UPDATE: The Illinois House on Monday also approved House Bill 3308.
In the same way that Zoom reshaped conference calls and staff meetings during the coronavirus pandemic, visiting the doctor has become, for many, a virtual affair.
But with COVID-19 cases on a steady decline, Illinois is set to resume business as usual as soon as June 11, when the state will enter what Gov. J.B. Pritzker has dubbed the Phase 5: Restore stage of reopening.
Barring quick action from the General Assembly, when Pritzker’s related pandemic executive orders lift, so too will the requirement that health insurance companies treat virtual visits as they would regular, in-person appointments.
Lawmakers appear to be on the verge of extending that mandate before Monday’s planned adjournment.
“There’s been a lot of terrible things that have happened in the past year with the pandemic, but one of the good things that’s come out of it has really been this test case that we have had in regards to telemedicine,” Senate Republican Leader Dan McConchie said. “I’m very excited about what kind of opportunities this is going to open up, whether it be for people who are disabled, whether it’s going to be people in rural areas, and I’m also particularly interested in how this is going to affect mental health.”
The Illinois Senate on Sunday easily approved legislation, House Bill 3308, that requires insurers to permanently cover telehealth visits for mental health and substance use disorder.
All other telehealth appointments must be covered though 2027.
“The pandemic has highlighted existing racial, economic, and geographic disparities that hinder access to medical treatment,” sponsor Sen. Napoleon Harris, D-Harvey, said in a statement. “Creating uniform rules for insurance companies’ telehealth services could improve access for everyone, especially members of disproportionately impacted communities that have limited resources.”
A government study due in 2026 will examine telehealth’s impact on health care disparities and patient access to care.
A coalition that’s been advocating for the measure, which includes the Illinois Home and Hospice Council, the Illinois Hospital Association, the Illinois State Medical Society and the National Association of Safety Workers has already been promoting the positive outcomes of telehealth services.
A fact sheet on the measure reads: “Telehealth has helped drive a reduction of missed appointments, demonstrated increased care plan adherence, and improved chronic disease management. Access barriers that exacerbate healthcare disparities such as transportation, lost income, missed work and school, or the stigma of seeking help are greatly reduced or eliminated when telehealth is used. Patients are empowered to address care needs swiftly, preventing conditions from worsening and requiring unnecessary visits to urgent care or a hospital.”
McConchie, who uses a wheelchair, said that “as someone who is disabled and has sometimes a difficult time getting around, and sometimes getting to and from appointments,” he’s been frustrated for years at the lack of opportunities for telemedicine.
He hinted at some of the political dynamics at play that prevented Illinois from embracing telehealth coverage mandates before the pandemic: insurance companies, a long powerful interest in Springfield, have concerns about costs.
Some patients and professionals have noted that a doctor may be more prone to miss cues – sounds, smells, mannerisms – online that would be otherwise obvious during a face-to-face visit.
But with hospitals and health care facilities trying to limit access in order to preserve beds and staff for potential COVID-19 patients, and with people encouraged to stay home as much as possible to stave off the possibility of contracting COVID-19, virtual check-ups became a virtual necessity.
The proposal awaiting House action bars insurers from requiring an in-person visit before a telehealth one and from making patients or health care professions give a reason – like a hardship or access barrier – for choosing an e-visit over an in-person consultation.
Likewise, an insurer can’t require health care professionals to offer telehealth, nor can insurers require that a patient see a physician virtually if they’d rather go to a doctor’s office.
McConchie said the ability for someone to see a counselor or therapist in short order via video chat – without the additional stressors of cost, given that doctors will be fully reimbursed – has been “ a lifesaving thing.”
He applauded the fact that the mandate for remote mental health care is indefinite, rather than temporary, as it is for other types of visits.
“During the pandemic we’ve seen a lot of people who have suffered mental health issues because of the lockdowns and because of the limitations and the mitigations that were placed,” McConchie said. “I think that that type of stability and security and expansiveness of coverage is going to be very important in trying to help those people who have those types of issues going forward.”
The proposal before lawmakers only applies to private insurance.
It does not mandate telehealth coverage for patients with Medicaid, the government-backed health care coverage for low-income individuals.
Federal and state rules have waived barriers to Medicaid and Medicare telehealth services during the pandemic.
The Pritzker administration could attempt to use executive authority to continue that policy after Illinois enters the final “Restore” phase of economic recovery from the pandemic.
Follow Amanda Vinicky on Twitter: @AmandaVinicky