Bill Text: CA AB415 | 2011-2012 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Healing arts: telehealth.

Spectrum: Moderate Partisan Bill (Democrat 4-1)

Status: (Passed) 2011-10-07 - Chaptered by Secretary of State - Chapter 547, Statutes of 2011. [AB415 Detail]

Download: California-2011-AB415-Amended.html

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BILL NUMBER: AB 415	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 27, 2011
	AMENDED IN ASSEMBLY  MAY 10, 2011
	AMENDED IN ASSEMBLY  APRIL 25, 2011
	AMENDED IN ASSEMBLY  MARCH 31, 2011

INTRODUCED BY   Assembly Member Logue
   (Principal coauthors: Assembly Members Chesbro, Pan, and V. Manuel
Pérez)

                        FEBRUARY 14, 2011

   An act to repeal and add Section 2290.5 of the Business and
Professions Code, to repeal and add Section 1374.13 of the Health and
Safety Code, to repeal and add Section 10123.85 of the Insurance
Code, and to amend Sections 14132.72 and 14132.725 of the Welfare and
Institutions Code, relating to telehealth.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 415, as amended, Logue. Healing arts: telehealth. 
   Existing 
    (1)     Existing  law provides for the
licensure and regulation of various healing arts professions by
various boards within the Department of Consumer Affairs. A violation
of specified provisions is a crime. Existing law defines
telemedicine, for the purpose of its regulation, to mean the practice
of health care delivery, diagnosis, consultation, treatment,
transfer of medical data, and education using interactive audio,
video, or data communications. Existing law requires a health care
practitioner, as defined, to obtained verbal and written informed
consent from the patient or the patient's legal representative before
telemedicine is delivered. Existing law also imposes various
requirements with regard to the provision of telemedicine by health
care service plans, health insurers, or under the Medi-Cal program,
including a prohibition on requiring face-to-face contact between a
health care provider and a patient for services appropriately
provided through telemedicine, subject to certain contracts or
policies. Existing law provides that health care service plans and
health insurers shall not be required to pay for consultations
provided by telephone or facsimile machines. Existing law provides
that a willful violation of the provisions governing health care
service plans is a crime.
   This bill would delete the provisions regarding telemedicine as
described above, and would instead set forth provisions relating to
telehealth, as defined. This bill would require a health care
provider, as defined, to, prior to the delivery health care via
telehealth, verbally inform the patient that telehealth may be used
and obtain verbal consent from the patient. This bill would provide
that failure to comply with this provision constitutes unprofessional
conduct. This bill would also set forth provisions for the payment
of telehealth services by health care service plans and health
insurers. By changing the definition of a crime applicable to health
care service plans, the bill would impose a state-mandated local
program. 
   Existing 
    (2)     Existing  law prohibits a
requirement of face-to-face contact between a health care provider
and a patient under the Medi-Cal program for services appropriately
provided through telemedicine, subject to reimbursement policies
developed by the Medi-Cal program to compensate licensed health care
providers who provide health care services, that are otherwise
covered by the Medi-Cal program, through telemedicine.
   This bill would, instead, prohibit a requirement of in-person
contact between a health care provider and patient under the Medi-Cal
program for any service otherwise covered by the Medi-Cal program
when the service is  appropriately  provided by telehealth,
as defined  , and would make related changes . 
   Existing 
    (3)     Existing  law, until January
1, 2013, and to the extent that federal financial participation is
available, authorizes, under the Medi-Cal program, teleophthalmology
and teledermatology by store and forward, as defined.
    This bill would delete the repeal of the above-described
authorization. 
   The 
    (4)   The  California Constitution requires the
state to reimburse local agencies and school districts for certain
costs mandated by the state. Statutory provisions establish
procedures for making that reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  This act shall be known, and may be cited, as the
Telehealth Advancement Act of 2011.
  SEC. 2.  The Legislature finds and declares all of the following:
   (a) Lack of primary care providers, specialty providers, and
transportation continue to be significant barriers to access to
health services in medically underserved rural and urban areas.
