Governor Pritzker Expands Access to Telehealth Services in Illinois

On March 19, 2020, Governor JB Pritzker issued an executive order (the Order) expanding access to telehealth services in the State of Illinois in response to his March 9, 2020 disaster proclamation arising out of the Trump Administration’s COVID-19 Emergency Declaration. Pursuant to his Order, Governor Pritzker mandated that all health insurance issuers (Insurers) regulated by the Illinois Department of Insurance cover the cost of all telehealth services – including the use of telehealth to deliver behavioral health services – rendered by in-network providers to deliver any clinically appropriate, medically necessary covered services to health plan members.

Insurers may establish reasonable requirements for telehealth services, including those with respect to documentation and recordkeeping. However, such requirements cannot be more restrictive than those required by Medicaid for the same service.

Further, Insurers may not impose unnecessary, duplicative or unwarranted utilization review requirements, or impose treatment limitations that are more stringent than those required by Medicaid. In addition, Insurers are prohibited from imposing cost-sharing requirements (e.g., copayments, deductibles and coinsurance) for telehealth services provided by in-network providers. Insurers may charge high deductible health plan members who have not met their deductibles for telehealth services, unless they are considered preventive care services. Testing, treatment and vaccination for COVID-19 all fall within the scope of preventive care.

Pursuant to the Order, telehealth services may be provided by a variety of clinicians, including physicians, physician assistants, optometrists, APNs, clinical and prescribing psychologists, dentists, occupational and physical therapists, pharmacists, clinical social workers, speech language pathologists, audiologists, hearing instrument dispensers, and other mental health and substance use disorder treatment providers who are licensed, registered, certified or authorized to practice in the State of Illinois.

The Order does not apply to excepted benefits under the Affordable Care Act (such as disability insurance, flexible spending accounts or Medicare supplemental insurance), but does apply to limited scope dental benefits, vision benefits, long-term care benefits, coverage for accidents, or coverage for only specific disease or illness.

To further facilitate the use of telehealth for behavioral health services, the Order also suspends the patient consent requirement and prohibition against disclosure of records provisions of the Illinois Mental Health and Developmental Disabilities Confidentiality Act as applied to telehealth services for the duration of the disaster proclamation. The Order also permits providers to use any non-public-facing telehealth technology to provide telehealth services to patients in need of mental health and developmental disabilities services.

For purposes of the Order, telehealth services include the provision of health care, psychiatry, mental health treatment, substance use disorder treatment and related services to a patient, regardless of location, through electronic or telephonic methods, such as telephone (landline or cellular); video technology commonly available on smart phones and other devices such as FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype; and videoconferencing, as well as any method within the meaning of telehealth services under the Illinois Insurance Code.

On the same day, Governor Prizker requested an 1135 Waiver from the federal Centers for Medicare and Medicaid Services to permit Illinois’ Medicaid program to further expand access to telehealth services.

Please note, the Order does not suspend or otherwise supersede conflicting federal law. Thus, for example, while the Order permits the use of a standard telephone to provide telehealth services, Medicare will cover such services only if provided using a smart phone with real-time video capabilities. 

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