Full Text of HB3498 102nd General Assembly
HB3498ham001 102ND GENERAL ASSEMBLY | Rep. Deb Conroy Filed: 4/20/2021
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| 1 | | AMENDMENT TO HOUSE BILL 3498
| 2 | | AMENDMENT NO. ______. Amend House Bill 3498 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Administrative Procedure Act is | 5 | | amended by adding Sections 5-45.8 and 5-45.9 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. |
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| 1 | | This Section is repealed on January 1, 2026. | 2 | | (5 ILCS 100/5-45.9 new) | 3 | | Sec. 5-45.9. Emergency rulemaking; Illinois Public Aid | 4 | | Code. To provide for the expeditious and timely implementation | 5 | | of changes made to the Illinois Public Aid Code by this | 6 | | amendatory Act of the 102nd General Assembly, emergency rules | 7 | | implementing the changes made to the Illinois Public Aid Code | 8 | | by this amendatory Act of the 102nd General Assembly may be | 9 | | adopted in accordance with Section 5-45 by the Department of | 10 | | Healthcare and Family Services. The adoption of emergency | 11 | | rules authorized by Section 5-45 and this Section is deemed to | 12 | | be necessary for the public interest, safety, and welfare. | 13 | | This Section is repealed on January 1, 2026. | 14 | | Section 10. The Illinois Insurance Code is amended by | 15 | | changing Section 356z.22 as follows: | 16 | | (215 ILCS 5/356z.22) | 17 | | Sec. 356z.22. Coverage for telehealth services. | 18 | | (a) For purposes of this Section: | 19 | | "Asynchronous store and forward system" means the | 20 | | transmission of a patient's medical information through an | 21 | | electronic communications system at an originating site to a | 22 | | health care professional or facility at a distant site that | 23 | | does not require real-time or synchronous interaction between |
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| 1 | | the health care professional and the patient. | 2 | | "Distant site" means the location at which the health care | 3 | | professional provider rendering the telehealth service is | 4 | | located. | 5 | | "Established patient" means a patient with a relationship | 6 | | with a health care professional in which there is an exchange | 7 | | of an individual's protected health information for the | 8 | | purpose of providing patient care treatment or services. | 9 | | "E-visit" means a patient-initiated non-face-to-face | 10 | | communication through an online patient portal with a health | 11 | | care professional. "E-visit" only includes communications | 12 | | where the initial inquiry is initiated by an established | 13 | | patient. | 14 | | "Facility" includes a facility that is owned or operated | 15 | | by a hospital under the Hospital Licensing Act or University | 16 | | of Illinois Hospital Act, a facility under the Nursing Home | 17 | | Care Act, a rural health clinic, a federally qualified health | 18 | | center, a local health department, a community mental health | 19 | | center, a behavioral health clinic, an encounter rate clinic, | 20 | | a skilled nursing facility, a substance use treatment program | 21 | | licensed by the Department of Human Services' Division of | 22 | | Substance Use Prevention and Recovery, a school-based health | 23 | | center as defined in 77 Ill. Adm. Code 641.10, a physician's | 24 | | office, a podiatrist's office, a supportive living program | 25 | | provider, a hospice provider, a facility under the ID/DD | 26 | | Community Care Act, community-integrated living arrangements |
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| 1 | | as defined in the Community-Integrated Living Arrangements | 2 | | Licensure and Certification Act, and a provider who receives | 3 | | reimbursement for a patient's room and board. | 4 | | "Health care professional" has the meaning ascribed to | 5 | | that term in Section 5 of the Telehealth Act. | 6 | | "Interactive telecommunications system" means an audio and | 7 | | video system , an audio-only telephone system (landline or | 8 | | cellular), or any other telecommunications system permitting | 9 | | 2-way, synchronous interactive communication between a patient | 10 | | at an originating site and a health care professional or | 11 | | facility at a distant site permitting 2-way, live interactive | 12 | | communication between the patient and the distant site health | 13 | | care provider . "Interactive telecommunications system" does | 14 | | not include a facsimile machine, electronic mail messaging, or | 15 | | text messaging. | 16 | | "Originating site" means the location at which the patient | 17 | | is located at the time telehealth services are provided to the | 18 | | patient via telehealth. | 19 | | "Remote patient monitoring" means the use of connected | 20 | | digital technologies or mobile medical devices to collect | 21 | | medical and other health data from a patient at one location | 22 | | and electronically transmit that data to a health care | 23 | | professional or facility at a different location for | 24 | | collection and interpretation. | 25 | | "Telehealth services" has the meaning ascribed to that | 26 | | term in Section 5 of the Telehealth Act means the delivery of |
