BILL ANALYSIS
AB 175
Page 1
ASSEMBLY THIRD READING
AB 175 (Galgiani)
As Amended April 21, 2009
Majority vote
HEALTH 19-0 BUSINESS & PROFESSIONS
10-0
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|Ayes:|Jones, Fletcher, Adams, |Ayes:|Hayashi, Emmerson, |
| |Ammiano, Block, Carter, | |Conway, |
| |Conway, De La Torre, De | |Eng, Hernandez, Nava, |
| |Leon, Emmerson, Gaines, | |Niello, |
| |Hall, Hayashi, Hernandez, | |John A. Perez, Ruskin, |
| |Bonnie Lowenthal, Nava, | |Smyth |
| |V. Manuel Perez, Salas, | | |
| |Audra Strickland | | |
| | | | |
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APPROPRIATIONS 16-0
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|Ayes:|De Leon, Nielsen, |
| |Ammiano, Charles |
| |Calderon, Davis, Duvall, |
| |Krekorian, Hall, Harkey, |
| |Miller, John A. Perez, |
| |Price, Skinner, Solorio, |
| |Audra Strickland, |
| |Torlakson |
|-----+--------------------------|
| | |
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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 a
licensed optometrist.
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.
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2)Prohibits health plans and insurers, including Medi-Cal, from
requiring face-to-face contact for services appropriately
provided through telemedicine.
3)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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis, this bill could result in General Fund
savings of $1.3 million if 500 screenings prevent blindness.
COMMENTS : 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. The author argues 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 areas or who 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.
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
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ophthalmology where visual examination is important in
diagnosis.
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 and poverty, low insurance rates, lack of regular
sources of care, health care provider shortages, and rural
settings that pose 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.
According to the Department of Health Care Services (DHCS),
sponsor of this bill, this bill would increase the number of
providers able to perform 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.
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Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097
FN: 0000724