Illinois 2023-2024 Regular Session

Illinois Senate Bill SB1913 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	Public Act 103-0243
2	1		SB1913 EnrolledLRB103 29930 BMS 56345 b SB1913 Enrolled LRB103 29930 BMS 56345 b
3	2		SB1913 Enrolled LRB103 29930 BMS 56345 b
4		-	AN ACT concerning regulation.
5		-	Be it enacted by the People of the State of Illinois,
6		-	represented in the General Assembly:
7		-	Section 5. The Illinois Public Aid Code is amended by
8		-	adding Section 5-47 as follows:
9		-	(305 ILCS 5/5-47 new)
10		-	Sec. 5-47. Coverage for mental health and substance use
11		-	disorder telehealth services.
12		-	(a) As used in this Section:
13		-	"Behavioral health care professional" has the meaning
14		-	given to "health care professional" in Section 5 of the
15		-	Telehealth Act, but only with respect to professionals
16		-	licensed or certified by the Division of Mental Health or
17		-	Division of Substance Use Prevention and Recovery of the
18		-	Department of Human Services engaged in the delivery of mental
19		-	health or substance use disorder treatment or services.
20		-	"Behavioral health facility" means a community mental
21		-	health center, a behavioral health clinic, a substance use
22		-	disorder treatment program, or a facility or provider licensed
23		-	or certified by the Division of Mental Health or Division of
24		-	Substance Use Prevention and Recovery of the Department of
25		-	Human Services.
26		-	"Behavioral telehealth services" has the meaning given to
	3	+	1 AN ACT concerning regulation.
	4	+	2 Be it enacted by the People of the State of Illinois,
	5	+	3 represented in the General Assembly:
	6	+	4 Section 5. The Illinois Public Aid Code is amended by
	7	+	5 adding Section 5-47 as follows:
	8	+	6 (305 ILCS 5/5-47 new)
	9	+	7 Sec. 5-47. Coverage for mental health and substance use
	10	+	8 disorder telehealth services.
	11	+	9 (a) As used in this Section:
	12	+	10 "Behavioral health care professional" has the meaning
	13	+	11 given to "health care professional" in Section 5 of the
	14	+	12 Telehealth Act, but only with respect to professionals
	15	+	13 licensed or certified by the Division of Mental Health or
	16	+	14 Division of Substance Use Prevention and Recovery of the
	17	+	15 Department of Human Services engaged in the delivery of mental
	18	+	16 health or substance use disorder treatment or services.
	19	+	17 "Behavioral health facility" means a community mental
	20	+	18 health center, a behavioral health clinic, a substance use
	21	+	19 disorder treatment program, or a facility or provider licensed
	22	+	20 or certified by the Division of Mental Health or Division of
	23	+	21 Substance Use Prevention and Recovery of the Department of
	24	+	22 Human Services.
	25	+	23 "Behavioral telehealth services" has the meaning given to
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33		-	the term "telehealth services" in Section 5 of the Telehealth
34		-	Act, but limited solely to mental health and substance use
35		-	disorder treatment or services to a patient, regardless of
36		-	patient location.
37		-	"Distant site" has the meaning given to that term in
38		-	Section 5 of the Telehealth Act.
39		-	"Originating site" has the meaning given to that term in
40		-	Section 5 of the Telehealth Act.
41		-	(b) The Department and any managed care plans under
42		-	contract with the Department for the medical assistance
43		-	program shall provide for coverage of mental health and
44		-	substance use disorder treatment or services delivered as
45		-	behavioral telehealth services as specified in this Section.
46		-	The Department and any managed care plans under contract with
47		-	the Department for the medical assistance program may also
48		-	provide reimbursement to a behavioral health facility that
49		-	serves as the originating site at the time a behavioral
50		-	telehealth service is rendered.
