Sen. Don Harmon
Filed: 4/15/2013
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1 | AMENDMENT TO SENATE BILL 2366
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2 | AMENDMENT NO. ______. Amend Senate Bill 2366 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The State Employees Group Insurance Act of 1971 | ||||||
5 | is amended by changing Section 6.11 as follows:
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6 | (5 ILCS 375/6.11)
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7 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
8 | Code
requirements. The program of health
benefits shall provide | ||||||
9 | the post-mastectomy care benefits required to be covered
by a | ||||||
10 | policy of accident and health insurance under Section 356t of | ||||||
11 | the Illinois
Insurance Code. The program of health benefits | ||||||
12 | shall provide the coverage
required under Sections 356g, | ||||||
13 | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | ||||||
14 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
15 | 356z.14, 356z.15, and 356z.17 , and 356z.22 and 356z.19 of the
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16 | Illinois Insurance Code.
The program of health benefits must |
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1 | comply with Sections 155.22a, 155.37, and 356z.19 of the
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2 | Illinois Insurance Code.
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3 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
4 | any, is conditioned on the rules being adopted in accordance | ||||||
5 | with all provisions of the Illinois Administrative Procedure | ||||||
6 | Act and all rules and procedures of the Joint Committee on | ||||||
7 | Administrative Rules; any purported rule not so adopted, for | ||||||
8 | whatever reason, is unauthorized. | ||||||
9 | (Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; | ||||||
10 | 96-639, eff. 1-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; | ||||||
11 | 97-343, eff. 1-1-12; 97-813, eff. 7-13-12.) | ||||||
12 | Section 10. The Counties Code is amended by changing | ||||||
13 | Section 5-1069.3 as follows: | ||||||
14 | (55 ILCS 5/5-1069.3)
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15 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
16 | including a home
rule
county, is a self-insurer for purposes of | ||||||
17 | providing health insurance coverage
for its employees, the | ||||||
18 | coverage shall include coverage for the post-mastectomy
care | ||||||
19 | benefits required to be covered by a policy of accident and | ||||||
20 | health
insurance under Section 356t and the coverage required | ||||||
21 | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | ||||||
22 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
23 | 356z.14, and 356z.15 , and 356z.22 of
the Illinois Insurance | ||||||
24 | Code. The coverage shall comply with Sections 155.22a and |
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1 | 356z.19 of
the Illinois Insurance Code. The requirement that | ||||||
2 | health benefits be covered
as provided in this Section is an
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3 | exclusive power and function of the State and is a denial and | ||||||
4 | limitation under
Article VII, Section 6, subsection (h) of the | ||||||
5 | Illinois Constitution. A home
rule county to which this Section | ||||||
6 | applies must comply with every provision of
this Section.
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7 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
8 | any, is conditioned on the rules being adopted in accordance | ||||||
9 | with all provisions of the Illinois Administrative Procedure | ||||||
10 | Act and all rules and procedures of the Joint Committee on | ||||||
11 | Administrative Rules; any purported rule not so adopted, for | ||||||
12 | whatever reason, is unauthorized. | ||||||
13 | (Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; | ||||||
14 | 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; | ||||||
15 | 97-813, eff. 7-13-12.) | ||||||
16 | Section 15. The Illinois Municipal Code is amended by | ||||||
17 | changing Section 10-4-2.3 as follows: | ||||||
18 | (65 ILCS 5/10-4-2.3)
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19 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
20 | municipality, including a
home rule municipality, is a | ||||||
21 | self-insurer for purposes of providing health
insurance | ||||||
22 | coverage for its employees, the coverage shall include coverage | ||||||
23 | for
the post-mastectomy care benefits required to be covered by | ||||||
24 | a policy of
accident and health insurance under Section 356t |
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1 | and the coverage required
under Sections 356g, 356g.5, | ||||||
2 | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
3 | 356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 , and 356z.22 of | ||||||
4 | the Illinois
Insurance
Code. The coverage shall comply with | ||||||
5 | Sections 155.22a and 356z.19 of
the Illinois Insurance Code. | ||||||
6 | The requirement that health
benefits be covered as provided in | ||||||
7 | this is an exclusive power and function of
the State and is a | ||||||
8 | denial and limitation under Article VII, Section 6,
subsection | ||||||
9 | (h) of the Illinois Constitution. A home rule municipality to | ||||||
10 | which
this Section applies must comply with every provision of | ||||||
11 | this Section.