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| 1 | | covered health care services by way of an interactive | 2 | | telecommunications system . | 3 | | "Virtual check-in" means a brief patient-initiated | 4 | | communication using a technology-based service, excluding | 5 | | facsimile, with a health care professional. "Virtual check-in" | 6 | | only includes communications where the initial inquiry is | 7 | | initiated by an established patient. "Virtual check-in" does | 8 | | not include communications from a related office visit | 9 | | provided within the previous 7 days, nor communications that | 10 | | lead to an office visit or procedure within the next 24 hours | 11 | | or soonest available appointment. | 12 | | (b) An If an individual or group policy of accident or | 13 | | health insurance or a managed care plan that is amended, | 14 | | delivered, issued, or renewed on or after the effective date | 15 | | of this amendatory Act of the 102nd General Assembly shall | 16 | | cover all telehealth services rendered by a health care | 17 | | professional to deliver any clinically appropriate, medically | 18 | | necessary covered services and treatments to insureds, | 19 | | enrollees, and members in the same manner as any other | 20 | | benefits covered under the policy. Reimbursement to a health | 21 | | care professional for telehealth services provided through an | 22 | | interactive telecommunications system, excluding virtual | 23 | | check-ins, shall be made on the same basis, in the same manner, | 24 | | and at the same rate as would be applied for the same services | 25 | | if they had been delivered in person. An individual or group | 26 | | policy of accident or health insurance or a managed care plan |
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| 1 | | shall provide reasonable compensation to a facility that | 2 | | serves as the originating site at the time a telehealth | 3 | | service is rendered. Nothing in this Section shall be deemed | 4 | | as precluding a health insurer from providing a higher rate of | 5 | | reimbursement for telehealth services. provides coverage for | 6 | | telehealth services, then it must comply with the following: | 7 | | (1) To ensure telehealth service access is equitable | 8 | | for all patients in receipt of health care services under | 9 | | this Section and health care professionals and facilities | 10 | | are able to deliver services within the scope of their | 11 | | licensure or certification, an An individual or group | 12 | | policy of accident or health insurance or a managed care | 13 | | plan that is amended, delivered, issued or renewed on or | 14 | | after the effective date of this amendatory Act of the | 15 | | 102nd General Assembly shall providing telehealth services | 16 | | may not: | 17 | | (A) require that in-person contact occur between a | 18 | | health care professional provider and a patient , | 19 | | except before an initial e-visit or virtual check-in | 20 | | in order to establish a patient relationship ; | 21 | | (B) require patients, the health care | 22 | | professionals, or facilities provider to prove or | 23 | | document a hardship or access barrier to an in-person | 24 | | consultation for coverage and reimbursement of | 25 | | telehealth services to be provided through telehealth ; | 26 | | (C) require the use of telehealth when the health |
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| 1 | | care professional provider has determined that it is | 2 | | not appropriate; or | 3 | | (D) require the use of telehealth when a patient | 4 | | chooses an in-person consultation ; . | 5 | | (E) require a physician or other health care | 6 | | professional to be physically present in the same room | 7 | | as the patient at the originating site, unless deemed | 8 | | medically necessary by the health care professional | 9 | | providing the telehealth service; | 10 | | (F) create geographic or facility restrictions or | 11 | | requirements for telehealth services; | 12 | | (G) negotiate different contract rates for | 13 | | telehealth services provided through an interactive | 14 | | telecommunications system and in-person services, | 15 | | excluding virtual check-ins; | 16 | | (H) require health care professionals or | 17 | | facilities to offer or provide telehealth services; | 18 | | (I) require patients to use telehealth services or | 19 | | require patients to use a separate panel of health | 20 | | care professionals or facilities to receive telehealth | 21 | | service coverage and reimbursement; or | 22 | | (J) impose upon telehealth services utilization | 23 | | review requirements that are unnecessary, duplicative, | 24 | | or unwarranted, or impose any treatment limitations, | 25 | | prior authorization, documentation, or recordkeeping | 26 | | requirements that are more stringent than the |
