BILL NUMBER: AB 1310	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 10, 2014
	AMENDED IN ASSEMBLY  MAY 24, 2013

INTRODUCED BY   Assembly Member  Brown   Bonta

    (   Principal coauthor:   Assembly Member
  Brown   ) 
    (   Coauthor:  
Assembly Member   Morrell   )


                        FEBRUARY 22, 2013

   An act to amend Section  14132.25   14132.72
 of the Welfare and Institutions Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1310, as amended,  Brown   Bonta  .
Medi-Cal:  pediatric subacute care.  telehealth.

   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions.  Existing law requires the
department to establish a subacute care program in health facilities
in order to more effectively use limited Medi-Cal dollars while
ensuring needed services for patients who meet subacute care
criteria, as established by the department. For the purposes of the
subacute care program, existing law defines pediatric subacute
services as the health care services needed by a person under 21
years of age who uses a medical technology that compensates for the
loss of a vital bodily function. Existing law also provides that, for
the purposes of the subacute care program, medical necessity for
pediatric subacute care services, as defined, shall be substantiated
in one of 5 ways.   Existing law prohibits a requirement
of in-person contact between a health care provider and patient
under the Medi-Cal program for any service otherwise covered by the
Medi-Cal program when the service is appropriately provided by
telehealth, as defined. Existing law, for purposes of payment of
covered treatment or services provided through telehealth,  
prohibits the department from limiting the type of setting where
services are provided for the patient or by the health care provider.
 
   This bill would expand the definition of pediatric subacute
services to include the health care services needed by a person under
21 years of age who requires treatment for one or more active
complex medical conditions or requires the administration of one or
more technically complex treatments.  
   This bill would also provide that one of the ways that medical
necessity for pediatric subacute care services shall be substantiated
is by dependence on complex wound care management or the presence of
a medical condition and necessity of care such that his or her
health care needs may be satisfied by placement in a facility
providing pediatric subacute care services, but, in the absence of
access to a pediatric subacute care service, the only alternative in
patient care appropriate to meet the patient's medical needs is an
acute care hospital bed. The bill would also provide that medical
necessity may be shown solely by dependence on total parenteral
nutrition or other intravenous nutritional support, without a showing
of dependence on additional treatments, and by dependence on
tracheostomy care, as specified, in conjunction with dependence on
tube feeding by means of a jejunostomy tube.  
   This bill would prohibit the department from requiring a health
care provider licensed in California to be located in California as a
condition of Medi-Cal provider enrollment or reimbursement for
telehealth services provided to Medicare or Medicaid beneficiaries
located in California at the time of service. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 14132.72 of the  
Welfare and Institutions Code   is amended to read: 
   14132.72.  (a) For purposes of this section, the definitions in
subdivision (a) of Section 2290.5 of the Business and Professions
Code shall apply.
   (b) It is the intent of the Legislature to recognize the practice
of telehealth as a legitimate means by which an individual may
receive health care services from a health care provider without
in-person contact with the provider.
   (c) In-person contact between a health care provider and a patient
shall not be required under the Medi-Cal program for services
appropriately provided through telehealth, subject to reimbursement
policies adopted by the department to compensate a licensed health
care provider who provides health care services through telehealth
that are otherwise reimbursed pursuant to the Medi-Cal program.
Nothing in this section or the Telehealth Advancement Act of 2011
 (Chapter 547 of the Statutes of 2011)  shall be construed
to conflict with or supersede the provisions of Section 14091.3 of
this code or any other existing state laws or regulations related to
reimbursement for services provided by a noncontracted provider.
   (d) The department shall not require a health care provider to
document a barrier to an in-person visit for Medi-Cal coverage of
services provided via telehealth. 
   (e) Notwithstanding Section 14122 or any other law, the department
shall not require a health care provider licensed in California to
be located in California as a condition of Medi-Cal provider
enrollment or reimbursement for telehealth services provided to
Medicare or Medicaid beneficiaries located in California at the time
of service.  
   (e) 
    (   f)  For the purposes of payment for covered
treatment or services provided through telehealth, the department
shall not limit the type of setting where services are provided for
the patient or by the health care provider. 
   (f) 
    (g)  Nothing in this section shall be interpreted to
authorize the department to require the use of telehealth when the
health care provider has determined that it is not appropriate.

