Bill Text: CA SB365 | 2021-2022 | Regular Session | Enrolled

Bill Title: E-consult service.

Spectrum: Slight Partisan Bill (Democrat 2-1)

Status: (Vetoed) 2022-01-27 - Veto sustained. [SB365 Detail]

Download: California-2021-SB365-Enrolled.html

Enrolled  September 03, 2021
Passed  IN  Senate  May 28, 2021
Passed  IN  Assembly  September 01, 2021
Amended  IN  Senate  May 04, 2021
Amended  IN  Senate  March 16, 2021


Senate Bill
No. 365

Introduced by Senator Caballero
(Coauthors: Senators Dahle and Wiener)

February 10, 2021

An act to amend Section 14132.72 of the Welfare and Institutions Code, relating to Medi-Cal.


SB 365, Caballero. E-consult service.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including federally qualified health center (FQHC) services and rural health clinic (RHC) services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. FQHC and RHC services are reimbursed, to the extent that federal financial participation is obtained, to providers on a per-visit basis, and a “visit” is defined as a face-to-face encounter between a patient of an FQHC or RHC and specified health care professionals.
Existing law prohibits a requirement of in-person contact between a health care provider and a Medi-Cal patient when the service may be provided by telehealth, and, for purposes of telehealth, prohibits the department from limiting the type of setting where Medi-Cal services are provided.
This bill would make electronic consultation services reimbursable under the Medi-Cal program for enrolled providers, including FQHCs or RHCs. The bill would require the department to seek federal waivers and approvals to implement this provision, and would condition the implementation of the bill’s provisions on the department obtaining necessary federal approval of federal matching funds. The bill would make related findings and declarations.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


 (a) The Legislature finds and declares all of the following:
(1) Telehealth is an effective means to ensure patients can access safe and effective health care regardless of location.
(2) Electronic consultation services, which are also referred to as “e-consults,” are a method of telehealth used to provide patient-centered care and improve treating or requesting providers’ ability to better manage their patients’ care.
(3) The State Department of Health Care Services has an existing telehealth policy that allows for reimbursement for e-consult services delivered by consultant providers who are usually specialists.
(4) However, under that policy, reimbursement is not authorized for any requesting or treating providers, who are usually primary care providers. Moreover, federally qualified health centers and rural health clinics are prohibited from seeking reimbursement for e-consult services that their requesting or treating and consultant providers render.
(5) Current department policy limits the use of e-consult services, and thereby hinders access to care. These services provide a critical way to improve access to care in California’s safety net.
(6) E-consult services offer benefits to patients, including improved specialty visit wait times and patient satisfaction rates, and reduced costs associated with in-person office visits, including patient travel time, time off work, and associated required childcare.
(7) E-consult services offer benefits to primary care providers, including reinforcing the medical home, improving provider satisfaction, and addressing current and future patient issues through specialist consultation obtained through e-consult services.
(8) E-consult services also benefit specialists by improving the readiness and appropriateness of referrals, reducing no-show rates, improving provider satisfaction, and bettering overall access to specialty care.
(b) Therefore, it is the intent of the Legislature to enact legislation that would do both of the following:
(1) Ensure coverage and utilization of e-consult services under the Medi-Cal program.
(2) Recognize the benefits of e-consult services that have been found to have particular impact on the safety net population, including Medi-Cal beneficiaries and uninsured Californians.

SEC. 2.

 Section 14132.72 of the Welfare and Institutions Code is amended to read:

 (a) For purposes of this section, both of the following apply:
(1) The definitions in subdivision (a) of Section 2290.5 of the Business and Professions Code.
(2) “Electronic consultation service,” or “e-consult service,” means an interprofessional health record assessment and management service initiated by a treating or requesting provider and delivered by a consultative provider, including a written report to the patient’s treating or requesting provider. An e-consult service ordinarily involves a treating or requesting provider sending information regarding the patient and a consultation request to a consultative provider, usually a specialist provider, who may then respond in any of a number of ways, including providing requested feedback, asking for additional information, recommending certain studies or examinations, or initiating the scheduling of an appointment.
(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. This section and the Telehealth Advancement Act of 2011 do not conflict with or supersede former Section 14091.3 or any other existing state laws or regulations related to reimbursement for services provided by a noncontracted provider.
(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) (1) An e-consult service shall be reimbursable under the Medi-Cal program for an enrolled provider, as described in subdivision (h) of Section 14043.1, including a federally qualified health center or rural health clinic, as defined in subsection (aa) of Section 1395x of Title 42 of the United States Code, and described in Section 14132.100, if a provider renders that service.
(2) The department shall seek any federal waivers and approvals necessary to implement this subdivision.
(3) This subdivision shall only be implemented to the extent that the department obtains necessary federal approval of federal matching funds.
(g) This section does not authorize the department to require the use of telehealth when the health care provider has determined that it is inappropriate.
(h) 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.