BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                  AB 1733|
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                                 THIRD READING


          Bill No:  AB 1733
          Author:   Logue (R)
          Amended:  8/6/12 in Senate
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  9-0, 6/27/12
          AYES:  Hernandez, Harman, Alquist, Anderson, Blakeslee, De 
            León, DeSaulnier, Rubio, Wolk

           SENATE APPROPRIATIONS COMMITTEE  :  7-0, 8/6/12
          AYES:  Kehoe, Walters, Alquist, Dutton, Lieu, Price, 
            Steinberg
           
          ASSEMBLY FLOOR  :  75-0, 5/17/12 (Consent) - See last page 
            for vote


           SUBJECT  :    Health

           SOURCE  :     California State Rural Health Association 


           DIGEST  :    This bill expands current law requirements 
          allowing for the use of telehealth in Medi-Cal managed care 
          plans to all health plans that contract with the Department 
          of Health Care Services (DHCS).  These current law 
          requirements prohibit health plans from requiring in-person 
          contract between an enrollee and a provider before services 
          can be provided to the enrollee through telehealth systems. 
           This bill also updates the term "telemedicine" to 
          "telehealth" in a variety of code sections to reflect 
          current practice.
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           ANALYSIS  :    

          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 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 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 

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             provider has determined that it is not appropriate.

          This bill expands current law requirements allowing for the 
          use of telehealth in Medi-Cal managed care plans to all 
          health plans that contract with DHCS.  These current law 
          requirements prohibit health plans from requiring in-person 
          contract between an enrollee and a provider before services 
          can be provided to the enrollee through telehealth systems. 
           This bill also updates the term "telemedicine" to 
          "telehealth" in a variety of code sections to reflect 
          current practice.

           Background  

           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:  

          1. Video conferencing, which is used for real-time 
             patient-provider consultations, provider-to-provider 
             discussions, and language translation services; 

          2. Patient monitoring, in which electronic devices transmit 
             patient health information to health care providers; and

          3. 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 
          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.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes   

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          Local:  Yes

          According to the Senate Appropriations Committee, the 
          long-term fiscal impact of the bill is unknown.  It is 
          possible that by increasing the ability of providers and 
          enrollees to use telehealth, enrollees will receive more 
          care from providers.  On the other hand, by easing the use 
          of telehealth, the bill may reduce costs because telehealth 
          services may be provided a lower cost and the use of 
          telehealth may reduce the need for expensive medical 
          transportation for fragile enrollees.  The Department of 
          Health Care Services indicates that savings are more likely 
          than increased costs.

           SUPPORT  :   (Verified  8/7/12)

          California State Rural Health Association (source)
          Association of California Healthcare Districts
          California Academy of Family Physicians
          California Primary Care Association
          California Psychological Association

           ARGUMENTS IN SUPPORT  :    The bill's sponsor, the California 
          State Rural Health Association, states that it wants to 
          make sure all intended purposes and reforms of last year's 
          AB 415 (Logue, Chapter 547, Statutes of 2011) 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.  In support, 
          the California Academy of Family Physicians states 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.  Also 
          in support, the Association of California Healthcare 
          Districts states 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 

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          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.


           ASSEMBLY FLOOR  :  75-0, 5/17/12
          AYES:  Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, 
            Bill Berryhill, Block, Blumenfield, Bonilla, Bradford, 
            Brownley, Buchanan, Butler, Charles Calderon, Campos, 
            Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson, 
            Donnelly, Eng, Feuer, Fong, Fuentes, Furutani, Beth 
            Gaines, Galgiani, Garrick, Gatto, Gordon, Gorell, Grove, 
            Hagman, Halderman, Hall, Harkey, Hayashi, Roger 
            Hernández, Hill, Huber, Hueso, Huffman, Jeffries, Jones, 
            Knight, Lara, Logue, Ma, Mansoor, Mendoza, Miller, 
            Mitchell, Monning, Morrell, Nestande, Nielsen, Norby, 
            Olsen, Pan, V. Manuel Pérez, Portantino, Silva, Smyth, 
            Solorio, Swanson, Torres, Valadao, Wagner, Wieckowski, 
            Williams, John A. Pérez
          NO VOTE RECORDED:  Fletcher, Bonnie Lowenthal, Perea, 
            Skinner, Yamada


          CTW:m  8/8/12   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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