BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1231|
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THIRD READING
Bill No: AB 1231
Author: V. Manuel Pérez (D)
Amended: 6/27/13 in Senate
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 6-0, 6/25/13
AYES: Yee, Berryhill, Emmerson, Evans, Liu, Wright
SENATE HEALTH COMMITTEE : 9-0, 7/3/13
AYES: Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,
Nielsen, Pavley, Wolk
SENATE APPROPRIATIONS COMMITTEE : 7-0, 8/30/13
AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg
ASSEMBLY FLOOR : 74-0, 5/23/13 - See last page for vote
SUBJECT : Regional centers: telehealth
SOURCE : Center for Autism and Related Disorders
DIGEST : This bill, until January 1, 2019, requires the
Department of Developmental Services (DDS) to inform all
regional centers (RCs) that any appropriate health service and
dentistry may be provided through the use of telehealth, as
defined, to consumers of RC services. This bill requires DDS to
provide technical assistance to RCs on the use of telehealth and
to include a consideration of telehealth in Individual Program
Plans (IPP) and Individualized Family Service Plans (IFSP), as
specified, for consumers. This bill requires the use of
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telehealth be voluntary and immediately discontinued at the
request of the consumer or his/her parent, legal guardian, or
conservator, as appropriate. This bill requires DDS, on or
before December 1, 2017, to forward to the fiscal and
appropriate policy committees of the Legislature information
provided by the RCs to assess the effectiveness and
appropriateness of providing telehealth services to RC
consumers, as specified.
ANALYSIS :
Existing law:
1.Establishes the Telehealth Advancement Act of 2011 and 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.Specifies that no health care service plan shall require that
in-person contact occur between a health care provider and a
patient before payment is made for the covered services
appropriately provided through telehealth, subject to the
terms and conditions of the contract entered into between the
enrollee or subscriber and the health care service plan, and
between the health care service plan and its participating
providers or provider groups.
3.Specifies that no health care service plan shall limit the
type of setting where services are provided for the patient or
by the health care provider before payment is made for the
covered services appropriately provided through telehealth,
subject to the terms and conditions of the contract entered
into between the enrollee or subscriber and the health care
service plan, and between the health care service plan and its
participating providers or provider groups.
4.Establishes the Lanterman Developmental Disabilities Services
Act, which declares California's responsibility for providing
an array of services and supports to meet the needs of each
person with developmental disabilities in the least
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restrictive environment, regardless of age or degree of
disability, and to support their integration into the
mainstream life of the community.
5.Establishes a system of nonprofit RCs to provide fixed points
of contact in the community for all persons with developmental
disabilities and their families, to coordinate services and
supports best suited to them throughout their lifetime.
6.Establishes an IPP and defines that planning process as the
vehicle to ensure that services and supports are customized to
meet the needs of consumers who are served by RCs.
7.Requires in federal statute, for each infant or toddler with a
disability, and the infant's or toddler's family, to receive a
written IFSP developed by a multidisciplinary team.
8.Requires in federal statute that the IFSP contain a statement
of the natural environments in which early intervention
services will appropriately be provided, including a
justification of the extent, if any, to which the services
will not be provided in a natural environment.
This bill:
1.States legislative intent to do all of the following:
A. Improve access to treatments and intervention services,
including dental health care services, for consumers of
regional center services and their families in underserved
populations;
B. Provide more cost-effective treatments and intervention
services for consumers of regional center services and
their families;
C. Maximize the effectiveness of the interpersonal and
face-to-face interactions that are utilized for the
treatment of consumers of regional center services;
D. Continue maintenance and support of the existing service
workforce for consumers of RC services; and
E. Utilize telehealth to improve services for consumers of
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RC services.
1.Requires DDS to do all of the following:
A. Inform all RCs that any appropriate health service may
be provided through the use of telehealth to consumers of
RC services;
B. Inform all RCs that dentistry may be provided through
the use of telehealth to consumers;
C. Request RCs to include a consideration of telehealth in
each IPP and IFSP for consumers;
D. Request RCs to consider the use of telehealth services
for inclusion in training programs for parents of
consumers, including, but not limited to, group training
programs, as defined; and
E. Provide, using existing resources, and in partnership
with other organizations, resources, and stakeholders,
technical assistance to RCs 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. Clarifies that any
consumer who receives services through the use of telehealth
pursuant to this bill has an automatic right to immediately
return to his/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 RCs 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
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for all expenses and costs related to the equipment,
transmission, storage, infrastructure, and other expenses
related to telehealth.
