BILL NUMBER: AB 1771	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MARCH 11, 2014

INTRODUCED BY   Assembly Member V. Manuel Pérez

                        FEBRUARY 14, 2014

   An act to add Section 1374.14 to the Health and Safety Code, and
to add Section 10123.855 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1771, as amended, V. Manuel Pérez. Telephonic and electronic
patient management services.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law also provides for the
regulation of health insurers by the Insurance Commissioner. Existing
law prohibits a health care service plan or health insurer from
requiring in-person contact between a health care provider and a
patient before payment is made for covered services appropriately
provided through telehealth, which is defined to mean the mode of
delivering health care services via information and communication
technologies, as specified.
   This bill would require a health care service plan or a health
insurer, with respect to contracts and policies issued, amended, or
renewed on or after January 1, 2015, to cover physician telephonic
and electronic patient management services and to reimburse those
services at the same level and amount as face-to-face patient
encounters with similar complexity and time expenditure. Because a
willful violation of the bill's requirements by a health care service
plan or health insurer would be a crime, the bill would impose a
state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


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

  SECTION 1.  The Legislature hereby finds and declares all of the
following:
   (a) The lack of primary and specialty care physicians continues to
be a significant barrier to individual access to health care
services, a barrier that will only be exacerbated by health care
reform efforts that will increase the number of insured individuals.
   (b)  Telephonic   The term "telehealth," as
defined in Section 2290.5 of the Business and Professions Code,
includes telephonic  and electronic patient management 
is   , which means  the use of electronic
communication tools, such as the telephone and electronic mail, to
enable treating physicians to evaluate and manage their existing
patients in a manner recognized by the American Medical Association,
Current Procedural Terminology codes.
   (c) Telephonic and electronic patient management is an effective
strategy to address the problems associated with the physician
shortage in California, as it increases physician practice efficiency
through the reduction of unnecessary office visits and increases
productivity by allowing physicians to treat more patients.
   (d) In addition, studies have shown that telephonic and electronic
patient management reduces costs and yields positive results for
health care payers due to the reduced use of costly services and
reported improvements in quality of care.
   (e) Consumers of health care will benefit from telephonic and
electronic patient management in many ways, including expanded access
to physicians, faster and more convenient treatment, better
continuity of care, and reduced lost work time and health care costs.

   (f) While some  third party-payers  
third-party payers  reimburse physicians for telephonic and
electronic patient management, some do not even though that
reimbursement would assist in improving the physical and economic
health of the state.
  SEC. 2.  Section 1374.14 is added to the Health and Safety Code, to
read:
   1374.14.  (a) Notwithstanding any other law, a health care service
plan shall, with respect to plan contracts issued, amended, or
renewed on or after January 1, 2015, cover physician telephonic and
electronic patient management services and reimburse those services
at the same level and amount as face-to-face patient encounters with
similar complexity and time expenditure.
   (b) This section shall not be construed to authorize a health care
service plan to require the use of telephonic and electronic patient
management services when the physician has determined that those
services are not medically appropriate.
   (c) This section shall not be construed to alter the scope of
practice of a health care provider or authorize the delivery of
health care services in a setting, or in a manner, that is not
otherwise authorized by law.
   (d) All laws regarding the confidentiality of health information
and a patient's rights to his or her medical information shall apply
to  telephone   telephonic  and electronic
patient management services.
   (e) This section shall not apply to a patient under the
jurisdiction of the Department of Corrections and Rehabilitation or
any other correctional facility.
   (f) For purposes of this section, "telephonic and electronic
patient management services" means the use of electronic
communication tools, such as the telephone and electronic mail, to
enable treating physicians to evaluate and manage existing patients
in a manner recognized by the American Medical Association, Current
Procedural Terminology codes.
  SEC. 3.  Section 10123.855 is added to the Insurance Code, to read:

   10123.855.  (a) Notwithstanding any other law, a health insurer
shall, with respect to policies of health insurance issued, amended,
or renewed on or after January 1, 2015, cover physician telephonic
and electronic patient management services and reimburse those
services at the same level and amount as face-to-face patient
encounters with similar complexity and time expenditure.
   (b) This section shall not be construed to authorize a health
insurer to require the use of telephonic and electronic patient
management services when the physician has determined that those
services are not medically appropriate.
   (c) This section shall not be construed to alter the scope of
practice of a health care provider or authorize the delivery of
health care services in a setting, or in a manner, that is not
otherwise authorized by law.
   (d) All laws regarding the confidentiality of health information
and a patient's rights to his or her medical information shall apply
to  telephone   telephonic  and electronic
patient management services.
   (e) This section shall not apply to a patient under the
jurisdiction of the Department of Corrections and Rehabilitation or
any other correctional facility.
   (f) For purposes of this section, "telephonic and electronic
patient management services" means the use of electronic
communication tools, such as the telephone and electronic mail, to
enable treating physicians to evaluate and manage existing patients
in a manner recognized by the American Medical Association, Current
Procedural Terminology codes.
  SEC. 4.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.