51		-	(c) To ensure behavioral telehealth services are equitably
52		-	provided, coverage required under this Section shall comply
53		-	with all of the following:
54		-	(1) The Department and any managed care plans under
55		-	contract with the Department for the medical assistance
56		-	program shall not:
57		-	(A) require that in-person contact occur between a
58		-	behavioral health care professional and a patient
	32	+	SB1913 Enrolled- 2 -LRB103 29930 BMS 56345 b SB1913 Enrolled - 2 - LRB103 29930 BMS 56345 b
	33	+	SB1913 Enrolled - 2 - LRB103 29930 BMS 56345 b
	34	+	1 the term "telehealth services" in Section 5 of the Telehealth
	35	+	2 Act, but limited solely to mental health and substance use
	36	+	3 disorder treatment or services to a patient, regardless of
	37	+	4 patient location.
	38	+	5 "Distant site" has the meaning given to that term in
	39	+	6 Section 5 of the Telehealth Act.
	40	+	7 "Originating site" has the meaning given to that term in
	41	+	8 Section 5 of the Telehealth Act.
	42	+	9 (b) The Department and any managed care plans under
	43	+	10 contract with the Department for the medical assistance
	44	+	11 program shall provide for coverage of mental health and
	45	+	12 substance use disorder treatment or services delivered as
	46	+	13 behavioral telehealth services as specified in this Section.
	47	+	14 The Department and any managed care plans under contract with
	48	+	15 the Department for the medical assistance program may also
	49	+	16 provide reimbursement to a behavioral health facility that
	50	+	17 serves as the originating site at the time a behavioral
	51	+	18 telehealth service is rendered.
	52	+	19 (c) To ensure behavioral telehealth services are equitably
	53	+	20 provided, coverage required under this Section shall comply
	54	+	21 with all of the following:
	55	+	22 (1) The Department and any managed care plans under
	56	+	23 contract with the Department for the medical assistance
	57	+	24 program shall not:
	58	+	25 (A) require that in-person contact occur between a
	59	+	26 behavioral health care professional and a patient
59	60
60	61
61		-	before the provision of a behavioral telehealth
62		-	service;
63		-	(B) require patients, behavioral health care
64		-	professionals, or behavioral health facilities to
65		-	prove or document a hardship or access barrier to an
66		-	in-person consultation for coverage and reimbursement
67		-	of behavioral telehealth services;
68		-	(C) require the use of behavioral telehealth
69		-	services when the behavioral health care professional
70		-	has determined that it is not appropriate;
71		-	(D) require the use of behavioral telehealth
72		-	services when a patient chooses an in-person
73		-	consultation;
74		-	(E) require a behavioral health care professional
75		-	to be physically present in the same room as the
76		-	patient at the originating site, unless deemed
77		-	medically necessary by the behavioral health care
78		-	professional providing the behavioral telehealth
79		-	service;
80		-	(F) create geographic or facility restrictions or
81		-	requirements for behavioral telehealth services;
82		-	(G) require behavioral health care professionals
83		-	or behavioral health facilities to offer or provide
84		-	behavioral telehealth services;
85		-	(H) require patients to use behavioral telehealth
86		-	services or require patients to use a separate panel
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88	63
89		-	of behavioral health care professionals or behavioral
90		-	health facilities to receive behavioral telehealth
91		-	services; or
92		-	(I) impose upon behavioral telehealth services
93		-	utilization review requirements that are unnecessary,
94		-	duplicative, or unwarranted or impose any treatment
95		-	limitations, prior authorization, documentation, or
96		-	recordkeeping requirements that are more stringent
97		-	than the requirements applicable to the same
98		-	behavioral health care service when rendered
99		-	in-person, except that procedure code modifiers may be
100		-	required to document behavioral telehealth.
101		-	(2) Any cost sharing applicable to services provided
102		-	through behavioral telehealth shall not exceed the cost
103		-	sharing required by the medical assistance program for the
104		-	same services provided through in-person consultation.
105		-	(3) The Department and any managed care plans under
106		-	contract with the Department for the medical assistance
107		-	program shall notify behavioral health care professionals
108		-	and behavioral health facilities of any instructions
109		-	necessary to facilitate billing for behavioral telehealth
110		-	services.