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| 1 | | requirements applicable to the same health care | 2 | | service when rendered in-person, except procedure code | 3 | | modifiers may be required to document telehealth; an | 4 | | individual or group policy of accident or health | 5 | | insurance or a managed care plan shall notify health | 6 | | care providers of any instructions necessary to | 7 | | facilitate billing for telehealth services. | 8 | | (2) Deductibles, copayments, or coinsurance , or any | 9 | | other cost-sharing applicable to services provided through | 10 | | telehealth shall not exceed the deductibles, copayments, | 11 | | or coinsurance , or any other cost-sharing required by the | 12 | | individual or group policy of accident or health insurance | 13 | | for the same services provided through in-person | 14 | | consultation. | 15 | | (b-5) An If an individual or group policy of accident or | 16 | | health insurance or a managed care plan that is amended, | 17 | | delivered, issued, or renewed on or after the effective date | 18 | | of this amendatory Act of the 102nd General Assembly shall | 19 | | provide provides coverage for telehealth services , it must | 20 | | provide coverage for licensed dietitian nutritionists and | 21 | | certified diabetes educators who counsel senior diabetes | 22 | | patients in the senior diabetes patients' homes to remove the | 23 | | hurdle of transportation for senior diabetes patients to | 24 | | receive treatment. | 25 | | (c) Any policy, contract, or certificate of health | 26 | | insurance coverage that does not distinguish between |
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| 1 | | in-network and out-of-network providers shall be subject to | 2 | | this Section as though all providers were in-network. | 3 | | (d) Services provided by telehealth pursuant to this | 4 | | Section shall be consistent with all federal and State | 5 | | privacy, security, and confidentiality laws. | 6 | | (e) Health care professionals and facilities shall | 7 | | determine the appropriateness of specific sites, technology | 8 | | platforms, and technology vendors for a telehealth service, as | 9 | | long as delivered services adhere to privacy laws, including, | 10 | | but not limited to, the Health Insurance Portability and | 11 | | Accountability Act of 1996 and the Mental Health and | 12 | | Developmental Disabilities Confidentiality Act. | 13 | | (f) (c) Nothing in this Section shall be deemed as | 14 | | precluding a health insurer from providing benefits for other | 15 | | telehealth services, including, but not limited to, remote | 16 | | monitoring services, other monitoring services, or oral | 17 | | communications otherwise covered under the policy. | 18 | | (g) There shall be no restrictions on originating site | 19 | | requirements for telehealth coverage or reimbursement to the | 20 | | distant site under this Section. | 21 | | (h) The Department may adopt rules, including emergency | 22 | | rules in accordance with the Illinois Administrative Procedure | 23 | | Act, to implement the 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 | | "Health care professional" includes , but is not limited | 5 | | to, physicians, physician assistants, optometrists, advanced | 6 | | practice registered nurses, clinical psychologists licensed in | 7 | | Illinois, prescribing psychologists licensed in Illinois, | 8 | | dentists, occupational therapists, pharmacists, physical | 9 | | therapists, clinical social workers, speech-language | 10 | | pathologists, audiologists, hearing instrument dispensers, | 11 | | licensed certified substance use disorder treatment providers | 12 | | and clinicians, and mental health professionals and clinicians | 13 | | authorized by Illinois law to provide mental health services , | 14 | | qualified providers listed under paragraph (8) of subsection | 15 | | (e) of Section 3 of the Early Intervention Services System | 16 | | Act, dietitian nutritionists licensed in Illinois, and health | 17 | | care professionals associated with a facility .
| 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 , mental health | 24 | | treatment and substance use disorder treatment and services to | 25 | | a patient, regardless of his or her location, provided by way |
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| 1 | | of an interactive telecommunications system, as defined in | 2 | | subsection (a) of Section 356z.22 of the Illinois Insurance | 3 | | Code.