   (g) 
    (   h)  Notwithstanding Chapter 3.5 (commencing
with Section 11340) of Part 1 of Division 3 of Title 2 of the
Government Code, the department may implement, interpret, and make
specific this section by means of all-county letters, provider
bulletins, and similar instructions. 
  SECTION 1.    Section 14132.25 of the Welfare and
Institutions Code is amended to read:
   14132.25.  (a) On or before July 1, 1983, the State Department of
Health Care Services shall establish a subacute care program in
health facilities in order to more effectively use the limited
Medi-Cal dollars available while at the same time ensuring needed
services for these patients. The subacute care program shall be
available to patients in health facilities who meet subacute care
criteria. Subacute care may be provided by any facility designated by
the director as meeting the subacute care criteria that has an
approved provider participation agreement with the department.
   (b) The department shall develop a rate of reimbursement for this
subacute care program. Reimbursement rates shall be determined in
accordance with methodology developed by the department, specified in
regulation, and may include the following:
   (1) All-inclusive per diem rates.
   (2) Individual patient-specific rates according to the needs of
the individual subacute care patient.
   (3) Other rates subject to negotiation with the health facility.
   (c) Reimbursement at subacute care rates, as specified in
subdivision (b), shall only be implemented if funds are available for
this purpose pursuant to the annual Budget Act.
   (d) The department may negotiate and execute an agreement with any
health facility that meets the standards for providing subacute
care. An agreement may be negotiated or established between the
health facility and the department for subacute care based on
individual patient assessment. The department shall establish level
of care criteria and appropriate utilization controls for patients
eligible for the subacute care program.
   (e) For the purposes of this section, pediatric subacute services
are the health care services needed by a person under 21 years of age
who uses a medical technology that compensates for the loss of a
vital bodily function, requires treatment for one or more active
complex medical conditions, or requires the administration of one or
more technically complex treatments.
   (f) Medical necessity for pediatric subacute care services shall
be substantiated in any one of the following ways:
   (1) A tracheostomy with dependence on mechanical ventilation for a
minimum of six hours each day.
   (2) Dependence on tracheostomy care requiring suctioning at least
every six hours, and room air mist or oxygen as needed, and
dependence on one of the five treatment procedures listed in
subparagraphs (B) to (F), inclusive:
   (A) Dependence on intermittent suctioning at least every eight
hours and room air mist and oxygen as needed.
   (B) Dependence on continuous intravenous therapy, including
administration of a therapeutic agent necessary for hydration or of
intravenous pharmaceuticals, or intravenous pharmaceutical
administration of one or more agents, via a peripheral or central
line, without continuous infusion.
   (C) Dependence on peritoneal dialysis treatments requiring at
least four exchanges every 24 hours.
   (D) Dependence on tube feeding by means of a nasogastric,
gastrostomy, or jejunostomy tube.
   (E) Dependence on other medical technologies required
continuously, that, in the opinion of the attending physician and the
Medi-Cal consultant, require the services of a licensed registered
nurse.
   (F) Dependence on biphasic positive airway pressure at least six
hours a day, including assessment or intervention every three hours
and lacking either cognitive or physical ability of the patient to
protect his or her airway.
   (3) Dependence on total parenteral nutrition or other intravenous
nutritional support.
   (4) Dependence on skilled nursing care in the administration of
any three of the following six treatment procedures:
   (A) Dependence on intermittent suctioning at least every eight
hours and room air mist and oxygen as needed.
   (B) Dependence on continuous intravenous therapy, including
administration of a therapeutic agent necessary for hydration or of
intravenous pharmaceuticals, or intravenous pharmaceutical
administration of one or more agents, via a peripheral or central
line, without continuous infusion.
   (C) Dependence on peritoneal dialysis treatments requiring at
least four exchanges every 24 hours.
   (D) Dependence on tube feeding by means of a nasogastric,
gastrostomy, or jejunostomy tube.
   (E) Dependence on other medical technologies required continuously
that in the opinion of the attending physician and the Medi-Cal
consultant, require the services of a licensed registered nurse.
   (F) Dependence on biphasic positive airway pressure at least six
hours a day, including assessment or intervention every three hours
for a patient lacking either cognitive or physical ability of the
patient to protect his or her airway.
   (5) Dependence on biphasic positive airway pressure or continuous
positive airway pressure at least six hours a day, including
assessment or intervention every three hours, for a patient lacking
either cognitive or physical ability to protect his or her airway,
and dependence on one of the following five treatment procedures:
   (A) Dependence on intermittent suctioning at least every eight
hours and room air mist and oxygen as needed.
   (B) Dependence on continuous intravenous therapy, including
administration of a therapeutic agent necessary for hydration or of
intravenous pharmaceuticals, or intravenous pharmaceutical
administration of one or more agents, via a peripheral or central
line, without continuous infusion.
   (C) Dependence on peritoneal dialysis treatments requiring at
least four exchanges every 24 hours.
   (D) Dependence on tube feeding by means of a nasogastric,
gastrostomy, or jejunostomy tube.
   (E) Dependence on other medical technologies required continuously
that in the opinion of the attending physician and the Medi-Cal
consultant, require the services of a licensed registered nurse.
   (6) Dependence on complex wound care management, including daily
assessment or intervention by a licensed registered nurse and daily
dressing changes, wound packing, debridement, negative pressure wound
therapy, or a special mattress.
   (7) The patient has a medical condition and requires an intensity
of medical or skilled nursing care such that his or her health care
needs may be satisfied by placement in a facility providing pediatric
subacute care services, but, in the absence of a facility providing
pediatric subacute care services, the only other inpatient care
appropriate to meet the patient's health care needs under the
Medi-Cal program is in an acute care licensed hospital bed.
   (g) The medical necessity determination outlined in subdivision
(f) is intended solely for the evaluation of a patient who is
potentially eligible and meets the criteria to be transferred from an
acute care setting to a subacute level of care.