BILL ANALYSIS Ó
AB 1174
Page 1
Date of Hearing: January 14, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1174 (Bocanegra and Logue) - As Amended: January 6, 2014
SUBJECT : Dental professionals: teledentistry under Medi-Cal.
SUMMARY : Authorizes Medi-Cal payments for teledentistry
services provided to individuals participating in the Medi-Cal
program. Expands duties of registered dental assistants (RDAs),
RDAs in extended functions (RDAEF), registered dental hygienists
(RDH), and registered dental hygienists in alternative practice
(RDHAP). Specifically, this bill :
1)Applies existing law provisions applicable to
teleophthalmology and teledermatology to teledentistry, as
follows:
a) Provides, to the extent federal financial participation
(FFP) is available, that face-to-face contact between a
health care provider and a patient is not required under
the Medi-Cal program for teledentistry by store and
forward. Subjects services appropriately provided through
the store and forward process to billing and reimbursement
policies developed by the Department of Health Care
Services (DHCS);
b) Requires a patient receiving teledentistry by store and
forward to be notified of their right to receive
interactive communication with the distant dentist and to
receive interactive communication with the distant dentist,
upon request, which may occur either at the time of the
consultation or within 30 days of the patient's
notification of the results of the consultation; and,
c) Permits DHCS to implement, interpret, and make specific
the provisions of this bill by means of all-county letters,
provider bulletins, and similar instructions; On or before
January 1, 2008, DHCS to report to the Legislature the
number and type of services provided and the payments made
related to the application of store and forward
teledentistry provided as a Medi-Cal benefit.
2)Authorizes an RDA to determine which radiographs to perform if
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the RDA has completed an educational program in those duties
approved by the Dental Board of California (Board), or if he
or she has provided evidence satisfactory to the Board of
having completed a Board-approved course in those duties.
3)Defines the following terms:
a) Clinical instruction means instruction in which students
receive supervised experience in performing procedures in a
clinical setting on patients. Requires clinical
instruction to be performed only upon successful
demonstration and evaluation of preclinical skills.
Requires at least one instructor for every six students who
are simultaneously engaged in clinical instruction;
b) Course means a Board-approved course preparing an RDAEF
to perform the duties specified in 4) below;
c) Didactic instruction means lectures, demonstrations, and
other instruction without active participation by students.
Authorizes an approved provider or its designee to provide
didactic instruction through electronic media, home study
materials, or live lecture methodology if the provider has
submitted that content to the Board for approval;
d) Interim therapeutic restoration (ITR) means a direct
provisional restoration placed to stabilize the tooth until
a licensed dentist diagnoses the need for further
definitive treatment;
e) Laboratory instruction means instruction in which
students receive supervised experience performing
procedures using study models, mannequins, or other
simulation methods; and,
f) Preclinical instruction means instruction in which
students receive supervised experience performing
procedures on students, faculty, or staff members.
Requires at least one instruction for every six students
who are simultaneously engaged in preclinical instruction.
4)Authorizes a RDAEF licensed on or after January 1, 2010, and
pursuant to the order, control and full professional
responsibility of a supervising dentist, a RDH, or a RDHAP to
perform both of the following additional duties:
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a) Choose radiographs without the supervising dentist
having first examined the patient, following protocols
established by the supervising dentist and, consistent with
the use of as low as reasonably necessary radiation for the
purpose of diagnosis and treatment planning by the dentist.
Requires the radiographs to be taken only in either of the
following settings:
i) In a dental office setting, under the direct or
general supervision of a dentist as determined by the
dentist; and for RDH and RDHAP, under the general
supervision of a dentist; or,
ii) In public health settings, including but not limited
to, schools, head start and preschool programs, and
residential facilities and institutions, under the
general supervision of a dentist.
b) Place protective restorations, which for this purpose
are identified as ITRs, as defined, that compromise the
removal of soft material from the tooth using only hand
instrumentation, without the use of rotary instrumentation,
and subsequent placement of an adhesive restorative
material, and only when local anesthesia is not necessary.
The protective restorations are to be placed only in
accordance with both of the following:
i) In either of the settings specified in 4) a) i) and
ii) above; and,
ii) After a diagnosis and treatment plan by a dentist.
5)Authorizes the functions specified in 4) above to be performed
by an RDAEF, RDH, and RDHAP only after completion of a program
that includes training in performing those functions, or after
providing evidence, satisfactory to the Board or Dental
Hygiene Committee (Committee), of having completed a Board- or
Committee-approved course in those functions.
