You won’t find much about telemedicine in the Illinois Statutes. The Telehealth Act boils down to a broad definition of the term and a list of providers that can practice telehealth. Another section of the Statutes provides guidance on insurance coverage, and that’s about it.

Illinois Medicaid offers much more detailed guidelines on who can practice telehealth and telemedicine and in what way in order to get reimbursement from this program. 

It’s not difficult to start practicing telehealth in Illinois. If you have a state-issued medical license, setting up your online clinic while observing the law shouldn’t be hard. This does not mean that there isn’t room for improvement. Illinois still doesn’t have a parity law, which means insurers are not obliged to reimburse for telemedicine services.

In this article, we will provide all the information you need to start practicing telehealth in Illinois and stay within the law.

How Illinois defines telehealth and telemedicine

We’ll review the definitions of telehealth and telemedicine found in two places:

1. The statutory law of Illinois
2. The Illinois Administrative Code

The Illinois Statutes

The Illinois Compiled Statutes contain the Telehealth Act, a document that outlines how the state views remote healthcare. Illinois defines telehealth as any interaction between a licensed healthcare professional and a “remote location” that involves diagnosis, evaluation, treatment recommendations, and interpretation of electronically transmitted patient data.

Telemedicine is defined as the delivery of healthcare services through an interactive system for telecommunication. The Illinois Insurance Code clarifies further what these systems are any interactive, two-way video or audio communication channels.

The Illinois Administrative Code

The Illinois Administrative Code (IAC) compiles administrative rules of state agencies. The Code provides definitions relevant to the telehealth services providers covered by the Department of Healthcare and Human Services’ (HHS) medical programs. This means that if you’re hoping to get reimbursed by Medicaid, your telehealth services need to fall within the scope of the definitions provided by the Code.

According to IAC, telehealth entails services provided through a telecommunication system. The document does not specify which services, leaving the definition incomplete.

Telemedicine is defined as the use of any system, synchronous or asynchronous, for the evaluation and treatment of a patient who is at one medical provider location by a provider who is at another one. This means that the patient must be at a hospital, clinic, or another medical facility at the time of the telemedicine encounter.

IAC also includes the term “telepsychiatry,” which means providing psychiatric services remotely under the same conditions that apply to telemedicine. Remote psychiatric care is allowed but only for inpatient care.

You can still treat patients remotely even if they aren’t in a medical facility—it is not forbidden by law—but HHS’ medical payer programs won’t reimburse you for your efforts. We will discuss HHS’ telehealth rules and regulations for Medicaid in great detail later in the article.

Who can practice telemedicine according to Illinois telemedicine law?

A healthcare professional who wants to treat patients in Illinois needs to be licensed or otherwise authorized to practice in the state. The Act doesn’t delve deeper into explaining how out-of-state providers can get the authorization to practice telehealth in Illinois. 

The law mandates that medical professionals need to adhere to the standards of practice for in-person care. They mustn’t provide services outside of their scope of practice. The bottom line is—healthcare providers must act in accordance with their medical licensing as they would during in-person appointments.

The list of professionals that can practice telehealth in Illinois is extensive, and it includes:

• Physicians
• Physician assistants
• Optometrists
• Dentists
• Advanced practice registered nurses
• Clinical psychologists licensed in Illinois
• Occupational therapists
• Prescribing psychologists licensed in Illinois
• Pharmacists
• Clinical social workers
• Physical therapists
• Speech-language pathologists
• Audiologists
• Hearing instrument dispensers
• Mental health professionals and clinicians authorized by Illinois law to provide mental health services

Cross-state licensing for telehealth in Illinois

Telehealth practice in the state is not limited to Illinois-based providers. The great news for out-of-state practitioners who wish to provide telehealth services in Illinois is that the state is a member of two interstate medical alliances:

1. Interstate Medical Licensure Compact
2. Psychology Interjurisdictional Compact

The state’s membership with these two compacts makes it easier for both physical and mental health professionals to obtain the authorization to practice telemedicine in Illinois.

