Bill Text: IL HB4986 | 2025-2026 | 104th General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Removes language providing that provisions concerning reimbursement for certain telehealth services are inoperative on and after January 1, 2028.

Sponsorship: Partisan Bill (Democrat 1)

Status: (Introduced - Dead) 2026-03-27 - Rule 19(a) / Re-referred to Rules Committee [HB4986 Detail]

Download: Illinois-2025-HB4986-Introduced.html

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104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026HB4986 Introduced , by Rep. Nabeela Syed SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.22
Amends the Illinois Insurance Code. Removes language providing that provisions concerning reimbursement for certain telehealth services are inoperative on and after January 1, 2028.
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A BILL FOR
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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:
"Asynchronous store and forward system" has the meaning
given to that term in Section 5 of the Telehealth Act.
"Distant site" has the meaning given to that term in
Section 5 of the Telehealth Act.
"E-visits" has the meaning given to that term in Section 5
of the Telehealth Act.
"Facility" means any hospital facility licensed under the
Hospital Licensing Act or the University of Illinois Hospital
Act, a federally qualified health center, a community mental
health center, a behavioral health clinic, a substance use
disorder treatment program licensed by the Division of
Substance Use Prevention and Recovery of the Department of
Human Services, or other building, place, or institution that
is owned or operated by a person that is licensed or otherwise
authorized to deliver health care services.

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"Health care professional" has the meaning given to that
term in Section 5 of the Telehealth Act.
"Interactive telecommunications system" has the meaning
given to that term in Section 5 of the Telehealth Act. As used
in this Section, "interactive telecommunications system" does
not include virtual check-ins.
"Originating site" has the meaning given to that term in
Section 5 of the Telehealth Act.
"Telehealth services" has the meaning given to that term
in Section 5 of the Telehealth Act. As used in this Section,
"telehealth services" do not include asynchronous store and
forward systems, remote patient monitoring technologies,
e-visits, or virtual check-ins.
"Virtual check-in" has the meaning given to that term in
Section 5 of the Telehealth Act.
(b) An individual or group policy of accident or health
insurance that is amended, delivered, issued, or renewed on or
after the effective date of this amendatory Act of the 102nd
General Assembly shall cover telehealth services, e-visits,
and virtual check-ins rendered by a health care professional
when clinically appropriate and medically necessary to
insureds, enrollees, and members in the same manner as any
other benefits covered under the policy. An individual or
group policy of accident or health insurance may provide
reimbursement to a facility that serves as the originating
site at the time a telehealth service is rendered.

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(c) To ensure telehealth service, e-visit, and virtual
check-in access is equitable for all patients in receipt of
health care services under this Section and health care
professionals and facilities are able to deliver medically
necessary services that can be appropriately delivered via
telehealth within the scope of their licensure or
certification, coverage required under this Section shall
comply with all of the following:
(1) An individual or group policy of accident or
health insurance shall not:
(A) require that in-person contact occur between a
health care professional and a patient before the
provision of a telehealth service;
(B) require patients, health care professionals,
or facilities to prove or document a hardship or
access barrier to an in-person consultation for
coverage and reimbursement of telehealth services,
e-visits, or virtual check-ins;
(C) require the use of telehealth services,
e-visits, or virtual check-ins when the health care
professional has determined that it is not
appropriate;
(D) require the use of telehealth services when a
patient chooses an in-person consultation;
(E) require a health care professional to be
physically present in the same room as the patient at

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the originating site, unless deemed medically
necessary by the health care professional providing
the telehealth service;
(F) create geographic or facility restrictions or
requirements for telehealth services, e-visits, or
virtual check-ins;
(G) require health care professionals or
facilities to offer or provide telehealth services,
e-visits, or virtual check-ins;
(H) require patients to use telehealth services,
e-visits, or virtual check-ins, or require patients to
use a separate panel of health care professionals or
facilities to receive telehealth service, e-visit, or
virtual check-in coverage and reimbursement; or
(I) impose upon telehealth services, e-visits, or
virtual check-ins utilization review requirements that
are unnecessary, duplicative, or unwarranted or 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,
except procedure code modifiers may be required to
document telehealth.
(2) Deductibles, copayments, coinsurance, or any other
cost-sharing applicable to services provided through
telehealth shall not exceed the deductibles, copayments,

