14132.721.
(a) Notwithstanding any other law, and subject to paragraph (2) of subdivision (c), health care services furnished by an enrolled clinic through telehealth shall be reimbursed by Medi-Cal on the same basis, to the same extent, and at the same payment rate as those services are reimbursed if furnished in person, consistent with this section.(b) Consistent with the protections for health care providers set forth in the Telehealth Advancement Act of 2011, including Section 14132.72, the department shall not restrict the ability of an enrolled clinic to provide and be reimbursed
for services furnished through telehealth. telehealth and this subdivision shall not prohibit policies that require all of the clinical elements of a service to be met as a condition of reimbursement. Prohibited restrictions include all of the following:
(1) Requirements for face-to-face contact between an enrolled clinic provider and a patient.
(2) Requirements for a patient’s or provider’s physical presence at the enrolled clinic or any other location.
(3) Requirements for prior in-person contacts between the enrolled clinic and a patient.
(4) Requirements for documentation of a barrier to an in-person visit or a special need for a telehealth visit.
(5) Policies, including reimbursement policies, that impose more stringent requirements on telehealth services than equivalent services furnished in person. This paragraph does not prohibit policies that require all of the clinical elements of a service to be met as a condition of reimbursement.
(6) Limitations on the means or technologies through which telehealth services are furnished. This
paragraph does not prohibit policies that require compliance with applicable federal and state health information privacy and security laws.
(c) (1) Notwithstanding the in-person requirements of Section 14132.100, if an enrolled clinic is also a federally qualified health center or a rural health center, the definition of “visit” set forth in subdivision (g) of Section 14132.100 includes a telehealth encounter to the same extent it includes an in-person encounter.
(2) Health care services furnished
through audio-only telehealth, including by telephone, by a federally qualified health center or a rural health clinic, other than mental health services that are excluded from the benefits provided by county mental health plans under the specialty mental health services waiver, shall be reimbursed pursuant to Section 14132.722.
(d) This section does not eliminate the obligation of a health care provider to obtain verbal or written consent from the patient before delivery of health care via telehealth or the rights of the patient, pursuant to subdivisions (b) and (c) of Section 2290.5 of the Business and Professions Code.
(e) (1) The department shall require Medi-Cal managed care plans, through contract or
otherwise, to adhere to the requirements of subdivision (b) of this section.
(e)This section does not conflict with or supersede
(2) Medi-Cal managed care plans shall comply with the requirements for health care service plan contracts set forth in Section 1374.14 of the Health and Safety Code and the requirements for health insurance policies set forth in Section 10123.855 of the Insurance Code. Medi-Cal managed care plans shall not be
required to pay federally qualified health centers and rural health clinics the same amount for audio-only telehealth visits as equivalent in-person visits on or after January 1, 2025. This paragraph shall be applied to the extent consistent with federal Medicaid requirements that a managed care plan provide payment for services furnished by a federally qualified health center or rural health clinic that is not less than the level and amount of payment the managed care plan would make for the services if the services were furnished by a provider that is not a federally qualified health center or rural health clinic.
(f) This section does not limit reimbursement for or coverage of, or reduce access to, services provided through telehealth before the enactment of this section.
(g)The department shall require Medi-Cal managed care plans, through contract or otherwise, to adhere to the requirements of this section.
(h)
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action.
(i)
(h) The department shall seek any necessary federal approvals and obtain federal financial participation in implementing this section.
This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and not otherwise jeopardized.
(j)
(i) For purposes of this section:
(1) “Enrolled clinic” means any of the following:
(A) A clinic licensed pursuant to subdivision (a) of Section 1204 of the Health and Safety Code.
(B) An intermittent clinic exempt from licensure
under subdivision (h) of Section 1206 of the Health and Safety Code.
(C) A hospital or nonhospital-based clinic operated by the state or any of its political subdivisions, including the University of California, or a city, county, city and county, or hospital authority.
(D) A tribal clinic exempt from licensure under subdivision (c) of Section 1206 of the Health and Safety Code, or an outpatient setting conducted, maintained, or operated by a federally recognized Indian tribe, tribal organization, or urban Indian organization, as defined in Section 1603 of Title 25 of the United States Code.
(2) “Telehealth” has the same meaning as in subdivision (a) of Section 2290.5 of the Business and Professions Code, which includes
audio-only telephone communication technologies.