BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 136|
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THIRD READING
Bill No: SB 136
Author: Yee (D)
Amended: 5/19/11
Vote: 21
SENATE HEALTH COMMITTEE : 6-2, 5/4/11
AYES: Hernandez, Alquist, De León, DeSaulnier, Rubio, Wolk
NOES: Strickland, Anderson
NO VOTE RECORDED: Blakeslee
SENATE APPROPRIATIONS COMMITTEE : 9-0, 5/16/11
AYES: Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley,
Price, Runner, Steinberg
SUBJECT : Medi-Cal: teleophthalmology and
teledermatology
SOURCE : Author
DIGEST : This bill extends, from January 1, 2013 to
January 1, 2018, Medi-Cal coverage for teleophthalmology
and teledermatology by store and forward, where a physician
or optometrist is transmitted medical information for
review at a later time.
ANALYSIS :
Existing law:
1. Prohibits, until January 1, 2013, the Department of
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Health Care Services (DHCS) from requiring face-to-face
contact between a health care provider and a patient
under the Medi-Cal program for teleophthalmology and
teledermatology by store and forward, to the extent
federal financial participation is available.
2. Requires services appropriately provided through the
store and forward process to be subject to billing and
reimbursement policies developed by DHCS.
3. Defines "teleophthalmology and teledermatology by store
and forward" as the transmission of a patient's 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 where the physician or optometrist at
the distant site reviews the medical information without
the patient being present in real time.
4. Requires a patient receiving teleophthalmology or
teledermatology by store and forward to be notified of
the right to receive interactive communication with the
distant specialist physician or optometrist, and to
receive an interactive communication with the distant
specialist physician or optometrist upon request.
This bill:
1. Extends the sunset date in existing law by five years
(from January 1, 2013 to January 1, 2018) that prohibits
DHCS from requiring face-to-face contact between a
health care provider and a patient under the Medi-Cal
program for teleophthalmology and teledermatology by
store and forward, to the extent federal financial
participation is available.
2. Requires DHCS to report to the appropriate policy and
fiscal committees of the Legislature no later than
January 1, 2015, and again no later than January 1,
2017, all of the following:
A. The number and dollar amount of claims billed
under the program established by this section for
every year that it has been implemented.
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B. The number and dollar amount of all ophthalmology
and dermatology claims for all years that the program
established by this section has been implemented.
C. The number and dollar amount of all ophthalmology
and dermatology claims for the three years prior to
the authorization of store and forward.
3. Requires DHCS to specify that providers billing for
store-and-forward teledermatology and teleophthalmology
services must use the appropriate billing code in the
next available general provider bulletin after the
effective date of this bill.
Background
"Telemedicine" is defined as the practice of health care
delivery, diagnosis, consultation, treatment, transfer of
medical data, and education using interactive audio, video,
or data communications. Telemedicine does not include a
telephone conversation or an electronic mail message
between a health care provider and a patient. In
traditional telemedicine, a physician at a distant site is
able to interview the patient and examine the patient via
closed circuit television. The telemedicine provisions in
current law were added by SB 1665 (Thompson), Chapter 864,
Statutes of 1996.
In 2005, DHCS sponsored AB 354 (Cogdill) to allow Medi-Cal
reimbursement for teleophthalmology and teledermatology by
store and forward. Teleophthalmology and teledermatology
by store and forward is the transmission of a patient's
medical information, which is then reviewed at a later time
by a physician at a distant site who is trained in
ophthalmology or dermatology (or by an optometrist for
teleophthalmology). The physician or optometrist at the
distant site reviews the medical information without the
patient being present.
In February 2009, DHCS provided to the Legislature a report
entitled "Medi-Cal Telemedicine Benefits: Store and
Forward Teleophthalmology and Teledermatology" in response
to statutory reporting requirement in AB 354. According to
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the DHCS report, since Medi-Cal coverage of store and
forward began, only one provider submitted bills to
Medi-Cal which identified teleophthalmology or
teledermatology store and forward services. This provider
reported 30 claims for dermatology services in the period
from July 1, 2006 through November 19, 2007. The total
Medi-Cal expenditures for these services were $1,786.
According to DHCS, it is possible that other providers have
provided teleophthalmology or teledermatology store and
forward services but because the reimbursement rates are
identical, failed to use the code modifier that
distinguishes telemedicine services from traditional
in-person services.
The Center for Connected Health Policy (CCHP), a non-profit
planning and strategy organization working to remove policy
barriers that prevent the integration of telehealth
technologies into California's health care system, is
supporting a yearlong research project that examines
California's teledermatology workforce, with a focus on the
2006 Medi-Cal teledermatology reimbursement law. CCHP
seeks to explore whether the law creates operational
efficiencies for dermatologists, or addresses access
barriers for medically underserved communities.
Comments
According to the author's office, this bill is necessary to
continue to allow teledermatology and teleophthalmology
services to continue to be provided under Medi-Cal.
Telemedicine is a growing model for health care delivery
that is used to improve health care access in rural and
underserved communities. The lack of primary care
practitioners, specialty providers, and transportation
continues to be significant barriers to access to health
care services in medically underserved rural and urban
areas. This bill addresses these problems by retaining
teledermatology and teleophthalmology as procedures for
which physicians can utilize "store and forward" technology
and receive Medi-Cal reimbursement.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
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CTW:mw 5/18/11 Senate Floor Analyses
SUPPORT/OPPOSITION: NONE RECEIVED
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