| 4 | | (Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19; | 5 | | 100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff. | 6 | | 7-19-19.) | 7 | | (225 ILCS 150/10)
| 8 | | Sec. 10. Practice authority. A health care professional | 9 | | treating a patient located in this State through telehealth | 10 | | services must be licensed or authorized to practice in | 11 | | Illinois.
| 12 | | (Source: P.A. 100-317, eff. 1-1-18 .) | 13 | | (225 ILCS 150/15)
| 14 | | Sec. 15. Use of telehealth services . A health care | 15 | | professional may engage in the practice of telehealth services | 16 | | in Illinois to the extent of his or her scope of practice as | 17 | | established in his or her respective licensing Act consistent | 18 | | with the standards of care for in-person services. This Act | 19 | | shall not be construed to alter the scope of practice of any | 20 | | health care professional or authorize the delivery of health | 21 | | care services in a setting or in a manner not otherwise | 22 | | authorized by the laws of this State.
| 23 | | (Source: P.A. 100-317, eff. 1-1-18 .) |
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| 1 | | Section 20. The Illinois Public Aid Code is amended by | 2 | | changing Section 5-5.25 as follows: | 3 | | (305 ILCS 5/5-5.25) | 4 | | Sec. 5-5.25. Access to behavioral health and medical | 5 | | services. | 6 | | (a) The Department and Medicaid managed care organizations | 7 | | shall comply with the requirements under Section 356z.22 of | 8 | | the Illinois Insurance Code regardless of whether a recipient | 9 | | of medical assistance under this Article is enrolled in the | 10 | | fee for service or managed care medical assistance program. | 11 | | (b) The Department may adopt rules, including emergency | 12 | | rules, in accordance with the Illinois Administrative | 13 | | Procedure Act to implement the provisions of this Section. | 14 | | (a) The General Assembly finds that providing access to | 15 | | behavioral health and medical services in a timely manner will | 16 | | improve the quality of life for persons suffering from illness | 17 | | and will contain health care costs by avoiding the need for | 18 | | more costly inpatient hospitalization. | 19 | | (b) The Department of Healthcare and Family Services shall | 20 | | reimburse psychiatrists, federally qualified health centers as | 21 | | defined in
Section 1905(l)(2)(B) of the federal Social | 22 | | Security Act, clinical psychologists, clinical social workers, | 23 | | advanced practice registered nurses certified in psychiatric | 24 | | and mental health nursing, and mental health professionals and | 25 | | clinicians authorized by Illinois law to provide behavioral |
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| 1 | | health services to recipients via telehealth. The Department, | 2 | | by rule, shall establish: (i) criteria for such services to be | 3 | | reimbursed, including appropriate facilities and equipment to | 4 | | be used at both sites and requirements for a physician or other | 5 | | licensed health care professional to be present at the site | 6 | | where the patient is located; however, the Department shall | 7 | | not require that a physician or other licensed health care | 8 | | professional be physically present in the same room as the | 9 | | patient for the entire time during which the patient is | 10 | | receiving telehealth services; and (ii) a method to reimburse | 11 | | providers for mental health services provided by telehealth.
| 12 | | (c) The Department shall reimburse any Medicaid certified | 13 | | eligible facility or provider organization that acts as the | 14 | | location of the patient at the time a telehealth service is | 15 | | rendered, including substance abuse centers licensed by the | 16 | | Department of Human Services' Division of Alcoholism and | 17 | | Substance Abuse. | 18 | | (d) On and after July 1, 2012, the Department shall reduce | 19 | | any rate of reimbursement for services or other payments or | 20 | | alter any methodologies authorized by this Code to reduce any | 21 | | rate of reimbursement for services or other payments in | 22 | | accordance with Section 5-5e. | 23 | | (Source: P.A. 100-385, eff. 1-1-18; 100-790, eff. 8-10-18; | 24 | | 100-1019, eff. 1-1-19; 101-81, eff. 7-12-19.) | 25 | | Section 99. Effective date. This Act takes effect upon |
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| 1 | | becoming law.".
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