Bill Text: IL HB3498 | 2021-2022 | 102nd General Assembly | Engrossed

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Bill Title: Amends the Illinois Insurance Code. Provides that an individual or group policy of accident or health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall cover all telehealth services rendered by a health care professional to deliver any clinically appropriate, medically necessary covered services, and shall not engage in specified activities. Provides that any policy, contract, or certificate of health insurance coverage that does not distinguish between in-network and out-of-network providers shall be subject to the Act as though all providers were in-network. Provides that health care professionals and facilities shall determine the appropriateness of specific sites, technology platforms, and technology vendors for a telehealth service, as long as delivered services adhere to privacy laws. Provides that there shall be no restrictions on originating site requirements for telehealth coverage or reimbursement to the distant site. Defines terms. Amends the Telehealth Act. Changes the term "telehealth" to "telehealth services". Amends the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services and managed care organizations shall comply with specified provisions of the Illinois Insurance Code and removes provisions concerning behavioral health and medical services via telehealth. Amends the Illinois Administrative Procedure Act to provide for emergency rulemaking. In provisions concerning coverage for telehealth services, removes language that provides that coverage and reimbursement for telehealth services delivered by health care professionals and facilities shall comply with the Telehealth Act. Removes changes to the Telehealth Act. Makes other changes. Effective immediately.

Spectrum: Slight Partisan Bill (Democrat 68-30)

Status: (Engrossed - Dead) 2021-05-29 - Rule 3-9(a) / Re-referred to Assignments [HB3498 Detail]

Download: Illinois-2021-HB3498-Engrossed.html

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AN ACT concerning health care.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Administrative Procedure Act is
amended by adding Sections 5-45.8, 5-45.9, and 5-45.10 as
follows:
(5 ILCS 100/5-45.8 new)
Sec. 5-45.8. Emergency rulemaking; Illinois Insurance
Code. To provide for the expeditious and timely implementation
of changes made to the Illinois Insurance Code by this
amendatory Act of the 102nd General Assembly, emergency rules
implementing the changes made to the Illinois Insurance Code
by this amendatory Act of the 102nd General Assembly may be
adopted in accordance with Section 5-45 by the Department of
Insurance. The adoption of emergency rules authorized by
Section 5-45 and this Section is deemed to be necessary for the
public interest, safety, and welfare.
This Section is repealed on January 1, 2026.
(5 ILCS 100/5-45.9 new)
Sec. 5-45.9. Emergency rulemaking; Telehealth Act. To
provide for the expeditious and timely implementation of
changes made to the Telehealth Act by this amendatory Act of

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the 102nd General Assembly, emergency rules implementing the
changes made to the Telehealth Act by this amendatory Act of
the 102nd General Assembly may be adopted in accordance with
Section 5-45 by the Department of Financial and Professional
Regulation. The adoption of emergency rules authorized by
Section 5-45 and this Section is deemed to be necessary for the
public interest, safety, and welfare.
This Section is repealed on January 1, 2026.
(5 ILCS 100/5-45.10 new)
Sec. 5-45.10. Emergency rulemaking; Illinois Public Aid
Code. To provide for the expeditious and timely implementation
of changes made to the Illinois Public Aid Code by this
amendatory Act of the 102nd General Assembly, emergency rules
implementing the changes made to the Illinois Public Aid Code
by this amendatory Act of the 102nd General Assembly may be
adopted in accordance with Section 5-45 by the Department of
Healthcare and Family Services. The adoption of emergency
rules authorized by Section 5-45 and this Section is deemed to
be necessary for the public interest, safety, and welfare.
This Section is repealed on January 1, 2026.
Section 10. The Illinois Insurance Code is amended by
changing Section 356z.22 as follows:
(215 ILCS 5/356z.22)

