BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1733
AUTHOR: Logue
AMENDED: June 20, 2012
HEARING DATE: June 27, 2012
CONSULTANT: Marchand
SUBJECT : Telehealth.
SUMMARY : Applies existing provisions of law, prohibiting health
care service plans from requiring in-person contact between a
provider and a patient prior to paying for telehealth services,
to additional types of Medi-Cal managed care plans, including
the Program of All-Inclusive Care for the Elderly (PACE), and
requires all health care practitioners providing telehealth
services to be subject to specified provisions of the Medical
Practice Act relating to telehealth.
Existing law:
1.Defines "telehealth" as the mode of delivering health care
services and public health via information and communication
technologies to facilitate the diagnosis, consultation,
treatment, education, care management, and self-management of
a patient's health care while the patient is at the
originating site and the health care provider is at a distant
site.
2.Requires the provider at the originating site (where the
patient is located), prior to the delivery of health care via
telehealth, to verbally inform the patient that telehealth may
be used, to obtain verbal consent from the patient for this
use, and to document the verbal consent in the patient's
medical record.
3.Prohibits a health care service plan from requiring an
in-person contact between a health care provider and a patient
before payment is made for services appropriately provided
through telehealth, subject to the terms and conditions of the
contract.
4.Prohibits a health care service 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 services
appropriately provided through telehealth, subject to the
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terms and conditions of the contract.
5.Applies the provisions in 3) and 4) above to various types of
Medi-Cal managed care plans, including health plan contracts
with the Department of Health Care Services (DHCS), pursuant
to provisions of law governing Medi-Cal managed care, county
organized health systems, the Managed Health System for Los
Angeles County, the Geographic Managed Care Pilot Project, and
Medi-Cal prepaid plans.
6.Prohibits the provisions in 3) and 4) above from being
interpreted as authorizing a health care service plan to
require the use of telehealth when the health care provider
has determined that it is not appropriate.
This bill:
1.Prohibits any PACE organization from requiring an in-person
contact between a health care provider and a patient before
payment is made for services appropriately provided through
telehealth, subject to the terms and conditions of the
contract.
2.Prohibits any 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 services
appropriately provided through telehealth, subject to the
terms and conditions of the contract.
3.Prohibits the provisions in 1) and 2) above from being
interpreted as authorizing a PACE organization to require the
use of telehealth when the health care provider has determined
that it is not appropriate.
4.Requires a health care practitioner licensed under any of the
Healing Arts licensing acts providing services via telehealth
to be subject to the telehealth requirements and definitions
established under specified provisions of the Medical Practice
Act.
5.Expands the application of provisions of law prohibiting
Medi-Cal managed care plans from requiring in-person contact
between a provider and a patient before making payment for
telehealth, or from limiting settings for telehealth, by
applying these prohibitions to all types of Medi-Cal managed
care plan contracts with DHCS, rather than specifying
AB 1733 | Page
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particular types of Medi-Cal managed care plans.
6.Replaces the term "telemedicine" with the term "telehealth" in
various provisions of law.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, negligible state fiscal impact.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations:17- 0
Assembly Floor: 75- 0
COMMENTS :
1.Author's statement. Last year, California led the nation by
passing landmark legislation in AB 415 (Logue), Chapter 547,
Statutes of 2011, known as "The Telehealth Advancement Act of
2011." Telehealth has the potential to reduce costs, increase
access and improve quality of care, especially in underserved
areas of the state where it is difficult to get specialized
care. This bill follows up on the achievement of AB 415 by
expanding its supplication to the PACE program. This will
ensure that PACE enrollees benefit from the use of telehealth
the same way as enrollees in Medi-Cal and in private health
insurance.
2.Telehealth. Telehealth is a mode of delivering health care
services and public health using information and communication
technologies that enable the diagnosis, consultation,
treatment, education, care management, and self-management of
patients. It includes telemedicine, which is the diagnosis and
treatment of illness or injury, and other telehealth services
such as monitoring, communications, and education. Currently,
telehealth services are primarily 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, such as
X-rays, video clips, and photos, between primary care
providers and medical specialists.
Telehealth is commonly used to address the problems of
inadequate provider distribution and is used in the
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development of health systems in rural and medically
underserved areas. It has the potential to reduce costs,
improve quality, change the conditions of practice, and
improve access to health care services.
1.Prior legislation. AB 415 established the Telehealth
Advancement 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. Among other
provisions, AB 415 updated and defined terminology related to
telehealth, removed various requirements imposed by health
care service plans, health insurers, and Medi-Cal for patients
to receive health care services through telehealth, and
removed the sunset date authorizing teleopthalmology and
teledermatology by store and forward in the Medi-Cal program.
2.Support. The California State Rural Health Association, the
sponsor of this bill, states that it wants to make sure all
intended purposes and reforms of last year's AB 415 are
included in all appropriate parts of our state's health care
system. This bill is also supported by the California Primary
Care Association, which states that telehealth enables health
centers to better coordinate their patient's care, reduce
duplicative tests, and lay the foundation for community
clinics and health centers aiming to transform their practices
into patient-centered health homes. The California Academy of
Family Physicians states in support that this bill would
further the application of AB 415 to all remaining health plan
contracts with DHCS, thereby expanding the potential for the
use of telehealth in Medi-Cal managed care programs and the
PACE program. The Association of California Healthcare
Districts states in support that creating the option for all
health care service plans to utilize telehealth services will
provide patients in all California communities, especially
those in rural areas, with increased access to health care
services. The California Psychological Association states that
it is working with the Board of Psychology on the definition
and parameters for the use of telehealth and views this
expansion of access as a positive step forward.
SUPPORT AND OPPOSITION :
Support: California State Rural Health Association (sponsor)
Association of California Healthcare Districts
California Academy of Family Physicians
California Primary Care Association
California Psychological Association
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Oppose: None received.
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