Bill Text: IL SB1913 | 2023-2024 | 103rd General Assembly | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services 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; and that 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. Sets forth provisions concerning coverage of mental health and substance use disorder telehealth services. Provides that the Department may adopt rules to implement the provisions.

Spectrum: Moderate Partisan Bill (Democrat 36-5)

Status: (Passed) 2023-06-30 - Public Act . . . . . . . . . 103-0243 [SB1913 Detail]

Download: Illinois-2023-SB1913-Enrolled.html

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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 Public Aid Code is amended by
adding Section 5-47 as follows:
(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.