | | (1) are designed to meet the developmental needs of | 21 | | each child
eligible under this Act and the needs of his or | 22 | | her family;
| 23 | | (2) are selected in collaboration with the child's | 24 | | family;
| 25 | | (3) are provided under public supervision;
| 26 | | (4) are provided at no cost except where a schedule of |
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| 1 | | sliding scale
fees or other system of payments by families | 2 | | has been adopted in accordance
with State and federal law;
| 3 | | (5) are designed to meet an infant's or toddler's | 4 | | developmental needs in
any of the following areas:
| 5 | | (A) physical development, including vision and | 6 | | hearing,
| 7 | | (B) cognitive development,
| 8 | | (C) communication development,
| 9 | | (D) social or emotional development, or
| 10 | | (E) adaptive development;
| 11 | | (6) meet the standards of the State, including the | 12 | | requirements of this Act;
| 13 | | (7) include one or more of the following:
| 14 | | (A) family training,
| 15 | | (B) social work services, including counseling, | 16 | | and home visits,
| 17 | | (C) special instruction,
| 18 | | (D) speech, language pathology and audiology,
| 19 | | (E) occupational therapy,
| 20 | | (F) physical therapy,
| 21 | | (G) psychological services,
| 22 | | (H) service coordination services,
| 23 | | (I) medical services only for diagnostic or | 24 | | evaluation purposes,
| 25 | | (J) early identification, screening, and | 26 | | assessment services,
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| 1 | | (K) health services specified by the lead agency | 2 | | as necessary to
enable the infant or toddler to | 3 | | benefit from the other early intervention
services,
| 4 | | (L) vision services,
| 5 | | (M) transportation,
| 6 | | (N) assistive technology devices and services,
| 7 | | (O) nursing services, | 8 | | (P) nutrition services, and | 9 | | (Q) sign language and cued language services;
| 10 | | (8) are provided by qualified personnel, including but | 11 | | not limited to:
| 12 | | (A) child development specialists or special | 13 | | educators, including teachers of children with hearing | 14 | | impairments (including deafness) and teachers of | 15 | | children with vision impairments (including | 16 | | blindness),
| 17 | | (B) speech and language pathologists and | 18 | | audiologists,
| 19 | | (C) occupational therapists,
| 20 | | (D) physical therapists,
| 21 | | (E) social workers,
| 22 | | (F) nurses,
| 23 | | (G) dietitian nutritionists,
| 24 | | (H) vision specialists, including ophthalmologists | 25 | | and optometrists,
| 26 | | (I) psychologists, and
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| 1 | | (J) physicians;
| 2 | | (9) are provided in conformity with an Individualized | 3 | | Family Service Plan;
| 4 | | (10) are provided throughout the year; and
| 5 | | (11) are provided in natural
environments, to the | 6 | | maximum extent appropriate, which may include the home and | 7 | | community settings, unless justification is provided | 8 | | consistent with federal regulations adopted under Sections | 9 | | 1431 through 1444 of Title 20 of the United States Code.
| 10 | | (f) "Individualized Family Service Plan" or "Plan" means a | 11 | | written plan for
providing early intervention services to a | 12 | | child eligible under this Act
and the child's family, as set | 13 | | forth in Section 11.
| 14 | | (g) "Local interagency agreement" means an agreement | 15 | | entered into by
local community and State and regional | 16 | | agencies receiving early
intervention funds directly from the | 17 | | State and made in accordance with
State interagency agreements | 18 | | providing for the delivery of early
intervention services | 19 | | within a local community area.
| 20 | | (h) "Council" means the Illinois Interagency Council on | 21 | | Early
Intervention established under Section 4.
| 22 | | (i) "Lead agency" means the State agency
responsible for | 23 | | administering this Act and
receiving and disbursing public | 24 | | funds received in accordance with State and
federal law and | 25 | | rules.
| 26 | | (i-5) "Central billing office" means the central billing |
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| 1 | | office created by
the lead agency under Section 13.
| 2 | | (j) "Child find" means a service which identifies eligible | 3 | | infants and
toddlers.
| 4 | | (k) "Regional intake entity" means the lead agency's | 5 | | designated entity
responsible for implementation of the Early | 6 | | Intervention Services System within
its designated geographic | 7 | | area.
| 8 | | (l) "Early intervention provider" means an individual who | 9 | | is qualified, as
defined by the lead agency, to provide one or | 10 | | more types of early intervention
services, and who has | 11 | | enrolled as a provider in the early intervention program.
