BILL NUMBER: AB 1733	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Logue

                        FEBRUARY 16, 2012

   An act to amend Section 1374.13 of the Health and Safety Code,
relating to health care service plans.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1733, as introduced, Logue. Health care service plans:
telehealth.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law prohibits a health care
service plan from requiring in-person contact between a health care
provider and a patient before payment is made for covered services
appropriately provided through telehealth, as specified. Existing law
specifies that this requirement applies to certain Medi-Cal managed
care plans, including county organized health systems and entities
contracting with the department to provide services pursuant to
2-plan models and geographic managed care.
   This bill would specify that the prohibition on requiring
in-person contact also applies to other health care service plan
contracts with the State Department of Health Care Services for
services under the Medi-Cal program publicly supported programs other
than Medi-Cal, and for services pursuant to the Program of
All-Inclusive Care for the Elderly. By expanding the scope of a
crime, the bill would impose a state-mandated local program.
   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: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1374.13 of the Health and Safety Code is
amended 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 telehealth, subject to the terms and conditions of the
contract entered into between the enrollee or subscriber and the
health care service plan, and between the health care service plan
and its participating providers or provider groups.
   (d) No health care service plan shall limit the type of setting
where services are provided for the patient or by the health care
provider before payment is made for the covered services
appropriately provided through telehealth, subject to the terms and
conditions of the contract entered into between the enrollee or
subscriber and the health care service plan, and between the health
care service plan and its participating providers or provider groups.

   (e) The requirements of this  subdivision shall also be
operative for health care service plan contracts with the department
pursuant to Article 2.7 (commencing with Section 14087.3), Article
2.8 (commencing with Section 14087.5), Article 2.81 (commencing with
Section 14087.96), or Article 2.91 (commencing with Section 14089) of
Chapter 7, or   section shall also apply to health care
service plan contracts with the State Department of Health Care
Services pursuant to Chapter 7 (commencing with Section 14000), 
Chapter 8 (commencing with Section 14200)  , or Chapter 8.75
(commencing with Section 14591)  of, Part 3 of Division 9 of the
Welfare and Institutions Code.
   (f) Notwithstanding any other provision, this section shall not be
interpreted to authorize a health care service plan to require the
use of telehealth when the health care provider has determined that
it is not appropriate.
  SEC. 2.  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.