BILL ANALYSIS
AB 175
Page 1
Date of Hearing: April 28, 2009
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Mary Hayashi, Chair
AB 175 (Galgiani) - As Amended: April 21, 2009
SUBJECT : Medical telemedicine: optometrists.
SUMMARY : Expands the definition of "teleophthalmology and
teledermatology by store and forward" to include the services of
an optometrist. Specifically, this bill :
1)Expands, until January 1, 2013, the definition of
"teleophthalmology and teledermatology by store and forward"
to include services of an optometrist.
2)States that if the reviewing optometrist identifies a disease
or condition requiring consultation or referral, as specified,
that consultation shall be with an appropriate physician and
surgeon or ophthalmologist.
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)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
AB 175
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dermatology, where the physician at the distant site reviews
the medical information without the patient being present in
real time.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office,
"Although optometrists are able to provide telemedicine services
pursuant to AB 1224 (Hernandez) Chapter 507, Statutes of 2007,
they are restricted from providing these services to Medi-Cal
recipients. An amendment to Welfare and Institutions Code
14132.725 should be made to allow the optometrists to provide
teleophthalmology services by store and forward. Welfare and
Institutions Code 14132.725 authorizes the Medi-Cal program to
reimburse for teleophthalmology and teledermatology by store and
forward, to the extent that federal participation is available,
until January 1, 2013.
"AB 175 will increase the number of providers able to perform
teleophthalmology services by store and forward, thereby
improving access in medically underserved rural and other areas
that pose geographic barriers to receiving these services.
Since the majority of the claims for teleophthalmology by store
and forward will be for the diagnosis of diabetic retinopathy,
this change will potentially decrease the risk of blindness in
diabetic Medi-Cal recipients through early detection and
prevention in these underserved areas."
Background . The 1996 Telemedicine Development Act declared the
lack of primary care, specialty providers, and transportation
are significant barriers to access to health services in
medically underserved rural and urban areas, and parts of
California have difficulty attracting and retaining health
professionals, as well as supporting local health facilities to
provide a continuum of health care. It also declared
telemedicine is part of multifaceted approach to address the
problem of provider distribution and the development of health
systems in medically underserved areas by improving
communication capabilities and providing convenient access to
up-to-date information, consultation, and other forms of
support. And consumers of health care will benefit from
telemedicine in many ways, including expanded access to
providers, faster and more convenient treatment, better
continuity of care, reduction of lost work time and travel
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costs, and the ability to remain with support networks.
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.
Arguments in support . The California Optometric Association
writes, "Passage of AB 175 will assure that more patients at
risk of becoming blind from diabetes or glaucoma will be
diagnosed and treated sooner. Optometrists are now the first
line of defense against debilitating eye disease; data show that
seven out of 10 eye care patients visit an optometrist first,
where threats to visual health and eyesight are first diagnosed.
Advances in retinal photography and digital technology have
made it possible to store retinal images and forward them
electronically for remote diagnosis. Assuring that optometrists
can maintain their presence in the Medi-Cal program to provide
these skills to those who desperately need them will have a
positive impact on the availability and affordability of primary
eye care."
REGISTERED SUPPORT / OPPOSITION :
Support
California Optometric Association
California Primary Care Association
State of California, Health and Human Services Agency,
Department of Health Care Services
Opposition
None on file.
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301