| 12 | | (m) "Fully credentialed early intervention provider" means | 13 | | an individual who
has met the standards in the State | 14 | | applicable to the relevant
profession, and has met such other | 15 | | qualifications as the lead agency has
determined are suitable | 16 | | for personnel providing early intervention services,
including | 17 | | pediatric experience, education, and continuing education. The | 18 | | lead
agency shall establish these qualifications by rule filed | 19 | | no later than 180
days
after the effective date of this | 20 | | amendatory Act of the 92nd General Assembly.
| 21 | | (n) "Telehealth" has the meaning given to that term in | 22 | | Section 5 of the Telehealth Act. | 23 | | (Source: P.A. 101-10, eff. 6-5-19.)
| 24 | | (325 ILCS 20/3b new) | 25 | | Sec. 3b. Services delivered by telehealth. An early |
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| 1 | | intervention provider may deliver via telehealth any type of | 2 | | early intervention service outlined in subsection (e) of | 3 | | Section 3 to the extent of the early intervention provider's | 4 | | scope of practice as established in the provider's respective | 5 | | licensing Act consistent with the standards of care for | 6 | | in-person services. This Section shall not be construed to | 7 | | alter the scope of practice of any early intervention provider | 8 | | or authorize the delivery of early intervention services in a | 9 | | setting or in a manner not otherwise authorized by the laws of | 10 | | this State.
| 11 | | (325 ILCS 20/11) (from Ch. 23, par. 4161)
| 12 | | Sec. 11. Individualized Family Service Plans.
| 13 | | (a) Each eligible infant or toddler and that infant's or | 14 | | toddler's family
shall receive:
| 15 | | (1) timely, comprehensive, multidisciplinary | 16 | | assessment of the unique
strengths and needs of each | 17 | | eligible infant and toddler, and assessment of the | 18 | | concerns
and priorities of the families to appropriately | 19 | | assist them in meeting
their needs and identify supports | 20 | | and services to meet those needs; and
| 21 | | (2) a written Individualized Family Service Plan | 22 | | developed by a
multidisciplinary team which includes the | 23 | | parent or guardian. The
individualized family service plan | 24 | | shall be based on the
multidisciplinary team's assessment | 25 | | of the resources, priorities,
and concerns of the family |
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| 1 | | and its identification of the supports
and services | 2 | | necessary to enhance the family's capacity to meet the
| 3 | | developmental needs of the infant or toddler, and shall | 4 | | include the
identification of services appropriate to meet | 5 | | those needs, including the
frequency, intensity, and | 6 | | method of delivering services. During and as part of
the | 7 | | initial development of the individualized family services | 8 | | plan, and any
periodic reviews of the plan, the | 9 | | multidisciplinary team may seek consultation from the lead
| 10 | | agency's designated experts, if any, to help
determine | 11 | | appropriate services and the frequency and intensity of | 12 | | those
services. All services in the individualized family | 13 | | services plan must be
justified by the multidisciplinary | 14 | | assessment of the unique strengths and
needs of the infant | 15 | | or toddler and must be appropriate to meet those needs.
At | 16 | | the periodic reviews, the team shall determine whether | 17 | | modification or
revision of the outcomes or services is | 18 | | necessary.
| 19 | | (b) The Individualized Family Service Plan shall be | 20 | | evaluated once a year
and the family shall be provided a review | 21 | | of the Plan at 6 month intervals or
more often where | 22 | | appropriate based on infant or toddler and family needs.
The | 23 | | lead agency shall create a quality review process regarding | 24 | | Individualized
Family Service Plan development and changes | 25 | | thereto, to monitor
and help assure that resources are being | 26 | | used to provide appropriate early
intervention services.
