Bill Text: IL HB4963 | 2019-2020 | 101st General Assembly | Introduced

---

Bill Title: Amends the Illinois Insurance Code. Requires individual or group policies of accident and health insurance that provides coverage for telehealth services to provide coverage for: telehealth services at the same rate as in-person services; reimbursement for a telehealth originating site facility fee; and telehealth services from an originating site that is a facility licensed under the Nursing Home Care Act. Amends the Medical Assistance Article of the Illinois Public Aid Code to provide that the medical assistance program is required to comply with the provisions of the Illinois Insurance Code regarding telehealth services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2020-02-18 - Referred to Rules Committee [HB4963 Detail]

Download: Illinois-2019-HB4963-Introduced.html

---

101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 HB4963 Introduced , by Rep. Daniel Didech SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.22
305 ILCS 5/5-16.8
Amends the Illinois Insurance Code. Requires individual or group policies of accident and health insurance that provides coverage for telehealth services to provide coverage for: telehealth services at the same rate as in-person services; reimbursement for a telehealth originating site facility fee; and telehealth services from an originating site that is a facility licensed under the Nursing Home Care Act. Amends the Medical Assistance Article of the Illinois Public Aid Code to provide that the medical assistance program is required to comply with the provisions of the Illinois Insurance Code regarding telehealth services.
LRB101 17110 BMS 66510 b
A BILL FOR
HB4963 LRB101 17110 BMS 66510 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 356z.22 as follows:
(215 ILCS 5/356z.22)
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. "Distant
site" includes a location outside of this State.
"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" means the delivery of covered health
care services by way of an interactive telecommunications
system.
(b) 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

HB4963 - 2 - LRB101 17110 BMS 66510 b
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
(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

HB4963 - 3 - LRB101 17110 BMS 66510 b
covered under the policy.
(d) If an individual or group policy of accident or health
insurance provides coverage for telehealth services, it must
provide coverage for telehealth services at the same rate as
in-person services.
(e) If an individual or group policy of accident or health
insurance provides coverage for telehealth services, it must
provide coverage for reimbursement for a telehealth
originating site facility fee.
(e) If an individual or group policy of accident or health
insurance provides coverage for telehealth services, it must
provide coverage for telehealth services from an originating
site that is a facility licensed under the Nursing Home Care
Act.
(Source: P.A. 100-1009, eff. 1-1-19.)
Section 10. The Illinois Public Aid Code is amended by
changing Section 5-16.8 as follows:
(305 ILCS 5/5-16.8)
Sec. 5-16.8. Required health benefits. The medical
assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.22,
356z.26, 356z.29, and 356z.32, and 356z.33, 356z.34, 356z.35,

HB4963 - 4 - LRB101 17110 BMS 66510 b
and 356z.39 of the Illinois Insurance Code and (ii) be subject
to the provisions of Sections 356z.19, 364.01, 370c, and 370c.1
of the Illinois Insurance Code.
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.
To ensure full access to the benefits set forth in this
Section, on and after January 1, 2016, the Department shall
ensure that provider and hospital reimbursement for
post-mastectomy care benefits required under this Section are
no lower than the Medicare reimbursement rate.
(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)