BILL NUMBER: AB 1733 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 20, 2012
AMENDED IN ASSEMBLY APRIL 26, 2012
AMENDED IN ASSEMBLY APRIL 16, 2012
INTRODUCED BY Assembly Member Logue
FEBRUARY 16, 2012
An act to amend Section 1374.13 Sections
2028.5, 3041, and 4999.90 of, and to add Section 686 to,
the Business and Professions Code, to amend Sections 78910.10 and
101041 of the Education Code, to amend Sections 1367, 1374.13,
1375.1, 123149.5, and 127620 of the Health and Safety Code,
to amend Sections 10123.13 and 10123.147 of the Insurance Code,
and to amend Sections 14132.725 and 14132.73 of, and to
add Section 14594 to , the Welfare and Institutions
Code, relating to telehealth.
LEGISLATIVE COUNSEL'S DIGEST
AB 1733, as amended, Logue. 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.
Existing law establishes the California Program of All-Inclusive
Care for the Elderly (PACE) and provides that the State Department of
Health Care Services may enter into contracts with public or private
nonprofit organizations for implementation of the PACE program.
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, and publicly supported programs
other than Medi-Cal, as well as to the organizations implementing the
PACE program. By expanding the scope of a crime, the bill would
impose a state-mandated local program. The bill would also make
various related conforming changes, including requiring health care
practitioners providing telehealth services to practice
according to the regulations regarding their profession.
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 686 is added to the
Business and Professions Code , to read:
686. A health care practitioner licensed under Division 2
(commencing with Section 500) providing services via telehealth shall
be subject to the requirements and definitions set forth in Section
2290.5, to the practice act relating to his or her licensed
profession, and to the regulations adopted by a board pursuant to
that practice act.
SEC. 2. Section 2028.5 of the Business
and Professions Code is amended to read:
2028.5. (a) The board may establish a pilot program to expand the
practice of telemedicine telehealth in
this state.
(b) To implement this pilot program, the board may convene a
working group of interested parties from the public and private
sectors, including, but not limited to, state health-related
agencies, health care providers, health plan administrators,
information technology groups, and groups representing health care
consumers.
(c) The purpose of the pilot program shall be to develop methods,
using a telemedicine telehealth model,
to deliver throughout the state health care to persons with chronic
diseases as well as information on the best practices for chronic
disease management services and techniques and other health care
information as deemed appropriate.
(d) The board shall make a report with its recommendations
regarding its findings to the Legislature within one calendar year of
the commencement date of the pilot program. The report shall include
an evaluation of the improvement and affordability of health care
services and the reduction in the number of complications achieved by
the pilot program.
SEC. 3. Section 3041 of the Business
and Professions Code is amended to read:
3041. (a) The practice of optometry includes the prevention and
diagnosis of disorders and dysfunctions of the visual system, and the
treatment and management of certain disorders and dysfunctions of
the visual system, as well as the provision of rehabilitative
optometric services, and is the doing of any or all of the following:
(1) The examination of the human eye or eyes, or its or their
appendages, and the analysis of the human vision system, either
subjectively or objectively.
(2) The determination of the powers or range of human vision and
the accommodative and refractive states of the human eye or eyes,
including the scope of its or their functions and general condition.
(3) The prescribing or directing the use of, or using, any optical
device in connection with ocular exercises, visual training, vision
training, or orthoptics.
(4) The prescribing of contact and spectacle lenses for, or the
fitting or adaptation of contact and spectacle lenses to, the human
eye, including lenses that may be classified as drugs or devices by
any law of the United States or of this state.
(5) The use of topical pharmaceutical agents for the purpose of
the examination of the human eye or eyes for any disease or
pathological condition.
(b) (1) An optometrist who is certified to use therapeutic
pharmaceutical agents, pursuant to Section 3041.3, may also diagnose
and treat the human eye or eyes, or any of its or their appendages,
for all of the following conditions:
(A) Through medical treatment, infections of the anterior segment
and adnexa, excluding the lacrimal gland, the lacrimal drainage
system, and the sclera in patients under 12 years of age.
(B) Ocular allergies of the anterior segment and adnexa.
(C) Ocular inflammation, nonsurgical in cause except when
comanaged with the treating physician and surgeon, limited to
inflammation resulting from traumatic iritis, peripheral corneal
inflammatory keratitis, episcleritis, and unilateral nonrecurrent
nongranulomatous idiopathic iritis in patients over 18 years of age.
Unilateral nongranulomatous idiopathic iritis recurring within one
year of the initial occurrence shall be referred to an
ophthalmologist. An optometrist shall consult with an ophthalmologist
or appropriate physician and surgeon if a patient has a recurrent
case of episcleritis within one year of the initial occurrence. An
optometrist shall consult with an ophthalmologist or appropriate
physician and surgeon if a patient has a recurrent case of peripheral
corneal inflammatory keratitis within one year of the initial
occurrence.
(D) Traumatic or recurrent conjunctival or corneal abrasions and
erosions.
(E) Corneal surface disease and dry eyes.
(F) Ocular pain, nonsurgical in cause except when comanaged with
the treating physician and surgeon, associated with conditions
optometrists are authorized to treat.
(G) Pursuant to subdivision (f), glaucoma in patients over 18
years of age, as described in subdivision (j).
(2) For purposes of this section, "treat" means the use of
therapeutic pharmaceutical agents, as described in subdivision (c),
and the procedures described in subdivision (e).
(c) In diagnosing and treating the conditions listed in
subdivision (b), an optometrist certified to use therapeutic
pharmaceutical agents pursuant to Section 3041.3 may use all of the
following therapeutic pharmaceutical agents:
(1) Pharmaceutical agents as described in paragraph (5) of
subdivision (a), as well as topical miotics.
(2) Topical lubricants.
(3) Antiallergy agents. In using topical steroid medication for
the treatment of ocular allergies, an optometrist shall consult with
an ophthalmologist if the patient's condition worsens 21 days after
diagnosis.
