BILL ANALYSIS
AB 175
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Date of Hearing: March 17, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 175 (Galgiani) - As Introduced: January 29, 2009
SUBJECT : Medical telemedicine: optometrists.
SUMMARY : For the purposes of Medi-Cal reimbursement, expands,
until January 1, 2013, the definition of "teleophthalmology and
teledermatology by store and forward" to include services of an
optometrist who is trained to diagnose and treat eye diseases.
EXISTING LAW :
1)Defines, in the Medical Practice Act, telemedicine as the
practice of health care delivery, diagnosis, consultation,
treatment, transfer of medical data, and education using
interactive audio, video, or data communications.
2)Establishes the Telemedicine Development Act of 1996, which
broadly defines telemedicine as the use of information
technology to deliver medical services and information from
one location to another, and imposes several requirements
governing the delivery of health care services through
telemedicine.
3)Establishes the Medi-Cal program, administered by the
Department of Health Cares Services (DHCS), which provides
comprehensive health benefits to low-income children, their
parents or caretaker relatives, pregnant women, elderly, blind
or disabled persons, nursing home residents, and refugees who
meet specified eligibility criteria.
4)Prohibits health plans and insurers, including Medi-Cal, from
requiring face-to-face contact for services appropriately
provided through telemedicine.
5)Defines, for the purposes of Medi-Cal, "teleophthalmology and
teledermatology by store and forward" as transmission of
medical information to be reviewed at a later time and at a
distant site by a physician who is trained in ophthalmology or
dermatology, where the physician at the distant site reviews
the medical information without the patient being present in
real time.
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6)Under Executive Order S-06-07, directs various state agencies
to develop a comprehensive strategy to advance the adoption of
health information technology, increase transparency of
quality and pricing information, and promote quality and
efficiency of health care services.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, although
existing law allows optometrists to provide telemedicine
services, they are restricted from providing these services to
Medi-Cal recipients. The author states studies have shown
that programs for early detection and treatment of diabetic
retinopathy and improving eye care for diabetic persons are
highly cost-effective and may prevent blindness. Medi-Cal
data indicate that the proportion of diabetic fee-for-service
Medi-Cal recipients who receive annual dilated eye
examinations is significantly lower (25%) than the United
States (U.S.) Department of Health and Human Services' target
of 75% for 2010. According to the author, this bill will
increase the number of providers able to perform
teleophthalmology services by store and forward, thereby
improving access for people who live in medically underserved
rural or have geographic barriers to receiving these services.
The author states the majority of the claims for
teleophthalmology by store and forward will be for the
diagnosis of diabetic retinopathy, therefore this bill will
potentially decrease the risk of blindness in diabetic
Medi-Cal recipients through early detection and prevention in
underserved areas.
2)BACKGROUND . In traditional telemedicine, a physician at a
distant site is able to interview and examine the patient via
closed circuit television. Store and forward telemedicine
allows video recording with viewing of the recording at a
later time by a health care provider at a distant location.
Store and forward is especially applicable to the fields of
dermatology and ophthalmology where visual examination is
important in diagnosis.
3)MEDI-CAL TELEMEDICINE REPORT . Pursuant to AB 354 (Cogdill)
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Chapter 449, Statutes of 2005, in February 2009, DHCS provided
to the Legislature a report entitled "Medi-Cal Telemedicine
Benefits: Store and Forward Teleophthalmology and
Teledermatology." According to the report, since Medi-Cal
coverage of store and forward began, only one provider
submitted bills to Medi-Cal which identified teleophthalmology
or teledermatology store and forward services. This provider
reported 30 claims for dermatology services in the period from
July 1, 2006 through November 19, 2007. The total Medi-Cal
expenditures for these services were $1,786. According to
DHCS, it is possible that other providers have provided
teleophthalmology or teledermatology store and forward
services but because the reimbursement rates are identical,
failed to use the code modifier that distinguishes
telemedicine services from traditional in-person services.