The providers holding one of the two interstate licenses must abide by the same rules and regulations as Illinois-based practitioners when providing telehealth services to Illinoisians.

Online prescription requirements

Illinois law doesn’t provide any regulation on issuing online prescriptions through telemedicine. Whether or not you should prescribe medication online to your patients is up to your interpretation. This doesn’t mean you should take the lack of regulation as a green light to administer any drug to anyone. The Telehealth Act still obliges you to uphold the standards for in-person patient care.

With some conditions, it’s better to see a patient before you prescribe them medication. You should be especially careful regarding controlled substances.

Obtaining patient consent

The law doesn’t say anything about patient consent. As you are not legally obligated to obtain it, you can start a telemedicine session without worrying about it.

Even though Illinois law doesn’t mandate getting informed consent, it is still advisable to do so. On the federal level, the Health Insurance Portability and Accountability Act (HIPAA) obliges you to keep your patient data private and secure. 

Telemedicine platforms often come with the risk of data breaches, and it would be reasonable to inform your patients about this issue. This is also why choosing the right platform for online patient care is essential. Instead of going for a consumer app that comes with many risks, you should opt for a healthcare-specific, 100% HIPAA compliant one, such as Curogram. Our platform has all the technical safeguards in place to ensure all protected health information (PHI) you exchange with your patients is safe.

Who covers telehealth services in Illinois?

There’s always a back-and-forth between insurers and states regarding telehealth services coverage. The former often argue that they should determine the reimbursement rates for telehealth, whereas the state lawmakers try to impose parity, which would oblige them to pay the same rates as they would for the corresponding in-person services.

When it comes to reimbursement for telehealth services in Illinois, there are two coverage options:

1. Private payers
2. Medicaid

Private payer laws

Private payer laws are covered by Section 356z.22 of the Illinois Insurance Code. Illinois is yet to get a coverage parity law, which means private insurance companies don’t have to cover telehealth services at all. If they do decide to reimburse for remote patient care, there’s no payment parity law either that would force them to do so at the same rate as for the corresponding in-person services.

Even though the state doesn’t impose parity, that doesn’t mean that no private payer will cover telemedicine services. Insurers are beginning to realize the potential of telehealth, and many are willing to cover it.

If a private payer chooses to cover telehealth services, they need to fulfill several requirements. These requirements hold true only for telehealth as defined in the Illinois Insurance Code. According to the Code, only those services provided via live, two-way audio or video communication are considered telehealth services. 

A private insurance company that covers telehealth as defined in the Illinois Insurance Code shall not do the following:

• Require the provider to prove that an in-person consultation was not possible
• Require a doctor-patient relationship to be established in-person prior to the online appointment
• Require the use of telehealth when it is inappropriate
• Require the use of telehealth after a patient opts for an in-person visit

Illinois Medicaid and telemedicine

As we’ve seen in the definitions found in the Illinois Administrative Code, state medical payers see both synchronous (real-time) and asynchronous (store-and-forward) technology use as telemedicine. That’s why it’s strange that Medicaid doesn’t cover all the services provided through telemedicine—the program only reimburses providers for live video telemedicine and telepsychiatry. 

The good thing about Medicaid is that it pays for telehealth services at the same rates as it would for the comparable in-person ones.

The most important thing to note is that Medicaid only covers telehealth services provided to a patient in one medical facility by a practitioner in another one. The clinic where the patient is situated is recognized as the originating site, and the other one is the distant site. There are only a couple of exceptions to this rule. 

This limitation proves that Illinois still doesn’t see telehealth as a viable stand-alone solution for patient care, but only as a supplementary tool. Providers should resort to remote patient care only when necessary and under controlled conditions. One prerequisite for starting a telemedicine session is that a healthcare professional needs to be present physically with the patient at the originating site throughout the appointment.

