Illinois Governor Pritzker signed legislation expanding telehealth access. The law was signed and became effective July 22, 2021. Below is a summary of and major points of the law.
Public Act 102-0104
Signed into Law: July 22, 2021 – effective 7/22/21
The law amends the Illinois Insurance Code expanding coverage for Telehealth Services, e-visits, and virtual check-ins including amendments to the Early Intervention Services Act.
Applies to: Individual or Group Policies of Accident or Health Insurance
Co-payments & Deductibles: Applies the same as if patient was seen in-person.
Reimbursement: The same reimbursement rate that would apply to the services if they were delivered via an in-person visit.
Licensure Requirements: The health care professional treating a patient located in the state through telehealth services must be licensed or authorized to practice in Illinois.
Prohibitions: The insurance plans cannot:
• Require that an in-person contact occur between a health care professional before telehealth is provided;
• Require patients prove or document a hardship or access barrier to an in-person visit;
• Require the use of telehealth services, e-visits, or virtual check-ins when the healthcare professional has determined it is not appropriate;
• Require the use of telehealth services when the patient chooses an in-person service;
• Require a health care professional to be physical present in the same room as the patient at an originating site, unless medically necessary;
• Create geographic or facility restrictions or requirements for telehealth services, e-visits, or virtual check-ins;
• Require health care professionals or facilities to offer or provide telehealth services;
• Require patients to use telehealth services, or require patients to use a separate panel of health care professionals or facilities to receive telehealth services; and
• Impose utilization review requirements that are unnecessary, duplicative, impose treatment limitations, prior authorization, documentation, or record keeping that are applicable to the same health care services when rendered in-person.
Originating Site: There is no restriction on the originating site.
Definitions:
Health care professionals: includes, but not limited to:
• Physicians
• Physician Assistants
• Optometrists
• Advanced Nurse Practitioners
• 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
• Licensed Certified Substance Use Disorder Treatment Providers and Clinicians
• Mental Health Professionals and Clinicians authorized by Illinois law to provide mental health services
• Healthcare Professionals Associated with a Facility
*Individual or group policy of accident or health insurance that is amended, delivered, issued, or renewed on or after the effective date of this Act shall provide coverage for telehealth services for licensed:
• Dietitian Nutritionists; and
• Diabetic Educators.
Telehealth Services: 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. Services includes mental health treatment and substance use disorder treatment and services to a patient, regardless of the patient’s location, provided by way of an interactive telecommunication system, asynchronous store and forward system, remote patient monitoring technologies, e-visits, or virtual check-ins.
Originating Site: the location at which the patient is located at the time telehealth services are provided to the patient via telehealth.
Virtual Check-in: is a brief patient-initiated communication using a technology-based service, excluding facsimile, between an established patient and a health care professional. It does not include communications from a related office visit provided within the previous 7 days, nor communication that leads to an office visit or procedure within the next 24 hours or soonest available appointment.
Source: Illinois General Assembly, Public Act 102-0104, HB3308, Sec. 10 The Illinois Insurance Code § 356z.22
