Part 3: How Does the New Telemedicine Law Address Equal Payment for Telemedicine and In-Person Visits?
October 8, 2021
What physicians need to know
Governor Pritzker recently signed House Bill 3308 into law, expanding access to telemedicine services for patients in Illinois. The new law makes permanent many of the emergency telemedicine rules that were authorized during COVID-19.
Physician Advocate is taking a deep dive into the various components of this important ISMS-backed legislation. This week’s installment will cover equal payment for telemedicine and in-person visits.
Before the new telemedicine law: Insurers were not required to ensure equal payment for telemedicine and in-person visits. Therefore, physicians and other healthcare professionals were not able to expand access to telemedicine services in a way that would be financially sustainable.
How the new law helps: The new law ensures equal payment for services provided via telemedicine and services provided in person.
Health insurance plans regulated by the Illinois Department of Insurance must now reimburse in-network healthcare professionals or facilities for telemedicine encounters on the same basis, in the same manner and at the same reimbursement rate that would apply to the services if they had been delivered via an in-person encounter by the in-network professional or facility. This payment parity provision in the law is permanent for behavioral health services. For non-behavioral health services, the law sunsets after Dec. 31, 2027*.
Payment parity requirements apply only to services provided by telehealth that could also be billed as an in-person service; for example, parity is not required for e-visits or virtual check-ins because the remote nature of the interaction is inherent in the service.
Please note: Health insurers and individual healthcare professionals or facilities are permitted to voluntarily negotiate their own, separate payment rates for telehealth services.
If you missed the previous installments in this series, access them below:
Part 2: Medical Visits Conducted Over the Telephone.
Part 1: How Does the New Telemedicine Law Impact Health Insurance Coverage?
For a comprehensive overview of the new telemedicine legislation, access ISMS’ new Issue Briefs:
*The new telemedicine law distinguishes between behavioral health services and non-behavioral health services. There is no end date for the requirement that insurers pay the same for behavioral health services delivered via telehealth as they would for services provided in person.
If you have questions, please contact ISMS Senior Vice President of State Legislative Affairs Erin O’Brien by email.