111		-	(d) For purposes of reimbursement, the Department and any
112		-	managed care plans under contract with the Department for the
113		-	medical assistance program shall reimburse a behavioral health
114		-	care professional or behavioral health facility for behavioral
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117		-	telehealth services on the same basis, in the same manner, and
118		-	at the same reimbursement rate that would apply to the
119		-	services if the services had been delivered via an in-person
120		-	encounter by a behavioral health care professional or
121		-	behavioral health facility. This subsection applies only to
122		-	those services provided by behavioral telehealth that may
123		-	otherwise be billed as an in-person service.
124		-	(e) Behavioral health care professionals and behavioral
125		-	health facilities shall determine the appropriateness of
126		-	specific sites, technology platforms, and technology vendors
127		-	for a behavioral telehealth service, as long as delivered
128		-	services adhere to all federal and State privacy, security,
129		-	and confidentiality laws, rules, or regulations, including,
130		-	but not limited to, the Health Insurance Portability and
131		-	Accountability Act of 1996, 42 CFR Part 2, and the Mental
132		-	Health and Developmental Disabilities Confidentiality Act.
133		-	(f) Nothing in this Section shall be deemed as precluding
134		-	the Department and any managed care plans under contract with
135		-	the Department for the medical assistance program from
136		-	providing benefits for other telehealth services.
137		-	(g) There shall be no restrictions on originating site
138		-	requirements for behavioral telehealth coverage or
139		-	reimbursement to the distant site under this Section other
140		-	than requiring the behavioral telehealth services to be
141		-	medically necessary and clinically appropriate.
142		-	(h) Nothing in this Section shall be deemed as precluding
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	70	+	1 before the provision of a behavioral telehealth
	71	+	2 service;
	72	+	3 (B) require patients, behavioral health care
	73	+	4 professionals, or behavioral health facilities to
	74	+	5 prove or document a hardship or access barrier to an
	75	+	6 in-person consultation for coverage and reimbursement
	76	+	7 of behavioral telehealth services;
	77	+	8 (C) require the use of behavioral telehealth
	78	+	9 services when the behavioral health care professional
	79	+	10 has determined that it is not appropriate;
	80	+	11 (D) require the use of behavioral telehealth
	81	+	12 services when a patient chooses an in-person
	82	+	13 consultation;
	83	+	14 (E) require a behavioral health care professional
	84	+	15 to be physically present in the same room as the
	85	+	16 patient at the originating site, unless deemed
	86	+	17 medically necessary by the behavioral health care
	87	+	18 professional providing the behavioral telehealth
	88	+	19 service;
	89	+	20 (F) create geographic or facility restrictions or
	90	+	21 requirements for behavioral telehealth services;
	91	+	22 (G) require behavioral health care professionals
	92	+	23 or behavioral health facilities to offer or provide
	93	+	24 behavioral telehealth services;
	94	+	25 (H) require patients to use behavioral telehealth
	95	+	26 services or require patients to use a separate panel
143	96
144	97
145		-	the Department and any managed care plans under contract with
146		-	the Department for the medical assistance program from
147		-	establishing limits on the use of telehealth for a particular
148		-	behavioral health service when the limits are consistent with
149		-	generally accepted standards of mental, emotional, nervous, or
150		-	substance use disorder or condition care.
151		-	(i) The Department may adopt rules to implement the
152		-	provisions of this Section.
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	104	+	SB1913 Enrolled- 4 -LRB103 29930 BMS 56345 b SB1913 Enrolled - 4 - LRB103 29930 BMS 56345 b
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	106	+	1 of behavioral health care professionals or behavioral
	107	+	2 health facilities to receive behavioral telehealth
	108	+	3 services; or
	109	+	4 (I) impose upon behavioral telehealth services
	110	+	5 utilization review requirements that are unnecessary,
	111	+	6 duplicative, or unwarranted or impose any treatment
	112	+	7 limitations, prior authorization, documentation, or
	113	+	8 recordkeeping requirements that are more stringent
	114	+	9 than the requirements applicable to the same
	115	+	10 behavioral health care service when rendered
	116	+	11 in-person, except that procedure code modifiers may be
	117	+	12 required to document behavioral telehealth.