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12 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
13 | any, is conditioned on the rules being adopted in accordance | ||||||
14 | with all provisions of the Illinois Administrative Procedure | ||||||
15 | Act and all rules and procedures of the Joint Committee on | ||||||
16 | Administrative Rules; any purported rule not so adopted, for | ||||||
17 | whatever reason, is unauthorized. | ||||||
18 | (Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; | ||||||
19 | 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; | ||||||
20 | 97-813, eff. 7-13-12.) | ||||||
21 | Section 20. The School Code is amended by changing Section | ||||||
22 | 10-22.3f as follows: | ||||||
23 | (105 ILCS 5/10-22.3f)
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24 | Sec. 10-22.3f. Required health benefits. Insurance |
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1 | protection and
benefits
for employees shall provide the | ||||||
2 | post-mastectomy care benefits required to be
covered by a | ||||||
3 | policy of accident and health insurance under Section 356t and | ||||||
4 | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
5 | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | ||||||
6 | 356z.13, 356z.14, and 356z.15 , and 356z.22 of
the
Illinois | ||||||
7 | Insurance Code.
Insurance policies shall comply with Section | ||||||
8 | 356z.19 of the Illinois Insurance Code. The coverage shall | ||||||
9 | comply with Section 155.22a of
the Illinois Insurance Code.
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10 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
11 | any, is conditioned on the rules being adopted in accordance | ||||||
12 | with all provisions of the Illinois Administrative Procedure | ||||||
13 | Act and all rules and procedures of the Joint Committee on | ||||||
14 | Administrative Rules; any purported rule not so adopted, for | ||||||
15 | whatever reason, is unauthorized. | ||||||
16 | (Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; | ||||||
17 | 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; | ||||||
18 | 97-813, eff. 7-13-12.) | ||||||
19 | Section 25. The Illinois Insurance Code is amended by | ||||||
20 | adding Section 356z.22 as follows: | ||||||
21 | (215 ILCS 5/356z.22 new) | ||||||
22 | Sec. 356z.22. Telehealth. | ||||||
23 | (a) The General Assembly finds and declares the following: | ||||||
24 | (1) Lack of primary care providers, specialty |
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1 | providers, and transportation continue to be significant | ||||||
2 | barriers to access to health services in medically | ||||||
3 | underserved rural and urban areas. | ||||||
4 | (2) Parts of Illinois have difficulty attracting and | ||||||
5 | retaining health professionals, as well as supporting | ||||||
6 | local health facilities to provide a continuum of health | ||||||
7 | care. | ||||||
8 | (3) Individuals in rural areas are much less likely to | ||||||
9 | have access to the specialty health services they need, due | ||||||
10 | to major distance and time barriers, transportation | ||||||
11 | limitations, or mobility limitations, all of which lead to | ||||||
12 | disparities in access to care. | ||||||
13 | (4) Hospital emergency rooms have become the default | ||||||
14 | provider of health care to patients with acute crises and | ||||||
15 | for whom no appropriate alternatives are available, and the | ||||||
16 | majority of emergency rooms do not have reliable, ready | ||||||
17 | consultative access to psychiatrists or other medical | ||||||
18 | specialties. | ||||||
19 | (5) Telehealth has been shown to be an effective medium | ||||||
20 | through which to deliver physical health and mental health | ||||||
21 | care. | ||||||
22 | (6) Key findings from the Illinois Rural Health | ||||||
23 | Association's Mental Health Access Forum Report recommend | ||||||
24 | the increased use of telehealth and technology to improve | ||||||
25 | access to care, increase training opportunities, and | ||||||
26 | evaluate quality of care. |
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1 | (7) The State of Illinois has already recognized, and | ||||||
2 | currently reimburses providers for, telepsychiatry | ||||||
3 | services to patients receiving State public aid. | ||||||
4 | (8) Telehealth is a mode of delivering health care | ||||||
5 | services of a personal, family, and public health nature | ||||||
6 | through utilizing information and communication | ||||||
7 | technologies to enable the examination, diagnosis, | ||||||
8 | consultation, treatment, education, care management, and | ||||||
9 | self-management of patients at a distance from health
care | ||||||
10 | providers. | ||||||