6)Deems RDAEF, RDH, or RDHAP who has completed the prescribed
training in the Health Workforce Pilot Project No. 172 (HWPP
No. 172) established by the Office of Statewide Health
Planning and Development (OSHPD), as specified, to have
satisfied the requirement for completion of a course of
instruction approved by the Board or Committee.
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7)Requires, in addition to the instructional components
described in 8) and 9) below, a program to contain both of the
instructional components:
a) The course to be established at the postsecondary
educational level; and,
b) All faculty responsible for clinical evaluation shall
have completed a one-hour methodology course in clinical
evaluation or have a faculty appointment at an accredited
dental education program prior to conducting evaluations of
students.
8)Requires a program or course to perform the duties specified
in 4) a) above (choose radiographs) to contain all of the
following additional instructional components:
a) The program must be of sufficient duration for the
student to develop minimum competency making decisions
about which radiographs to take to facilitate an evaluation
by a dentist, but in no event be less than six hours,
including at least two hours of didactic training, at least
two hours of guided laboratory simulation training, and at
least two hours of examination using simulated cases;
b) Didactic instruction must consist of instruction on both
the following topics:
i) Guidelines for radiographic decisionmaking prepared
by the American Dental Association and other professional
dental associations; and,
ii) Specific decisionmaking protocols that incorporate
information about the patient's health and radiographic
history, the time span since previous radiographs were
taken, the availability of previous radiographs, the
general condition of the mouth including the extent of
dental restorations present, and visible signs of
abnormalities, including broken teeth, dark areas, and
holes in teeth.
c) Laboratory instruction must consist of simulated
decisionmaking using case studies containing the elements
specified in 8) b) above. Requires at least one instructor
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for every 14 students who are simultaneously engaged in
laboratory instruction; and,
d) Examinations to consist of decisionmaking where students
make decisions and demonstrate competency to faculty on
case studies containing the elements described in b) above.
9)Requires a program or course to perform the duties described
in 4) b) above (place protective restorations) to contain all
of the additional instructional components:
a) The program must be of sufficient duration for the
student to develop minimum competency in the application of
protective restorations, including ITRs, but in no event be
less than 16 clock hours, including at least four hours of
didactic training, at least four hours of laboratory
training, and at least eight hours of clinical training;
b) Didactic instruction to consist of instruction on
specified topics, including: i) pulpal anatomy; ii) theory
of adhesive restorative materials used in the placement of
adhesive protective restorations related to mechanisms of
bonding to tooth structure, handling characteristics of the
materials, preparation of the tooth prior to material
placement, and placement techniques; iii) criteria that
dentists use to make decisions about placement of adhesive
protective restorations, as specified, including patient
factors, as specified, and, tooth factors, as specified;
iv) criteria for evaluating successful completion of
adhesive protective restorations, as specified; v)
protocols for handling sensitivity, complications, or
unsuccessful completion of adhesive protective restorations
including situations requiring immediate referral to a
dentist; and vi) protocols for followup of adhesive
protective restorations, as specified;
c) Laboratory instruction must consist of placement of
adhesive protective restorations where students demonstrate
competency in this technique on typodont teeth; and,
d) Clinical instruction must consist of experiences where
students demonstrate placement of adhesive protective
restorations under direct supervision of faculty.
10)Defines teledentistry consistent with existing law's
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definition of teleophthalmology and teledermatology.
11)Makes other conforming changes.
EXISTING LAW :
1)Establishes the Medi-Cal program under which qualified
low-income persons receive health care benefits.
2)Provides, to the extent FFP is available, face-to-face contact
between a health care provider and a patient is not required
under the Medi-Cal program for teleophthalmology and
teledermatology by store and forward. Indicates that services
appropriately provided through the store and forward process
are subject to billing and reimbursement policies developed by
DHCS.
3)Defines, "teleophthalmology and teledermatology by store and
forward" as an asynchronous transmission of 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 a licensed optometrist where the
physician or optometrist at the distant site reviews the
medical information without the patient being present in real
time.
4)Prohibits in-person contact between a health care provider and
a patient from being required under the Medi-Cal program for
services appropriately provided through telehealth, subject to
reimbursement policies adopted by DHCS to compensate a
licensed health care provider who provides health care
services through telehealth that are otherwise reimbursed
pursuant to the Medi-Cal program.
