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| Public Act 103-0243
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| SB1913 Enrolled | LRB103 29930 BMS 56345 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Public Aid Code is amended by |
adding Section 5-47 as follows:
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(305 ILCS 5/5-47 new) |
Sec. 5-47. Coverage for mental health and substance use |
disorder telehealth services. |
(a) As used in this Section: |
"Behavioral health care professional" has the meaning |
given to "health care professional" in Section 5 of the |
Telehealth Act, but only with respect to professionals |
licensed or certified by the Division of Mental Health or |
Division of Substance Use Prevention and Recovery of the |
Department of Human Services engaged in the delivery of mental |
health or substance use disorder treatment or services. |
"Behavioral health facility" means a community mental |
health center, a behavioral health clinic, a substance use |
disorder treatment program, or a facility or provider licensed |
or certified by the Division of Mental Health or Division of |
Substance Use Prevention and Recovery of the Department of |
Human Services. |
"Behavioral telehealth services" has the meaning given to |
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the term "telehealth services" in Section 5 of the Telehealth |
Act, but limited solely to mental health and substance use |
disorder treatment or services to a patient, regardless of |
patient location. |
"Distant site" has the meaning given to that term in |
Section 5 of the Telehealth Act. |
"Originating site" has the meaning given to that term in |
Section 5 of the Telehealth Act. |
(b) The Department and any managed care plans under |
contract with the Department for the medical assistance |
program shall provide for coverage of mental health and |
substance use disorder treatment or services delivered as |
behavioral telehealth services as specified in this Section. |
The Department and any managed care plans under contract with |
the Department for the medical assistance program may also |
provide reimbursement to a behavioral health facility that |
serves as the originating site at the time a behavioral |
telehealth service is rendered. |
(c) To ensure behavioral telehealth services are equitably |
provided, coverage required under this Section shall comply |
with all of the following: |
(1) The Department and any managed care plans under |
contract with the Department for the medical assistance |
program shall not: |
(A) require that in-person contact occur between
a |
behavioral health care professional and a patient |
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before the provision of a behavioral telehealth |
service; |
(B) require patients, behavioral health care |
professionals,
or behavioral health facilities to |
prove or document a hardship or access barrier to an |
in-person consultation for coverage and reimbursement |
of behavioral telehealth services; |
(C) require the use of behavioral telehealth |
services when the behavioral health care professional |
has determined that it is not appropriate; |
(D) require the use of behavioral telehealth |
services when
a patient chooses an in-person |
consultation; |
(E) require a behavioral health care professional |
to be
physically present in the same room as the |
patient at the originating site, unless deemed |
medically necessary by the behavioral health care |
professional providing the behavioral telehealth |
service; |
(F) create geographic or facility restrictions or |
requirements for behavioral telehealth services; |
(G) require behavioral health care professionals |
or behavioral health facilities to offer or provide |
behavioral telehealth services; |
(H) require patients to use behavioral telehealth |
services or require patients to use a separate panel |
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of behavioral health care professionals or behavioral |
health facilities to receive behavioral telehealth |
services; or |
(I) impose upon behavioral telehealth services |
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 |
behavioral health care service when rendered |
in-person, except that procedure code modifiers may be |
required to document behavioral telehealth. |
(2) Any cost sharing applicable to services provided |
through behavioral telehealth shall not exceed the cost |
sharing required by the medical assistance program for the |
same services provided through in-person consultation. |
(3) The Department and any managed care plans under |
contract with the Department for the medical assistance |
program shall notify behavioral health care professionals |
and behavioral health facilities of any instructions |
necessary to facilitate billing for behavioral telehealth |
services. |
(d) For purposes of reimbursement, the Department and any |
managed care plans under contract with the Department for the |
medical assistance program shall reimburse a behavioral health |
care professional or behavioral health facility for behavioral |
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telehealth services 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 a behavioral health care professional or |
behavioral health facility. This subsection applies only to |
those services provided by behavioral telehealth that may |
otherwise be billed as an in-person service. |
(e) Behavioral health care professionals and behavioral |
health facilities shall determine the appropriateness of |
specific sites, technology platforms, and technology vendors |
for a behavioral 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, 42 CFR Part 2, and the Mental |
Health and Developmental Disabilities Confidentiality Act. |
(f) Nothing in this Section shall be deemed as precluding |
the Department and any managed care plans under contract with |
the Department for the medical assistance program from |
providing benefits for other telehealth services. |
(g) There shall be no restrictions on originating site |
requirements for behavioral telehealth coverage or |
reimbursement to the distant site under this Section other |
than requiring the behavioral telehealth services to be |
medically necessary and clinically appropriate. |
(h) Nothing in this Section shall be deemed as precluding |
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the Department and any managed care plans under contract with |
the Department for the medical assistance program from |
establishing limits on the use of telehealth for a particular |
behavioral health service when the limits are consistent with |
generally accepted standards of mental, emotional, nervous, or |
substance use disorder or condition care. |
(i) The Department may adopt rules to implement the |
provisions of this Section.
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