BILL ANALYSIS Ó
AB 415
Page 1
ASSEMBLY THIRD READING
AB 415 (Logue)
As Amended May 27, 2011
Majority vote
HEALTH 16-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Hayashi, Bonnie | |Charles Calderon, Campos, |
| |Lowenthal, Mansoor, | |Davis, Donnelly, Gatto, |
| |Mitchell, Nestande, Pan, | |Hall, Hill, Lara, |
| |V. Manuel Pérez, Silva, | |Mitchell, Nielsen, Norby, |
| |Williams | |Solorio, Wagner |
| | | | |
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SUMMARY : Revises the Telemedicine Development Act of 1996 (TDA)
to update and define terminology, repeals verbal and written
informed consent requirements prior to the delivery of health
care via telemedicine, requires health care service plans
(health plans), including those that contract with the Medi-Cal
Program, and health insurers to adopt payment policies to
compensate health care providers who provide covered health care
services appropriately provided through telehealth.
Specifically, this bill :
1)Replaces provisions in the Medical Practice Act (MPA) relating
to written and informed patient consent prior to the delivery
of health care via telemedicine, with a requirement that prior
to the use of telehealth, verbal consent of the patient is
obtained and documented in the patient's record. Requires all
laws regarding the confidentiality of health care information
and a patient's rights to his/her medical information to apply
to all telehealth interactions.
2)Repeals a prohibition on health plans and disability insurers
that prevents them from requiring face-to-face contact between
a health care provider and a patient for services
appropriately provided through telemedicine, and replaces it
with a prohibition on health plans and health insurers from
requiring in-person contact between a health care provider and
a patient before payment is made for the covered services
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appropriately provided through telehealth. Prohibits
in-person contact between a health care provider and a patient
before payment is made in the Medi-Cal Program subject to
reimbursement policies adopted by the Department of Health
Care Services (DHCS) to compensate a licensed health care
provider who provides health care services through telehealth
that are otherwise reimbursed pursuant to Medi-Cal.
3)Requires every health plan, including those contracting with
the Medi-Cal Managed Care Program, and every health insurer to
adopt payment policies consistent with 2) above to compensate
health care providers who provide covered health care services
through telehealth, subject to the terms and conditions of the
contract between the enrollee or subscriber and the health
plan.
4)Prohibits a health plan, a health insurer, and DHCS from
limiting the type of setting where services are provided for
the patient or by the health care provider.
5)Deletes the January 1, 2013, sunset date on existing law that
authorizes teleophthalmology and teledermatology by store and
forward in the Medi-Cal Program.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Unknown one-time workload, unlikely to exceed $100,000, to
DHCS to modify regulations, develop specific payment policies,
and communicate the new policies via provider bulletins.
2)Potential unknown additional costs, or savings, for telehealth
services in the Medi-Cal Program. The cost impacts would
depend on changes in payment policies developed by DHCS and
any resulting changes in provider billing behavior. A
significant increase in the use of telehealth could have
indirect fiscal impacts on Medi-Cal and health plans and
insurers. However, these potential impacts are speculative
and would be effects of the broader adoption of telehealth,
not specific impacts of this bill.
COMMENTS : According to the author, in 1996 California was the
first state to pass legislation (TDA) that, among other things,
established telemedicine as a legitimate means of receiving
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health care services, and provided parameters for reimbursement
in both private and public health coverage plans. When first
passed in 1996, telemedicine was still an unknown entity to
many. With almost two decades of experience utilizing
telemedicine in California and nationwide, the Veteran's
Administration has been one of the most prolific users of this
mode of health care, some of the concerns in 1996 no longer
apply. The provisions of the original TDA and its subsequent
amendments are outdated and may inhibit the full adoption of
telehealth in this state and the potential benefits (e.g.,
reducing costs, increasing access and improving the quality of
care it can offer).
In 2010, the Center for Connected Health Policy (CCHP) convened
a diverse work group of 25 prominent health care and policy
professionals to participate in a Telehealth Model Statute Work
Group. This group examined the barriers to the integration of
telehealth as a tool into California's health care delivery
system. A report that contained 13 recommendations was issued
in March 2011. This bill picks up some of the 13 workgroup
recommendations, and will clean up parts of current law that
have provided barriers in adopting the advances and changes
made in the last 15 years in addition to reducing the
duplicative administrative work and barriers regarding
telehealth.
Telehealth services consist of diagnosis, treatment, assessment,
monitoring, communications, and education. Telehealth includes
telemedicine, which is the diagnosis and treatment of illness or
injury. Telehealth medical services are delivered in three
ways: video conferencing, which is used for real-time
patient-provider consultations, provider-to-provider
discussions, and language translation services; patient
monitoring, in which electronic devices transmit patient health
information to health care providers; and, store and forward
technologies, which electronically transmit pre-recorded videos
and digital images (X-rays, video clips, and photos) between
primary care providers and medical specialists.
The CCHP indicates that telehealth is a mode of providing
services (not a treatment or procedure) but is treated similarly
in California law as these highly invasive procedures. By
eliminating the required written informed consent, more
expedient choices are created for patients; a delay to obtain
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written consent can be avoided.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN:
0001069