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Sec. 356z.22. Coverage for telehealth services.
(a) For purposes of this Section:
"Distant site" means the location at which the health care
provider rendering the telehealth service is located.
"Interactive telecommunications system" means an audio and
video system permitting 2-way, live interactive communication
between the patient and the distant site health care provider.
"Telehealth services" has the meaning ascribed to the term
"telehealth service" in the Telehealth Act means the delivery
of covered health care services by way of an interactive
telecommunications system.
(b) Coverage and reimbursement for telehealth services
delivered by health care professionals and facilities shall
comply with the Telehealth Act. If an individual or group
policy of accident or health insurance provides coverage for
telehealth services, then it must comply with the following:
(1) An individual or group policy of accident or
health insurance providing telehealth services may not:
(A) require that in-person contact occur between a
health care provider and a patient;
(B) require the health care provider to document a
barrier to an in-person consultation for coverage of
services to be provided through telehealth;
(C) require the use of telehealth when the health
care provider has determined that it is not
appropriate; or

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(D) require the use of telehealth when a patient
chooses an in-person consultation.
(2) Deductibles, copayments, or coinsurance applicable
to services provided through telehealth shall not exceed
the deductibles, copayments, or coinsurance required by
the individual or group policy of accident or health
insurance for the same services provided through in-person
consultation.
(b-5) If an individual or group policy of accident or
health insurance provides coverage for telehealth services, it
must provide coverage for licensed dietitian nutritionists and
certified diabetes educators who counsel senior diabetes
patients in the senior diabetes patients' homes to remove the
hurdle of transportation for senior diabetes patients to
receive treatment.
(c) Nothing in this Section shall be deemed as precluding
a health insurer from providing benefits for other services,
including, but not limited to, remote monitoring services,
other monitoring services, or oral communications otherwise
covered under the policy.
(Source: P.A. 100-1009, eff. 1-1-19.)
Section 15. The Telehealth Act is amended by changing
Sections 5, 10, and 15 and by adding Sections 20, 25, 30, and
35 as follows:

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(225 ILCS 150/5)
Sec. 5. Definitions. As used in this Act:
"Asynchronous store and forward system" means the
transmission of a patient's medical information through an
electronic communications system at an originating site to a
health care professional or facility at a distant site that
does not require real-time or synchronous interaction between
the health care professional and the patient.
"Distant site" means the location at which the health care
provider rendering the telehealth service is located.
"E-visits" means non—face-to-face communications through
an online patient portal with a health care professional.
"Facility" includes a facility that is owned or operated
by a hospital under the Hospital Licensing Act or University
of Illinois Hospital Act, a facility under the Nursing Home
Care Act, a rural health clinic, a federally qualified health
center, a local health department, a community mental health
center, a behavioral health clinic, an encounter rate clinic,
a skilled nursing facility, a substance use treatment program
licensed by the Department of Human Services' Division of
Substance Use Prevention and Recovery, a school-based health
center as defined in 77 Ill. Adm. Code 641.10, a physician's
office, a podiatrist's office, a supportive living program
providers a hospice provider, a facility under the ID/DD
Community Care Act, community-integrated living arrangements
as defined in the Community-Integrated Living Arrangements

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Licensure and Certification Act, and a provider who receives
reimbursement for a patient's room and board.
"Health care professional" includes physicians, physician
assistants, optometrists, advanced practice registered nurses,
clinical psychologists licensed in Illinois, prescribing
psychologists licensed in Illinois, dentists, occupational
therapists, pharmacists, physical therapists, clinical social
workers, speech-language pathologists, audiologists, hearing
instrument dispensers, and mental health professionals and
clinicians authorized by Illinois law to provide mental health
services. For billing and reimbursement purposes, a "health
care professional" means any individual licensed, registered,
certified, or authorized to provide health care services in
Illinois, including health care professionals billed and
reimbursed through a facility bill or claim.
"Health insurance coverage" means benefits consisting of
medical care (provided directly, through insurance or
reimbursement, or otherwise and including items and services
paid for as medical care, including, without limitation,
behavioral health care) under any hospital or medical service
policy or certificate, hospital or medical service plan
contract, health maintenance organization contract offered by
a health insurance issuer, or under the medical assistance
program authorized under the Illinois Public Aid Code.
"Health insurance issuer" means any insurance company,
insurance service, or insurance organization, including,