11 | (9) The use of information and telecommunication | ||||||
12 | technologies to deliver health services has the potential | ||||||
13 | to reduce costs, improve quality, change the conditions of | ||||||
14 | practice, and improve access to health care, particularly | ||||||
15 | in rural and other medically underserved areas, as well as | ||||||
16 | in emergency rooms in large urban areas where the wait for | ||||||
17 | specialty care can be lengthy. | ||||||
18 | (10) Telehealth will assist in maintaining or | ||||||
19 | improving the physical and economic health of medically | ||||||
20 | underserved communities by keeping the source of medical | ||||||
21 | care in the local area by assisting primary care | ||||||
22 | physicians, strengthening the health infrastructure, and | ||||||
23 | preserving health care-related jobs. | ||||||
24 | (11) Consumers of health care will benefit from | ||||||
25 | telehealth in many ways, including expanded access to | ||||||
26 | providers, faster and more convenient treatment, better |
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1 | continuity of care, reduction of lost work time and travel | ||||||
2 | costs, and the ability to remain with support networks. | ||||||
3 | (12) It is the intent of the General Assembly that the | ||||||
4 | fundamental health care provider-patient relationship not | ||||||
5 | only be preserved, but also be augmented and enhanced, | ||||||
6 | through the use of telehealth as a tool to be integrated | ||||||
7 | into practices. | ||||||
8 | (13)
Without the assurance of payment and the | ||||||
9 | resolution of legal and policy barriers, the full potential | ||||||
10 | of telehealth will not be realized. | ||||||
11 | The purpose of this Section is to require certain insurers, | ||||||
12 | nonprofit health service plans, managed care organizations, | ||||||
13 | and health maintenance organizations to provide coverage for | ||||||
14 | health care services delivered through telehealth in a certain | ||||||
15 | manner; prohibit certain insurers, nonprofit health service | ||||||
16 | plans, health maintenance organizations and managed care | ||||||
17 | organizations from excluding a health care service from | ||||||
18 | coverage solely because it is delivered by telehealth and not | ||||||
19 | in another manner; require certain insurers, nonprofit health | ||||||
20 | service plans, and health maintenance organizations to | ||||||
21 | reimburse health care providers for certain services under | ||||||
22 | certain circumstances; authorize the imposition of a | ||||||
23 | deductible, copayment, coinsurance amount, or annual dollar | ||||||
24 | maximum for certain services in compliance with Illinois and | ||||||
25 | federal parity laws; prohibit the imposition of a lifetime | ||||||
26 | dollar maximum for certain services; prohibit a health |
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1 | insurance policy or contract from distinguishing between | ||||||
2 | patients in rural or urban locations in providing certain | ||||||
3 | coverage; and provide for the application of this Code. | ||||||
4 | (b) For the purposes of this Section: | ||||||
5 | "Asynchronous store and forward" means the transmission of | ||||||
6 | a patient's medical information from an originating site to the | ||||||
7 | health care provider at a distant site without the presence of | ||||||
8 | the patient. | ||||||
9 | "Distant site" means the location at which the provider | ||||||
10 | rendering the service is located. | ||||||
11 | "Facility fee" means the reimbursement made to the | ||||||
12 | following originating sites for the telehealth service: | ||||||
13 | physician's office, local health departments, community mental | ||||||
14 | health centers, rural health clinics, hospitals, and substance | ||||||
15 | use disorder facilities licensed by the Department of Human | ||||||
16 | Services or the Department of Public Health. | ||||||
17 | "Health care provider" means a licensed or certified health | ||||||
18 | care professional, including, but not limited to, advanced | ||||||
19 | practice nurses, psychologists, social workers, physicians, | ||||||
20 | licensed clinical professional counselors, and mental health | ||||||
21 | professionals as defined in 59 Ill. Adm. Code 132.25 and | ||||||
22 | substance use disorder professionals as defined in 77 Ill. Adm. | ||||||
23 | Code 2060.309. | ||||||
24 | "Interactive telecommunications system" means multimedia | ||||||
25 | communications equipment that includes, at a minimum, audio and | ||||||
26 | video equipment permitting 2-way, real-time interactive |
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1 | communication between the patient and the distant site | ||||||