(4) Topical and oral antiinflammatories. In using steroid
medication for:
(A) Unilateral nonrecurrent nongranulomatous idiopathic iritis or
episcleritis, an optometrist shall consult with an ophthalmologist or
appropriate physician and surgeon if the patient's condition worsens
72 hours after the diagnosis, or if the patient's condition has not
resolved three weeks after diagnosis. If the patient is still
receiving medication for these conditions six weeks after diagnosis,
the optometrist shall refer the patient to an ophthalmologist or
appropriate physician and surgeon.
(B) Peripheral corneal inflammatory keratitis, excluding Moorens
and Terriens diseases, an optometrist shall consult with an
ophthalmologist or appropriate physician and surgeon if the patient's
condition worsens 72 hours after diagnosis.
(C) Traumatic iritis, an optometrist shall consult with an
ophthalmologist or appropriate physician and surgeon if the patient's
condition worsens 72 hours after diagnosis and shall refer the
patient to an ophthalmologist or appropriate physician and surgeon if
the patient's condition has not resolved one week after diagnosis.
(5) Topical antibiotic agents.
(6) Topical hyperosmotics.
(7) Topical and oral antiglaucoma agents pursuant to the
certification process defined in subdivision (f).
(A) The optometrist shall refer the patient to an ophthalmologist
if requested by the patient or if angle closure glaucoma develops.
(B) If the glaucoma patient also has diabetes, the optometrist
shall consult with the physician treating the patient's diabetes in
developing the glaucoma treatment plan and shall inform the physician
in writing of any changes in the patient's glaucoma medication.
(8) Nonprescription medications used for the rational treatment of
an ocular disorder.
(9) Oral antihistamines.
(10) Prescription oral nonsteroidal antiinflammatory agents.
(11) Oral antibiotics for medical treatment of ocular disease.
(A) If the patient has been diagnosed with a central corneal ulcer
and the central corneal ulcer has not improved 48 hours after
diagnosis, the optometrist shall refer the patient to an
ophthalmologist.
(B) If the patient has been diagnosed with preseptal cellulitis or
dacryocystitis and the condition has not improved 48 hours after
diagnosis, the optometrist shall refer the patient to an
ophthalmologist.
(12) Topical and oral antiviral medication for the medical
treatment of the following: herpes simplex viral keratitis, herpes
simplex viral conjunctivitis, and periocular herpes simplex viral
dermatitis; and varicella zoster viral keratitis, varicella zoster
viral conjunctivitis, and periocular varicella zoster viral
dermatitis.
(A) If the patient has been diagnosed with herpes simplex
keratitis or varicella zoster viral keratitis and the patient's
condition has not improved seven days after diagnosis, the
optometrist shall refer the patient to an ophthalmologist. If a
patient's condition has not resolved three weeks after diagnosis, the
optometrist shall refer the patient to an ophthalmologist.
(B) If the patient has been diagnosed with herpes simplex viral
conjunctivitis, herpes simplex viral dermatitis, varicella zoster
viral conjunctivitis, or varicella zoster viral dermatitis, and if
the patient's condition worsens seven days after diagnosis, the
optometrist shall consult with an ophthalmologist. If the patient's
condition has not resolved three weeks after diagnosis, the
optometrist shall refer the patient to an ophthalmologist.
(13) Oral analgesics that are not controlled substances.
(14) Codeine with compounds and hydrocodone with compounds as
listed in the California Uniform Controlled Substances Act (Division
10 (commencing with Section 11000) of the Health and Safety Code) and
the United States Uniform Controlled Substances Act (21 U.S.C. Sec.
801 et seq.). The use of these agents shall be limited to three days,
with a referral to an ophthalmologist if the pain persists.
(d) In any case where this chapter requires that an optometrist
consult with an ophthalmologist, the optometrist shall maintain a
written record in the patient's file of the information provided to
the ophthalmologist, the ophthalmologist's response, and any other
relevant information. Upon the consulting ophthalmologist's request
and with the patient's consent, the optometrist shall furnish a copy
of the record to the ophthalmologist.
(e) An optometrist who is certified to use therapeutic
pharmaceutical agents pursuant to Section 3041.3 may also perform all
of the following:
(1) Corneal scraping with cultures.
(2) Debridement of corneal epithelia.
(3) Mechanical epilation.
(4) Venipuncture for testing patients suspected of having
diabetes.
(5) Suture removal, with prior consultation with the treating
physician and surgeon.
(6) Treatment or removal of sebaceous cysts by expression.
(7) Administration of oral fluorescein to patients suspected as
having diabetic retinopathy.
(8) Use of an auto-injector to counter anaphylaxis.
(9) Ordering of smears, cultures, sensitivities, complete blood
count, mycobacterial culture, acid fast stain, urinalysis, and X-rays
necessary for the diagnosis of conditions or diseases of the eye or
adnexa. An optometrist may order other types of images subject to
prior consultation with an ophthalmologist or appropriate physician
and surgeon.
(10) Punctal occlusion by plugs, excluding laser, diathermy,
cryotherapy, or other means constituting surgery as defined in this
chapter.
(11) The prescription of therapeutic contact lenses, including
lenses or devices that incorporate a medication or therapy the
optometrist is certified to prescribe or provide.
(12) Removal of foreign bodies from the cornea, eyelid, and
conjunctiva with any appropriate instrument other than a scalpel or
needle. Corneal foreign bodies shall be nonperforating, be no deeper
than the midstroma, and require no surgical repair upon removal.
(13) For patients over 12 years of age, lacrimal irrigation and
dilation, excluding probing of the nasal lacrimal tract. The board
shall certify any optometrist who graduated from an accredited school
of optometry before May 1, 2000, to perform this procedure after
submitting proof of satisfactory completion of 10 procedures under
the supervision of an ophthalmologist as confirmed by the
ophthalmologist. Any optometrist who graduated from an accredited
school of optometry on or after May 1, 2000, shall be exempt from the
certification requirement contained in this paragraph.
(f) The board shall grant a certificate to an optometrist
certified pursuant to Section 3041.3 for the treatment of glaucoma,
as described in subdivision (j), in patients over 18 years of age
after the optometrist meets the following applicable requirements:
(1) For licensees who graduated from an accredited school of
optometry on or after May 1, 2008, submission of proof of graduation
from that institution.
