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HB4986 - 104th General Assembly

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4986

Introduced , by Rep. Nabeela Syed

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.22

Amends the Illinois Insurance Code. Removes language providing that
provisions concerning reimbursement for certain telehealth services are
inoperative on and after January 1, 2028.
LRB104 15321 BAB 28475 b

A BILL FOR

HB4986
LRB104 15321 BAB 28475 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Illinois Insurance Code is amended by
5
changing Section 356z.22 as follows:

6

(215 ILCS 5/356z.22)
7

Sec. 356z.22.
Coverage for telehealth services.
8

(a) For purposes of this Section:
9

"Asynchronous store and forward system" has the meaning
10
given to that term in Section 5 of the Telehealth Act.
11

"Distant site" has the meaning given to that term in
12
Section 5 of the Telehealth Act.
13

"E-visits" has the meaning given to that term in Section 5
14
of the Telehealth Act.
15

"Facility" means any hospital facility licensed under the
16
Hospital Licensing Act or the University of Illinois Hospital
17
Act, a federally qualified health center, a community mental
18
health center, a behavioral health clinic, a substance use
19
disorder treatment program licensed by the Division of
20
Substance Use Prevention and Recovery of the Department of
21
Human Services, or other building, place, or institution that
22
is owned or operated by a person that is licensed or otherwise
23
authorized to deliver health care services.

HB4986
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LRB104 15321 BAB 28475 b
1

"Health care professional" has the meaning given to that
2
term in Section 5 of the Telehealth Act.
3

"Interactive telecommunications system" has the meaning
4
given to that term in Section 5 of the Telehealth Act. As used
5
in this Section, "interactive telecommunications system" does
6
not include virtual check-ins.
7

"Originating site" has the meaning given to that term in
8
Section 5 of the Telehealth Act.
9

"Telehealth services" has the meaning given to that term
10
in Section 5 of the Telehealth Act. As used in this Section,
11
"telehealth services" do not include asynchronous store and
12
forward systems, remote patient monitoring technologies,
13
e-visits, or virtual check-ins.
14

"Virtual check-in" has the meaning given to that term in
15
Section 5 of the Telehealth Act.
16

(b) An individual or group policy of accident or health
17
insurance that is amended, delivered, issued, or renewed on or
18
after the effective date of this amendatory Act of the 102nd
19
General Assembly shall cover telehealth services, e-visits,
20
and virtual check-ins rendered by a health care professional
21
when clinically appropriate and medically necessary to
22
insureds, enrollees, and members in the same manner as any
23
other benefits covered under the policy. An individual or
24
group policy of accident or health insurance may provide
25
reimbursement to a facility that serves as the originating
26
site at the time a telehealth service is rendered.

HB4986
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LRB104 15321 BAB 28475 b
1

(c) To ensure telehealth service, e-visit, and virtual
2
check-in access is equitable for all patients in receipt of
3
health care services under this Section and health care
4
professionals and facilities are able to deliver medically
5
necessary services that can be appropriately delivered via
6
telehealth within the scope of their licensure or
7
certification, coverage required under this Section shall
8
comply with all of the following:
9

(1) An individual or group policy of accident or
10

health insurance shall not:
11

(A) require that in-person contact occur between a
12

health care professional and a patient before the
13

provision of a telehealth service;
14

(B) require patients, health care professionals,
15

or facilities to prove or document a hardship or
16

access barrier to an in-person consultation for
17

coverage and reimbursement of telehealth services,
18

e-visits, or virtual check-ins;
19

(C) require the use of telehealth services,
20

e-visits, or virtual check-ins when the health care
21

professional has determined that it is not
22

appropriate;
23

(D) require the use of telehealth services when a
24

patient chooses an in-person consultation;
25

(E) require a health care professional to be
26

physically present in the same room as the patient at

HB4986
- 4 -
LRB104 15321 BAB 28475 b
1

the originating site, unless deemed medically
2

necessary by the health care professional providing
3

the telehealth service;
4

(F) create geographic or facility restrictions or
5

requirements for telehealth services, e-visits, or
6

virtual check-ins;
7

(G) require health care professionals or
8

facilities to offer or provide telehealth services,
9

e-visits, or virtual check-ins;
10

(H) require patients to use telehealth services,
11

e-visits, or virtual check-ins, or require patients to
12

use a separate panel of health care professionals or
13

facilities to receive telehealth service, e-visit, or
14

virtual check-in coverage and reimbursement; or
15

(I) impose upon telehealth services, e-visits, or
16

virtual check-ins utilization review requirements that
17

are unnecessary, duplicative, or unwarranted or impose
18

any treatment limitations, prior authorization,
19

documentation, or recordkeeping requirements that are
20

more stringent than the requirements applicable to the
21

same health care service when rendered in-person,
22

except procedure code modifiers may be required to
23

document telehealth.
24

(2) Deductibles, copayments, coinsurance, or any other
25

cost-sharing applicable to services provided through
26

telehealth shall not exceed the deductibles, copayments,

HB4986
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LRB104 15321 BAB 28475 b
1