2 | provider. Telephones, facsimile machines, and electronic mail | ||||||
3 | systems do not meet the definition of "interactive | ||||||
4 | telecommunications system". | ||||||
5 | "Originating site" means the location at which the | ||||||
6 | participant receiving the service is located, including, but | ||||||
7 | not limited to, hospitals, rural health clinics, Federally | ||||||
8 | Qualified Health Centers, and other health care providers. | ||||||
9 | "Physician" means a physician licensed to practice | ||||||
10 | medicine in all its branches. | ||||||
11 | "Synchronous interaction" means a real-time interaction | ||||||
12 | between a patient at an originating site and a health care | ||||||
13 | provider located at a distant site. | ||||||
14 | "Telecommunication system" means an asynchronous store and | ||||||
15 | forward technology or an interactive telecommunications | ||||||
16 | system, or both, that is used to transmit data between the | ||||||
17 | originating and distant sites. | ||||||
18 | "Telehealth" means (1) the provision of services and the | ||||||
19 | mode of delivering health care services and public health via | ||||||
20 | information and communication technologies to facilitate the | ||||||
21 | examination, assessment, diagnosis, consultation, treatment, | ||||||
22 | education, care management, and self-management of a patient's | ||||||
23 | health care while the patient is at the originating site and | ||||||
24 | the health care provider is at a distant site; telehealth | ||||||
25 | facilitates patient self-management and caregiver support for | ||||||
26 | patients and includes synchronous interactions
and |
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1 | asynchronous store and forward transfers and (2) as it relates | ||||||
2 | to the delivery of health care, mental health care, substance | ||||||
3 | use disorder treatment, and public health services, the use of | ||||||
4 | interactive audio, video, or other telecommunications or | ||||||
5 | electronic technology by a health care provider to deliver a | ||||||
6 | health care service within the scope of practice of the health | ||||||
7 | care provider from the distant site to the originating site at | ||||||
8 | which the patient is located; telehealth is the provision of | ||||||
9 | services via information and communication technologies to | ||||||
10 | facilitate the assessment, diagnosis, consultation, treatment, | ||||||
11 | education, care management, and self-management of a patient's | ||||||
12 | health care while the patient is at the originating site and | ||||||
13 | the health care provider is at a distant site; telehealth | ||||||
14 | facilitates patient self-management and caregiver support for | ||||||
15 | patients and includes synchronous interactions and | ||||||
16 | asynchronous store and forward transfers.
"Telehealth" does | ||||||
17 | not include: | ||||||
18 | (A) an audio-only telephone conversation between a | ||||||
19 | health care provider and a patient; | ||||||
20 | (B) an electronic mail message between a health care | ||||||
21 | provider and a patient; or | ||||||
22 | (C) a facsimile transmission between a health care | ||||||
23 | provider and a patient. | ||||||
24 | "Teleophthalmology and teledermatology by store and | ||||||
25 | forward" means an asynchronous transmission of medical | ||||||
26 | information to be reviewed at a later time by a physician at a |
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1 | distant site who is trained in ophthalmology or dermatology or, | ||||||
2 | for teleophthalmology, by an optometrist who is licensed | ||||||
3 | pursuant to the Illinois Optometric Practice Act of 1987 where | ||||||
4 | the physician or optometrist at the distant site reviews the | ||||||
5 | medical information without the patient being present in real | ||||||
6 | time. | ||||||
7 | (c) This Section applies to: | ||||||
8 | (1) insurers and nonprofit health service plans that | ||||||
9 | provide hospital, medical, mental health, substance use | ||||||
10 | disorder, or surgical benefits to individuals or groups on | ||||||
11 | an expense-incurred basis under health insurance policies | ||||||
12 | or contracts that are issued or delivered in this State; | ||||||
13 | and | ||||||
14 | (2) health maintenance organizations that provide | ||||||
15 | hospital, medical, mental health, substance use disorder, | ||||||
16 | or surgical benefits to individuals or groups under | ||||||
17 | contracts that are issued or delivered in this State. | ||||||
18 | This Section shall not be construed to alter the scope of | ||||||
19 | practice of any health care provider or authorize the delivery | ||||||
20 | of health care services in a setting or in a manner not | ||||||
21 | otherwise authorized by law.