5)Prohibits DHCS from requiring a health care provider to
document a barrier to an in-person visit for Medi-Cal coverage
of services provided via telehealth.
6)Prohibits DHCS, for the purposes of payment for covered
treatment or services provided through telehealth, from
limiting the type of setting where services are provided for
the patient or by the health care provider.
7)Establishes the Dental Practice Act, administered by the
Board, to regulate the practice of dentistry. Requires the
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Board to review and evaluate all applications for licensure in
all dental assisting categories. Requires the Board at least
every seven years to review the allowable duties for dental
assistants, RDAs, and RDAEFs. Establishes the Dental
Assisting Council of the Board to consider all matters
relating to dental assistants.
8)Defines a dental assistant as someone who is without a license
and may perform basic supportive dental procedures. Requires
the Board to license RDAs and RDAEFs upon completion of
specified education, work requirements, passage of a written
examination and a clinical or practical examination.
9)Establishes the Committee within the jurisdiction of the Board
to, among other functions, evaluate all RDH educational
programs, determine the appropriate type of licensure
examination, and deny, suspend, or revoke a license of a RDH.
10)Defines direct supervision as supervision of dental
procedures based on instructions given by a licensed dentist
who must be physically present in the treatment facility
during the performance of these procedures. Defines general
supervision as supervision of dental procedure based on
instructions given by a licensed dentist but not requiring the
physical presence of the supervising dentist during the
performance of those procedures.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . The author believes existing law does
not allow Medi-Cal to pay for the use of teledentistry
services, especially store and forward dental care. The
author is also concerned about the shortage of dental services
in rural areas. The author cites a 2008 University of
California, Los Angeles study that found that California has
about 14% of the dentists in the nation (about 3.5 dentists
for every 5,000), slightly higher than the national average,
however, according to the author, California has 233 dental
shortage areas. The author indicates that dentists cluster
around urban communities which leave many rural and urban
underserved communities without dentists. The author says
Yuba County has less than one dentist for every 5,000 people,
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and counties such as Colusa, Imperial, Mariposa, Mono, and San
Benito have less than 1.5 dentists for every 5,000 people.
The author states that every dentist in these counties needs
to be utilized to the full extent of their ability. According
to the author, the report found that California could soon be
facing a dentist shortage since there will soon be more
dentists retiring (19% have been licensed for 30+ years)
compared to coming into the system (15% have been licensed for
less than five years).
2)BACKGROUND .
a) Virtual Dental Home . According to an article published
in July 2012 in the Journal of the California Dental
Association (CDA Journal), "The Virtual Dental Home:
Bringing Oral Health to Vulnerable and Underserved
Populations," the traditional office and clinic-based oral
health delivery system is failing to reach a large and
increasing segment of the population. The CDA Journal
article says that in California, oral health disparities
are more severe than the national average, particularly
among low-income and disabled populations. Just 25% of
Medi-Cal beneficiaries reported a dental visit in 2007 and
among pregnant women with Medi-Cal coverage only one in
seven received dental services. Almost one-quarter of all
children in California have never seen a dentist and about
40% of California's black, Latino, and Asian preschoolers
and approximately 65% of elementary school children in
these groups need dental care. In 2011, only 22% of the
total number of people eligible for Medi-Cal dental
services received any service, a decrease of 8% from 2009.
A decrease was expected for adults since most adult dental
benefits were eliminated in 2009, however there was also a
decrease for children. In 2011, only 27% of eligible
children received any dental service compared to 34% in
2009. In California, approximately 6.3 million children,
or two-thirds of all children in the state, suffer
needlessly from poor oral health by the time they reach the
third grade. Approximately 7% of California children
missed school due to a dental problem in 2007, excluding
time for cleaning or routine check-up. In 2007, there were
more than 83,000 visits to California hospital emergency
departments for preventable dental conditions.
b) Institute of Medicine (IOM) Report on Oral Health
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(2011 ). In 2011 the IOM published a report titled,
"Improving Access to Oral Health Care for Vulnerable and
Underserved Populations." Various factors create barriers,
preventing access to care for vulnerable and underserved
populations, such as children and Medicaid beneficiaries.
