BILL ANALYSIS �
AB 809
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Date of Hearing: May 7, 2013
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Richard S. Gordon, Chair
AB 809 (Logue) - As Amended: April 29, 2013
SUBJECT : Healing arts: telehealth.
SUMMARY : Clarifies that the initiating health care provider
must only inform the patient and receive verbal consent for the
use of telehealth at the outset of care. Specifically, this
bill :
1)Authorizes a patient's initial verbal consent to the use of
telehealth to apply to that immediate instance and any
subsequent use of telehealth as well.
2)States that nothing in this bill precludes a patient from
receiving in-person health care delivery services during a
course of treatment after agreeing to receive services via
telehealth.
3)Contains an urgency clause citing a lack of access to health
care providers in medically underserved areas of California,
the increasing strain on existing providers expected to occur
with the implementation of the federal Patient Protection and
Affordable Care Act, and the assistance that further
implementation of telehealth can provide to help relieve these
burdens.
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. Telehealth facilitates patient self-management and
caregiver support for patients and includes synchronous
interactions and asynchronous store and forward transfers.
(Business and Professions Code (BPC) Section 2290.5 (a)(6))
2)Requires a health care provider to verbally inform the patient
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that telehealth may be used and obtain verbal consent from the
patient for this use, and requires the verbal consent to be
documented in the patient's medical record. (BPC 2290.5 (b))
3)States that all laws regarding the confidentiality of health
care information and a patient's rights to his or her medical
information apply to telehealth interactions. (BPC 2209.5
(e))
FISCAL EFFECT : None. This bill is keyed non-fiscal by
Legislative Counsel.
COMMENTS :
1)Purpose of this bill . This bill clarifies that a healthcare
provider must verbally inform a patient only once about the
use of telehealth and receive consent before the healthcare
provider initiates care. Healthcare providers believe current
law requires disclosure and consent at the outset of each
instance of care provided by telehealth, which is arguably an
inefficient use of care provider time. This bill is author
sponsored.
2)Author's statement . According to the author, "AB 415 (Logue)
of 2011 replaced and updated the outdated terminology of
'telemedicine' with 'telehealth,' to reflect the current use
of telehealth in California's healthcare system, providing a
broader range of services than contained in the outdated 1996
model statute. Under AB 415, in order to ensure that both
physicians and patients understood that telehealth may be used
to treat a patient, a physician is required to obtain verbal
consent for each and every visit with the patient. With [sic]
a year after implementation, physicians have reported that
this constant requirement is onerous and burdensome on their
ability to treat patients efficiently.
"Telehealth has the potential to reduce costs, increase access
and improve quality of care, especially in rural and urban
underserved areas of the state where it is difficult to get
specialized care. This bill is an update to AB 415 from 2011,
'The Telehealth Advancement Act of 2011,' to revise a portion
of the original bill known as 'oral consent' that has proved
problematic to instead require oral consent only for the first
use of telehealth."
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3)Telehealth . Telehealth is the delivery of health-related
services and information via telecommunications technologies.
Telehealth could be as simple as two health professionals
discussing a case over the telephone or as sophisticated as
doing robotic surgery between facilities at different ends of
the globe.
Current law requires a healthcare provider to verbally inform
the patient that telehealth may be used and obtain verbal
consent from the patient. Healthcare providers believe
current law requires them to obtain consent for the use of
telehealth at the beginning of every use of telehealth care,
even if they have previously received consent from the same
patient.
This bill will allow the healthcare provider to inform a
patient and receive consent once, and rely on this consent
throughout the course of treatment. This bill also clarifies
that nothing prohibits in-person care after a patient consents
to telehealth care.
4)Arguments in support . The Association of California
Healthcare Districts writes, "In the most rural Healthcare
Districts, the ability to bring patients together with
specialized physicians through telehealth removes the obstacle
of remoteness in patient care.
"AB 809 is yet another measure that ensures that patient
access is at the center of care in all communities throughout
California."
5)Related legislation . AB 318 (Logue) authorizes Medi-Cal
payments for teledentistry services provided to individuals
participating in the Medi-Cal program. AB 318 is currently
pending in Assembly Health Committee.
AB 1174 (Bocanegra) expands the scope of practice for
registered dental assistants, registered dental assistants in
extended functions, and registered dental hygienists to better
enable the practice of teledentistry in accordance with the
findings of a Health Workforce Pilot Program, and enables
reimbursement by Medi-Cal for Virtual Dental Home treatment.
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AB 1174 is currently pending in Assembly Health Committee.
6)Previous legislation . SB 764 (Steinberg) of 2012 would have
required the Department of Developmental Services (DDS) to
pilot the use of "telehealth systems," defined as a mode of
delivering services that utilizes information and
communications technologies to facilitate the diagnosis,
evaluation and consultation, treatment, education, care
management supports, and self-management of consumers in the
provision of Applied Behavioral Analysis and Intensive
Behavioral Intervention. SB 764 was vetoed by Governor Brown.
The Governor's veto message said, "I appreciate the author's
desire to bring more efficiency to regional centers as well as
promote the value of telehealth. The goals of this bill,
however, can already be accomplished under existing law.
Mandating every individual program planning team to consider
telehealth appears excessive. Where beneficial and available,
I expect they will consider it, without the state telling them
to do so."
SB 1050 (Alquist) of 2012 would have required DDS to establish
an autism telehealth taskforce to be administered and led by a
public or nonprofit entity responsible for the activities and
work of the taskforce, would have provided that the lead
administrator appoint members of the taskforce who have
knowledge or experience, as specified, and would have provided
that the taskforce provide technical assistance and
recommendations in the area of telehealth services for
individuals with autism spectrum disorder, as specified. SB
1050 was vetoed by Governor Brown. The Governor's veto
message said, "I am returning SB 1050 without my signature.
Last year I signed AB 415 (Logue), the Telehealth Advancement
Act of 2011, to update our statutes on the use of telehealth.
As we work to improve and modernize our health care system, we
can expect telehealth to play an increasingly prominent role
in rural and urban areas, for many diseases and conditions.
Such advancements and collaboration are occurring now, and a
privately funded, disease-specific task force set forth in
statute does not appear to be warranted."
AB 1733 (Logue), Chapter 782, Statutes of 2012, updated
several code sections to replace the term "telemedicine" with
"telehealth" and expands the potential for telehealth use in
health care programs administered by the Department of Health
Care Services.
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AB 415 (Logue), Chapter 547, Statutes of 2011, established the
Telehealth Advancement Act of 2011 to revise and update
existing law to facilitate the advancement of telehealth in
managed care and the Medi-Cal program.
AB 175 (Galgiani), Chapter 419, Statutes of 2010, expanded 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 until January 1,
2013.
AB 2120 (Galgiani), Chapter 260, Statutes of 2008, extended
the Medi-Cal telemedicine reimbursement authorization until
January 1, 2013.
SB 1665 (Thompson), Chapter 864, Statutes of 1996, established
California's Telemedicine Development Act (TDA) to set
standards for the use of telemedicine by health care
practitioners and insurers. TDA 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.
7)Double-referral . This bill is double-referred, having been
previously heard by the Health Committee on April 23, 2013,
and approved on a 15-0 vote.
8)Urgency clause . This bill contains an urgency clause, allowing
the bill to take effect immediately upon enactment.
REGISTERED SUPPORT / OPPOSITION :
Support
Association of California Healthcare Districts
California Academy of Physician Assistants
California Association of Physician Groups
Occupational Therapy Association of California
Opposition
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None on file.
Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916)
319-3301