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without limitation, a health maintenance organization,
licensed to engage in the business of insurance in a state and
licensed in the State.
"Interactive telecommunications system" means an audio and
video system, an audio-only telephone system (landline or
cellular), or any other telecommunications system permitting
2-way, synchronous interactive communication between the
patient at an originating site and the health care
professional or facility at a distant site.
"Originating site" means the location at which the patient
is located at the time health care services are provided to the
patient via telehealth.
"Remote patient monitoring" means the use of digital
technologies to collect medical and other health data from a
patient at an originating site and electronically transmit
that data to a health care professional or facility at a
distant site.
"Telehealth services" means the evaluation, diagnosis, or
interpretation of electronically transmitted patient-specific
data between a remote location and a licensed health care
professional that generates interaction or treatment
recommendations. "Telehealth services" includes telemedicine
and the delivery of health care services, mental health
treatment, and substance use disorder treatment to a patient,
regardless of his or her location, provided by way of an
interactive telecommunications system, including telephone or

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video technology, asynchronous store and forward system,
remote patient monitoring technologies, e-visits, and virtual
check-ins as defined in subsection (a) of Section 356z.22 of
the Illinois Insurance Code.
"Virtual check-in" means a brief communication using a
technology-based service by a health care professional.
"Virtual check-in" shall not originate from a related office
visit provided within the previous 7 days, nor lead to an
office visit or procedure within the next 24 hours or soonest
available appointment.
(Source: P.A. 100-317, eff. 1-1-18; 100-644, eff. 1-1-19;
100-930, eff. 1-1-19; 101-81, eff. 7-12-19; 101-84, eff.
7-19-19.)
(225 ILCS 150/10)
Sec. 10. Practice authority. A health care professional
treating a patient located in this State through telehealth
services must be licensed or authorized to practice in
Illinois.
(Source: P.A. 100-317, eff. 1-1-18.)
(225 ILCS 150/15)
Sec. 15. Use of telehealth services. A health care
professional may engage in the practice of telehealth services
in Illinois to the extent of his or her scope of practice as
established in his or her respective licensing Act consistent

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with the standards of care for in-person services. This Act
shall not be construed to alter the scope of practice of any
health care professional or authorize the delivery of health
care services in a setting or in a manner not otherwise
authorized by the laws of this State.
(Source: P.A. 100-317, eff. 1-1-18.)
(225 ILCS 150/20 new)
Sec. 20. Applicability.
(a) This Act applies to all health insurance coverage
offered by health insurance issuers regulated by the
Department of Insurance or the Department of Healthcare and
Family Services and the medical assistance program authorized
under the Illinois Public Aid Code that is amended, delivered,
issued, or renewed on or after the effective date of this
amendatory Act of the 102nd General Assembly.
(b) Any policy, contract, or certificate of health
insurance coverage that does not distinguish between
in-network and out-of-network providers shall be subject to
this Act as though all providers were in-network.
(225 ILCS 150/25 new)
Sec. 25. Coverage for telehealth services.
(a) Health insurance issuers shall cover all telehealth
services rendered by a health care professional to deliver any
clinically appropriate, medically necessary covered services

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and treatments to insureds, enrollees, and members under each
policy, contract, or certificate of health insurance coverage
in the same manner as any other benefits covered under the
policy. Reimbursement to a health care provider for telehealth
services provided through an interactive telecommunications
system shall be made on the same basis, in the same manner, and
at the same rate as would be applied for the same services if
they had been delivered in-person. Health insurance issuers
shall include reasonable compensation to a facility that
serves as the originating site at the time a telehealth
service is rendered.
(b) To ensure telehealth service access is equitable for
all patients in receipt of health care services under this Act
and healthcare professionals and facilities are able to
deliver services within the scope of their licensure or
certification, health insurance issuers shall not:
(1) create geographic or facility restrictions or
requirements for telehealth services; procedure code
modifiers may be required to document telehealth use;
(2) require patients, health care professionals, or
facilities to prove a hardship or access barrier prior to
the approval of telehealth services for coverage or
reimbursement;
(3) negotiate different contract rates for telehealth
services and in-person services;
(4) require health care professionals or facilities to

