Telemedicine in Illinois: Emergency Measures Made Permanent
Telemedicine Is Here to Stay
What Physicians Need to Know About the New Law
On July 21, 2021, Governor Pritzker signed a new law (Public Act 102-0104) that expands access to telemedicine services for patients throughout Illinois. The new law makes permanent many of the emergency telemedicine rules that were authorized during COVID-19.
Illinois implemented several special rules to facilitate the use of telemedicine during the COVID-19 public health emergency, including requiring private health insurers and Medicaid managed care organizations (MCOs) to:
- Cover services provided via telemedicine
- Reimburse physicians and other healthcare professionals at the same rate as would be paid for delivering services in person
The response to these temporary changes was overwhelmingly positive. An ISMS survey of Illinois physicians found that of the 81% of physicians who reported using telemedicine, three-quarters had not done so prior to the start of the pandemic. The most common barriers to previous telemedicine use included technology requirements and payer reimbursement policies.
Illinois physicians believe telemedicine is a useful tool for caring for their patients. In an ISMS survey, nearly 75% indicated that telemedicine is especially helpful for chronic care management and delivering services to frail and elderly patients. And two-thirds indicated it was useful for handling urgent care issues, allowing physicians to more effectively “triage” patients and ensure their complaints are handled in the most appropriate care setting.
Public Act 102-0104 addresses many issues that have been barriers to expanding telemedicine access for Illinois patients. Some important highlights:
- Requires all health insurance plans regulated by the Illinois Department of Insurance to cover all clinically appropriate, medically necessary services delivered via telemedicine by in-network health professionals.
- Includes both video and audio-only (for example, cellular or landline phone) encounters, e-visits and virtual check-ins as services that must be covered when clinically appropriate.
- Requires health insurance plans regulated by the Illinois Department of Insurance to 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 the services had been delivered via an in-person encounter by the in-network professional or facility. This provision sunsets for nonbehavioral health services only in December 2027.
- Prohibits health insurers from imposing certain restrictions on the use of telemedicine, and coverage of such services.
- Allows healthcare professionals and facilities to determine the appropriateness of telemedicine services as long as services adhere to federal and state laws, rules and regulations with respect to privacy, security and confidentiality. This includes acceptable originating and distant sites, technology platforms and technology vendors.
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