BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
175 (Galgiani)
Hearing Date: 8/17/2009 Amended: 6/24/2009
Consultant: Katie Johnson Policy Vote: Health 10-0 BPED
10-0
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BILL SUMMARY: AB 175 would add optometrists to the list of
physicians who may review teleopthalmology eye exams by store
and forward.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
Increased retinal $33 - $102 $75 -
$237 $86 - $270General/*
scan reimbursement $53 - $167 $96 - $302$86 -
$270 Federal
*October 1, 2008 - December 31, 2010 FMAP = 38%GF / 62%FF
January 1, 2011 - ongoing FMAP = 50%GF / 50%FF
FMAP = Federal Medical Assistance Percentage-the percent of
total costs paid by the federal government.
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
Existing law establishes the Medi-Cal program, California's
version of the federal Medicaid program, which provides
comprehensive health care coverage for eligible low-income
individuals. Existing law also provides that, commencing July 1,
2006, face-to-face contact between a health care provider and a
patient is not required under Medi-Cal for teleopthalmology and
teledermatology by store and forward, defined as an asynchronous
transmission of medical information to be reviewed at a later
time by a physician at a distant site 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. These provisions will sunset January 1,
2013.
This bill would, in the case of teleopthalmology, allow an
optometrist to provide services via store and forward. This bill
would provide that if the reviewing optometrist identifies a
disease or condition that would require consultation or
referral, that consultation or referral would be with an
ophthalmologist or other appropriate physician or surgeon.
The Budget Act of 2009 eliminated adult optometry services
effective July 1, 2009. Teleopthamology would not be covered for
adults 21 years of age and older if provided by an optometrist.
Optometry services remain available for Medi-Cal beneficiaries
under age 21 and for residents of skilled nursing facilities.
There are approximately 150,000 Medi-Cal beneficiaries who are
diabetic and at a high risk for blindness who would be eligible
for this service and about 20 percent, or 30,000, reside in
rural areas where teleopthalmology by store and forward would be
beneficial. Medi-Cal reimburses $30.60 - $59.50 for a
consultation depending on the complexity of the case. The
telemedicine originating site is also paid a $22.94 originating
fee as well as $0.24 per minute in
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AB 175 (Galgiani)
transmission costs. If 10 to 20 percent of these eligible
individuals in rural areas were able to newly access screening
as a result of this bill, Medi-Cal reimbursements would increase
by about $175,000 - $550,000.
Medi-Cal costs are generally shared equally between the federal
government (FF) and state General Fund (GF). However, as a
result of the passage of the American Reinvestment and Recovery
Act (ARRA) in February of 2009, the Federal Medical Assistance
Percentage (FMAP) increased from 50 percent to 61.59 percent.
Thus, retroactively from October 1, 2008 through December 31,
2010, the federal government would pay for approximately 62
percent and the state General Fund would pay for 38 percent of
benefit-related Medi-Cal expenditures. After December 31, 2010,
the FMAP reduces to 50 percent FF, 50 percent GF.
A recent study commissioned by the California Health Care
Foundation and completed by the Blue Sky Consulting Group to
study the cost effectiveness of store and forward telemedicine
in the context of using digital imaging as a means of screening
patients with diabetes for retinopathy concluded that the state
could expect to save over $2,500 for each patient screened when
measured over the patient's life time. Although these savings
are relevant, they do not directly offset the annual day-to-day
costs of providing these services.