The Health Resources and Services Administration and the
California HealthCare Foundation (CHCF) asked the IOM and
the National Research Council to assess the current oral
health care system, to develop a vision for how to improve
oral health care for these populations, and to recommend
ways to achieve this vision. According to the IOM report,
access to oral health care across the life cycle is
critical to overall health, and it will take flexibility
and ingenuity among multiple stakeholders-including
government leaders, oral health professionals, and
others-to make this access available. The IOM report says
to improve provider participation in public programs,
states should increase Medicaid and Children's Health
Insurance Program reimbursement rates. In addition, with
proper training, nondental health care professionals can
acquire the skills to perform oral disease screenings and
provide other preventive services. The IOM report calls on
dental schools to expand opportunities for dental students
to care for patients with complex oral health care needs in
community-based settings in order to improve the students'
comfort levels in caring for vulnerable and underserved
populations. Finally, according to the IOM report, states
should examine and amend state practice laws to allow
healthcare professionals to practice to their highest level
of competence. The IOM's recommendations provide a roadmap
for the important and necessary next steps to improve
access to oral health care, reduce oral health disparities,
and improve the oral health of the nation's vulnerable and
underserved populations.
c) HWPP No. 172 . The HWPP at OSHPD permits temporary
legal waivers of certain practice restrictions or
educational requirements to test expanded roles and
accelerated training programs for health care
professionals. In December 2010, OSHPD approved HWPP No.
172 that allowed RDAs and RDHS to perform an expanded scope
of practice. Specifically, the HWPP involved RDAs making
decisions on which radiographs to take, if any, to
facilitate an initial oral evaluation by a dentist.
Secondly, RDAs, RDHs, and RDHs in alternative practice will
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be permitted to place ITRs. The long-term objective of the
project is to facilitate the development of new models of
care designed to improve the oral health status of
underserved populations. The project has been extended
twice, with the second extension running from December 1,
2012 to December 1, 2013. Funding for HWPP No. 172 comes
from various sources including CHCF, American Dental
Hygiene Association, American Dental Association, Paradise
Foundation, and Verizon Foundation. Evaluation of the
project is also funded by CHCF.
HWPP No. 172 is a project at the University of Pacific,
School of Dentistry which creates a virtual dental home and
is testing a concept where patients interact with RDAs and
RDHs after a telehealth consultation with a collaborating
dentist who makes diagnostic and treatment decisions and
determines the best location for treatment, thus creating a
true community-based dental home. There are nine sites
currently operating this model of care in California.
Preventive and early intervention care is being provided in
the community (two elementary schools in Sacramento and San
Diego counties, a consortium of Head Start centers in San
Francisco and San Diego, residential facilities associated
with three regional centers for persons with developmental
disabilities, four long-term care facilities, and one
community clinic). Patients with advanced disease
requiring the service of a dentist are being referred to
dental offices and clinics.
A policy brief describing the model and the results of the
current project indicates that under HWPP No. 172, allied
dental personnel completed the following types of
procedures: collect patient information (including medical
and dental history, consent forms, and caries risk
assessment); chart pre-existing conditions; take digital
radiographs; take digital intra and extra-oral photographs;
prophylaxis; fluoride varnish; sealants; ITRs; patient,
parent, and staff oral health education; nutritional
counseling; oral hygiene instructions; case management;
referrals; and, communication with collaborating dentists.
As of March 31, 2013, a total of 1,494 patients have been
seen: Head Start centers (797); elementary schools (212);
long-term care facilities (176); multifunction community
centers (197); and, regional centers (112). The policy
brief also indicates that 110 ITRs were placed during the
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training phase of the program in addition to the 295 placed
in the utilization phase for a total of 405.
d) ITR . According to the American Academy of Pediatric
Dentistry, an ITR may be used to restore and prevent
further decalcification and caries in young patients,
uncooperative patients, or patients with special health
care needs or when traditional cavity preparation and/or
placement of traditional dental restorations are not
feasible and need to be postponed. Additionally, ITR may
be used for step-wise excavation in children with multiple
open carious lesions prior to definitive restoration of the
teeth. The use of ITR has been shown to reduce the levels
of cariogenic oral bacteria (e.g., mutans streptococci,
lactobacilli) in the oral cavity. The ITR procedure
involves removal of caries using hand or slow speed rotary
instruments with caution not to expose the pulp. Leakage
of the restoration can be minimized with maximum caries
removal from the periphery of the lesion. Following
preparation, the tooth is restored with an adhesive
restorative material such as self-setting or resin-modified
glass ionomer cement. ITR has the greatest success when
applied to single surface or small two surface
restorations. Inadequate cavity preparation with
subsequent lack of retention and insufficient bulk can lead
to failure. Follow-up care with topical fluorides and oral
hygiene instruction may improve the treatment outcome in
high caries-risk dental populations.
