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Illinois Expands Reimbursement for Diabetes Care Via Telehealth

Amid a flurry of telemedicine legislation taking effect with the new year is a law in Illinois that mandates telehealth coverage for diabetes care for seniors who face challenges in accessing healthcare.

Source: ThinkStock

By Eric Wicklund

- A new law taking effect in Illinois this week expands coverage for telehealth programs aimed at seniors living with diabetes.

HB 5351, passed in May 2018 and signed by Gov. Bruce Rauner in August, amends the Illinois Insurance Code to mandate that any “individual or group policy of accident or health insurance” that includes telehealth coverage expand that coverage to include licensed dietitian nutritionists and certified diabetes educators. The coverage would apply in particular to care providers serving seniors in their homes.

The amendment expands opportunities for healthcare providers to use connected care platforms to reach seniors who can’t or don’t access care management services. According to the 2017 Diabetes Report Card issued by the Centers for Disease Control & Prevention, roughly 9 percent of the state’s adult population has been diagnosed with this chronic disease.

Telehealth and telemedicine are fast gaining traction as a means of improving care management and coordination for those living with diabetes. While some platforms focus on monitoring and care management, other services are aimed at health and wellness education, in an effort to improve diet and exercise routines and reduce negative clinical outcomes.

The concept is also carrying over to the pre-diabetes population, where connected health platforms are being put to use to help improve the lifestyles of those at risk of developing the disease. As with the other platforms, the primary incentive for using telehealth is to expand access to healthcare for those who face access barriers.

The insurance bill was one of three bills signed into law by Rauner this past year that focus on telehealth. The others mandated the state’s Medicaid program to reimburse behavioral and mental health providers for telehealth and amended the Illinois Telehealth Act to include dentists, occupational therapists, pharmacists, physical therapists, clinical social workers, speech-language pathologists, audiologists and hearing instrument dispensers in the definition of “health care professional,” enabling them to use telehealth under state guidelines.

Illinois is one of many states making changes to its telemedicine and telehealth laws this past year – according to the Center for Connected Health Policy, 39 states and the District of Columbia passed 65 pieces of legislation during the 2018 legislative year.

Despite the advances, some telehealth experts say the state needs to do more.

“While this change is a step in the right direction, Illinois remains in the minority as one of the states without a telehealth coverage and/or payment parity law,” Lisa Schmitz Mazur, an attorney with McDermott, Will & Emery who specializes in digital health, wrote in a September 2018 blog. “The vast majority of states have parity laws that, at a minimum, include a coverage requirement, mandating certain types of payors to approve and reimburse certain telehealth encounters the same as they would in-person medical encounters.”


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