(2) For licensees who were certified to treat glaucoma under this
section prior to January 1, 2009, submission of proof of completion
of that certification program.
(3) For licensees who have substantially completed the
certification requirements pursuant to this section in effect between
January 1, 2001, and December 31, 2008, submission of proof of
completion of those requirements on or before December 31, 2009.
"Substantially completed" means both of the following:
(A) Satisfactory completion of a didactic course of not less than
24 hours in the diagnosis, pharmacological, and other treatment and
management of glaucoma.
(B) Treatment of 50 glaucoma patients with a collaborating
ophthalmologist for a period of two years for each patient that will
conclude on or before December 31, 2009.
(4) For licensees who completed a didactic course of not less than
24 hours in the diagnosis, pharmacological, and other treatment and
management of glaucoma, submission of proof of satisfactory
completion of the case management requirements for certification
established by the board pursuant to Section 3041.10.
(5) For licensees who graduated from an accredited school of
optometry on or before May 1, 2008, and not described in paragraph
(2), (3), or (4), submission of proof of satisfactory completion of
the requirements for certification established by the board pursuant
to Section 3041.10.
(g) Other than for prescription ophthalmic devices described in
subdivision (b) of Section 2541, any dispensing of a therapeutic
pharmaceutical agent by an optometrist shall be without charge.
(h) The practice of optometry does not include performing surgery.
"Surgery" means any procedure in which human tissue is cut, altered,
or otherwise infiltrated by mechanical or laser means. "Surgery"
does not include those procedures specified in subdivision (e).
Nothing in this section shall limit an optometrist's authority to
utilize diagnostic laser and ultrasound technology within his or her
scope of practice.
(i) An optometrist licensed under this chapter is subject to the
provisions of Section 2290.5 for purposes of practicing
telemedicine telehealth .
(j) For purposes of this chapter, "glaucoma" means either of the
following:
(1) All primary open-angle glaucoma.
(2) Exfoliation and pigmentary glaucoma.
(k) In an emergency, an optometrist shall stabilize, if possible,
and immediately refer any patient who has an acute attack of angle
closure to an ophthalmologist.
SEC. 4. Section 4999.90 of the Business
and Professions Code is amended to read:
4999.90. The board may refuse to issue any registration or
license, or may suspend or revoke the registration or license of any
intern or licensed professional clinical counselor, if the applicant,
licensee, or registrant has been guilty of unprofessional conduct.
Unprofessional conduct includes, but is not limited to, the
following:
(a) The conviction of a crime substantially related to the
qualifications, functions, or duties of a licensee or registrant
under this chapter. The record of conviction shall be conclusive
evidence only of the fact that the conviction occurred. The board may
inquire into the circumstances surrounding the commission of the
crime in order to fix the degree of discipline or to determine if the
conviction is substantially related to the qualifications,
functions, or duties of a licensee or registrant under this chapter.
A plea or verdict of guilty or a conviction following a plea of nolo
contendere made to a charge substantially related to the
qualifications, functions, or duties of a licensee or registrant
under this chapter shall be deemed to be a conviction within the
meaning of this section. The board may order any license or
registration suspended or revoked, or may decline to issue a license
or registration when the time for appeal has elapsed, or the judgment
of conviction has been affirmed on appeal, or, when an order
granting probation is made suspending the imposition of sentence,
irrespective of a subsequent order under Section 1203.4 of the Penal
Code allowing the person to withdraw a plea of guilty and enter a
plea of not guilty, or setting aside the verdict of guilty, or
dismissing the accusation, information, or indictment.
(b) Securing a license or registration by fraud, deceit, or
misrepresentation on any application for licensure or registration
submitted to the board, whether engaged in by an applicant for a
license or registration, or by a licensee in support of any
application for licensure or registration.
(c) Administering to himself or herself any controlled substance
or using any of the dangerous drugs specified in Section 4022, or any
alcoholic beverage to the extent, or in a manner, as to be dangerous
or injurious to the person applying for a registration or license or
holding a registration or license under this chapter, or to any
other person, or to the public, or, to the extent that the use
impairs the ability of the person applying for or holding a
registration or license to conduct with safety to the public the
practice authorized by the registration or license, or the conviction
of more than one misdemeanor or any felony involving the use,
consumption, or self-administration of any of the substances referred
to in this subdivision, or any combination thereof. The board shall
deny an application for a registration or license or revoke the
license or registration of any person, other than one who is licensed
as a physician and surgeon, who uses or offers to use drugs in the
course of performing licensed professional clinical counseling
services.
(d) Gross negligence or incompetence in the performance of
licensed professional clinical counseling services.
(e) Violating, attempting to violate, or conspiring to violate any
of the provisions of this chapter or any regulation adopted by the
board.
(f) Misrepresentation as to the type or status of a license or
registration held by the person, or otherwise misrepresenting or
permitting misrepresentation of his or her education, professional
qualifications, or professional affiliations to any person or entity.
(g) Impersonation of another by any licensee, registrant, or
applicant for a license or registration, or, in the case of a
licensee or registrant, allowing any other person to use his or her
license or registration.
(h) Aiding or abetting, or employing, directly or indirectly, any
unlicensed or unregistered person to engage in conduct for which a
license or registration is required under this chapter.
(i) Intentionally or recklessly causing physical or emotional harm
to any client.
(j) The commission of any dishonest, corrupt, or fraudulent act
substantially related to the qualifications, functions, or duties of
a licensee or registrant.
(k) Engaging in sexual relations with a client, or a former client
within two years following termination of therapy, soliciting sexual
relations with a client, or committing an act of sexual abuse, or
sexual misconduct with a client, or committing an act punishable as a
sexually related crime, if that act or solicitation is substantially
related to the qualifications, functions, or duties of a licensed
professional clinical counselor.
(l) Performing, or holding oneself out as being able to perform,
or offering to perform, or permitting any clinical counselor trainee
or intern under supervision to perform, any professional services
beyond the scope of the license authorized by this chapter.