	118	+	13 (2) Any cost sharing applicable to services provided
	119	+	14 through behavioral telehealth shall not exceed the cost
	120	+	15 sharing required by the medical assistance program for the
	121	+	16 same services provided through in-person consultation.
	122	+	17 (3) The Department and any managed care plans under
	123	+	18 contract with the Department for the medical assistance
	124	+	19 program shall notify behavioral health care professionals
	125	+	20 and behavioral health facilities of any instructions
	126	+	21 necessary to facilitate billing for behavioral telehealth
	127	+	22 services.
	128	+	23 (d) For purposes of reimbursement, the Department and any
	129	+	24 managed care plans under contract with the Department for the
	130	+	25 medical assistance program shall reimburse a behavioral health
	131	+	26 care professional or behavioral health facility for behavioral
	132	+
	133	+
	134	+
	135	+
	136	+
	137	+	SB1913 Enrolled - 4 - LRB103 29930 BMS 56345 b
	138	+
	139	+
	140	+	SB1913 Enrolled- 5 -LRB103 29930 BMS 56345 b SB1913 Enrolled - 5 - LRB103 29930 BMS 56345 b
	141	+	SB1913 Enrolled - 5 - LRB103 29930 BMS 56345 b
	142	+	1 telehealth services on the same basis, in the same manner, and
	143	+	2 at the same reimbursement rate that would apply to the
	144	+	3 services if the services had been delivered via an in-person
	145	+	4 encounter by a behavioral health care professional or
	146	+	5 behavioral health facility. This subsection applies only to
	147	+	6 those services provided by behavioral telehealth that may
	148	+	7 otherwise be billed as an in-person service.
	149	+	8 (e) Behavioral health care professionals and behavioral
	150	+	9 health facilities shall determine the appropriateness of
	151	+	10 specific sites, technology platforms, and technology vendors
	152	+	11 for a behavioral telehealth service, as long as delivered
	153	+	12 services adhere to all federal and State privacy, security,
	154	+	13 and confidentiality laws, rules, or regulations, including,
	155	+	14 but not limited to, the Health Insurance Portability and
	156	+	15 Accountability Act of 1996, 42 CFR Part 2, and the Mental
	157	+	16 Health and Developmental Disabilities Confidentiality Act.
	158	+	17 (f) Nothing in this Section shall be deemed as precluding
	159	+	18 the Department and any managed care plans under contract with
	160	+	19 the Department for the medical assistance program from
	161	+	20 providing benefits for other telehealth services.
	162	+	21 (g) There shall be no restrictions on originating site
	163	+	22 requirements for behavioral telehealth coverage or
	164	+	23 reimbursement to the distant site under this Section other
	165	+	24 than requiring the behavioral telehealth services to be
	166	+	25 medically necessary and clinically appropriate.
	167	+	26 (h) Nothing in this Section shall be deemed as precluding
	168	+
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	170	+
	171	+
	172	+
	173	+	SB1913 Enrolled - 5 - LRB103 29930 BMS 56345 b
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	178	+	1 the Department and any managed care plans under contract with
	179	+	2 the Department for the medical assistance program from
	180	+	3 establishing limits on the use of telehealth for a particular
	181	+	4 behavioral health service when the limits are consistent with
	182	+	5 generally accepted standards of mental, emotional, nervous, or
	183	+	6 substance use disorder or condition care.
	184	+	7 (i) The Department may adopt rules to implement the
	185	+	8 provisions of this Section.
	186	+
	187	+
	188	+
	189	+
	190	+
	191	+	SB1913 Enrolled - 6 - LRB103 29930 BMS 56345 b