All laws regarding the | ||||||
22 | confidentiality of health care information and a patient's | ||||||
23 | rights to his or her medical information shall apply to | ||||||
24 | telehealth interactions. This Section applies to a group or | ||||||
25 | individual policy of accident and health insurance or managed | ||||||
26 | care plan amended, delivered, issued, or renewed after the |
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1 | effective date of this amendatory Act of the 98th General | ||||||
2 | Assembly. | ||||||
3 | (d) An entity subject to this Section: | ||||||
4 | (1) shall provide coverage under a health insurance | ||||||
5 | policy or contract for health care services appropriately | ||||||
6 | delivered through telehealth; | ||||||
7 | (2) may not exclude from coverage a health care service | ||||||
8 | solely because it is provided through telehealth and is not | ||||||
9 | provided through an in-person consultation or contact | ||||||
10 | between a health care provider and a patient; and | ||||||
11 | (3) shall not require that in-person contact occur | ||||||
12 | between a health care provider and a patient before payment | ||||||
13 | is made for the covered services appropriately provided | ||||||
14 | through telehealth. | ||||||
15 | No health care service plan shall require the health care | ||||||
16 | provider to document a barrier to an in-person visit for | ||||||
17 | coverage of services to be provided via telehealth. No health | ||||||
18 | care service plan shall limit the type of setting where | ||||||
19 | services are provided for the patient or by the health care | ||||||
20 | provider before payment is made for the covered services | ||||||
21 | appropriately provided through telehealth, subject to the | ||||||
22 | terms and conditions of the contract entered into between the | ||||||
23 | enrollee or subscriber and the health care service plan and its | ||||||
24 | participating providers or provider groups. | ||||||
25 | Notwithstanding any other provision, this Section shall | ||||||
26 | not be interpreted to authorize a health care service plan to |
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1 | require the use of telehealth when the health care provider has | ||||||
2 | determined that it is not appropriate. | ||||||
3 | (e) With regard to reimbursement, an entity subject to this | ||||||
4 | Section: | ||||||
5 | (1) shall reimburse a health care provider for the | ||||||
6 | examination, assessment, diagnosis, consultation, and | ||||||
7 | treatment of an insured patient for a health care service | ||||||
8 | covered under a health insurance policy or contract that | ||||||
9 | can appropriately be provided through telehealth; | ||||||
10 | (2) is not required to: | ||||||
11 | (A) reimburse a health care provider for a health | ||||||
12 | care service delivered in person or through telehealth | ||||||
13 | that is not a covered benefit under the health | ||||||
14 | insurance policy or contract; or | ||||||
15 | (B) reimburse a health care provider who is not a | ||||||
16 | covered provider under the health insurance policy or | ||||||
17 | contract; | ||||||
18 | (3) may impose the same deductible, copayment, or | ||||||
19 | coinsurance amount on benefits for health care services | ||||||
20 | that are delivered through an in-person consultation or | ||||||
21 | through telehealth in compliance with Illinois and federal | ||||||
22 | parity laws; and | ||||||
23 | (4) may not impose a lifetime dollar maximum or limit | ||||||
24 | the provision of mental health or substance use disorder | ||||||
25 | services in a manner that violates Illinois or federal | ||||||
26 | parity laws. |
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1 | A facility fee shall be paid to providers. Participating | ||||||
2 | providers shall be reimbursed for the appropriate current | ||||||
3 | procedural terminology (CPT) code for the telehealth service | ||||||
4 | rendered. | ||||||
5 | (f) A patient receiving services by store and forward shall | ||||||
6 | be notified of the right to receive interactive communication | ||||||
7 | with the distant specialist physician or optometrist, and shall | ||||||
8 | receive an interactive communication with the distant | ||||||
9 | specialist physician or optometrist upon request. If | ||||||
10 | requested, communication with the distant specialist physician | ||||||
11 | or optometrist may occur either at the time of the consultation | ||||||
12 | or within 30 days after the patient's notification of the | ||||||
13 | results of the consultation. If the reviewing optometrist | ||||||
14 | identifies a disease or condition requiring consultation or | ||||||
15 | referral, then that consultation or referral shall be with an | ||||||
16 | ophthalmologist or other appropriate physician and surgeon as | ||||||
17 | required. | ||||||
18 | (g) The requirements for telehealth services are as | ||||||
19 | follows: | ||||||
20 | (1) A physician or other health care provider must be | ||||||
