﻿<?xml version="1.0" encoding="utf-8"?><Search><pages Count="5"><page Index="1"><![CDATA[



                                                                                 Center for Connected Health Policy

           Illinois


           Medicaid Program:  Illinois Medicaid

           Program Administrator:  Illinois Dept. of Healthcare and Family Services

           Regional Telehealth Resource Center:
           Upper Midwest Telehealth Resource Center
           2901 Ohio Boulevard, Ste. 110
           Terre Haute, IN 47803
           (855) 283-3734 ext. 232
           www.umtrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth
            The Medical Practice Act of 1987 defines ‘telemedicine’   “Telemedicine” is the use of a telecommunication
            as “the performance of diagnosing patients, prescribing   system to provide medical services for the purpose of
            drugs, maintaining a medical office, etc., including but   evaluation and treatment when the patient is at one
            not limited to rendering written or oral opinions   medical provider location and the rendering provider is
            concerning diagnosis or treatment of a patient in Illinois   at another location.
            by a person located outside the State of Illinois as a
            result of transmission of individual patient data by   Source: IL Admin. Code, Title 89 ,140.403 (2012).
            telephonic, electronic, or other means of communication
            from within this State.”                           “Telehealth is defined as the use of a telecommunication
                                                               system to provide medical services between places of
            Source: IL Compiled Statutes, Chapter 225, 60/49.5 (2012).   lesser and greater medical capability and/or expertise,
                                                               for the purpose of evaluation and treatment. Medical
            The Administrative Code for the Department of      data exchanged can take the form of multiple formats:
            Healthcare and Family Services defines ‘telemedicine’   text, graphics, still images, audio and video. The
            as “the use of a telecommunication system to provide   information or data exchanged can occur in real time
            medical services for the purpose of evaluation and   (synchronous) through interactive video or multimedia
            treatment when the patient is at one medical provider   collaborative environments or in near real time
            location and the rendering provider is at another   (asynchronous) through “store and forward”
            location.”                                         applications.”

            Source: IL Admin. Code, Title 89 ,140.403 (2012).   Source: IL Dept. of Healthcare and Family Svcs., Expansion of
                                                               Telehealth Services, Informational Notice, Jan. 1, 2010.
            Under the Department of Public Health, telemedicine   http://www.hfs.illinois.gov/html/011210n2.html,
            means the provision of clinical services to patients by
            physicians and practitioners from a distance via   Source: IL Dept. of Healthcare and Family Svcs., Handbook for
                                                               Practitioners. Ch. A-200 Policy and Procedures, p. 37.
            electronic communications.

            Source: IL Admin. Code, Title 77, Sec. 250.310

            (also see Medicaid column)

            Live Video Reimbursement
            Occupational therapy may be provided by telehealth as   Illinois Medicaid will reimburse for live video under the
            long as the standard of care is the same as in person   following conditions:
            care.
                                                                   •   A physician or other licensed health care
            Source: IL Statute, 225 ILCS 75/2. (Sunsets on Jan. 1, 2024).    professional must be present with the patient at all
            (see Medicaid column)                                      times with the patient at the originating site;
                                                                   •   The distant site provider must be a physician,
                                                                       physician assistant, podiatrist or advanced practice

                                                                                                                1
]]></page><page Index="2"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                       nurse who is licensed by Illinois or the state where
                                                                       the patient is located;
                                                                   •   The originating and distant site provider must not
                                                                       be terminated, suspended or barred from the
                                                                       Department’s medical programs;
                                                                   •   Medical data may be exchanged through a
                                                                       telecommunication system;
                                                                   •   The interactive telecommunication system must, at
                                                                       a minimum, have the capability of allowing the
                                                                       consulting distant site provider to examine the
                                                                       patient sufficiently to allow proper diagnosis of the
                                                                       involved body system.  The system must also be
                                                                       capable of transmitting clearly audible heart tones
                                                                       and lung sounds, as well as clear video images of
                                                                       the patient and any diagnostic tools, such as
                                                                       radiographs.

