Illinois Approves Medicaid Coverage for Mental Health Via Telehealth

Illinois Approves Medicaid Coverage for Mental Health Via Telehealth

Illinois Gov. Bruce Rauner has approved legislation mandating the state’s Medicaid program to reimburse behavioral and mental health providers for telehealth.

The bill was one of five signed into law this week by Rauner, all designed to improve access to mental healthcare and increase treatment opportunities in the midst of an opioid abuse crisis.

“We are taking steps to dramatically improve mental health and substance use disorder treatment for the people of Illinois,” Rauner said during a Wednesday ceremony in Springfield. “These five initiatives work together to improve the quality of care and hopefully, the quality of life for so many Illinoisans suffering from mental health and substance use disorders.”

“This is no time for moral platitudes, judgment or shame,” he added. “We are amid an opioid crisis in our state and around the country. We need comprehensive, evidence-based solutions. And that is what we have here today.”

Senate Bill 3049 adds clinical psychologists, clinical social workers, advanced practice registered nurses certified in psychiatric and mental health nursing, and mental health professionals and clinicians authorized by state law to provide behavioral health services to the list of providers eligible for reimbursement for connected health services.

Psychiatrists and federally qualified health centers (FQHCs) are already covered by state law to provide telepsychiatry services.

“The Department (of Healthcare and Family Services) shall reimburse any Medicaid certified eligible facility or provider organization that acts as the location of the patient at the time a telehealth service is rendered, including substance abuse centers licensed by the Department of Human Services’ Division of Alcoholism and Substance Abuse,” the new law states.

Roughly 30 states now allow Medicaid coverage for telemental health, though each state’s guidelines are different. Still, that number is expected to rise – in part because of recent guidance from the Centers for Medicare & Medicaid Services (CMS) urging state Medicaid programs to look at telehealth and telemedicine to combat the opioid abuse crisis.

“States should also consider telehealth optimized Medication Assisted Treatment (MAT) given access considerations,” one guidance document continues. “Virtual treatment centers or remote counseling options integrated into care coordination technology might help with addressing provider shortages, particularly in rural areas. Many behavioral health providers lack access to EHRs; states may consider reviewing what app-based technologies might be appropriate as described in the Office of the National Coordinator for Health IT’s Health IT Playbook in the module addressing Behavioral Health Providers.”

In Illinois, the new law follows more than nine months of difficult legwork by the Illinois Telemedicine Task Force.

“Medicaid clients with behavioral health needs represent 25 percent of all Medicaid enrollees but account for 56 percent of all Medicaid spending,” said Lt. Gov. Evelyn Sanguinetti, the task force co-chair. “By signing SB 3049 today, Gov. Rauner will immediately improve access to mental health experts for Medicaid beneficiaries. The result will be fewer emergency visits, reduced hospital stays and readmissions, and lower costs to taxpayers — but most importantly, a better quality of life for those with mental and behavioral health needs.”

State law will now require Medicaid to reimburse eligible behavioral and mental health providers at the same rate as for in-person care. It also enables schools, hospitals, substance abuse centers and other Medicaid-eligible facilities to receive a $25 facility fee from Medicaid.

“This is a positive step in strengthening Illinoisans’ access to provider networks, contributing to timely care in the most appropriate setting and helping facilitate the integration of physical and behavioral health care in hospital and primary care settings,” Illinois Health and Hospital Association (IHA) President and CEO A.J. Wilhelmi said in a prepared statement. The IHA has long advocated for improved telehealth guidelines.

“This will help enhance the efficient delivery of care, such as by avoiding unnecessary hospital emergency department utilization,” Wilhelmi said.

State lawmakers last year passed the Illinois Telehealth Act, the state’s first comprehensive legislation to set definitions and parameters for telehealth and telemedicine.