21 | onsite and available to the patient at the originating | ||||||
22 | site, except: | ||||||
23 | (A) where the patient requests that the health care | ||||||
24 | provider not be present in the same room with the | ||||||
25 | patient, but such health care provider is otherwise | ||||||
26 | available to the patient onsite; or |
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1 | (B) where the patient and his or her treating | ||||||
2 | health care provider consent to the provision of level | ||||||
3 | one substance use disorder treatment services in | ||||||
4 | accordance with 77 Ill. Adm. Code 2060.401 without a | ||||||
5 | health care provider present onsite with the patient. | ||||||
6 | (2) The distant site provider must be a physician or | ||||||
7 | health care provider. | ||||||
8 | (3) Medical data may be exchanged through a | ||||||
9 | telecommunication system. | ||||||
10 | (4) The interactive telecommunications system must, at | ||||||
11 | a minimum, have the capability of allowing the consulting | ||||||
12 | physician to examine the patient sufficiently to allow | ||||||
13 | proper diagnosis. The system must also be capable of | ||||||
14 | transmitting clearly audible sounds as well as clear video | ||||||
15 | images. | ||||||
16 | (h) The requirements for telepsychiatry services are as | ||||||
17 | follows: | ||||||
18 | (1) A physician or other health care provider as | ||||||
19 | defined in 59 Ill. Adm. Code 132.25 must be onsite and | ||||||
20 | available to the patient at the originating site, but at | ||||||
21 | the patient's request does not need to be present in the | ||||||
22 | room with the patient. | ||||||
23 | (2) The distant site provider must be a physician or | ||||||
24 | health care provider licensed by the State of Illinois or | ||||||
25 | by the state where the patient is located and must have | ||||||
26 | completed or be registered in and supervised by a physician |
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1 | who has completed an approved general psychiatry residency | ||||||
2 | program. When treating patients age 16 and younger, the | ||||||
3 | physician must have also completed an approved child and | ||||||
4 | adolescent residency program or be registered in an | ||||||
5 | approved general psychiatry residency program or a child | ||||||
6 | and adolescent psychiatry fellowship program and | ||||||
7 | supervised by a physician who has completed an approved | ||||||
8 | child and adolescent psychiatry fellowship program. The | ||||||
9 | distant site provider must personally render the | ||||||
10 | telepsychiatry service. Telepsychiatry services must be | ||||||
11 | rendered using an interactive video telecommunications | ||||||
12 | system. | ||||||
13 | Group psychotherapy is a covered telepsychiatry service. | ||||||
14 | (i) The originating site must maintain records to document | ||||||
15 | the services provided to patients and the health care providers | ||||||
16 | involved in the services at all originating and distant site | ||||||
17 | locations.
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18 | Section 30. The Health Maintenance Organization Act is | ||||||
19 | amended by changing Section 5-3 as follows:
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20 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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21 | Sec. 5-3. Insurance Code provisions.
| ||||||
22 | (a) Health Maintenance Organizations
shall be subject to | ||||||
23 | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
| ||||||
24 | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, |
| |||||||
| |||||||
1 | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | ||||||
2 | 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, 356z.5, | ||||||
3 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
4 | 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, | ||||||
5 | 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, | ||||||
6 | 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, 408.2, 409, 412, | ||||||
7 | 444,
and
444.1,
paragraph (c) of subsection (2) of Section 367, | ||||||
8 | and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, | ||||||
9 | and XXVI of the Illinois Insurance Code.
| ||||||
10 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
11 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
12 | Maintenance Organizations in
the following categories are | ||||||
13 | deemed to be "domestic companies":
| ||||||
14 | (1) a corporation authorized under the
Dental Service | ||||||
15 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
16 | (2) a corporation organized under the laws of this | ||||||
17 | State; or
| ||||||
18 | (3) a corporation organized under the laws of another | ||||||
19 | state, 30% or more
of the enrollees of which are residents | ||||||
20 | of this State, except a
corporation subject to | ||||||
21 | substantially the same requirements in its state of
| ||||||
22 | organization as is a "domestic company" under Article VIII | ||||||
23 | 1/2 of the
Illinois Insurance Code.
