BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1231
AUTHOR: Pérez
AMENDED: June 17, 2013
HEARING DATE: July 3, 2013
CONSULTANT: Moreno
SUBJECT : Regional centers: telehealth.
SUMMARY : Requires the Department of Developmental Services
inform all regional centers that any appropriate health service
may be provided through the use of telehealth to consumers of
regional center services and that dentistry may be provided
through the use of telehealth to consumers. Requires the
department to request regional centers to include a
consideration of telehealth in each individual program plan and
individualized family service plan for consumers and to consider
the use of telehealth services for inclusion in training
programs for parents of consumers. Requires the department to
provide technical assistance to regional centers regarding the
use of telehealth, as specified.
Existing law:
1.Establishes the Lanterman Developmental Disabilities Services
Act (Lanterman Act), under which the Department of
Developmental Services (DDS) is authorized to contract with
private non-profit regional centers to provide case management
services and arrange for, or purchase, services that meet the
individual needs and choices of each person with developmental
disabilities, as specified.
2.Grants all individuals with developmental disabilities the
right to treatment and habilitation services and supports in
the least restrictive environment.
3.Defines "telehealth" as the mode of delivering health care
services and public health via information and communication
technologies for diagnosis, consultation, treatment,
education, care management, and self-management while a health
care provider is at a distant site relative to a patient, as
specified.
4.Requires laws regarding the confidentiality of health care
information and a patient's rights to his or her medical
Continued---
AB 1231 | Page 2
information to apply to telehealth interactions.
This bill:
1.Requires DDS to:
a. Inform all regional centers that any appropriate health
service may be provided through the use of telehealth to
consumers of regional center services;
b. Inform all regional centers that dentistry may be
provided through the use of telehealth to consumers;
c. Request regional centers to include a consideration of
telehealth in each individual program plan (IPP) and
individualized family service plan (IFSP) for consumers;
d. Request regional centers to consider the use of
telehealth services for inclusion in training programs for
parents of consumers, including, but not limited to, group
training programs; and,
e. Provide, using existing resources, and in partnership
with other organizations, resources, and stakeholders,
technical assistance to regional centers regarding the use
of telehealth to meet the health and dental care needs of
consumers.
1.Permits DDS to implement appropriate vendorization subcodes
for services provided through telehealth.
2.Requires the provision of a service through the use of
telehealth to be voluntary and immediately discontinued at the
request of the consumer or, as appropriate, the consumer's
parent, legal guardian, or conservator. Requires any consumer
who receives services through the use of telehealth pursuant
to this bill have an automatic right to immediately return to
his or her preexisting services, as defined by the consumer's
IPP, that were in place prior to the implementation of the
telehealth service.
3.Requires DDS, on or before December 1, 2017, to forward to the
fiscal and appropriate policy committees of the Legislature
any information provided by the regional centers to the
department to assess the effectiveness and appropriateness of
providing telehealth services to consumers through the IPP and
IFSP processes.
4.Requires a provider of telehealth services to be responsible
for all expenses and costs related to the equipment,
transmission, storage, infrastructure, and other expenses
AB 1231 | Page
3
related to telehealth.
5.Sunsets this bill's provisions on January 1, 2019.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, costs associated with this legislation should be
minor and absorbable within existing DDS resources.
PRIOR VOTES :
Assembly Human Services: 7- 0
Assembly Health: 19- 0
Assembly Appropriations: 17- 0
Assembly Floor: 74- 0
Senate Human Services: 6- 0
COMMENTS :
1.Author's statement. Multiple scientific studies have
demonstrated that telehealth is an effective healthcare
delivery option with genuine potential to decrease costs. This
is especially relevant for a regional center system that bears
responsibility for transportation costs. In addition, private
insurance carriers and the Department of Defense already
utilize telehealth successfully in treating individuals with
developmental disabilities. The rise of Internet-based
technologies provides a new treatment model for families with
developmental disabilities. The use of telehealth can improve
quality of care and help bridge the barriers of time that many
consumers and their families currently face. Telehealth will
enable individuals in remote or medically underserved areas to
receive treatment without the burden of extended and recurring
travel. This not only saves hours of transportation time, but
dollars spent on transportation by the regional centers. This
bill will help ensure that all consumers have access to the
services they require.
2.Telehealth. Telehealth services consist of diagnosis,
treatment, assessment, monitoring, communications, and
education. Telehealth includes telemedicine, which is the
diagnosis and treatment of illness or injury. Telehealth
medical services are delivered in three ways: video
conferencing, which is used for real-time patient-provider
consultations, provider-to-provider discussions, and language
translation services; patient monitoring, in which electronic
devices transmit patient health information to health care
providers; and, store and forward technologies, which
AB 1231 | Page 4
electronically transmit pre-recorded videos and digital
images, such as X-rays, video clips, and photos, between
primary care providers and medical specialists.
3.Double referral. This bill was heard in the Senate Human
Services Committee on June 25, 2013, and passed with a 6-0
vote.
4.Related legislation. AB 809 (Logue) would permit the health
care provider initiating the use of telehealth to request
verbal consent prior to the delivery of health care via
telehealth. This bill has been referred to the Senate
Committees on Business, Professions, and Economic Development
and Health.
5.Prior legislation. SB 764 (Steinberg) of 2012 would have
required each IPP team to consider the use of telehealth
whenever applicable for the purpose of improving access to
intervention and therapeutic services and facilitating better
and cost-effective services, as specified. SB 764 was vetoed
by the Governor, who stated, "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 required
the taskforce to provide technical assistance and
recommendations in the area of telehealth services for
individuals with ASD, as specified. SB 1050 was vetoed by the
Governor, who stated, "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
AB 1231 | Page
5
warranted."
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
the Department of Health Care Services such as the Program of
All-Inclusive Care for the Elderly.
AB 171 (Beall) of 2011 would have required health plans and
insurers to provide coverage for behavioral health treatment
for autism or Pervasive Developmental Disorder (PDD).
AB 171 died in the Senate Health Committee without a hearing.
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.
AB 329 (Nakanishi), Chapter 386, Statutes of 2007, 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. MBC reports that this pilot program is
currently commencing.
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 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.
6.Support. Supporters write that many regional center consumers
do not have adequate access to behavioral health treatment,
AB 1231 | Page 6
especially in underserved and rural populations where
transportation and provider shortages present significant
obstacles to treatment. Telehealth technology represents an
opportunity to bridge the gap in the services by offering
regional center consumers another option.
SUPPORT AND OPPOSITION :
Support: (previous version)
ACT Today!
Association of Regional Center Agencies
Autism Research Group
Center for Autism and Related Disorders
Institute for Behavioral Training
Law Offices of Bonnie Z. Yates, Inc.
Special Needs Network
The Children's Partnership
1 individual
Oppose: None received
-- END --