Loyola University Chicago School of Law, JD 2022
The Coalition to Protect Telehealth and State Representative Deb Conroy of the Illinois 46th House District have introduced legislation that would permanently expand access to telehealth services for Illinoisans. The legislation also details provisions that promote telehealth payment rate partity between telehealth services and in-person care. In a direct response to the COVID-19 pandemic, telehealth providers have been granted temporary waivers to align their payment rates with those prescribed for traditional care in health care facilities. These waivers have served as stabilizing financial mechanisms for many practitioners experiencing revenue loss due to the restrictions on elective procedures and non-emergency care. The proposed legislation would give patients more freedom to utilize telehealth services by removing the patient responsibilities to demonstrate hardship or access issues.
Increased use of telehealth services in the past year
There has been a rapid increase in the use of telehealth technology spurred by the COVID-19 pandemic since March 2020. In direct response to the new demand for remote health care services, new regulations have been introduced on both the state and federal levels. These new telehealth policies, some temporary and some permanent, aim to provide additional guidance and flexibility for providers. Virtual health care services preserve patient safety and quality for individuals with access to these services. These services have also been proven to reduce the risk of transmission of COVID-19, conserve scarce medical supplies, and reduce overall strain on the health care workforce.
FAIR Health, an independent nonprofit organization that tracks private commercial insurance claims, recently reported that when compared to the year prior, October 2020 telehealth usage increased by 3,060 percent and accounted for 5.61 percent of all claim lines that month (an individual service or procedure listed on an insurance claim) as compared to 0.18 percent in 2019. Although this data excludes Medicare and Medicaid claims, the U.S. Department of Health and Human Services (“HHS”) has also reported a dramatic uptick in the utilization of telehealth services for primary care delivery in fee-for-service (“FFS”) Medicare beneficiaries. Similarly, almost every state Medicaid program covers some form of telehealth services and those states are all uniformly reporting dramatic increases in claims. Although many preventative care and elective procedures were delayed in the early months of the public health emergency (“PHE”), 80 percent specialists such as cardiologists, gastroenterologists, and pulmonologists have reported a heavy reliance on telehealth services compared to less than half who engaged in telemedicine technology prior to the PHE.
Despite the increase in demand for telehealth services, there have been significant barriers for individuals to access these services and for providers to remain in compliance with shifting regulations. A recent RAND Corporation study found telehealth use was highest for members in affluent and urban Americans, sounding the alarm bells for Americans living below the poverty line or in rural areas.
Telehealth payment and coverage prior to pandemic
Historically, telehealth services have been paid at a fraction of in-person care and providers have been subject to strict geographic and facility restrictions on their telemedicine practices in Illinois. As a result, both practitioners and consumers have been slow to adopt new technologies. Prior to the COVID-19 pandemic, only 22 percent of states had telehealth parity laws for commercial plans – Illinois had no such laws. For Medicaid, 21 states had coverage parity policies and 28 states had payment parity. Illinois offers some Medicaid coverage for telemedicine services, the state does not have any laws that direct the Medicaid program to treat telehealth and in-person services for similar purposes. In fact, a survery conductd by the Illinois State Medical Society found that three out of four physicians had not used telehealth before, many citing the cost and poor reimbursement rates.
Although the PHE has paved the way for a loosening of virtual healthcare regulations via temporary waivers, these expansions could disappear. If this legislation were to be enacted, patient access to telemedicine and regular contact with medical professionals without the risk of contracting the COVID-19 virus. Additionally, telehealth payment and coverage would be more closely aligned with in-person care for residents across the state.
Key details within proposed legislation and anticipated impacts
In direct response to the threat of reverting back to previous telehealth rules, House Bill 3498 drops geographic and facility restrictions on telehealth services that were previously mandated by state laws. The proposed legislation would prevent patients from having to access separate providers or professionals for telehealth appointments and would bar patient prerequisites to prove hardship or access barriers prior to engaging in telemedicine. The legislation also considers patient preference for in-person care and provides for this by establishing that a patient cannot be required to utilize telehealth services in lieu of other methods of care delivery, a provision that anticipates provider incentives to deliver virtual care in a bid to save on time and expensive resources.
Providers stand to benefit from the proposed bill as it would allow them more liberty to elect the specific sites and technology platforms that benefit their practice and patients the most. Desipite Governor J.B. Pritzker’s March 2020 Executive Order allowing out-of-state physicians and nurses to provide services in the state under a temporary license, this legislation does not extend after the PHE.
House Bill 3498 has 35 co-sponsors and has been assigned to the Health Care Availability and Accessibility Committee in the Illinois House of Representatives for review. If this bill makes it through both chambers of the Illinois Legislature, it is expected that Governor Pritzker would sign it into law, requiring health care providers and insurers to closely analyze and update their current policies and procedures to come into compliance with the new telehealth rules.