(m) Failure to maintain confidentiality, except as otherwise
required or permitted by law, of all information that has been
received from a client in confidence during the course of treatment
and all information about the client which is obtained from tests or
other means.
(n) Prior to the commencement of treatment, failing to disclose to
the client or prospective client the fee to be charged for the
professional services, or the basis upon which that fee will be
computed.
(o) Paying, accepting, or soliciting any consideration,
compensation, or remuneration, whether monetary or otherwise, for the
referral of professional clients. All consideration, compensation,
or remuneration shall be in relation to professional clinical
counseling services actually provided by the licensee. Nothing in
this subdivision shall prevent collaboration among two or more
licensees in a case or cases. However, no fee shall be charged for
that collaboration, except when disclosure of the fee has been made
in compliance with subdivision (n).
(p) Advertising in a manner that is false, fraudulent, misleading,
or deceptive, as defined in Section 651.
(q) Reproduction or description in public, or in any publication
subject to general public distribution, of any psychological test or
other assessment device, the value of which depends in whole or in
part on the naivete of the subject, in ways that might invalidate the
test or device.
(r) Any conduct in the supervision of a registered intern,
associate clinical social worker, or clinical counselor trainee by
any licensee that violates this chapter or any rules or regulations
adopted by the board.
(s) Performing or holding oneself out as being able to perform
professional services beyond the scope of one's competence, as
established by one's education, training, or experience. This
subdivision shall not be construed to expand the scope of the license
authorized by this chapter.
(t) Permitting a clinical counselor trainee or intern under one's
supervision or control to perform, or permitting the clinical
counselor trainee or intern to hold himself or herself out as
competent to perform, professional services beyond the clinical
counselor trainee's or intern's level of education, training, or
experience.
(u) The violation of any statute or regulation of the standards of
the profession, and the nature of the services being rendered,
governing the gaining and supervision of experience required by this
chapter.
(v) Failure to keep records consistent with sound clinical
judgment, the standards of the profession, and the nature of the
services being rendered.
(w) Failure to comply with the child abuse reporting requirements
of Section 11166 of the Penal Code.
(x) Failing to comply with the elder and dependent adult abuse
reporting requirements of Section 15630 of the Welfare and
Institutions Code.
(y) Repeated acts of negligence.
(z) (1) Engaging in an act described in Section 261, 286, 288a, or
289 of the Penal Code with a minor or an act described in Section
288 or 288.5 of the Penal Code regardless of whether the act occurred
prior to or after the time the registration or license was issued by
the board. An act described in this subdivision occurring prior to
the effective date of this subdivision shall constitute
unprofessional conduct and shall subject the licensee to refusal,
suspension, or revocation of a license under this section.
(2) The Legislature hereby finds and declares that protection of
the public, and in particular minors, from sexual misconduct by a
licensee is a compelling governmental interest, and that the ability
to suspend or revoke a license for sexual conduct with a minor
occurring prior to the effective date of this section is equally
important to protecting the public as is the ability to refuse a
license for sexual conduct with a minor occurring prior to the
effective date of this section.
(aa) Engaging in any conduct that subverts or attempts to subvert
any licensing examination or the administration of an examination as
described in Section 123.
(ab) Revocation, suspension, or restriction by the board of a
license, certificate, or registration to practice as a professional
clinical counselor, clinical social worker, educational psychologist,
or marriage and family therapist.
(ac) Failing to comply with the procedures set forth in Section
2290.5 when delivering health care via telemedicine
telehealth .
SEC. 5. Section 78910.10 of the
Education Code is amended to read:
78910.10. (a) (1) The California Virtual Campus, pursuant to
funding provided to the Board of Governors of the California
Community Colleges for this purpose in the annual Budget Act, may
pursue all of the following purposes, to the extent funding is
available:
(A) To enrich formal and informal educational experiences and
improve students' academic performance by supporting the development
of highly engaging, research-based innovations in teaching and
learning in K-12 public schools and the California Community
Colleges, the California State University, and the University of
California.
(B) To enhance the awareness of, and access to, highly engaging
online courses of study, emphasizing courses of study that support a
diverse and highly skilled science, technology, engineering, and
mathematics workforce.
(C) To support education research, the implementation of
research-based practices, and promote economic development through
the use of next generation advanced network infrastructure, services,
and network technologies that enable collaboration and resource
sharing between formal and informal educators in K-12 public schools,
the California Community Colleges, the California State University,
the University of California, independent colleges and universities,
public libraries, and community-based organizations at locations
across the state.
(D) To increase access to next generation Internet services, 21st
century workforce development programs, and e-government services for
students and staff served or employed by education entities and
students served primarily online through partnerships with public
libraries and community-based organizations.
(E) To enhance access to health care education and training
programs to current or future health care workers.
(F) To manage digital assets and develop contracts for services
necessary to provide the technical and management support needed to
maximize the benefits of the high-speed, high-bandwidth network
infrastructure available to public higher education
entities in California.
(G) Through the aggregation of demand for network enabled
technologies and related services from public education entities, and
through partnerships with the private sector, to provide education
entities with access to technical support and staff who can
facilitate statewide efforts that support innovations in teaching and
learning that are necessary to provide for a well-educated
citizenry, and economic and 21st century workforce development.
(2) To accomplish the purposes of paragraph (1), the California
Virtual Campus may partner with local educational agencies, the State
Department of Education, the 11 regional California Technology
Assistance Projects, the California Community Colleges, the
California State University, the University of California,
independent colleges and universities, public libraries, and
community-based organizations to facilitate ongoing collaboration and
joint efforts relating to the use of technology resources and
high-speed Internet connectivity to support teaching, learning,
workforce development, and research.
(3) Efforts conducted as a result of this chapter shall not
prohibit or otherwise exclude the ability of existing or new
educational technology programs from being developed, expanded, or
enhanced.