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| 1 | | (c) The initial evaluation and initial assessment and | 2 | | initial
Plan meeting must be held within 45 days after the | 3 | | initial
contact with the early intervention services system. | 4 | | The 45-day timeline does not apply for any period when the | 5 | | child or parent is unavailable to complete the initial | 6 | | evaluation, the initial assessments of the child and family, | 7 | | or the initial Plan meeting, due to exceptional family | 8 | | circumstances that are documented in the child's early | 9 | | intervention records, or when the parent has not provided | 10 | | consent for the initial evaluation or the initial assessment | 11 | | of the child despite documented, repeated attempts to obtain | 12 | | parental consent. As soon as exceptional family circumstances | 13 | | no longer exist or parental consent has been obtained, the | 14 | | initial evaluation, the initial assessment, and the initial | 15 | | Plan meeting must be completed as soon as possible. With | 16 | | parental consent,
early intervention services may commence | 17 | | before the completion of the
comprehensive assessment and | 18 | | development of the Plan.
| 19 | | (d) Parents must be informed that early
intervention
| 20 | | services shall be provided to each eligible infant and | 21 | | toddler, to the maximum extent appropriate, in the natural
| 22 | | environment, which may include the home or other community | 23 | | settings. Parents must also be informed of the availability of | 24 | | early intervention services provided through telehealth | 25 | | services. Parents
shall make
the final decision to accept or | 26 | | decline
early intervention services , including whether |
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| 1 | | accepted services are delivered in person or via telehealth | 2 | | services . A decision to decline such services shall
not be a | 3 | | basis for administrative determination of parental fitness, or
| 4 | | other findings or sanctions against the parents. Parameters of | 5 | | the Plan
shall be set forth in rules.
| 6 | | (e) The regional intake offices shall explain to each | 7 | | family, orally and
in
writing, all of the following:
| 8 | | (1) That the early intervention program will pay for | 9 | | all early
intervention services set forth in the | 10 | | individualized family service plan that
are not
covered or | 11 | | paid under the family's public or private insurance plan | 12 | | or policy
and not
eligible for payment through any other | 13 | | third party payor.
| 14 | | (2) That services will not be delayed due to any rules | 15 | | or restrictions
under the family's insurance plan or | 16 | | policy.
| 17 | | (3) That the family may request, with appropriate | 18 | | documentation
supporting the request, a
determination of | 19 | | an exemption from private insurance use under
Section | 20 | | 13.25.
| 21 | | (4) That responsibility for co-payments or
| 22 | | co-insurance under a family's private insurance
plan or | 23 | | policy will be transferred to the lead
agency's central | 24 | | billing office.
| 25 | | (5) That families will be responsible
for payments of | 26 | | family fees,
which will be based on a sliding scale
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| 1 | | according to the State's definition of ability to pay | 2 | | which is comparing household size and income to the | 3 | | sliding scale and considering out-of-pocket medical or | 4 | | disaster expenses, and that these fees
are payable to the | 5 | | central billing office. Families who fail to provide | 6 | | income information shall be charged the maximum amount on | 7 | | the sliding scale.
| 8 | | (f) The individualized family service plan must state | 9 | | whether the family
has private insurance coverage and, if the | 10 | | family has such coverage, must
have attached to it a copy of | 11 | | the family's insurance identification card or
otherwise
| 12 | | include all of the following information:
| 13 | | (1) The name, address, and telephone number of the | 14 | | insurance
carrier.
| 15 | | (2) The contract number and policy number of the | 16 | | insurance plan.
| 17 | | (3) The name, address, and social security number of | 18 | | the primary
insured.
| 19 | | (4) The beginning date of the insurance benefit year.
| 20 | | (g) A copy of the individualized family service plan must | 21 | | be provided to
each enrolled provider who is providing early | 22 | | intervention services to the
child
who is the subject of that | 23 | | plan.
| 24 | | (h) Children receiving services under this Act shall | 25 | | receive a smooth and effective transition by their third | 26 | | birthday consistent with federal regulations adopted pursuant |
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| 1 | | to Sections 1431 through 1444 of Title 20 of the United States | 2 | | Code. Beginning July 1, 2022, children who receive early | 3 | | intervention services prior to their third birthday and are | 4 | | found eligible for an individualized education program under | 5 | | the Individuals with Disabilities Education Act, 20 U.S.C. | 6 | | 1414(d)(1)(A), and under Section 14-8.02 of the School Code | 7 | | and whose birthday falls between May 1 and August 31 may | 8 | | continue to receive early intervention services until the | 9 | | beginning of the school year following their third birthday in | 10 | | order to minimize gaps in services, ensure better continuity | 11 | | of care, and align practices for the enrollment of preschool | 12 | | children with special needs to the enrollment practices of | 13 | | typically developing preschool children. | 14 | | (Source: P.A. 101-654, eff. 3-8-21.)
| 15 | | Section 99. Effective date. This Act takes effect upon | 16 | | becoming law.".
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