5.Defines "telehealth" to have the same meaning as set forth in
Section 2290.5 of the Business and Professions Code.
6.Establishes a sunset date of January 1, 2019.
Background
Telehealth . Telehealth can be used 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. According to the Health Resources and Services
Administration (HRSA), within the U.S. Health and Human Services
Department, telehealth technology can be a valuable addition to
a wide variety of care settings. Telehealth programs, for
example, allow a smaller hospital to draw on the knowledge of a
much larger one, which may be of particular interest to
critical-access hospitals and rural health clinics.
A 2008 report, "Meeting the Health Care Needs of California's
Children: the Role of Telemedicine," by the Children's
Partnership, stated that "Quality health care no longer requires
a health care provider and patient to be in the same room at the
same time. With the advancement of information and
communications technology, children and adults can receive
high-quality health care from a distance through telemedicine.
In fact, telemedicine is rapidly becoming a viable solution to
meeting the health care needs of patients in rural and other
underserved areas."
California was one of the first states to adopt legislation to
dene and support the role of telemedicine in health care
delivery. In 1996, California adopted the Telemedicine
Development Act of 1996, identifying telemedicine as a
legitimate means of providing health care. Currently, no
statute prohibits RCs from providing consumers with telehealth
or teledentistry services.
Teledentristy . The application and use of telehealth in
dentistry are not as well-developed as the use of telehealth
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technologies in other aspects of the health care delivery
system. However, telehealth technologies have been available
and used in the delivery of oral health services for quite some
time. Some reports describe the use of teledentistry to
facilitate collaborative dental care to rural communities.
In 2003, an initiative based at the University of Southern
California (USC) demonstrated that dentists were able to work
with a dental hygienist at a remote location to decide on
preventive services that could be delivered by the hygienist at
that location. Participating hygienists also were able to
facilitate referrals to the USC mobile dental clinic that
delivered on-site dental services at a later date. A 2004
report reviewed available telehealth technologies and outlined
the potential for using these technologies to foster
collaboration between dentists and dental hygienists in order to
reach and improve oral health of underserved populations.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Minor costs to provide technical assistance to regional
centers by DDS (General Fund).
Potential costs in the range of $30,000 - $60,000 to collect
effectiveness data from RCs and report that information to the
Legislature (General Fund).
Unknown impact on the use of services by regional center
consumers (General Fund and federal funds). To the extent
that the bill results in RC consumers using telehealth
services, there could be both increased utilization of
services and reduced costs for current services. To date,
there has been limited use of telehealth in the RC system, so
predicting utilization impacts is difficult.
There may be circumstances where greater knowledge of the
availability of telehealth services by consumers and their
families increases the utilization services. For example, in
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rural areas of the state there may be limited numbers of
providers for certain services. For services that are
recurring or of long duration (such as behavioral health
services), greater access to providers in other areas of the
state through telehealth may increase the demand for those
services by consumers from rural areas.
On the other hand, services provided through telehealth may be
less expensive than services provided in person. In such
cases, greater use of telehealth may reduce costs to the RCs.
SUPPORT : (Verified 8/30/13)
Center for Autism and Related Disorders (source)
ACT Today!
Autism Research Group
Institute for Behavioral Training
ARGUMENTS IN SUPPORT : According to the author, "Regional
centers historically are reluctant to integrate new models of
healthcare into existing consumer services without specific
direction from DDS." The author states that "Telehealth,
including dental care, has the potential to expand access to
vital services, and to decrease the cost of providing those
services while maintaining the same quality of service."
ASSEMBLY FLOOR : 74-0, 5/23/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,
Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown,
Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway,
Cooley, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gordon, Gorell,
Gray, Hagman, Hall, Harkey, Roger Hernández, Jones-Sawyer,
Levine, Linder, Logue, Lowenthal, Maienschein, Mansoor,
Medina, Melendez, Mitchell, Morrell, Mullin, Muratsuchi,
Nazarian, Nestande, Olsen, Pan, Patterson, Perea, V. Manuel
Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone,
Ting, Wagner, Weber, Wieckowski, Wilk, Williams, Yamada, John
A. Pérez
NO VOTE RECORDED: Grove, Holden, Jones, Waldron, Vacancy,
Vacancy
JL:ej 8/31/13 Senate Floor Analyses
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SUPPORT/OPPOSITION: SEE ABOVE
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