4)DIABETIC RETINOPATHY . According to the National Eye Institute
(NEI), diabetic retinopathy, which is damage to the blood
vessels at the back of the eye, is a leading cause of
blindness in American adults. The California HealthCare
Foundation (CHCF), in a March 2009 report on its diabetic
retinopathy program, states 24,000 diabetics become legally
blind each year in the U.S., but clinical trials demonstrate
that early detection and treatment can prevent 90% of vision
loss. NEI recommends that everyone with diabetes - whether
type I or type II - get an annual comprehensive dilated eye
exam. According to CHCF, residents of California's Central
Valley face the challenges of high rates of diabetes, high
rates of poverty, low insurance rates, lack of regular sources
of care, health provider shortages, and a rural setting that
poses transportation obstacles. CHCF funded a pilot project
to implement screening for diabetic retinopathy using EyePACS,
which is open-source telemedicine software that the University
of California, Berkeley School of Optometry developed
specifically for exchanging eye-related clinical information.
Providers in the 13 primary care sites in the pilot project
screened over 12,000 patients, of whom 15% required referrals
for further eye care. CHCF subsequently expanded the project
to help 43 more clinics throughout the state to acquire
digital retinal cameras, telemedicine software and/or expert
consultation. CHCF's goal for this program is 100 clinics and
100,000 patients.
5)SUPPORT . According to the DHCS, sponsor of this bill, this
bill would increase the number of providers able to perform
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teleophthalmology services by store and forward, thereby
improving access in medically underserved rural and other
communities, and could potentially decrease the risk of
blindness in diabetic Medi-Cal recipients through early
detection and prevention. DHCS argues that optometrists are
the first line of defense against debilitating eye disease and
outnumber physicians in their willingness to participate in
the Medi-Cal program. The California Optometric Association
writes in support that this bill does not expand the scope of
optometric practice and will assure that more patients at risk
of becoming blind from diabetes or glaucoma will be diagnosed
and treated sooner.
6)PREVIOUS LEGISLATION .
a) AB 2120 (Galgiani) Chapter 260, Statutes of 2008 extends
the Medi-Cal telemedicine reimbursement authorization until
January 1, 2013.
b) AB 329 (Nakanishi) Chapter 386, Statutes of 2007
authorizes the Medical Board of California (MBC) to
establish a pilot program to expand the practice of
telemedicine, and to convene a working group. AB 329
specifies that the purpose of the pilot program is to
develop methods, using a telemedicine model, of delivering
health care to those with chronic diseases and delivering
other health information, and requires MBC to make
recommendations regarding its findings to the Legislature
within one calendar year of the commencement date of the
pilot program. MBC reports that this pilot program is
currently commencing.
c) AB 1224 (Hernandez) Chapter 507, Statutes of 2007 adds
optometrists to the list of health care providers covered
under laws governing telemedicine services.
d) AB 354 (Cogdill) Chapter 449, Statutes of 2005 expanded
telemedicine provisions by providing that, from July 1,
2006 through December 31, 2008, face-to-face contact
between a health care provider and a patient shall not be
required for the Medi-Cal program for "store and forward"
teleophthalmology and teledermatology services.
e) SB 1665 (Thompson) Chapter 864, Statutes of 1996, the
Telemedicine Development Act of 1996 (Act), sets standards
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for the use of telemedicine by health care practitioners
and insurers. The Act specifies, in part, that
face-to-face contact between a health care provider and a
patient shall not be required under the Medi-Cal program
for services appropriately provided through telemedicine,
when those services are otherwise covered by the Medi-Cal
program, and requires a health care practitioner to obtain
verbal and written consent prior to providing services
through telemedicine.
7)RELATED LEGISLATION . AB 1289 (Galgiani), pending in the
Assembly, would require the Department of Corrections and
Rehabilitation to establish guidelines for the use of
telemedicine, use telemedicine for all appropriate
consultations, and establish annual performance targets
regarding the use of telemedicine in prisons.
8)DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to
the Assembly Business and Professions Committee.
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REGISTERED SUPPORT / OPPOSITION :
Support
Department of Health Care Services (sponsor)
California Optometric Association
Opposition
None on file.
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097