BILL ANALYSIS Ó
AB 1733
Page 1
Date of Hearing: April 24, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1733 (Logue) - As Amended: April 16, 2012
SUBJECT : Telehealth.
SUMMARY : Expands the potential for the use of telehealth in
Medi-Cal managed care programs and the Program of All-Inclusive
Care (PACE) for the Elderly program by prohibiting requirements
for in-person contact and limitations on the type of setting
where services are provided before payment can be made.
Specifically, this bill :
1)Expands existing law prohibiting health plans from requiring
in-person contact before payment is made for covered services
appropriately provided through telehealth, and prohibiting
health plans from limiting the type of setting where services
are provided before payment is made for covered services
appropriately provided through telehealth, to apply to health
plan contracts with the Department of Health Care Services
(DHCS) associated with additional managed care programs
administered by DHCS.
2)States legislative intent 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.
3)Prohibits a PACE organization from requiring 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 PACE
organization and its participating providers or provider
groups.
4)Prohibits a PACE organization from limiting 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
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or provider groups.
5)States that, notwithstanding any other provision, this bill
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.
EXISTING LAW :
1)Establishes the Medi-Cal program under which qualified
low-income persons receive health care benefits.
2)Requires the Director of DHCS to establish the California
PACE, to provide community-based, risk-based, and capitated
long-term care services as optional services under the state's
Medi-Cal State Plan and under contracts entered into between
the federal Centers for Medicare and Medicaid Services, DHCS,
and PACE organizations, that meet the requirements of federal
law and regulations, as specified.
3)Regulates health plans at the Department of Managed Health
Care and health insurers at the California Department of
Insurance.
4)Prohibits health plans from requiring 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 plan, and between the health plan
and its participating provider groups.
5)Prohibits a health plan from limiting 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 plan, and between the
health plan and its participating providers or provider
groups.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
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1)PURPOSE OF THIS BILL . According to the author, this bill
would remove barriers in current law and update to current
practice the use of telehealth in the delivery of health care
by furthering the application of AB 415 (Logue), Chapter 547,
Statutes of 2011, to all remaining health plan contracts with
the DHCS. The author states that this consists of PACE, the
SCAN Health Plan, and the AIDS Healthcare Foundation.
2)BACKGROUND . In February 2011, the Center for Connected Health
Policy (CCHP) issued a report with 13 recommendations to
update California's Telemedicine Development Act established
by SB 1665 (Thompson), Chapter 864, Statutes of 1996. AB 415
enacted those recommendations in the Telehealth Advancement
Act of 2011 (Act). One of the provisions in the Act extended
some provisions to "health care service plan contracts with
the Department of Health Care Services" pursuant to specified
statutes related to County Organized Health Systems,
Geographic Managed Care, and other Medi-Cal managed care
programs. According to a January 2012 issue brief jointly
prepared by the California Telemedicine and eHealth Center and
the CCHP, AB 415 eliminated a Medi-Cal rule requiring
providers to document a barrier to an in-person visit before a
beneficiary could receive services via telehealth, which was
widely viewed as a disincentive by providers to utilize
telehealth. This bill amends AB 415 to include additional
DHCS administered programs where a health plan has a contract
with DHCS.
3)PACE . The PACE program provides integrated health and social
services care for the elderly. To qualify for PACE, a
recipient must: a) be over the age of 55; b) meet the level of
care necessary for placement in a skilled nursing facility
(SNF) or intermediate care facility; c) live in an area where
PACE is available; and, d) be able to safely remain in the
community if PACE is provided. The PACE program receives a
capitated rate to coordinate and provide long-term social and
medical care for recipients, the majority of whom are dually
eligible for Medicaid and Medicare. Generally, this capitated
rate is less than what it would cost if the recipient enters a
nursing home. This creates the incentive for the PACE plans
to provide services in the community rather than in an
institutional setting. The PACE site is fully responsible for
the cost of all medical and social services each participant
requires. Statewide, there are roughly 2,800 PACE
participants. Each PACE site employs an interdisciplinary
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team that is responsible for conducting assessments,
delivering services, and coordinating care. Examples of
members of this team are doctors, nurses, social workers,
transportation operators, and nutritionists. If not in a SNF
or hospital, most PACE recipients receive medical and social
services at the PACE site.
Originally put forward as a demonstration program, PACE is now
a mainstream benefit under both the Medi-Cal and Medicare
programs. Five fully operational PACE programs provide
services through 23 PACE centers in seven large counties; in
addition, two to three additional PACE programs are expected
to become operational in 2013, bringing the PACE model to
three additional large counties. Applications are also
pending that, if approved, could bring PACE to even more
counties by 2014.
