BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 175|
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THIRD READING
Bill No: AB 175
Author: Galgiani (D), et al
Amended: 6/24/09 in Senate
Vote: 21
SEN. BUS., PROF. & ECON. DEV. COMMITTEE : 10-0, 6/29/09
AYES: Negrete McLeod, Wyland, Aanestad, Corbett, Correa,
Florez, Oropeza, Romero, Walters, Yee
SENATE HEALTH COMMITTEE : 10-0, 6/17/09
AYES: Alquist, Strickland, Aanestad, Cedillo, Cox,
DeSaulnier, Leno, Maldonado, Pavley, Wolk
NO VOTE RECORDED: Negrete McLeod
SENATE APPROPRIATIONS COMMITTEE : 13-0, 8/27/09
AYES: Kehoe, Cox, Corbett, Denham, Hancock, Leno, Oropeza,
Price, Runner, Walters, Wolk, Wyland, Yee
ASSEMBLY FLOOR : 77-0, 05/21/09 - See last page for vote
SUBJECT : Medical telemedicine: optometrists
SOURCE : Department of Health Care Services
DIGEST : This bill expands the definition of
teleophthalmology and teledermatology by store and forward
to include the services of an optometrist.
ANALYSIS :
CONTINUED
AB 175
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Existing Law
1.Establishes the Medi-Cal program, administered by the
Department of Health Care 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.
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.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.
4.Allows the use of telemedicine in the Medi-Cal program,
when those services would be otherwise covered by the
program when appropriate, and when the contact between
the health care provider and the patient is real time or
near real time.
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 and allows these
telemedicine services to be reimbursed under the Medi-Cal
program.
6.Provides a sunset date of January 1, 2013 for these
provisions.
7.Authorizes optometrists to engage in the practice of
telemedicine in California.
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This bill:
1.Expands the definition of teleophthalmology and
teledermatology by store and forward to include the
services of an optometrist.
2.Requires that if the reviewing optometrist identifies a
disease or condition requiring consultation or referral,
as specified, that consultation shall be with an
ophthalmologist or other appropriate physician and
surgeon.
Background
The 1996 Telemedicine Development Act declared the lack of
primary care and specialty providers, combined with
inadequate transportation are significant barriers to
access to health services in medically underserved rural
and urban areas. The Act also declares that parts of
California have difficulty attracting and retaining health
professionals, as well as supporting health facilities to
provide a continuum of health care.
Telemedicine is increasingly being seen as part of the
approach to address the problem of inadequate access to
providers, especially specialists, and the development of
health systems in medically underserved areas.
Telemedicine can improve communication capabilities and
provide convenient access to up-to-date information,
consultation and other forms of support. Telemedicine can
result in consumers benefiting from expanded access to
providers, faster and more convenient treatment, better
continuity of care, reduction of lost work time and travel
costs, and the ability to receive care while they 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.
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According to the National Eye Institute, 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 United States, but clinical trials demonstrate
that early detection and treatment can prevent 90 percent
of vision loss. The National Eye Institute 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 percent 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11
2011-12 Fund
Increased retinal $33 - $102 $75 - $237
$86 - $270 General/*
scan reimbursement $53 - $167 $96 - $302 $86
- $270 Federal
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*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
SUPPORT : (Verified 8/27/09)
Department of Health Care Services (source)
American Federation of State, County and Municipal
Employees, AFL-CIO
California Optometric Association
California Primary Care Association
Medical Board of California
ARGUMENTS IN SUPPORT : DHCS, the sponsor of the bill,
argues that this bill enables the Medi-Cal program to
recognize optometrists as an additional provider for
telephthalmology services store and forward technology.
They noted that optometrists are already authorized to use
telemedicine but are restricted from providing these
services to Medi-Cal patients. The California Optometric
Association states that passage of this bill will assure
that more patients at risk of becoming blind from diabetes
or glaucoma will be diagnosed and treated sooner. They
point out that optometrists are now the first line of
defense against debilitating eye disease; data show that
seven out of ten eye care patients visit an optometrist
first, where threats to visual health and eyesight are
first diagnosed.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, DeVore,
Duvall, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,
Huber, Huffman, Jeffries, Jones, Knight, Krekorian, Lieu,
Logue, Bonnie Lowenthal, Ma, Mendoza, Miller, Monning,
Nava, Nestande, Niello, Nielsen, John A. Perez, V. Manuel
Perez, Portantino, Ruskin, Salas, Silva, Skinner, Smyth,
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Solorio, Audra Strickland, Swanson, Torlakson, Torres,
Torrico, Tran, Villines, Yamada, Bass
NO VOTE RECORDED: De Leon, Price, Saldana
CTW:JJA:cm 8/28/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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