(b) For purposes of this article, the following terms have the
following meanings:
(1) "Online courses of study" means any of the following:
(A) Online teaching, learning, and research resources, including,
but not necessarily limited to, books, course materials, video
materials, interactive lessons, tests, or software, the copyrights of
which have expired, or have been released with an intellectual
property license that permits their free use or repurposing by others
without the permission of the original authors or creators of the
learning materials or resources.
(B) Professional development opportunities for formal and informal
educators who desire to use the resources in subparagraph (A).
(C) Online instruction.
(2) "Online instruction" means technology enabled online real time
(synchronous) interaction between the instructor and the student,
near time (asynchronous) interaction between the instructor and the
student, or any combination thereof.
(c) The California Virtual Campus grant recipient may accomplish
all of the following:
(1) Convene at least four leadership stakeholder group meetings
annually comprised of representatives from the State Department of
Education, the California Technology Assistance Project, and other
related programs administered through the department, local education
agencies, including adult education, the California Community
Colleges, the California State University, the University of
California, independent colleges and universities, the California
State Library, and representatives from community-based organizations
to ensure the efforts affecting segments represented are
appropriately meeting the needs of those segments. The leadership
stakeholder group shall also coordinate and obtain assistance with
the implementation of efforts delineated in this article, to identify
and maintain an up-to-date list of the technology resources and
tools that are necessary to support innovation in teaching and
learning, and to identify opportunities for leveraging resources and
expertise for meeting those needs in an efficient and cost-effective
manner.
(2) Lead efforts to make online courses of study available across
the state that include, but are not limited to, the following:
(A) Developing online courses of study that are pedagogically
sound and fully accessible, in compliance with the federal Americans
with Disabilities Act (Public Law 101-336), by students with varying
learning styles and disabilities.
(i) The development of K-12 online courses pursuant to this
subparagraph shall be achieved in partnership with local education
agencies and the California Technology Assistance Project.
(ii) Online courses developed for grades K-12 pursuant to this
subparagraph shall be aligned to the California academic content
standards and guidelines for online courses.
(B) Overseeing the development of at least 12 model online courses
of study that, collectively, would allow students to meet the
requirements of the Intersegmental General Education Transfer
Curriculum (IGETC) and at least two courses that support basic skills
education courses in English, English as a second language, or
mathematics.
(C) Encouraging the entities listed in paragraph (1) to do both of
the following:
(i) Make accessible to each other their courses of study that are
funded by the state.
(ii) Allow their courses of study to be accessible to the general
public if they determine access would not inhibit their ability to
provide appropriate protection of the state's intellectual property
rights.
(3) Ensure that the learning objects created as part of the
California Virtual Campus online courses of study with state General
Fund revenues are linked to digital content libraries that include
information about course content freely available to California
educators and students.
(4) Develop formal partnership agreements between the entities
listed in paragraph (1) and the California Virtual Campus, including
course articulation agreements that allow qualified high school
students to accelerate the completion of requirements for a high
school diploma and a two-year or four-year degree and agreements that
provide opportunities for part-time faculty teaching online to
obtain full-time employment teaching online.
(5) Develop formal partnership agreements with the entities listed
in paragraph (1) and others to enhance access to professional
development courses that introduce faculty, teachers, staff, and
college course developers to the conceptual development, creation,
and production methodologies that underlie the development of online
courses of study and support students' successful completion of those
courses. The professional development opportunities may include, but
not necessarily be limited to, all of the following:
(A) Addressing issues relating to copyright, permission for the
use or reuse of material, use of resources in the public domain, and
other intellectual property concepts.
(B) Accessibility for students with disabilities.
(C) Factors to ensure that content is culturally relevant to a
diverse student body.
(D) Delivery options that incorporate multiple learning styles and
strategies.
(6) Develop formal partnership agreements with entities,
including, but not limited to, those listed in paragraph (1), to
ensure access to online professional learning communities that
incorporate the use of Internet-based collaboration tools and to
support joint discussions between K-12 educators, higher education
faculty and staff, and others to examine student performance data,
student learning objectives, curriculum, and other issues that relate
to students' academic success and preparation for the workforce.
(7) In partnership with entities, including those listed in
paragraph (1), develop an e-portfolio system that allows
participating students to demonstrate their attainment of academic
learning objectives, skills and knowledge that relate to their career
interests, and completion of prerequisites for participation in
courses or training programs. The e-portfolio system may do all of
the following:
(A) Ensure that student privacy is protected in accordance with
existing law.
(B) Comply with accessibility laws for students with disabilities.
(C) Be designed in a manner that supports the use of e-portfolio
content in the accreditation requirements of schools, colleges, and
universities.
(8) In partnership with entities, including those listed in
paragraph (1), identify opportunities to enhance students' access to
medical education and medical services through the use of high-speed
Internet connections to the campuses, and opportunities for education
programs and services to support the telemedicine
telehealth efforts taking place within the state.
(d) The lead agency for the California Virtual Campus, in
consultation with the leadership stakeholder group described in
paragraph (1) of subdivision (c) if that group is convened by the
California Virtual Campus grant recipient, shall contract with an
independent third party with expertise in online teaching, learning,
and the development of online courses of study, as approved by the
board, to evaluate the California Virtual Campus. The evaluation
shall include, but not be limited to, an assessment of the number of
faculty, teachers, consortia, informal educators, and students that
use the online courses of study, the quality of students'
experiences, student grades earned, and the cost of the online course
content, comparing the online course content with traditional
textbooks. The board may require additional information that it
determines to be necessary to evaluate the effectiveness and
viability of the California Virtual Campus. This evaluation shall be
submitted to the Legislature no later than three years of the
enactment of this act.
SEC. 6. Section 101041 of the Education
Code is amended to read:
101041. (a) From the proceeds of bonds issued and sold pursuant
to Article 4 (commencing with Section 101050), the sum of eight
hundred ninety million dollars ($890,000,000) shall be deposited in
the 2006 University Capital Outlay Bond Fund for the purposes of this
article. When appropriated, these funds shall be available for
expenditure for the purposes of this article.
(b) The purposes of this article include assisting in meeting the
capital outlay financing needs of the University of California and
the Hastings College of the Law.