4)SUPPORT . According to the California Center for Rural Policy
at Humboldt State University and the California State Rural
Health Association, this bill ensures the prohibition on
requiring in-person contact applies to health plans contracted
under the Medi-Cal program, and that seniors being cared for
by these health plans enjoy the same benefits all other
Californians have. Aging Services of California believes
expanding the prohibition of in-person contact for services
provided outside of the Medi-Cal program, such as for PACE,
would allow for greater use of telehealth and expand care
options for seniors in California. The California
Psychological Association writes that they and the Board of
Psychology are currently working together on the definition
and parameters for the use of telehealth and view this
expansion of access as a positive step forward.
5)RELATED LEGISLATION .
a) AB 2074 (Bradford), pending in the Assembly Human
Services Committee, requires the DHCS to develop a training
program for In-Home Supportive Services workers on the
utilization of telehealth.
b) SB 764 (Steinberg), pending in the Assembly, requires
the Department of Developmental Disabilities to pilot the
use of "telehealth systems," defined as a mode of
delivering services that utilizes information and
communications technologies to facilitate the diagnosis,
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evaluation and consultation, treatment, education, care
management supports, and self-management of consumers in
the provision of Applied Behavioral Analysis and Intensive
Behavioral Intervention.
c) SB 1050 (Alquist), pending in the Senate, declares
legislative intent to enact legislation to establish a
pilot program to promote the use of technology and
telehealth systems for the screening, diagnosis, and
evaluation of children with autism spectrum disorders.
6)PREVIOUS LEGISLATION .
a) AB 415 establishes the Act of 2011 to revise and update
existing law to facilitate the advancement of telehealth as
a service delivery mode in managed care and the Medi-Cal
Program.
b) AB 175 (Galgiani), Chapter 419, Statutes of 2010, for
the purposes of Medi-Cal reimbursement, expands, until
January 1, 2013, the definition of "teleophthalmology and
teledermatology by store and forward" to include services
of an optometrist who is trained to diagnose and treat eye
diseases.
c) AB 2120 (Galgiani), Chapter 260, Statutes of 2008,
extends the Medi-Cal telemedicine reimbursement
authorization until January 1, 2013.
d) AB 329 (Nakanishi), Chapter 386, Statutes of 2007,
authorizes the Medical Board of California (MBC) to
establish a pilot program to expand the practice of
telemedicine, and to convene a working group. AB 329
specifies that the purpose of the pilot program is to
develop methods, using a telemedicine model, of delivering
health care to those with chronic diseases and delivering
other health information, and requires MBC to make
recommendations regarding its findings to the Legislature
within one calendar year of the commencement date of the
pilot program. MBC reports that this pilot program is
currently commencing.
e) AB 1224 (Hernandez), Chapter 507, Statutes of 2007, adds
optometrists to the list of health care providers covered
under laws governing telemedicine services.
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f) AB 354 (Cogdill), Chapter 449, Statutes of 2005, expands
telemedicine provisions by providing that, from July 1,
2006, through December 31, 2008, face-to-face contact
between a health care provider and a patient shall not be
required for the Medi-Cal program for "store and forward"
teleophthalmology and teledermatology services.
g) SB 1665 establishes the Telemedicine Development Act
(Act) to set standards for the use of telemedicine by
health care practitioners and insurers. The Act specifies,
in part, that face-to-face contact between a health care
provider and a patient shall not be required under the
Medi-Cal Program for services appropriately provided
through telemedicine, when those services are otherwise
covered by the Medi-Cal program, and requires a health care
practitioner to obtain verbal and written consent prior to
providing services through telemedicine.
6)TECHNICAL AMENDMENTS .
a) On page 2, line 29 delete "State".
b) On page 2, lines 29-30 "health care service plan" should
be replaced with "Medi-Cal managed care." Health care
service plan is a designation found in the Health and
Safety Code (Knox-Keene Health Care Service Plan Act of
1975) and refers to entities licensed by the Department of
Managed Health Care. Existing law enacted by AB 415
already applies to health care service plans that contract
with DHCS. It is the author's intent to apply these
provisions to other Medi-Cal managed care programs,
including to plans which may not hold a Knox-Keene license.
REGISTERED SUPPORT / OPPOSITION :
Support
Aging Services of California
AIDS Healthcare Foundation
Association of California Healthcare Districts
California Academy of Physician Assistants
California Center for Rural Policy
California Healthcare Institute
California Primary Care Association
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California Psychological Association
California State Rural Health Association
Several individuals
Opposition
None on file.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097