| ||||||
24 | (c) In considering the merger, consolidation, or other | ||||||
25 | acquisition of
control of a Health Maintenance Organization | ||||||
26 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
|
| |||||||
| |||||||
1 | (1) the Director shall give primary consideration to | ||||||
2 | the continuation of
benefits to enrollees and the financial | ||||||
3 | conditions of the acquired Health
Maintenance Organization | ||||||
4 | after the merger, consolidation, or other
acquisition of | ||||||
5 | control takes effect;
| ||||||
6 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
7 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
8 | apply and (ii) the Director, in making
his determination | ||||||
9 | with respect to the merger, consolidation, or other
| ||||||
10 | acquisition of control, need not take into account the | ||||||
11 | effect on
competition of the merger, consolidation, or | ||||||
12 | other acquisition of control;
| ||||||
13 | (3) the Director shall have the power to require the | ||||||
14 | following
information:
| ||||||
15 | (A) certification by an independent actuary of the | ||||||
16 | adequacy
of the reserves of the Health Maintenance | ||||||
17 | Organization sought to be acquired;
| ||||||
18 | (B) pro forma financial statements reflecting the | ||||||
19 | combined balance
sheets of the acquiring company and | ||||||
20 | the Health Maintenance Organization sought
to be | ||||||
21 | acquired as of the end of the preceding year and as of | ||||||
22 | a date 90 days
prior to the acquisition, as well as pro | ||||||
23 | forma financial statements
reflecting projected | ||||||
24 | combined operation for a period of 2 years;
| ||||||
25 | (C) a pro forma business plan detailing an | ||||||
26 | acquiring party's plans with
respect to the operation |
| |||||||
| |||||||
1 | of the Health Maintenance Organization sought to
be | ||||||
2 | acquired for a period of not less than 3 years; and
| ||||||
3 | (D) such other information as the Director shall | ||||||
4 | require.
| ||||||
5 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
6 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
7 | any health maintenance
organization of greater than 10% of its
| ||||||
8 | enrollee population (including without limitation the health | ||||||
9 | maintenance
organization's right, title, and interest in and to | ||||||
10 | its health care
certificates).
| ||||||
11 | (e) In considering any management contract or service | ||||||
12 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
13 | Code, the Director (i) shall, in
addition to the criteria | ||||||
14 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
15 | into account the effect of the management contract or
service | ||||||
16 | agreement on the continuation of benefits to enrollees and the
| ||||||
17 | financial condition of the health maintenance organization to | ||||||
18 | be managed or
serviced, and (ii) need not take into account the | ||||||
19 | effect of the management
contract or service agreement on | ||||||
20 | competition.
| ||||||
21 | (f) Except for small employer groups as defined in the | ||||||
22 | Small Employer
Rating, Renewability and Portability Health | ||||||
23 | Insurance Act and except for
medicare supplement policies as | ||||||
24 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
25 | Maintenance Organization may by contract agree with a
group or | ||||||
26 | other enrollment unit to effect refunds or charge additional |
| |||||||
| |||||||
1 | premiums
under the following terms and conditions:
| ||||||
2 | (i) the amount of, and other terms and conditions with | ||||||
3 | respect to, the
refund or additional premium are set forth | ||||||
4 | in the group or enrollment unit
contract agreed in advance | ||||||
5 | of the period for which a refund is to be paid or
| ||||||
6 | additional premium is to be charged (which period shall not | ||||||
7 | be less than one
year); and
| ||||||
8 | (ii) the amount of the refund or additional premium | ||||||
9 | shall not exceed 20%
of the Health Maintenance | ||||||
10 | Organization's profitable or unprofitable experience
with | ||||||
11 | respect to the group or other enrollment unit for the | ||||||
12 | period (and, for
purposes of a refund or additional | ||||||
13 | premium, the profitable or unprofitable
experience shall | ||||||
14 | be calculated taking into account a pro rata share of the
| ||||||
15 | Health Maintenance Organization's administrative and | ||||||
16 | marketing expenses, but
shall not include any refund to be | ||||||
17 | made or additional premium to be paid
pursuant to this | ||||||
18 | subsection (f)). The Health Maintenance Organization and | ||||||
19 | the
group or enrollment unit may agree that the profitable | ||||||
20 | or unprofitable
experience may be calculated taking into | ||||||
21 | account the refund period and the
immediately preceding 2 | ||||||
22 | plan years.