(c) Of the amount made available under subdivision (a), the amount
of two hundred million dollars ($200,000,000) shall be used for
capital improvements that expand and enhance medical education
programs with an emphasis on telemedicine
telehealth aimed at developing high-tech approaches to health
care.
(d) Proceeds from the sale of bonds issued and sold for the
purposes of this article may be used to fund construction on existing
campuses, including the construction of buildings and the
acquisition of related fixtures, construction of facilities that may
be used by more than one segment of public higher education
(intersegmental), the renovation and reconstruction of facilities,
site acquisition, the equipping of new, renovated, or reconstructed
facilities, which equipment shall have an average useful life of 10
years; and to provide funds for the payment of preconstruction costs,
including, but not limited to, preliminary plans and working
drawings for facilities of the University of California and the
Hastings College of the Law.
SEC. 7. Section 1367 of the Health and
Safety Code is amended to read:
1367. A health care service plan and, if applicable, a
specialized health care service plan shall meet the following
requirements:
(a) Facilities located in this state including, but not limited
to, clinics, hospitals, and skilled nursing facilities to be utilized
by the plan shall be licensed by the State Department of Health
Services, where licensure is required by law. Facilities not located
in this state shall conform to all licensing and other requirements
of the jurisdiction in which they are located.
(b) Personnel employed by or under contract to the plan shall be
licensed or certified by their respective board or agency, where
licensure or certification is required by law.
(c) Equipment required to be licensed or registered by law shall
be so licensed or registered, and the operating personnel for that
equipment shall be licensed or certified as required by law.
(d) The plan shall furnish services in a manner providing
continuity of care and ready referral of patients to other providers
at times as may be appropriate consistent with good professional
practice.
(e) (1) All services shall be readily available at reasonable
times to each enrollee consistent with good professional practice. To
the extent feasible, the plan shall make all services readily
accessible to all enrollees consistent with Section 1367.03.
(2) To the extent that telemedicine
telehealth services are appropriately provided through
telemedicine telehealth , as defined in
subdivision (a) of Section 2290.5 of the Business and Professions
Code, these services shall be considered in determining compliance
with Section 1300.67.2 of Title 28 of the California Code of
Regulations.
(3) The plan shall make all services accessible and appropriate
consistent with Section 1367.04.
(f) The plan shall employ and utilize allied health manpower for
the furnishing of services to the extent permitted by law and
consistent with good medical practice.
(g) The plan shall have the organizational and administrative
capacity to provide services to subscribers and enrollees. The plan
shall be able to demonstrate to the department that medical decisions
are rendered by qualified medical providers, unhindered by fiscal
and administrative management.
(h) (1) Contracts with subscribers and enrollees, including group
contracts, and contracts with providers, and other persons furnishing
services, equipment, or facilities to or in connection with the
plan, shall be fair, reasonable, and consistent with the objectives
of this chapter. All contracts with providers shall contain
provisions requiring a fast, fair, and cost-effective dispute
resolution mechanism under which providers may submit disputes to the
plan, and requiring the plan to inform its providers upon
contracting with the plan, or upon change to these provisions, of the
procedures for processing and resolving disputes, including the
location and telephone number where information regarding disputes
may be submitted.
(2) A health care service plan shall ensure that a dispute
resolution mechanism is accessible to noncontracting providers for
the purpose of resolving billing and claims disputes.
(3) On and after January 1, 2002, a health care service plan shall
annually submit a report to the department regarding its dispute
resolution mechanism. The report shall include information on the
number of providers who utilized the dispute resolution mechanism and
a summary of the disposition of those disputes.
(i) A health care service plan contract shall provide to
subscribers and enrollees all of the basic health care services
included in subdivision (b) of Section 1345, except that the director
may, for good cause, by rule or order exempt a plan contract or any
class of plan contracts from that requirement. The director shall by
rule define the scope of each basic health care service that health
care service plans are required to provide as a minimum for licensure
under this chapter. Nothing in this chapter shall prohibit a health
care service plan from charging subscribers or enrollees a copayment
or a deductible for a basic health care service or from setting
forth, by contract, limitations on maximum coverage of basic health
care services, provided that the copayments, deductibles, or
limitations are reported to, and held unobjectionable by, the
director and set forth to the subscriber or enrollee pursuant to the
disclosure provisions of Section 1363.
(j) A health care service plan shall not require registration
under the Controlled Substances Act of 1970 (21 U.S.C. Sec. 801 et
seq.) as a condition for participation by an optometrist certified to
use therapeutic pharmaceutical agents pursuant to Section 3041.3 of
the Business and Professions Code.
Nothing in this section shall be construed to permit the director
to establish the rates charged subscribers and enrollees for
contractual health care services.
The director's enforcement of Article 3.1 (commencing with Section
1357) shall not be deemed to establish the rates charged subscribers
and enrollees for contractual health care services.
The obligation of the plan to comply with this section shall not
be waived when the plan delegates any services that it is required to
perform to its medical groups, independent practice associations, or
other contracting entities.
SECTION 1. SEC. 8. 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 section shall also apply to health
care service plan and Medi-Cal managed care plan contracts with the
State Department of Health Care Services pursuant to Chapter 7
(commencing with Section 14000) or Chapter 8 (commencing with Section
14200) 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. 9. Section 1375.1 of the Health
and Safety Code is amended to read:
1375.1. (a) Every plan shall have and shall demonstrate to the
director that it has all of the following:
(1) A fiscally sound operation and adequate provision against the
risk of insolvency.
(2) Assumed full financial risk on a prospective basis for the
provision of covered health care services, except that a plan may
obtain insurance or make other arrangements for the cost of providing
to any subscriber or enrollee covered health care services, the
aggregate value of which exceeds five thousand dollars ($5,000) in
any year, for the cost of covered health care services provided to
its members other than through the plan because medical necessity
required their provision before they could be secured through the
plan, and for not more than 90 percent of the amount by which its
costs for any of its fiscal years exceed 115 percent of its income
for that fiscal year.