                                                               An encounter clinic serving as the distant site shall be
                                                               reimbursed as follows:

                                                                   1.  If the originating site is another encounter clinic,
                                                                       the distant site encounter clinic shall receive no
                                                                       reimbursement from the Department.  The
                                                                       originating site encounter clinic is responsible for
                                                                       reimbursement to the distant site encounter clinic;
                                                                       and
                                                                   2.  If the originating site is not an encounter clinic, the
                                                                       distant site encounter clinic shall be reimbursed for
                                                                       its medical encounter.  The originating site
                                                                       provider will receive a facility fee.

                                                               Source: IL Admin. Code Title 89, 140.403.

                                                               Eligible originating site providers include:
                                                                   •   Physicians;
                                                                   •   Podiatrists;
                                                                   •   Local health departments;
                                                                   •   Community mental health centers;
                                                                   •   Outpatient hospitals;
                                                                   •   Encounter Rate Clinics
                                                                   •   Federally Qualified Health Centers (FQHC);
                                                                   •   Rural Health Clinics (RHC)

                                                               Eligible distant site providers include:
                                                                   •   Physicians;
                                                                   •   Podiatrists;
                                                                   •   Advanced practice nurses;
                                                                   •   Encounter Rate Clinics
                                                                   •   Federally Qualified Health Centers (FQHC);
                                                                   •   Rural Health Clinics;

                                                               Source: IL Dept. of Healthcare and Family Svcs., Expansion of
                                                               Telehealth Services, Informational Notice, Jan. 1, 2010.
                                                               http://www.hfs.illinois.gov/html/011210n2.html,

                                                               Source: IL Dept. of Healthcare and Family Svcs., Handbook for
                                                               Practitioners. Ch. A-200 Policy and Procedures, p. 38.



                                                                                                                2
]]></page><page Index="3"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               Distant Site providers may not seek reimbursement for
                                                               their services when the Originating Site is an encounter
                                                               clinic. The Originating Site encounter clinic is
                                                               responsible for reimbursement to the Distant Site
                                                               provider.
                                                               Non-enrolled providers rendering services as a Distant
                                                               Site provider shall not be eligible for reimbursement from
                                                               the department, but may be reimbursed by the
                                                               Originating Site provider.
                                                               Under the department’s telehealth policy, providers will
                                                               be paid as either an Originating Site or Distant Site.
                                                               Source: IL Dept. of Healthcare and Family Svcs., Expansion of
                                                               Telehealth Services, Informational Notice, Jan. 1, 2010.
                                                               http://www.hfs.illinois.gov/html/011210n2.html,

                                                               Source: IL Dept. of Healthcare and Family Svcs. Handbook for
                                                               Practitioners. Ch. A-200 Policy and Procedures, p. 38.

                                                               Psychiatric Services

                                                               With the exception of group psychotherapy, tele-psychiatry
                                                               is covered, if all of the conditions stated above are met.

                                                               Tele-psychiatry eligible originating site providers:

                                                                   •   Physician;
                                                                   •   Other licensed healthcare professional or other
                                                                       licensed clinician;
                                                                   •   Mental health professional;
                                                                   •   Qualified mental health professional

                                                               Source: IL Dept. of Healthcare and Family Svcs., Expansion of
                                                               Telehealth Services, Informational Notice, Jan. 1, 2010.
                                                               http://www.hfs.illinois.gov/html/011210n2.html,

                                                               Source: IL Dept. of Healthcare and Family Svcs., Handbook for
                                                               Practitioners. Ch. A-200 Policy and Procedures, p. 38.
            Store and Forward Reimbursement
            (see Medicaid column)                              Illinois Medicaid will reimburse a provider at a distant site
                                                               when they “review the medical case without the patient
                                                               being present.”

                                                               Source: IL Administrative Code, Title 89 ,140.403 (2012).

                                                               The Illinois Medicaid definition encompasses store and
                                                               forward.  “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.”

