Bill Text: CA SB960 | 2015-2016 | Regular Session | Amended
Bill Title: Medi-Cal: telehealth: reproductive health care.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Failed) 2016-11-30 - From committee without further action. [SB960 Detail]
Download: California-2015-SB960-Amended.html
BILL NUMBER: SB 960 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 26, 2016
INTRODUCED BY Senators Hernandez and Leno
(Coauthor: Senator McGuire)
FEBRUARY 8, 2016
An act to amend Section 14132.725 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 960, as amended, Hernandez. Medi-Cal: telehealth: reproductive
health care.
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,
as specified. The Medi-Cal program is, in part, governed and funded
by federal Medicaid Program program
provisions. Existing law provides that, to the extent that federal
financial participation is available, face-to-face contact between a
health care provider and a patient is not required under the Medi-Cal
program for "teleophthalmology, teledermatology
teledermatology, and teledentistry by store and forward,"
as defined to mean the asynchronous transmission of medical
information to be reviewed at a later time by a licensed physician or
optometrist, as specified, at a distant site.
This bill would enact similar provisions relating to the use of
reproductive health care under the Medi-Cal program. The bill would
provide that, 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
"reproductive health care provided by store and forward." The bill
would define that term to mean an asynchronous transmission of
medical information to be reviewed at a later time by a physician,
nurse practitioner, certified nurse midwife, licensed midwife,
physician assistant, or registered nurse at a distant site, where the
provider at the distant site reviews the dental information without
the patient being present in real time, as defined and as specified.
The bill would require Medi-Cal managed care plans that contract
with the department to cover reproductive health care provided by
store and forward.
This bill would also provide that, to the extent federal financial
participation is available and any necessary federal approvals are
obtained, telephonic and electronic patient management services, as
defined, provided by a physician or nonphysician health care provider
acting within his or her scope of licensure shall be a benefit under
the Medi-Cal program in fee-for-service and managed care delivery
systems, as specified. The bill would authorize the department to
seek approval of any state plan amendments necessary to implement
these provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14132.725 of the Welfare and Institutions Code
is amended to read:
14132.725. (a) To the extent that federal financial participation
is available, face-to-face contact between a health care provider
and a patient is not required under the Medi-Cal program for
teleophthalmology, teledermatology, and teledentistry, and
reproductive health care provided by store and forward. Services
appropriately provided through the store and forward process are
subject to billing and reimbursement policies developed by the
department. A Medi-Cal managed care plan that contracts with the
department pursuant to this chapter and Chapter 8 (commencing with
Section 14200) shall be required to cover the services
described in this section. reproductive health care
provided by store and forward.
(b) For purposes of this section, "teleophthalmology,
teledermatology, and teledentistry, and reproductive health care
provided by store and forward" means an asynchronous transmission of
medical or dental 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, or a dentist, or,
for reproductive health care, by a physician, nurse practitioner,
certified nurse midwife, licensed midwife, physician assistant, or
registered nurse operating within his or her scope of practice, where
the physician, optometrist, dentist, nurse practitioner, certified
nurse midwife, licensed midwife, physician assistant, or registered
nurse at the distant site reviews the medical or dental information
without the patient being present in real time. A patient receiving
teleophthalmology, teledermatology, teledentistry, or reproductive
health care by store and forward shall be notified of the right to
receive interactive communication with the distant specialist
physician, optometrist, dentist, nurse practitioner, certified nurse
midwife, licensed midwife, physician assistant, or registered nurse
and shall receive an interactive communication with the distant
specialist physician, optometrist, dentist, nurse practitioner,
certified nurse midwife, licensed midwife, physician assistant, or
registered nurse upon request. If requested, communication with the
distant specialist physician, optometrist, dentist, nurse
practitioner, certified nurse midwife, licensed midwife, physician
assistant, or registered nurse 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) (1) To the extent that federal financial participation is
available and any necessary federal approvals have been obtained,
telephonic and electronic patient management services provided by a
physician, or a nonphysician health care provider acting within his
or her scope of licensure is a benefit under the Medi-Cal program,
both in fee-for-service and managed care delivery systems delivered
by Medi-Cal managed care plans that contract with the department
pursuant to this chapter and Chapter 8 (commencing with Section
14200). Reimbursement for telephonic and electronic patient
management services shall be based on the complexity of and time
expended in rendering those services.
(2) This subdivision shall not be construed to authorize a
Medi-Cal managed care plan to require the use of telephonic and
electronic patient management services when the physician or
nonphysician health care provider has determined that those services
are not medically necessary.
(3) This subdivision shall not be construed to alter the scope of
practice of a health care provider or authorize the delivery of
health care services in a setting or in a manner than
that is not otherwise authorized by law.
(4) All laws regarding the confidentiality of health information
and a patient's right of access to his or her medical information
shall apply to telephonic and electronic patient management services.
(5) This subdivision shall not apply to a patient in the custody
of the Department of Corrections and Rehabilitation or any other
correctional facility.
(d) Notwithstanding paragraph (1) of subdivision (b), separate
reimbursement of a physician or a nonphysician health care provider
shall not be required for any of the following:
(1) A telephonic or electronic visit that is related to a service
or procedure provided to an established patient within a reasonable
period of time prior to the telephonic or electronic visit, as
recognized by the Current Procedural Terminology codes published by
the American Medical Association.
(2) A telephonic or electronic visit that leads to a related
service or procedure provided to an established patient within a
reasonable period of time, or within an applicable postoperative
period, as recognized by the Current Procedural Terminology codes
published by the American Medical Association.
(3) A telephonic or electronic visit provided as part of a bundle
of services for which reimbursement is provided for on a prepaid
basis, including capitation, or which reimbursement is provided for
using an episode-based payment methodology.
(4) A telephonic or electronic visit that is not initiated by an
established patient, by the parents or guardians of a minor who is an
established patient, or by a person legally authorized to make
health care decisions on behalf of an established patient.
(e) Nothing in this section shall be construed to prohibit a
Medi-Cal managed care plan from requiring documentation reasonably
relevant to a telephonic or electronic visit, as recognized by the
Current Procedural Terminology codes published by the American
Medical Association.
(f) For purposes of this section, the following definitions apply:
(1) "Established patient" means a patient who, within three years
immediately preceding the telephonic or electronic visit, has
received professional services from the provider or another provider
of the same specialty or subspecialty who belongs to the same group
practice.
(2) "Nonphysician health care provider" means a provider, other
than a physician, who is licensed pursuant to Division 2 (commencing
with Section 500) of the Business and Professions Code.
(3) "Reproductive health care" means the general reproductive
health care services described in paragraph (8) of subdivision (aa)
of Section 14132.
(4) "Telephonic and electronic patient management service" means
the use of electronic communication tools to enable treating
physicians and nonphysician health care providers to evaluate and
manage established patients in a manner that meets all of the
following criteria:
(A) The service does not require an in-person visit with the
physician or nonphysician health care provider.
(B) The service is initiated by the established patient, the
parents or guardians of a minor who is an established patient, or a
person legally authorized to make health care decisions on behalf of
an established patient. "Initiated by an established patient" does
not include a visit for which a provider or a person employed by a
provider contacts a patient to initiate a service.
(C) The service is recognized by the Current Procedural
Terminology codes published by the American Medical Association.
(g) The department may seek approval of any state plan amendments
necessary to implement this section.
(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.
