Amended in Assembly April 21, 2015

Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1485

Introduced by Assembly Member Patterson

February 27, 2015

An act to add Section 14132.735 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1485, as amended, Patterson. Medi-Cal: begin delete teleradiology. end delete begin insert radiology. end insert

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 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 prohibit the department from begin delete requiring a radiologist to be located in California as a condition of end delete begin insert conditioning end insert Medi-Cal provider enrollment or reimbursement for begin delete teleradiology services, as defined, end delete begin insert radiology services end insert provided to Medi-Cal beneficiaries undergoing imaging procedures at locations within California begin insert on the location of the radiologist end insert , if the radiologist meets specified conditions and criteria, as specified.

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 14132.735 is added to the Welfare and
Institutions Code, to read:

14132.735.  

(a) It is the intent of the Legislature that begin delete the
utilization of national teleradiology networks in the delivery of
timely and cost-effective health care services to Medi-Cal
beneficiaries supplement, and not supplant, end delete begin insert this section not be
considered a precedent for other types of health care service
providers because the services performed by radiologists are
provided to attending physicians and not to patients, and therefore
they do not supplant end insert work performed by begin insert other end insert California health
care providers.

(b) Notwithstanding Section 14122, the department shall not
begin delete require a radiologist to be located in California as a condition of end delete
begin insert condition end insert Medi-Cal provider enrollment or reimbursement for
begin delete teleradiology end delete begin insert radiology end insert services provided to Medi-Cal beneficiaries
undergoing imaging procedures at locations within California begin insert on
the location of the radiologist end insert , if the radiologist meets all of the
following conditions and criteria:

(1) The radiologist is licensed pursuant to Division 2
(commencing with Section 500) of the Business and Professions
Code.

(2) The radiologist is enrolled and in good standing in the
Medicaid program for the state where the radiologist is located, is
enrolled in good standing in Medicare, or is enrolled in good
standing in both programs.

(3) The radiologist is not located outside the United States of
America.

(4) The radiologist satisfies all requirements for enrollment and
participation in the Medi-Cal begin delete program, and other statutory
requirements for providing telehealth services. end delete begin insert program. end insert

(5) The radiologist consents to Medi-Cal acting through the
state Medicaid program where the radiologist is located and the
Medicare Program with respect to any issues concerning the
radiologist’s enrollment or participation in Medi-Cal.

(6) The radiologist consents to jurisdiction and venue in
Sacramento, California, for any and all legal proceedings in any
way related to the radiologist’s enrollment in Medi-Cal, including,
but not limited to, formal or informal proceedings, as well as
administrative, civil, and criminal proceedings.

begin delete

(c) For purposes of this section, “teleradiology services” means
professional diagnostic review and interpretation of medical
imaging studies by remote means, including asynchronous store
and forward transmission.

end delete begin delete

(d)

end delete

begin insert (c) end insert  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.

begin delete

(e)

end delete

begin insert (d) end insert  This section shall be implemented only to the extent
permitted by federal law and to the extent that federal financial
participation is available.