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: 8/21/12 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. It also contains provisions of SB 1575
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(Senate Business, Professions and Economic Development
Committee) relative to licensed professional clinical
counselors (LPCCs) by (1) adding language ensuring
conformity with existing laws regarding substance abuse,
supervision and inclusion of LPCCs; and (2) adding a
provision stating that it is unprofessional conduct for an
LPCC applicant or registrant to violate the law regarding
patient access to his/her records.
Senate Floor Amendments of 8/21/12 address chaptering-out
issues.
Senate Floor Amendments of 8/13/12 remove the proposed
changes to a provision of the Business and Professions Code
that is also being amended by AB 761 (Hernandez), relating
to optometry, to avoid chaptering out conflicts, and add to
the bill a provision of SB 1575 relative to licensed
professional clinical counselors.
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.
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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
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
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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.
SB 1575 Language
Existing law, the Licensed Professional Clinical
Counselor Act, provides for the licensure and regulation
of the practice of professional clinical counseling by
the Board of Behavioral Sciences.
Existing law authorizes the board to refuse to issue any
registration or license, or to 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 that includes, but is not limited to, the
conviction of more than one misdemeanor or any felony
involving the use, consumption, or self-administration of
any of specified substances, or any combination thereof.
This bill would delete the conviction of more than one
misdemeanor or any felony involving the use, consumption,
or self-administration of any of specified substances, or
any combination thereof, from the list of what
constitutes professional conduct. The bill would make it
unprofessional conduct to willfully violate specified
provisions governing patient access to health care
records.
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 8/22/12)
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 8/22/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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