Illinois Telemedicine Policy, Simplified.

Healthcare legislation is complicated. Let’s clarify a few things.

We strive to keep this information updated and current. It is intended to be an informative guide, and not a comprehensive legal resource. Always consult with your local team of experts and administrators.

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Illinois Telemedicine Policy

updated October 2019

Illinois Telemedicine Policy

 

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Effective Jan. 1, 2019:

“The Department of Healthcare and Family Services must reimburse psychiatrists, federally qualified health centers, clinical psychologists, clinical social workers, advances practice registered nurses certified in psychiatric and mental health nursing and mental health professionals and clinicians to provide behavioral health services to recipients via telehealth.  The Department can establish by rule the reimbursement criteria, however the Department cannot require a professional be physically present in the same room as the patient for the entire time during which the patient is receiving telehealth services.”

Center for Connected Health Policy
https://www.cchpca.org

Check out our comprehensive guide to Illinois telemedicine policy!

Illinois still has some work to do to expand access to telehealth. While the state introduced legislation in 2016 to gain full parity for both medical and mental health telemedicine, the bills failed to pass.

One innovative feature of Illinois coverage of telehealth includes coverage for services provided by local schools and podiatrists. Hopefully the state will expand forward-thinking policies like these in the near future.

State Policy Overview

Medicaid
Private Payers
Parity

Additional state telemedicine information

  • Parity Laws

    Telemedicine parity laws require private payers to pay for telemedicine services the same way they would in-person services. Unfortunately, Illinois does not have a private payer parity law yet, so coverage by private payers isn’t mandated. However, that doesn’t mean private payers won’t cover telemedicine! Check with your insurance companies to see what their telehealth policies are for your state.

  • Medicaid

    Illinois’ Medicaid program defines telehealth as “the use of a telecommunication system to provide medical services between places of lesser and greater medical capability and/or expertise, for the purpose of evaluation and treatment. Medical data exchanged can take the form of multiple formats: text, graphics, still images, audio and video. The information or data exchanged can occur in real time (synchronous) through interactive video or multimedia collaborative environments or in near real time (asynchronous) through “store and forward” applications.”

    The program reimburses for live video, store-and-forward, and remote patient monitoring telemedicine under specific conditions. Medicaid does not reimburse for email, phone calls, or FAX. 

  • Type of Telemedicine Covered

    Illinois Medicaid covers live-video telemedicine for both medical and mental health services, as well as store-and-forward telemedicine services for dermatology. The state also covers remote patient monitoring, but only for home uterine monitoring and for elderly patients. 

  • Covered Health Services

    Under Illinois telehealth expansion bill, covered services include those provided by:

    • Physicians
    • Advanced practice nurses
    • Podiatrists
    • Federally Qualified Health Centers (FQHCs)
    • Rural Health Clinics
    • Encounter Rate Clinics
    • Telepsychiatry is also covered under the bill.

  • Eligible Healthcare Providers

    • Physicians
    • Physician Assistants
    • Podiatrists
    • Advanced practice nurses
    • Local health departments
    • Community mental health centers
    • Outpatient hospitals
    • Federally Qualified Health Centers
    • Rural Health Clinics
    • Encounter Rate Clinics
    • Mental Health professionals

  • Online Prescriptions

    Illinois does not have any specific regulations on providing online prescriptions through telemedicine.

  • Informed Patient Consent

    Illinois does not currently have any requirements for getting a patient’s informed consent prior to a telemedicine visit.

  • Cross-State Telemedicine Licensing

    Great news! Illinois has elected to join the Interstate Medical Licensure Compact. This means the application process for out-of-state providers will be easier (expedited processing, discounted licensing fee, less paperwork), but still requires providers to follow all the state’s rules and standards.

  • Restrictions on Locations

    Illinois Medicaid requires the patient to be at one of the following locations to receive telehealth services:

    • Physician office
    • Podiatrist office
    • Local health departments
    • Community mental health centers
    • Outpatient hospitals
    • Rural health clinics
    • Encounter Rate Clinics
    • Federally Qualified Health Centers

  • Reimbursement Rates

    Illinois Medicaid reimburses telemedicine services at the same rate as the comparable in-person service.

  • Billing Codes

    To bill for your telemedicine services, Illinois Medicaid requires the relevant CPT code and the GT (telemedicine) modifier.

  • Helpful Resources

Additional resources to help you get started.

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