Illinois Medicaid Program Expands Telehealth Reimbursement to Increase Access to Behavioral Health and Other Critical Services

October 2018 ~

Illinois has passed a series of bills that meaningfully expand the reimbursement of telehealth services delivered to its Medicaid patients.

The passing of the Illinois Public Aid Code, the Illinois Telehealth Act’s, and the Illinois Insurance Code comes as a result of the collaborative efforts of state legislators, telemedicine advocates, healthcare providers and patient advocacy groups that wanted to create targeted legislative solutions to effectively meet the needs for critical behavioral health services without increasing costs for the state.

The bill package includes the following changes:

The Illinois Public Aid Code (305 ILCS 5/5-5.25) will ensure the following providers receive reimbursement from the Department of Healthcare and Family Services for delivering telehealth services that meet applicable requirements:

  • Clinical psychologists
  • Clinical social workers
  • Advanced practice registered nurses certified in psychiatric and mental health nursing
  • Mental health professionals and clinicians who are authorized by Illinois law to provide mental health services to recipients via telehealth (in addition to psychiatrists and federally qualified health centers)
  • The Department will also now be required to reimburse any Medicaid certified eligible facility or provider organization that acts as the originating site, including substance abuse centers licensed by the Department of Human Services’ Division of Alcoholism and Substance Abuse.

The Illinois Telehealth Act’s definition of a “Health care professional” (225 ILCS 150/5) has been revised to include dentists, occupational therapists, pharmacists, physical therapists, clinical social workers, speech-language pathologists, audiologists, and hearing instrument dispensers. As a result of this change, these professionals are now explicitly subject to the Illinois Telehealth Act’s requirements.

The Illinois Insurance Code (215 ILCS 5/356z.22) has been amended to require that any individual or group policy of accident or health insurance that provides coverage for telehealth services also provide coverage for telehealth services provided by licensed dietitian nutritionists and certified diabetes educators to senior diabetes patients. The amended section clearly states that this change is intended to “remove the hurdle of transportation for senior diabetes patients to receive treatment.” While this change is a step in the right direction, Illinois remains in the minority as one of the states without a telehealth coverage and/or payment parity law. The vast majority of states have parity laws that, at a minimum, include a coverage requirement, mandating certain types of payors to approve and reimburse certain telehealth encounters the same as they would in-person medical encounters.

Governor Rauner of Illinois stated that these “initiatives work together to improve the quality of care and hopefully the quality of life for so many Illinoisans suffering from mental health and substance use disorders.” Supporters of the legislation are optimistic that these changes will further expand telehealth programs in Illinois, continuing the growth experienced in the past several years.




Source(s): Illinois General Assembly; McDermott Will & Emery; Effingham Daily News; Now Decatur;