Eligible providers

The following providers are eligible to provide telehealth services under Medicaid:

• Physician
• Physician assistant
• Podiatrist
• Advanced practice nurse

Eligible originating sites

To receive remote care, a patient needs to be at one of the following sites:

• Physician office
• Podiatrist office
• Local health departments
• Community mental health centers
• Outpatient hospitals
• Substance abuse treatment centers licensed by the Department of Human Services-Division of Alcoholism and Substance Abuse (DASA)
• Rural health clinics
• Encounter Rate Clinics
• Federally Qualified Health Centers

Who can be with the patient during a telehealth session?

For telemedicine, any physician or another licensed healthcare provider can be with the patient at the originating site. When it comes to telepsychiatry, staff members with mental health professional (MHP) qualifications and higher must be present with the patient receiving remote care. 

Documenting requirements for telehealth sessions

Both originating and distant sites need to keep thorough medical records documenting the services rendered.

Store-and-forward

Although Illinois Medicaid manuals include store-and-forward apps in the definition of telehealth, there is no indication anywhere that Medicaid reimburses for the use of this kind of technology and how it does so. They did make it explicit that the program doesn’t cover phone calls, texts, emails, or fax.

It seems that live video is a prerequisite for providing remote patient care if you want to stand a chance with Medicaid. We understand this as a great telemedicine platform should offer top-notch functionality for the best possible connection with the patient. That’s why Curogram is a perfect telemedicine solution. It lets you set up a virtual clinic and benefit from its numerous features designed to help doctors and nurses do their jobs as efficiently as they would in a physical setting.

Remote patient care

As you have seen, Medicaid usually doesn’t offer reimbursement for seeing your patient unless they’re at a medical facility already. It is clear that the state is still suspicious about the use of telecommunication channels for remote patient care.

There are two instances of remote patient monitoring that Medicaid will cover:

• Elderly patient care
• Home uterine monitoring

These come with their own sets of requirements, which makes it even more obvious that you’re unlikely to get any money from Medicaid practicing telemedicine.

Expansion of telehealth services during the COVID-19 national emergency

Due to the national health crisis caused by the spread of COVID-19, Governor Pritzker issued Executive Order 2020-09 to expand the scope of what the state considers telehealth services as well as the technology that can be used. The Order loosens the Medicaid regulations significantly and presents a great example of how the Telehealth Act could be revised in the near future.

On the federal level, the HHS’ Office for Civil Rights issued legislation that allows providers to use non-HIPAA compliant remote communication technologies for as long as the national emergency lasts. 

Illinois decision-makers did not stop at relaxing the legal requirements for telehealth practice—they introduced a program for monitoring patients with milder symptoms of the virus through the use of telemedicine.

This might be the right time for the State of Illinois to realize how useful telehealth can be and make some of the temporary changes permanent.

Start practicing telemedicine in Illinois with Curogram

Whether you’re transitioning to telemedicine or broadening the scope of your services to include online medical care, Curogram is the right solution for you. There’s no need to test your luck and your patients’ patience by using an inadequate platform that could compromise their sensitive data. Curogram provides you with a top-of-the-line messaging and telemedicine platform designed for use in healthcare.

Curogram is the best solution for everyone—patients, staff, and doctors

Choosing the familiarity of a consumer app over the efficiency of our medical platform will cost you and your clinic a lot in the long run. You shouldn’t be afraid of a learning curve because there isn’t one—your patients will receive appointment reminders and visit links in an SMS! You get a real local number for texting that your patients can save in their contacts.

Your staff will love Curogram as it will allow them to communicate with everyone—be it patients, colleagues, or partner providers— from a single dashboard! There’s no need for dedicated business phones or other devices.

Your doctors won’t have to waste time prepping the patients or dealing with tedious administrative tasks—Curogram streamlines the appointments and makes it possible for doctors to see patient after patient without hindrances. The best thing about it—Curogram integrates with any electronic management system in less than 48 hours.

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.