Bill Amendment: IL HB3498 | 2021-2022 | 102nd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: TELEHEALTH SERVICES
Status: 2021-05-29 - Rule 3-9(a) / Re-referred to Assignments [HB3498 Detail]
Download: Illinois-2021-HB3498-House_Amendment_001.html
Bill Title: TELEHEALTH SERVICES
Status: 2021-05-29 - Rule 3-9(a) / Re-referred to Assignments [HB3498 Detail]
Download: Illinois-2021-HB3498-House_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 3498
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2 | AMENDMENT NO. ______. Amend House Bill 3498 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Administrative Procedure Act is | ||||||
5 | amended by adding Sections 5-45.8 and 5-45.9 as follows:
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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1 | This Section is repealed on January 1, 2026.
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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.
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14 | Section 10. The Illinois Insurance Code is amended by | ||||||
15 | changing Section 356z.22 as follows:
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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.
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24 | (Source: P.A. 100-1009, eff. 1-1-19 .)
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25 | Section 15. The Telehealth Act is amended by changing |
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1 | Sections 5, 10, and 15 as follows:
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2 | (225 ILCS 150/5)
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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 .
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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.
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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.)
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7 | (225 ILCS 150/10)
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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.
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12 | (Source: P.A. 100-317, eff. 1-1-18 .)
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13 | (225 ILCS 150/15)
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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.
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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:
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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.
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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.)
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25 | Section 99. Effective date. This Act takes effect upon |
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1 | becoming law.".
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