| ||||||
23 | The Health Maintenance Organization shall include a | ||||||
24 | statement in the
evidence of coverage issued to each enrollee | ||||||
25 | describing the possibility of a
refund or additional premium, | ||||||
26 | and upon request of any group or enrollment unit,
provide to |
| |||||||
| |||||||
1 | the group or enrollment unit a description of the method used | ||||||
2 | to
calculate (1) the Health Maintenance Organization's | ||||||
3 | profitable experience with
respect to the group or enrollment | ||||||
4 | unit and the resulting refund to the group
or enrollment unit | ||||||
5 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
6 | experience with respect to the group or enrollment unit and the | ||||||
7 | resulting
additional premium to be paid by the group or | ||||||
8 | enrollment unit.
| ||||||
9 | In no event shall the Illinois Health Maintenance | ||||||
10 | Organization
Guaranty Association be liable to pay any | ||||||
11 | contractual obligation of an
insolvent organization to pay any | ||||||
12 | refund authorized under this Section.
| ||||||
13 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
14 | if any, is conditioned on the rules being adopted in accordance | ||||||
15 | with all provisions of the Illinois Administrative Procedure | ||||||
16 | Act and all rules and procedures of the Joint Committee on | ||||||
17 | Administrative Rules; any purported rule not so adopted, for | ||||||
18 | whatever reason, is unauthorized. | ||||||
19 | (Source: P.A. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; | ||||||
20 | 96-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; | ||||||
21 | 97-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12; | ||||||
22 | 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, eff. | ||||||
23 | 7-13-12.) | ||||||
24 | Section 35. The Limited Health Service Organization Act is | ||||||
25 | amended by changing Section 4003 as follows:
|
| |||||||
| |||||||
1 | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| ||||||
2 | Sec. 4003. Illinois Insurance Code provisions. Limited | ||||||
3 | health service
organizations shall be subject to the provisions | ||||||
4 | of Sections 133, 134, 136, 137, 139,
140, 141.1, 141.2, 141.3, | ||||||
5 | 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, | ||||||
6 | 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 356v, 356z.10, | ||||||
7 | 356z.21, 356z.22, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, | ||||||
8 | 409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII | ||||||
9 | 1/2,
XIII,
XIII 1/2, XXV, and XXVI of the Illinois Insurance | ||||||
10 | Code. For purposes of the
Illinois Insurance Code, except for | ||||||
11 | Sections 444 and 444.1 and Articles XIII
and XIII 1/2, limited | ||||||
12 | health service organizations in the following categories
are | ||||||
13 | deemed to be domestic companies:
| ||||||
14 | (1) a corporation under the laws of this State; or
| ||||||
15 | (2) a corporation organized under the laws of another | ||||||
16 | state, 30% of more
of the enrollees of which are residents | ||||||
17 | of this State, except a corporation
subject to | ||||||
18 | substantially the same requirements in its state of | ||||||
19 | organization as
is a domestic company under Article VIII | ||||||
20 | 1/2 of the Illinois Insurance Code.
| ||||||
21 | (Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff. | ||||||
22 | 1-1-13; 97-813, eff. 7-13-12.)
| ||||||
23 | Section 40. The Voluntary Health Services Plans Act is | ||||||
24 | amended by changing Section 10 as follows:
|
| |||||||
| |||||||
1 | (215 ILCS 165/10) (from Ch. 32, par. 604)
| ||||||
2 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
3 | services
plan corporations and all persons interested therein | ||||||
4 | or dealing therewith
shall be subject to the provisions of | ||||||
5 | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | ||||||
6 | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 356g, | ||||||
7 | 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 356y, | ||||||
8 | 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
| ||||||
9 | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, | ||||||
10 | 356z.19, 356z.21, 356z.22, 364.01, 367.2, 368a, 401, 401.1,
| ||||||
11 | 402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) and | ||||||
12 | (15) of Section 367 of the Illinois
Insurance Code.
| ||||||
13 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
14 | any, is conditioned on the rules being adopted in accordance | ||||||
15 | with all provisions of the Illinois Administrative Procedure | ||||||
16 | Act and all rules and procedures of the Joint Committee on | ||||||
17 | Administrative Rules; any purported rule not so adopted, for | ||||||
18 | whatever reason, is unauthorized. | ||||||
19 | (Source: P.A. 96-328, eff. 8-11-09; 96-833, eff. 6-1-10; | ||||||
20 | 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; | ||||||
21 | 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; | ||||||
22 | 97-813, eff. 7-13-12.)".
|