BILL ANALYSIS Ó
AB 1485
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Date of Hearing: May 13, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
1485 (Patterson) - As Amended May 5, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill prohibits the Department of Health Care Services
(DHCS) from using the location of a radiologist as a condition
of approving Medi-Cal provider enrollment or reimbursement for
radiology services provided to Medi-Cal beneficiaries undergoing
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imaging procedures, if the radiologist meets requirements, as
specified.
FISCAL EFFECT:
1)One-time costs, likely in the range of $50,000, to review and
revise existing regulations, as well as policies and
procedures, by the Department of Health Care Services (DHCS)
(GF/federal). Although this bill is specific to radiology, if
this review prompted DHCS to assess and revisit out-of-state
provider payment policies for other health care services, the
regulatory effort could be more significant.
2)Ongoing costs to DHCS to process additional provider
enrollments, and to potentially perform investigations into
out-of-state radiologists for Medi-Cal fraud or abuse, in the
range of $100,000-$150,000 annually (GF/federal).
3)Enforcement investigations and enrollment activities for
out-of-state providers would incur additional travel time and
expense on average than the same activities for in-state
providers.
COMMENTS:
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1)Purpose. The author states that high speed broadband and the
Internet are providing patients unparalleled access to
radiology subspecialists through national radiology networks,
which can, within minutes, provide expert analyses to
attending physicians, regardless of the location of the
patient or radiologist. However, existing law governing
Medi-Cal provider enrollment and reimbursement have not kept
pace with these innovations. The author intends this bill to
clarify existing law, providing necessary statutory guidance
for DHCS regarding Medi-Cal provider enrollment and
reimbursements for radiologists.
2)Telehealth in Medi-Cal. "Telehealth" is defined 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. 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. Existing law
also, 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.
3)Current Practice. According to the author, DHCS will not
reimburse California licensed out-of-state physicians who seek
to bill Medi-Cal for telehealth services for fee-for-service
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beneficiaries. These providers cannot be enrolled in Medi-Cal
using their out-of-state location practice location, or DHCS
will deny their applications. DHCS' denial letters state that
out-of-state medical care for Medi-Cal beneficiaries is
covered only when emergency services have been provided to a
Medi-Cal beneficiary traveling out-of-state.
4)Support. Virtual Radiologic, the sponsor of the bill, states
that the bill is necessary to provide statutory guidance to
DHCS. The sponsor points to its experience working with DHCS;
in particular, that DHCS has switched its position several
times in the last few years, making clear legislative guidance
necessary. Virtual Radiologic reports that in some cases,
after receiving denial letters for Medi-Cal reimbursement and
provider enrollment, DHCS rescinded denials, agreeing that
technological advances in the delivery of radiology services
are consistent with existing law. Other times, DHCS has
denied such provider enrollment and reimbursement requests.
5)Opposition. Union of American Physicians and Dentists/
American Federation of State, County & Municipal Employees
(AFSCME)-Local 206, AFSCME, California Labor Federation, and
California Nurses Association oppose this bill, on the
principle that this practice would allow Medi-Cal dollars to
be contracted to out-of-state for-profit corporations, and
would take away employment opportunities and Medi-Cal dollars
from state and local economies.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
AB 1485
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