                                                               Source: IL Dept. of Healthcare and Family Svcs., Expansion of
                                                               Telehealth Services, Informational Notice, Jan. 1, 2010.
                                                               http://www.hfs.illinois.gov/html/011210n2.html,

                                                               Source: IL Dept. of Healthcare and Family Svcs., Handbook for
                                                               Practitioners. Ch. A-200 Policy and Procedures, p. 38.


                                                                                                                3
]]></page><page Index="4"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Remote Patient Monitoring Reimbursement
            No reference found.                                No reference found
            Email/Phone/FAX

            (see Medicaid column)                              No reimbursement for email.
                                                               No reimbursement for telephone.
                                                               No reimbursement for FAX.


                                                               Source: IL Dept. of Healthcare and Family Services, Handbook for
                                                               Practitioners Rendering Medical Services, Chapter A-200, Policy
                                                               and Procedures for Medical Services, p. 38 (August 2010) &
                                                               Source: IL Administrative Code, Title 89 ,140.403 (2012).
            Online Prescribing

            No reference found.                                No reference found.
            Consent
            No reference found.                                No reference found.

            Location
                                                               Eligible originating site:

            (see Medicaid column)                                  •   Physician office;
                                                                   •   Podiatrist office;
                                                                   •   Local health departments;
                                                                   •   Community mental health centers;
                                                                   •   Outpatient hospitals;
                                                                   •   Rural health clinics;
                                                                   •   Encounter Rate Clinics
                                                                   •   Federally Qualified Health Centers;

                                                               Source: IL Dept. of Healthcare and Family Svcs., Expansion of
                                                               Telehealth Services, Informational Notice, Jan. 1, 2010.
                                                               http://www.hfs.illinois.gov/html/011210n2.html,

            Cross-State Licensing

            No reference found.                                For medical services, the provider rendering the service
                                                               at the distant site can be a physician, physician
                                                               assistant, podiatrist or advanced practice nurse, who is
                                                               licensed by the State of Illinois or by the state where the
                                                               patient is located.

                                                               For psychiatric services, the provider rendering the
                                                               service at the distant site must be a physician licensed
                                                               by the State of Illinois, or by the state where the patient
                                                               is located, who has completed an approved general
                                                               psychiatry residency program or a child and adolescent
                                                               psychiatry residency program.

                                                               Source: IL Handbook for Practitioners Rendering Medical
                                                               Services, Chapter A-200, Policy and Procedures for Medical
                                                               Services, p. 38 (August 2010).
            Private Payers


                                                                                                                4
]]></page><page Index="5"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Newly Passed Legislation (Eff. Jan. 1, 2015)       No reference found.
            If an insurer provides coverage for telehealth services,
            then it shall not:
               •   Require in-person contact occur between a
                   health care provider and a patient;
               •   Require the health care provider to document a
                   barrier to an in-person consultation;
               •   Require telehealth use when it is not
                   appropriate; or
               •   Require the use of telehealth when the patient
                   chooses an in-person consultation

            Source: SB 647 (2014) IL Insurance Code. Sec. 356z.22.
            Site/Transmission Fee

            No reference found.                                There is reimbursement for originating site facility fees.

                                                               Eligible facilities include:
                                                                   •   Physician’s office;
                                                                   •   Podiatrist’s office;
                                                                   •   Local health departments;
                                                                   •   Community mental health centers;
                                                                   •   Outpatient hospitals;
                                                                   •   Community Mental Health Providers

                                                               Originating site providers who receive reimbursement for
                                                               the patient’s room and board are not eligible for facility
                                                               fees.

                                                               Source: IL Handbook for Practitioners Rendering Medical
                                                               Services, Ch. A-200, Policy and Procedures for Medical Services,
                                                               p. 38 (Aug. 2010).

                                                               Source (Community mental health providers):  IL Dept. of
                                                               Healthcare and Family Svcs., Expansion of Telehealth Services,
                                                               Mar. 25, 2014.
            Miscellaneous



























                                                                                                                5
]]></page></pages></Search>