(3) A procedure for prompt payment or denial of provider and
subscriber or enrollee claims, including those telemedicine
telehealth services, as defined in subdivision
(a) of Section 2290.5 of the Business and Professions Code, covered
by the plan. Except as provided in Section 1371, a procedure meeting
the requirements of Subchapter G of the regulations (29 C.F.R. Part
2560) under Public Law 93-406 (88 Stats. 829-1035, 29 U.S.C. Secs.
1001 et seq.) shall satisfy this requirement.
(b) In determining whether the conditions of this section have
been met, the director shall consider, but not be limited to, the
following:
(1) The financial soundness of the plan's arrangements for health
care services and the schedule of rates and charges used by the plan.
(2) The adequacy of working capital.
(3) Agreements with providers for the provision of health care
services.
(c) For the purposes of this section, "covered health care
services" means health care services provided under all plan
contracts.
SEC. 10. Section 123149.5 of the Health
and Safety Code is amended to read:
123149.5. (a) It is the intent of the Legislature that all
medical information transmitted during the delivery of health care
via telemedicine telehealth , as
defined in subdivision (a) of Section 2290.5 of the Business and
Professions Code, become part of the patient's medical record
maintained by the licensed health care provider.
(b) This section shall not be construed to limit or waive any of
the requirements of Chapter 1 (commencing with Section 123100) of
Part 1 of Division 106 of the Health and Safety Code.
SEC. 11. Section 127620 of the Health
and Safety Code is amended to read:
127620. (a) The Office of Statewide Health Planning and
Development, in conjunction with the State Department of Health
Services, shall act as the coordinating agency to develop a strategic
plan that would assist rural California to prepare for health care
reform. The plan shall assist in the coordination and integration of
all rural health care services on the birth to death continuum and
serve as an infrastructure for rural communities to establish
priorities and develop appropriate programs.
(b) The office shall designate representatives from provider
groups including rural hospitals, clinics, physicians, other rural
providers including psychologists, counties, beneficiaries, and other
entities directly affected by the plan. The office shall convene
meetings with the objectives of doing all of the following:
(1) Assessing the current status of health care in rural
communities.
(2) Assembling and reviewing data related to available programs
and resources for rural California.
(3) Assembling and reviewing data related to other states'
strategic plans for rural communities.
(4) Reviewing and integrating the office's rural work plan, as
appropriate.
(5) Making assumptions about the future of health care and
developing a strategic plan based on these assumptions.
(c) The rural health care strategic plan shall address all of the
following:
(1) The special needs of the elderly and of ethnic populations.
(2) Elimination of barriers in planning and coordinating health
services.
(3) The lack of primary and specialty providers.
(4) Access to emergency services.
(5) The role of new technologies, including, but not limited to,
telemedicine telehealth .
SEC. 12. Section 10123.13 of the
Insurance Code is amended to read:
10123.13. (a) Every insurer issuing group or individual policies
of health insurance that covers hospital, medical, or surgical
expenses, including those telemedicine
telehealth services covered by the insurer as defined in
subdivision (a) of Section 2290.5 of the Business and Professions
Code, shall reimburse claims or any portion of any claim, whether in
state or out of state, for those expenses as soon as practical, but
no later than 30 working days after receipt of the claim by the
insurer unless the claim or portion thereof is contested by the
insurer, in which case the claimant shall be notified, in writing,
that the claim is contested or denied, within 30 working days after
receipt of the claim by the insurer. The notice that a claim is being
contested or denied shall identify the portion of the claim that is
contested or denied and the specific reasons including for each
reason the factual and legal basis known at that time by the insurer
for contesting or denying the claim. If the reason is based solely on
facts or solely on law, the insurer is required to provide only the
factual or the legal basis for its reason for contesting or denying
the claim. The insurer shall provide a copy of the notice to each
insured who received services pursuant to the claim that was
contested or denied and to the insured's health care provider that
provided the services at issue. The notice shall advise the provider
who submitted the claim on behalf of the insured or pursuant to a
contract for alternative rates of payment and the insured that either
may seek review by the department of a claim that the insurer
contested or denied, and the notice shall include the address,
Internet Web site address, and telephone number of the unit within
the department that performs this review function. The notice to the
provider may be included on either the explanation of benefits or
remittance advice and shall also contain a statement advising the
provider of its right to enter into the dispute resolution process
described in Section 10123.137. The notice to the insured may also be
included on the explanation of benefits.
(b) If an uncontested claim is not reimbursed by delivery to the
claimant's address of record within 30 working days after receipt,
interest shall accrue and shall be payable at the rate of 10 percent
per annum beginning with the first calendar day after the 30-working
day period.
(c) For purposes of this section, a claim, or portion thereof, is
reasonably contested when the insurer has not received a completed
claim and all information necessary to determine payer liability for
the claim, or has not been granted reasonable access to information
concerning provider services. Information necessary to determine
liability for the claims includes, but is not limited to, reports of
investigations concerning fraud and misrepresentation, and necessary
consents, releases, and assignments, a claim on appeal, or other
information necessary for the insurer to determine the medical
necessity for the health care services provided to the claimant. If
an insurer has received all of the information necessary to determine
payer liability for a contested claim and has not reimbursed a claim
determined to be payable within 30 working days of receipt of that
information, interest shall accrue and be payable at a rate of 10
percent per annum beginning with the first calendar day after the
30-working day period.
(d) The obligation of the insurer to comply with this section
shall not be deemed to be waived when the insurer requires its
contracting entities to pay claims for covered services.
SEC. 13. Section 10123.147 of the
Insurance Code is amended to read:
10123.147. (a) Every insurer issuing group or individual policies
of health insurance that covers hospital, medical, or surgical
expenses, including those telemedicine
telehealth services covered by the insurer as defined in
subdivision (a) of Section 2290.5 of the Business
and Professions Code, shall reimburse each
complete claim, or portion thereof, whether in state or out of state,
as soon as practical, but no later than 30 working days after
receipt of the complete claim by the insurer. However, an insurer may
contest or deny a claim, or portion thereof, by notifying the
claimant, in writing, that the claim is contested or denied, within
30 working days after receipt of the complete claim by the insurer.