e) Regulation of RDAs, RDAEFs, and RDHs in California . In
2008, AB 2637 (Eng), Chapter 499, Statutes of 2008,
established the current practice structures for RDAs,
RDAEFs, and other dental assisting categories. AB 2637
contains a consensus language that was a product of several
years of negotiation. The California Dental Association,
the Dental Assisting Alliance which represents dental
assisting schools and dental assistants, the California
Association of Oral and Maxillofacial Surgeons, the
California Society of Periodontists, and the California
Association of Orthodontists all participated in a process
of evaluating a more feasible and effective dental
assisting structure, the result of which are the provisions
adopted in AB 2637.
Current law authorizes an RDA to, among various functions,
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apply and activate bleaching agents, obtain intraoral
images for computer-aided design, chemically prepare teeth
for bonding, place, adjust, and finish direct provisional
restorations, place periodontal dressing, and place
ligature ties and archwires. On the other hand, RDAEFs can
perform all the functions of an RDA, and under direct
supervision , and pursuant to the order of, control, and
full professional responsibility of a licensed dentist:
conduct preliminary evaluation of the patient's oral
health; perform oral health assessments in school-based
community health projects settings, as specified; size and
fit endodontic master points and accessory points; and,
adjust and cement permanent indirect restorations. These
additional procedures could only be performed by a RDAEF
upon evidence of having completed Board-approved courses in
the additional procedures. Additionally, a RDAEF must also
successfully complete an examination consisting of the
additional procedures that would be performed. This
examination is administered by the Board.
Unlike for RDAs and RDAEFs, the Committee exists to license,
regulate, and discipline RDHs. RDHs can perform soft
tissue curettage, administer local anesthesia or nitrous
oxide and oxygen, whether administered alone or in
combination with each other, but only under the direct
supervision (the dentist is physically present in the
treatment facility). Under general supervision, RDHs are
authorized to perform preventive and therapeutic
interventions (including oral prophylaxis, scaling, and
root planing), application of topical, therapeutic, and
subgingival agents used for the control of caries and
periodontal disease, and the taking of impressions for
bleaching trays, as specified. The law also authorizes
RDHs licensed as of December 31, 2005, to perform the
duties of an RDA.
3)SUPPORT . The 100% Campaign (a collaborative effort of the
Children's Partnership, Children Now, and the Children's
Defense Fund-California) supports this bill indicating it has
the potential to improve access to dental care for large
numbers of California children and other underserved
populations through the deployment of teledentistry. The
proponents indicate that many children and underserved
populations suffer from poor oral health because they face
significant obstacles in obtaining dental services. The
geographic mal-distribution of dentists often means there are
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not enough providers in places where children live and go to
school, and many dentists don't accept children's Medi-Cal
health insurance, which provides coverage to more than
one-third of California children. Dentists may not serve
people with special health care needs and may not be located
in low-income communities. The proponents believe that
teledentistry is a successful solution to bring dental care to
children and other populations that would otherwise go
without. The 100% Campaign states that Medi-Cal does not pay
dentists for providing care via store and forward
teledentistry and thus, this bill is necessary so that data
can be collected at a patient site and sent via a Web-based
server for review and consultation by a distant dentist at a
later time.
The California Primary Care Association, Maternal and Child
Health Access indicate that this bill ensures that RDAs and
RDHs can continue to perform the duties they are performing
under the HWPP No. 172 and ensure Medi-Cal pays dentists for
providing store and forward teledentistry, and that this bill
will bring dental care to large number of children and other
underserved populations in their communities.
4)SUPPORT IF AMENDED . The California Association of Oral and
Maxillofacial Surgeons (CALAOMS) has taken a support if
amended position and indicates that it believes that this bill
should only focus on establishing teledentistry as a billable
and reimbursed service in the Medi-Cal program and also allow
RDAs and RDHs to determine which radiographs to perform under
supervision of a licensed dentist. CALAOMS is seeking to
delete provisions allowing RDAs and RDHs to perform ITRs, and
states that patients in need of high-quality dental care first
deserve rigorous and scientific analysis of these same
mid-level providers performing ITRs.
The California Dental Association (CDA) indicates that it has
been working with the author on several of the details of the
bill, including supervision and settings for the new duties.
CDA states that it will continue to resolve outstanding
issues, most notably the oversight for curriculum development.
