BILL NUMBER: AB 415	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 25, 2011
	AMENDED IN ASSEMBLY  MARCH 31, 2011

INTRODUCED BY   Assembly Member Logue

                        FEBRUARY 14, 2011

    An act to amend Section 14132.72 of the   An
act to repe   al 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 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, and 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 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. 

   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 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:  no   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 can not 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.  
   2290.5.  (a) (1) For the purposes of this section, "telemedicine"
means 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. 
   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) This section shall not be construed to alter the scope of
practice of any health care provider.
   (c) 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.  
   1374.13.  (a)  It is the intent of the Legislature to recognize
the practice of telemedicine as a legitimate means by which an
individual may receive medical services from a health care provider
without person-to-person contact with the provider.
   (b)  For the purposes of this section, the meaning of
"telemedicine" is as defined in subdivision (a) of Section 2290.5 of
the Business and Professions Code.
   (c)  On and after January 1, 1997, no health care service plan
contract that is issued, amended, or renewed shall require
face-to-face contact between a health care provider and a patient for
services appropriately provided through telemedicine, subject to all
terms and conditions of the contract agreed upon between the
enrollee or subscriber and the plan. The requirement of this
subdivision shall be operative for health care service plan contracts
with the Medi-Cal managed care program only to the extent that both
of the following apply:
   (1)  Telemedicine services are covered by, and reimbursed under,
the Medi-Cal fee-for-service program, as provided in subdivision (c)
of Section 14132.72.
   (2)  Medi-Cal contracts with health care service plans are amended
to add coverage of telemedicine services and make any appropriate
capitation rate adjustments.
   (d)  Health care service plans shall not be required to pay for
consultation provided by the health care provider by telephone or
facsimile machines. 
   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) 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 Medi-Cal managed care
program. 
   SEC. 7.    Section 10123.85 of the  
Insurance Code   is repealed.  
   10123.85.  (a) It is the intent of the Legislature to recognize
the practice of telemedicine as a legitimate means by which an
individual may receive medical services from a health care provider
without person-to-person contact with the provider.
   (b) For the purposes of this section, the meaning of "telemedicine"
is as defined in subdivision (a) of Section 2290.5 of the Business
and Professions Code.
   (c) On and after January 1, 1997, no disability insurance contract
that is issued, amended, or renewed for hospital, medical, or
surgical coverage shall require face-to-face contact between a health
care provider and a patient for services appropriately provided
through telemedicine, subject to all terms and conditions of the
contract agreed upon between the policyholder or contractholder and
the insurer.
   (d) Disability insurers shall not be required to pay for
consultation provided by the health care provider by telephone or
facsimile machines. 
   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
contract holder and the insurer.
   (d) The health insurer shall not limit the type of setting where
services are provided for the patient or by the health care provider.

   SECTION 1.   SEC. 9.   Section 14132.72
of the Welfare and Institutions Code is amended to read: 
   14132.72.  (a) 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. 
    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.
   (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.  
   (e) The department shall not limit the type of setting where
services are provided for the patient or by the health care provider.
 
   (h) 
    (f)  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.

   (e) The health care provider shall comply with the informed
consent provisions of subdivisions (c) to (g), inclusive, of, and
subdivisions (i) and (j) of, Section 2290.5 of the Business and
Professions Code when a patient receives teleophthalmology or
teledermatology by store and forward.  
   (f) This section shall remain in effect only until January 1,
2013, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2013, deletes or extends
that date. 
   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.