coinsurance, or any other cost-sharing required by the
2

individual or group policy of accident or health insurance
3

for the same services provided through in-person
4

consultation.
5

(3) An individual or group policy of accident or
6

health insurance shall notify health care professionals
7

and facilities of any instructions necessary to facilitate
8

billing for telehealth services, e-visits, and virtual
9

check-ins.
10

(d) For purposes of reimbursement, an individual or group
11
policy of accident or health insurance that is amended,
12
delivered, issued, or renewed on or after the effective date
13
of this amendatory Act of the 102nd General Assembly shall
14
reimburse an in-network health care professional or facility,
15
including a health care professional or facility in a tiered
16
network, for telehealth services provided through an
17
interactive telecommunications system on the same basis, in
18
the same manner, and at the same reimbursement rate that would
19
apply to the services if the services had been delivered via an
20
in-person encounter by an in-network or tiered network health
21
care professional or facility. This subsection applies only to
22
those services provided by telehealth that may otherwise be
23
billed as an in-person service.
This subsection is inoperative
24
on and after January 1, 2028, except that this subsection is
25
operative after that date with respect to mental health and
26
substance use disorder telehealth services.

HB4986
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LRB104 15321 BAB 28475 b
1

(e) The Department and the Department of Public Health
2
shall commission a report to the General Assembly administered
3
by an established medical college in this State wherein
4
supervised clinical training takes place at an affiliated
5
institution that uses telehealth services, subject to
6
appropriation. The report shall study the telehealth coverage
7
and reimbursement policies established in subsections (b) and
8
(d) of this Section, to determine if the policies improve
9
access to care, reduce health disparities, promote health
10
equity, have an impact on utilization and cost-avoidance,
11
including direct or indirect cost savings to the patient, and
12
to provide any recommendations for telehealth access expansion
13
in the future. An individual or group policy of accident or
14
health insurance shall provide data necessary to carry out the
15
requirements of this subsection upon request of the
16
Department. The Department and the Department of Public Health
17
shall submit the report by December 31, 2026. The established
18
medical college may utilize subject matter expertise to
19
complete any necessary actuarial analysis.
20

(f) Nothing in this Section is intended to limit the
21
ability of an individual or group policy of accident or health
22
insurance and a health care professional or facility to
23
voluntarily negotiate alternate reimbursement rates for
24
telehealth services. Such voluntary negotiations shall take
25
into consideration the ongoing investment necessary to ensure
26
these telehealth platforms may be continuously maintained,

HB4986
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LRB104 15321 BAB 28475 b
1
seamlessly updated, and integrated with a patient's electronic
2
medical records.
3

(g) An individual or group policy of accident or health
4
insurance that is amended, delivered, issued, or renewed on or
5
after the effective date of this amendatory Act of the 102nd
6
General Assembly shall provide coverage for telehealth
7
services for licensed dietitian nutritionists and certified
8
diabetes educators who counsel diabetes patients in the
9
diabetes patients' homes to remove the hurdle of
10
transportation for diabetes patients to receive treatment, in
11
accordance with the Dietitian Nutritionist Practice Act.
12

(h) Any policy, contract, or certificate of health
13
insurance coverage that does not distinguish between
14
in-network and out-of-network health care professionals and
15
facilities shall be subject to this Section as though all
16
health care professionals and facilities were in-network.
17

(i) Health care professionals and facilities shall
18
determine the appropriateness of specific sites, technology
19
platforms, and technology vendors for a telehealth service, as
20
long as delivered services adhere to all federal and State
21
privacy, security, and confidentiality laws, rules, or
22
regulations, including, but not limited to, the Health
23
Insurance Portability and Accountability Act of 1996 and the
24
Mental Health and Developmental Disabilities Confidentiality
25
Act.
26

(j) Nothing in this Section shall be deemed as precluding

HB4986
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LRB104 15321 BAB 28475 b
1
a health insurer from providing benefits for other telehealth
2
services, including, but not limited to, services not required
3
for coverage provided through an asynchronous store and
4
forward system, remote patient monitoring services, other
5
monitoring services, or oral communications otherwise covered
6
under the policy.
7

(k) There shall be no restrictions on originating site
8
requirements for telehealth coverage or reimbursement to the
9
distant site under this Section other than requiring the
10
telehealth services to be medically necessary and clinically
11
appropriate.
12

(l) The Department may adopt rules, including emergency
13
rules subject to the provisions of Section 5-45 of the
14
Illinois Administrative Procedure Act, to implement the
15
provisions of this Section.
16
(Source: P.A. 102-104, eff. 7-22-21.)

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