A new Illinois law, P.A. 102-0104 effective July 22, 2021, expands and modernizes the definition of telehealth services. The law also requires insurers issuing individual or group policies in the state after the effective date to cover certain types of telehealth services. (As with most state insurance regulation, self-funded employer plans would not be affected.)
Telehealth was defined in prior law as 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. The new definition of telehealth services retains this definition, but adds a specific reference to mental health treatment and substance use disorder treatment services to a patient, regardless of patient location. The definition of telehealth services also includes asynchronous store and forward systems, remote patient monitoring technologies, e-visits and virtual check-ins. An asynchronous store and forward system involves transmission of a patient's medical information through electronic communications from an originating site to a health care professional or facility at a distant site that does not include real-time interaction. Remote patient monitoring means the use of connected digital technologies or mobile medical devices to collect medical and other health data from a patient at one location and electronically transmit the data to a health care professional or facility at a different location.
The definitions of e-visit and virtual check-ins apply only to established patients (i.e., a patient with a relationship with a health care provider in which there has been an exchange of the patient's protected health information for the purpose of providing patient care, treatment or services). Interestingly, the definition of established patient does not require a prior in-person visit. The term e-visit is defined as a patient-initiated non-face-to-face communication through an online patient portal. The term virtual check-in is defined as a brief patient-initiated communication using a technology based service (excluding facsimile) between an established patient and a health care provider, but excluding communications that relate to an office visit provided within the previous seven days or that lead to an office visit or procedure within 24 hours or at the soonest available appointment.
Illinois law continues to require that health care professionals rendering telehealth services to Illinois residents be licensed in Illinois. The new law expands the definition of health care professional to include licensed certified substance use disorder treatment providers, dietician nutritionists, health care professionals associated with a facility, and qualified providers under the Early Intervention Services System Act.
The new telehealth law amends several provisions of the Insurance Code. For purposes of the Insurance Code, the definition of telehealth services excludes asynchronous store and forward systems, remote patient monitoring, e-visits and virtual check-ins. The law requires that any individual or group policy that is amended, delivered, issued or renewed after the effective date must cover telehealth services, e-visits and virtual check-ins rendered by a health care professional when clinically appropriate and medically necessary in the same manner as other benefits under the policy. Insurers may, but are not required to, cover services provided through asynchronous store and forward, remote patient monitoring and other monitoring services. Insurers must reimburse an in-network health care professional or facility 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 if the services had been delivered in an in-person encounter. (This requirement expires on January 1, 2028 except for mental health and substance use disorder services.). Insurers and health care professionals and facilities are permitted to voluntarily negotiate alternate reimbursement rates for telehealth services, provided the negotiations take into account the ongoing investment necessary to ensure telehealth platforms are maintained and integrated with a patient's electronic medical record.
Insurers may not require an in-person contact before provision of telehealth services; require use of telehealth services, e-visits or virtual check-ins when a health care professional determines it is not appropriate; require use of telehealth when the patient has chosen in-person consultation; require a health care professional to be physically present in the same room as the patient unless deemed medically necessary by the health care professional; create geographic or facility restrictions for telehealth services, e-visits or virtual check-ins; require health care professionals or facilities to offer telehealth services, e-visits or virtual check-ins; require patients to use telehealth services, e-visits or virtual check-ins or to use a separate panel of health care professionals to receive telehealth services; impose utilization review requirements that are unnecessary, duplicative or unwarranted or impose treatment limitations, prior authorization, documentation or recordkeeping requirements more stringent than the requirements applicable to in-person services (but a procedure code modifier may be required). Cost-sharing applicable to telehealth services may not exceed cost-sharing applicable to in-person services.