The notice that a claim, or portion thereof, is contested shall
identify the portion of the claim that is contested, by revenue code,
and the specific information needed from the provider to reconsider
the claim. The notice that a claim, or portion thereof, is denied
shall identify the portion of the claim that is denied, by revenue
code, and the specific reasons for the denial, including the factual
and legal basis known at that time by the insurer for each reason. If
the reason is based solely on facts or solely on law, the insurer is
required to provide only the factual or legal basis for its reason
to deny the claim. The insurer shall provide a copy of the notice
required by this subdivision to each insured who received services
pursuant to the claim that was contested or denied and to the insured'
s health care provider that provided the services at issue. The
notice required by this subdivision shall include a statement
advising the provider who submitted the claim on behalf of the
insured or pursuant to a contract for alternative rates of payment
and the insured that either may seek review by the department of a
claim that was contested or denied by the insurer and the address,
Internet Web site address, and telephone number of the unit within
the department that performs this review function. The notice to the
provider may be included on either the explanation of benefits or
remittance advice and shall also contain a statement advising the
provider of its right to enter into the dispute resolution process
described in Section 10123.137. An insurer may delay payment of an
uncontested portion of a complete claim for reconsideration of a
contested portion of that claim so long as the insurer pays those
charges specified in subdivision (b).
(b) If a complete claim, or portion thereof, that is neither
contested nor denied, is not reimbursed by delivery to the claimant's
address of record within the 30 working days after receipt, the
insurer shall pay the greater of fifteen dollars ($15) per year or
interest at the rate of 10 percent per annum beginning with the first
calendar day after the 30-working-day period. An insurer shall
automatically include the fifteen dollars ($15) per year or interest
due in the payment made to the claimant, without requiring a request
therefor.
(c) For the purposes of this section, a claim, or portion thereof,
is reasonably contested if the insurer has not received the
completed claim. A paper claim from an institutional provider shall
be deemed complete upon submission of a legible emergency department
report and a completed UB 92 or other format adopted by the National
Uniform Billing Committee, and reasonable relevant information
requested by the insurer within 30 working days of receipt of the
claim. An electronic claim from an institutional provider shall be
deemed complete upon submission of an electronic equivalent to the UB
92 or other format adopted by the National Uniform Billing
Committee, and reasonable relevant information requested by the
insurer within 30 working days of receipt of the claim. However, if
the insurer requests a copy of the emergency department report within
the 30 working days after receipt of the electronic claim from the
institutional provider, the insurer may also request additional
reasonable relevant information within 30 working days of receipt of
the emergency department report, at which time the claim shall be
deemed complete. A claim from a professional provider shall be deemed
complete upon submission of a completed HCFA 1500 or its electronic
equivalent or other format adopted by the National Uniform Billing
Committee, and reasonable relevant information requested by the
insurer within 30 working days of receipt of the claim. The provider
shall provide the insurer reasonable relevant information within 15
working days of receipt of a written request that is clear and
specific regarding the information sought. If, as a result of
reviewing the reasonable relevant information, the insurer requires
further information, the insurer shall have an additional 15 working
days after receipt of the reasonable relevant information to request
the further information, notwithstanding any time limit to the
contrary in this section, at which time the claim shall be deemed
complete.
(d) This section shall not apply to claims about which there is
evidence of fraud and misrepresentation, to eligibility
determinations, or in instances where the plan has not been granted
reasonable access to information under the provider's control. An
insurer shall specify, in a written notice to the provider within 30
working days of receipt of the claim, which, if any, of these
exceptions applies to a claim.
(e) If a claim or portion thereof is contested on the basis that
the insurer has not received information reasonably necessary to
determine payer liability for the claim or portion thereof, then the
insurer shall have 30 working days after receipt of this additional
information to complete reconsideration of the claim. If a claim, or
portion thereof, undergoing reconsideration is not reimbursed by
delivery to the claimant's address of record within the 30 working
days after receipt of the additional information, the insurer shall
pay the greater of fifteen dollars ($15) per year or interest at the
rate of 10 percent per annum beginning with the first calendar day
after the 30-working-day period. An insurer shall automatically
include the fifteen dollars ($15) per year or interest due in the
payment made to the claimant, without requiring a request therefor.
(f) An insurer shall not delay payment on a claim from a physician
or other provider to await the submission of a claim from a hospital
or other provider, without citing specific rationale as to why the
delay was necessary and providing a monthly update regarding the
status of the claim and the insurer's actions to resolve the claim,
to the provider that submitted the claim.
(g) An insurer shall not request or require that a provider waive
its rights pursuant to this section.
(h) This section shall apply only to claims for services rendered
to a patient who was provided emergency services and care as defined
in Section 1317.1 of the Health and Safety Code in the United States
on or after September 1, 1999.
(i) This section shall not be construed to affect the rights or
obligations of any person pursuant to Section 10123.13.
(j) This section shall not be construed to affect a written
agreement, if any, of a provider to submit bills within a specified
time period.
SEC. 14. 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 telehealth as provided,
under this section as a Medi-Cal benefit.
SEC. 15. Section 14132.73 of the
Welfare and Institutions Code is amended to read:
14132.73. The State Department of Health Services shall allow
psychiatrists to receive fee-for-service Medi-Cal reimbursement for
services provided through telemedicine
telehealth until June 30, 2004, or until the State Department
of Mental Health and mental health plans, in collaboration with
stakeholders, develop a method for reimbursing psychiatric services
provided through telemedicine telehealth
that is administratively feasible for the mental health plans,
primary care providers, and psychiatrists providing the services,
whichever occurs later.
SEC. 2. SEC. 16. Section 14594 is
added to the Welfare and Institutions Code, to read:
14594. (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 PACE organization 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 PACE
organization, and between the PACE organization and its participating
providers or provider groups.
(d) No PACE organization 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
PACE organization, and between the PACE organization and its
participating providers or provider groups.
(e) Notwithstanding any other provision, this section shall not be
interpreted to authorize a PACE organization to require the use of
telehealth when the health care provider has determined that it is
not appropriate.
SEC. 3. SEC. 17. 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.