BILL NUMBER: AB 415 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 31, 2011
INTRODUCED BY Assembly Member Logue
FEBRUARY 14, 2011
An act to amend Section 2290.5 of the Business and
Professions Code, relating to healing arts. An act to
amend Section 14132.72 of the Welfare and Institutions Code, relating
to telehealth.
LEGISLATIVE COUNSEL'S DIGEST
AB 415, as amended, Logue. Healing arts: telemedicine.
telehealth.
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.
This bill would make a nonsubstantive change to that provision.
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 provided by telehealth, as defined. The bill
would prescribe the rate of reimbursement for covered services
provided by telehealth and would provide that reimbursement for
telehealth interactions would include reasonable compensation to the
health care provider at the originating site for the transmission
cost incurred during the delivery of health care services.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14132.72 of the
Welfare and Institutions Code is amended to read:
14132.72. (a) It For purposes of this
section, 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" has the same meaning as "licentiate,"
as defined in paragraph (2) of subdivision (a) of Section 805 of the
Business and Professions Code, and also includes a person licensed as
an optometrist pursuant to Chapter 7 (commencing with Section 3000)
of the Business and Professions Code.
(4) "Originating site" means a site where a patient is located
while a synchronous store and forward occurs and health care services
are provided via a telecommunications system.
(5) "Telehealth" means the process of delivering health care
services via information and communication technologies to facilitate
the diagnosis, consultation, treatment, education, care management,
and self-management of a patients' 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) It is the intent of the
Legislature to recognize the practice of telemedicine
telehealth as a legitimate means by which an
individual may receive medical health care
services from a health care provider without
person-to-person in-person contact with the
provider.
(b) For the purposes of this section, "telemedicine" and
"interactive" are defined as those terms are defined in subdivision
(a) of Section 2290.5 of the Business and Professions Code.
(c) (1) Commencing
July 1, 1997, face-to-face 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 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. The audio and
visual telemedicine system used shall, at a minimum, have the
capability of meeting the procedural definition of the Current
Procedural Terminology Fourth Edition (CPT-4) codes which represent
the service provided through telemedicine. The telecommunications
equipment shall be of a level of quality to adequately complete all
necessary components to document the level of service for the CPT-4
code billed. If a peripheral diagnostic scope is required to assess
the patient, it shall provide adequate resolution or audio quality
for decisionmaking telehealth .
(2) The department shall report to the appropriate committees of
the Legislature, by January 1, 2000, on the application of
telemedicine to provide home health care; emergency care; critical
and intensive care, including neonatal care; psychiatric evaluation;
psychotherapy; and medical management as potential Medi-Cal benefits.
(d) The Medi-Cal program shall not be required to pay for
consultation provided by the health care provider by telephone or
facsimile machines.
(e) The Medi-Cal program shall pursue private or federal funding
to conduct an evaluation of the cost-effectiveness and quality of
health care provided through telemedicine by those providers who are
reimbursed for telemedicine services by the 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) The reimbursement rate for Medi-Cal covered services provided
by telehealth shall be the lower of the usual and customary rate
charged for that service or the fee schedule amount the program pays
for the same service when provided in an in-person visit with the
patient.
(f) The department shall not limit the type of setting where
services are provided for the patient or health care provider when
reimbursing the provider at both the distant site and the originating
site.
(g) Reimbursement for telehealth visits shall include reasonable
compensation to the health care provider at the originating site for
the transmission cost incurred during the delivery of health care
services.
(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.
SECTION 1. Section 2290.5 of the Business and
Professions Code is amended to read:
2290.5. (a) (1) For the purposes of this section, "telemedicine"
shall mean the practice of health care delivery, diagnosis,
consultation, treatment, transfer of medical data, and education
using interactive audio, video, or data communications. Neither a
telephone conversation nor an electronic mail message between a
health care practitioner and patient constitutes "telemedicine" for
purposes of this section.
(2) For purposes of this section, "interactive" means an audio,
video, or data communication involving a real time (synchronous) or
near real time (asynchronous) two-way transfer of medical data and
information.
(b) For the purposes of this section, "health care practitioner"
has the same meaning as "licentiate" as defined in paragraph (2) of
subdivision (a) of Section 805 and also includes a person licensed as
an optometrist pursuant to Chapter 7 (commencing with Section 3000).
(c) Prior to the delivery of health care via telemedicine, the
health care practitioner who has ultimate authority over the care or
primary diagnosis of the patient shall obtain verbal and written
informed consent from the patient or the patient's legal
representative. The informed consent procedure shall ensure that at
least all of the following information is given to the patient or the
patient's legal representative verbally and in writing:
(1) The patient or the patient's legal representative retains the
option to withhold or withdraw consent at any time without affecting
the right to future care or treatment nor risking the loss or
withdrawal of any program benefits to which the patient or the
patient's legal representative would otherwise be entitled.
(2) A description of the potential risks, consequences, and
benefits of telemedicine.
(3) All existing confidentiality protections apply.
(4) All existing laws regarding patient access to medical
information and copies of medical records apply.
(5) Dissemination of any patient identifiable images or
information from the telemedicine interaction to researchers or other
entities shall not occur without the consent of the patient.
(d) A patient or the patient's legal representative shall sign a
written statement prior to the delivery of health care via
telemedicine, indicating that the patient or the patient's legal
representative understands the written information provided pursuant
to subdivision (a), and that this information has been discussed with
the health care practitioner, or his or her designee.
(e) The written consent statement signed by the patient or the
patient's legal representative shall become part of the patient's
medical record.
(f) The failure of a health care practitioner to comply with this
section shall constitute unprofessional conduct. Section 2314 shall
not apply to this section.
(g) All existing laws regarding surrogate decisionmaking shall
apply. For purposes of this section, "surrogate decisionmaking" means
any decision made in the practice of medicine by a parent or legal
representative for a minor or an incapacitated or incompetent
individual.
(h) Except as provided in paragraph (3) of subdivision (c), this
section shall not apply when the patient is not directly involved in
the telemedicine interaction, for example when one health care
practitioner consults with another health care practitioner.
(i) This section shall not apply in an emergency situation in
which a patient is unable to give informed consent and the
representative of that patient is not available in a timely manner.
(j) This section shall not apply to a patient under the
jurisdiction of the Department of Corrections or any other
correctional facility.
(k) 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.