   (b) Parts of California have difficulty attracting and retaining
health professionals, as well as supporting local health facilities
to provide a continuum of health care.
   (c) Many health care providers in medically underserved areas are
isolated from mentors, colleagues, and the information resources
necessary to support them personally and professionally.
   (d) It is the intent of the Legislature to create a parity of
telehealth with other health care delivery modes, to actively promote
telehealth as a tool to advance stakeholders' goals regarding health
status and health system improvement, and to create opportunities
and flexibility for telehealth to be used in new models of care and
system improvements.
   (e) Telehealth is a mode of delivering health care services and
public health utilizing information and communication technologies to
enable the diagnosis, consultation, treatment, education, care
management, and self-management of patients at a distance from health
care providers.
   (f) Telehealth is part of a multifaceted approach to address the
problem of inadequate provider distribution and the development of
health systems in medically underserved areas by improving
communication capabilities and providing convenient access to
up-to-date information, consultations, and other forms of support.
   (g) The use of information and telecommunication technologies to
deliver health services has the potential to reduce costs, improve
quality, change the conditions of practice, and improve access to
health care, particularly in rural and other medically underserved
areas.
   (h) Telehealth will assist in maintaining or improving the
physical and economic health of medically underserved communities by
keeping the source of medical care in the local area, strengthening
the health infrastructure, and preserving health care-related jobs.
   (i) Consumers of health care will benefit from telehealth in many
ways, including expanded access to providers, faster and more
convenient treatment, better continuity of care, reduction of lost
work time and travel costs, and the ability to remain with support
networks.
   (j) It is the intent of the Legislature that the fundamental
health care provider-patient relationship cannot only be preserved,
but can also be augmented and enhanced, through the use of telehealth
as a tool to be integrated into practices.
   (k) Without the assurance of payment and the resolution of legal
and policy barriers, the full potential of telehealth will not be
realized.
  SEC. 3.  Section 2290.5 of the Business and Professions Code is
repealed.
  SEC. 4.  Section 2290.5 is added to the Business and Professions
Code, to read:
   2290.5.  (a) For purposes of this division, the following
definitions shall apply:
   (1) "Asynchronous store and forward" means the transmission of a
patient's medical information from an originating site to the health
care provider at a distant site without the presence of the patient.
   (2) "Distant site" means a site where a health care provider who
provides health care services is located while providing these
services via a telecommunications system.
   (3) "Health care provider" means a person who is licensed under
this division.
   (4) "Originating site" means a site where a patient is located at
the time health care services are provided via a telecommunications
system or where the asynchronous store and forward transfer occurs.
   (5) "Telehealth" means the mode of delivering health care services
and public health via information and communication technologies to
facilitate the diagnosis, consultation, treatment, education, care
management, and self-management of a patient's health care while the
patient is at the originating site and the health care provider is at
a distant site. Telehealth facilitates patient self-management and
caregiver support for patients and includes synchronous interactions
and asynchronous store and forward transfers.
   (b) Prior to the delivery of health care via telehealth, the
health care provider shall verbally inform the patient that
telehealth may be used and obtain verbal consent from the patient for
this use. The verbal consent shall be documented in the patient's
medical record.
   (c) The failure of a health care provider to comply with this
section shall constitute unprofessional conduct. Section 2314 shall
not apply to this section.
   (d) This section shall not be construed to alter the scope of
practice of any health care provider or authorize the delivery of
health care services in a setting, or in a manner, not otherwise
authorized by law.
   (e) All laws regarding the confidentiality of health care
information and a patient's rights to his or her medical information
shall apply to telehealth interactions.
  SEC. 5.  Section 1374.13 of the Health and Safety Code is repealed.