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coinsurance, or any other cost-sharing required by the
individual or group policy of accident or health insurance
for the same services provided through in-person
consultation.
(3) An individual or group policy of accident or
health insurance shall notify health care professionals
and facilities of any instructions necessary to facilitate
billing for telehealth services, e-visits, and virtual
check-ins.
(d) For purposes of reimbursement, an individual or group
policy of accident or health insurance that is amended,
delivered, issued, or renewed on or after the effective date
of this amendatory Act of the 102nd General Assembly shall
reimburse an in-network health care professional or facility,
including a health care professional or facility in a tiered
network, for telehealth services provided through an
interactive telecommunications system on the same basis, in
the same manner, and at the same reimbursement rate that would
apply to the services if the services had been delivered via an
in-person encounter by an in-network or tiered network health
care professional or facility. This subsection applies only to
those services provided by telehealth that may otherwise be
billed as an in-person service. This subsection is inoperative
on and after January 1, 2028, except that this subsection is
operative after that date with respect to mental health and
substance use disorder telehealth services.

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(e) The Department and the Department of Public Health
shall commission a report to the General Assembly administered
by an established medical college in this State wherein
supervised clinical training takes place at an affiliated
institution that uses telehealth services, subject to
appropriation. The report shall study the telehealth coverage
and reimbursement policies established in subsections (b) and
(d) of this Section, to determine if the policies improve
access to care, reduce health disparities, promote health
equity, have an impact on utilization and cost-avoidance,
including direct or indirect cost savings to the patient, and
to provide any recommendations for telehealth access expansion
in the future. An individual or group policy of accident or
health insurance shall provide data necessary to carry out the
requirements of this subsection upon request of the
Department. The Department and the Department of Public Health
shall submit the report by December 31, 2026. The established
medical college may utilize subject matter expertise to
complete any necessary actuarial analysis.
(f) Nothing in this Section is intended to limit the
ability of an individual or group policy of accident or health
insurance and a health care professional or facility to
voluntarily negotiate alternate reimbursement rates for
telehealth services. Such voluntary negotiations shall take
into consideration the ongoing investment necessary to ensure
these telehealth platforms may be continuously maintained,

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seamlessly updated, and integrated with a patient's electronic
medical records.
(g) An individual or group policy of accident or health
insurance that is amended, delivered, issued, or renewed on or
after the effective date of this amendatory Act of the 102nd
General Assembly shall provide coverage for telehealth
services for licensed dietitian nutritionists and certified
diabetes educators who counsel diabetes patients in the
diabetes patients' homes to remove the hurdle of
transportation for diabetes patients to receive treatment, in
accordance with the Dietitian Nutritionist Practice Act.
(h) Any policy, contract, or certificate of health
insurance coverage that does not distinguish between
in-network and out-of-network health care professionals and
facilities shall be subject to this Section as though all
health care professionals and facilities were in-network.
(i) 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 all federal and State
privacy, security, and confidentiality laws, rules, or
regulations, including, but not limited to, the Health
Insurance Portability and Accountability Act of 1996 and the
Mental Health and Developmental Disabilities Confidentiality
Act.
(j) Nothing in this Section shall be deemed as precluding

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a health insurer from providing benefits for other telehealth
services, including, but not limited to, services not required
for coverage provided through an asynchronous store and
forward system, remote patient monitoring services, other
monitoring services, or oral communications otherwise covered
under the policy.
(k) There shall be no restrictions on originating site
requirements for telehealth coverage or reimbursement to the
distant site under this Section other than requiring the
telehealth services to be medically necessary and clinically
appropriate.
(l) The Department may adopt rules, including emergency
rules subject to the provisions of Section 5-45 of the
Illinois Administrative Procedure Act, to implement the
provisions of this Section.
(Source: P.A. 102-104, eff. 7-22-21.)