Fact Sheet

• Bars insurers from requiring patients to prove a hardship or access barrier in order to receive healthcare services through telehealth.
• Prohibits geographic or facility restrictions on telehealth services, allowing patients to be treated via telehealth in their home.
• Protects patient preference by establishing that a patient cannot be required to use telehealth services.
• Ensures patients will not be required to use a separate panel of providers or practitioners to receive telehealth services.
• Aligns telehealth practice with privacy laws for in-person practice, while giving healthcare providers the professional latitude to determine the appropriateness of specific sites and technology platforms for telehealth services.
• Aligns telehealth coverage and payment with in-person care, making appropriate patient access to care the priority and removing harmful barriers that shift costs to the patient and healthcare provider.
  • Equal coverage eliminates policy loopholes that allow insurers to create separate telehealth networks which ship tax dollars to out-of-state providers that work outside of a patient’s care team.

Amends the Illinois Insurance Code to ensure that all Medicaid MCOs and commercial insurer medical necessity determinations concerning mental health and substance use disorders are fully consistent with generally accepted standards of care.

• Establishes a clear definition and standards for when services and treatment qualify as medically necessary.
• Requires insurers to rely on the transparent, publicly available guidelines published by nonprofit clinical societies for mental health disorder medical necessity determinations, as Illinois already requires for substance use disorders.
• Requires insurers to cover all medically necessary mental health and substance use disorder care and explicitly prohibits insurers from limiting benefits to short-term, acute care or from excluding certain levels of care (e.g., residential treatment).
• Encourages compliance with Illinois’ parity law by making sure illegal practices are appropriately penalized.