Temporary Telehealth Coverage Announced

March 25, 2020

On Mar. 19, Governor Pritzker issued an Executive Order, while the Department of Healthcare and Family Services (HFS) issued Emergency Rules (89 Ill. Adm. Code 140.403(e)) and a Provider Notice, all focused on temporary broadened telehealth coverage and reimbursement. The temporary coverage and reimbursement details and restrictions to help facilitate services during the public health emergency have been outlined in an IHA memo.

The Executive Order requires commercial insurers regulated by the Dept. of Insurance to cover costs of all clinically appropriate, medically necessary telehealth services rendered by in-network providers.  The Executive Order does not apply to out-of-network telehealth services. In addition to telehealth platforms stipulated in the Illinois Insurance Code (215 ILCS 5/356z.22) services may be delivered via video (e.g., FaceTime, Facebook Messenger video chat, Google Hangouts video, Skype) or telephonically (e.g., landline or cellular).

The Medicaid Emergency Rules and Provider Notice stipulate that HFS will reimburse medically necessary and clinically appropriate telehealth for patients with Medicaid fee-for service (FFS) and Managed Medicaid (HealthChoice Illinois).  Providers will be paid at the same reimbursement rate as in-person services with dates of service after March 9.