5)OPPOSE UNLESS AMENDED . The California Dental Hygienists
Association (CDHA) seeks an amendment to remove provisions
allowing RDHs to determine which radiographs to take since
this is already part of the dental assessment provided
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currently by RDHs and is part of their education and training.
CDHA opposes including duties that RDHS can already perform
because it causes confusion within the professions and for
consumers. Additionally, requiring a dentist's order for ITR
will be a problem for RDHs in public health setting and for
RDHAPs outside of dental offices because this limits access to
treatment for patients in need. RDHs licensed prior to 2006
are already trained, educated, and are placing reversible,
temporary fillings using glass ionomer technology. Updating
their education to use the methods tested under the pilot
project could be done in regulation.
6)RELATED LEGISLATION .
a) AB 318 (Logue), pending in this committee, authorizes
Medi-Cal payments for teledentistry services provided to
individuals participating in the Medi-Cal program.
b) AB 809 (Logue) eliminates a requirement on health care
providers prior to the delivery of health care via
telehealth to verbally inform and document consent of the
patient for this use. AB 809 is pending in Senate Health
Committee.
7)PREVIOUS LEGISLATION .
a) 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."
b) SB 1050 (Alquist) of 2012 would have required DDS to
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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."
c) AB 1733 (Logue), Chapter 782, Statutes of 2012, updates
several code sections to replace the term "telemedicine"
with "telehealth" and expands the potential for the use of
telehealth in additional health care programs administered
by DHCS such as the Program of All-Inclusive Care for the
Elderly (PACE).
d) AB 415 (Logue), Chapter 547, Statutes of 2011,
establishes 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.
e) AB 175 (Galgiani), Chapter 419, Statutes of 2010, for
the purposes of Medi-Cal reimbursement, expands, until
January 1, 2013, 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.
f) AB 2120 (Galgiani), Chapter 260, Statutes of 2008,
extends the Medi-Cal telemedicine reimbursement
authorization until January 1, 2013.
g) AB 329 (Nakanishi), Chapter 386, Statutes of 2007,
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authorizes the Medical Board of California (MBC) to
establish a pilot program to expand the practice of
telemedicine and to convene a working group. AB 329
specifies that the purpose of the pilot program is to
develop methods, using a telemedicine model, of delivering
health care to those with chronic diseases and delivering
other health information, and requires MBC to make
recommendations regarding its findings to the Legislature
within one calendar year of the commencement date of the
pilot program.
h) AB 1224 (Hernandez), Chapter 507, Statutes of 2007, adds
optometrists to the list of health care providers covered
under laws governing telemedicine services.
i) AB 354 (Cogdill), Chapter 449, Statutes of 2005, expands
telemedicine provisions by providing that, from July 1,
2006 through December 31, 2008, face-to-face contact
between a health care provider and a patient is not
required for the Medi-Cal program for "store and forward"
teleophthalmology and teledermatology services.
j) SB 1665 (Thompson), Chapter 864, Statutes of 1996,
establishes the 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 is not 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.
8)TECHNICAL AMENDMENTS . The committee recommends the following
technical amendments:
a) On page 7, line 5, delete "compromise" and insert
"comprise."
b) On page 15, line 27, delete "compromise" and insert
"comprise."
9)POLICY CONSIDERATION . To increase assurance that the required
supervision by a dentist will be present in patient care, the
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Committee chair recommends establishing a limit on the number
of RDAEF, RDH or RDHAP that a dentist can supervise in the
teledentistry setting.
REGISTERED SUPPORT / OPPOSITION :
Support
100% Campaign
Alzheimer's Association
Brighter Smiles for You Mobile Dental Hygiene Services
California Academy of Physician Assistants
California Coverage & Health Initiatives
California Primary Care Association
California School Health Centers Association
California School-Based Health Alliance
Children Now
Children's Defense Fund California
Children's Partnership
Community Clinic Association of Los Angeles County
Connecting to Care
Golden Gate Regional Center
La Maestro Community Health Centers
Los Angeles Area Chamber of Commerce
Los Angeles Trust for Children's Health
Los Angeles Unified School District
Maternal and Child Health Access
Open Door Community Health Centers
Oral Health Access Council
PICO California
United Ways California
Venice Family Clinic
Western Dental Services Inc
Worksite Wellness LA
Several individuals
Opposition
None on file.
Analysis Prepared by : Rosielyn Pulmano/HEALTH / (916)
319-2097
AB 1174
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