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offer or provide telehealth services;
(5) require patients to use telehealth services or
require patients to use a separate panel of health care
professionals or facilities to receive telehealth service
coverage and reimbursement; and
(6) impose upon telehealth services utilization review
requirements that are unnecessary, duplicative, or
unwarranted, nor impose any treatment limitations, prior
authorization, documentation, or recordkeeping
requirements that are more stringent than the requirements
applicable to the same health care service when rendered
in-person.
(c) There shall be no restrictions on originating site
requirements for telehealth coverage or reimbursement to the
distant site under this Act.
(d) Services provided by telehealth pursuant to this
Section shall be consistent with all federal and State
privacy, security, and confidentiality laws.
(e) Nothing in this Section shall be deemed as precluding
a health insurer from providing benefits for other telehealth
services, including, but not limited to, other monitoring
services and oral communications otherwise covered under the
policy.
(225 ILCS 150/30 new)
Sec. 30. Permissible use of communication technologies and

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locations. Health care professionals and facilities shall
determine the appropriateness of specific sites, technology
platforms, and technology vendors for a telehealth service, as
long as delivered services adhere to privacy laws, including,
but not limited to, the Health Insurance Portability and
Accountability Act of 1996 and the Mental Health and
Developmental Disabilities Confidentiality Act.
(225 ILCS 150/35 new)
Sec. 35. Rulemaking authority. The Department of Financial
and Professional Regulation, Department of Insurance, and
Department of Healthcare and Family Services may adopt rules,
including emergency rules in accordance with the Illinois
Administrative Procedure Act, to implement the provisions of
this Act.
Section 20. The Illinois Public Aid Code is amended by
changing Section 5-5.25 as follows:
(305 ILCS 5/5-5.25)
Sec. 5-5.25. Access to behavioral health and medical
services. The Department and managed care organizations shall
comply with the Telehealth Act.
(a) The General Assembly finds that providing access to
behavioral health and medical services in a timely manner will
improve the quality of life for persons suffering from illness

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and will contain health care costs by avoiding the need for
more costly inpatient hospitalization.
(b) The Department of Healthcare and Family Services shall
reimburse psychiatrists, federally qualified health centers as
defined in Section 1905(l)(2)(B) of the federal Social
Security Act, clinical psychologists, clinical social workers,
advanced practice registered nurses certified in psychiatric
and mental health nursing, and mental health professionals and
clinicians authorized by Illinois law to provide behavioral
health services to recipients via telehealth. The Department,
by rule, shall establish: (i) criteria for such services to be
reimbursed, including appropriate facilities and equipment to
be used at both sites and requirements for a physician or other
licensed health care professional to be present at the site
where the patient is located; however, the Department shall
not require that a physician or other licensed health care
professional be physically present in the same room as the
patient for the entire time during which the patient is
receiving telehealth services; and (ii) a method to reimburse
providers for mental health services provided by telehealth.
(c) The Department shall reimburse any Medicaid certified
eligible facility or provider organization that acts as the
location of the patient at the time a telehealth service is
rendered, including substance abuse centers licensed by the
Department of Human Services' Division of Alcoholism and
Substance Abuse.

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(d) On and after July 1, 2012, the Department shall reduce
any rate of reimbursement for services or other payments or
alter any methodologies authorized by this Code to reduce any
rate of reimbursement for services or other payments in
accordance with Section 5-5e.
(Source: P.A. 100-385, eff. 1-1-18; 100-790, eff. 8-10-18;
100-1019, eff. 1-1-19; 101-81, eff. 7-12-19.)
Section 99. Effective date. This Act takes effect upon
becoming law.
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INDEX
Statutes amended in order of appearance