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 ----------------------------------------------------------------- |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 | | | | | | ----------------------------------------------------------------- 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 AB 415 Page 2 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 AB 415 Page 3 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 AB 415 Page 4 written consent can be avoided. Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097 FN: 0001069