  SEC. 6.  Section 1374.13 is added to the Health and Safety Code, to
read:
   1374.13.  (a) For the purposes of this section, the definitions in
subdivision (a) of Section 2290.5 of the Business and Professions
Code shall apply.
   (b) It is the intent of the Legislature to recognize the practice
of telehealth as a legitimate means by which an individual may
receive health care services from a health care provider without
in-person contact with the health care provider.
   (c) No health care service plan shall require that in-person
contact occur between a health care provider and a patient before
payment is made for the covered services appropriately provided
through teleheath, and every health care service plan shall adopt
payment policies consistent with this section to compensate health
care providers who provide covered health care services through
telehealth, subject to the terms and conditions of the contract
entered into between the enrollee or subscriber and the health care
service plan.
   (d) For the purposes of payment for covered treatment or services
provided through telehealth, the health care service plan shall not
limit the type of setting where services are provided for the patient
or by the health care provider.
   (e) The requirements of this subdivision shall also be operative
for health care service plan contracts with the department pursuant
to Article 2.7 (commencing with Section 14087.3), Article 2.8
(commencing with Section 14087.5), Article 2.81 (commencing with
Section 14089), or Chapter 8 (commencing with Section 14200).
   (f) Nothing in this section shall be interpreted to authorize a
health care service plan to require the use of telehealth when the
health care provider has determined that it is not appropriate.
  SEC. 7.  Section 10123.85 of the Insurance Code is repealed.
  SEC. 8.  Section 10123.85 is added to the Insurance Code, to read:
   10123.85.  (a) For purposes of this section, the definitions in
subdivision (a) of Section 2290.5 of the Business and Professions
Code shall apply.
   (b) It is the intent of the Legislature to recognize the practice
of telehealth as a legitimate means by which an individual may
receive health care services from a health care provider without
in-person contact with the health care provider.
   (c) No health insurer shall require that in-person contact occur
between a health care provider and a patient before payment is made
for the services appropriately provided through telehealth, and every
health insurer shall adopt payment policies consistent with this
section to compensate health care providers who provide covered
health care services through telehealth, subject to the terms and
conditions of the contract entered into between the policyholder or
contractholder and the insurer.
   (d) For the purposes of payment for covered treatment or services
provided through telehealth, the health insurer shall not limit the
type of setting where services are provided for the patient or by the
health care provider.
   (e) Nothing in this section shall be interpreted to authorize a
health insurer to require the use of telehealth when the health care
provider has determined that it is not appropriate.
  SEC. 9.  Section 14132.72 of the Welfare and Institutions Code is
amended to read:
   14132.72.  (a) For purposes of this section, the definitions in
subdivision (a) of Section 2290.5 of the Business and Professions
Code shall apply.
   (b) It is the intent of the Legislature to recognize the practice
of telehealth as a legitimate means by which an individual may
receive health care services from a health care provider without
in-person contact with the provider.
   (c) In-person contact between a health care provider and a patient
shall not be required under the Medi-Cal program for services
appropriately provided through telehealth  , subject to 
 reimbursement policies adopted by the department to compensate a
licensed health care provider who provides health care services
through telehealth that are otherwise reimbursed pursuant to the
Medi-Cal program  .
   (d) The department shall not require a health care provider to
document a barrier to an in-person visit for Medi-Cal coverage of
services provided via telehealth.
   (e) For the purposes of payment for covered treatment or services
provided through telehealth, the department shall not limit the type
of setting where services are provided for the patient or by the
health care provider.
   (f) Nothing in this section shall be interpreted to authorize the
department to require the use of telehealth when the health care
provider has determined that it is not appropriate.
   (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, provider bulletins, and similar
instructions.
  SEC. 10.  Section 14132.725 of the Welfare and Institutions Code is
amended to read:
   14132.725.  (a) Commencing July 1, 2006, to the extent that
federal financial participation is available, face-to-face contact
between a health care provider and a patient shall not be required
under the Medi-Cal program for teleophthalmology and teledermatology
by store and forward. Services appropriately provided through the
store and forward process are subject to billing and reimbursement
policies developed by the department.
   (b) For purposes of this section, "teleophthalmology and
teledermatology by store and forward" means an asynchronous
transmission of medical information to be reviewed at a later time by
a physician at a distant site who is trained in ophthalmology or
dermatology or, for teleophthalmology, by an optometrist who is
licensed pursuant to Chapter 7 (commencing with Section 3000) of
Division 2 of the Business and Professions Code, where the physician
or optometrist at the distant site reviews the medical information
without the patient being present in real time. A patient receiving
teleophthalmology or teledermatology by store and forward shall be
notified of the right to receive interactive communication with the
distant specialist physician or optometrist, and shall receive an
interactive communication with the distant specialist physician or
optometrist, upon request. If requested, communication with the
distant specialist physician or optometrist may occur either at the
time of the consultation, or within 30 days of the patient's
notification of the results of the consultation. If the reviewing
optometrist identifies a disease or condition requiring consultation
or referral pursuant to Section 3041 of the Business and Professions
Code, that consultation or referral shall be with an ophthalmologist
or other appropriate physician and surgeon, as required.
   (c) 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, provider bulletins, and similar
instructions.
   (d) On or before January 1, 2008, the department shall report to
the Legislature the number and type of services provided, and the
payments made related to the application of store and forward
telemedicine as provided, under this section as a Medi-Cal benefit.
  SEC. 11.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.