BILL ANALYSIS �
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 136
S
AUTHOR: Yee
B
AMENDED: April 28, 2011
HEARING DATE: May 4, 2011
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CONSULTANT:
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Bain
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SUBJECT
Medi-Cal: teleophthalmology and teledermatology
SUMMARY
Extends, from January 1, 2013, to January 1, 2018, Medi-Cal
coverage for teleophthalmology and teledermatology by store
and forward, where a physician or optometrist is
transmitted medical information for review at a later time.
CHANGES TO EXISTING LAW
Existing law:
Prohibits, until January 1, 2013, the Department of Health
Care Services (DHCS) from requiring face-to-face contact
between a health care provider and a patient under the
Medi-Cal program for teleophthalmology and teledermatology
by store and forward, to the extent federal financial
participation is available.
Requires services appropriately provided through the store
and forward process to be subject to billing and
reimbursement policies developed by DHCS.
Defines "teleophthalmology and teledermatology by store and
forward" as the transmission of a patient's medical
information to be reviewed at a later time by a physician
Continued---
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at a distant site who is trained in ophthalmology or
dermatology or, for teleophthalmology, by an optometrist
where the physician or optometrist at the distant site
reviews the medical information without the patient being
present in real time.
Requires a patient receiving teleophthalmology or
teledermatology by store and forward to be notified of the
right to receive interactive communication with the distant
specialist physician or optometrist, and to receive an
interactive communication with the distant specialist
physician or optometrist upon request.
This bill:
Extends the sunset date in existing law by five years (from
January 1, 2013 to January 1, 2018) that prohibits DHCS
from requiring face-to-face contact between a health care
provider and a patient under the Medi-Cal program for
teleophthalmology and teledermatology by store and forward,
to the extent federal financial participation is available.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
According to the author, this bill is necessary to continue
to allow teledermatology and teleophthalmology services to
continue to be provided under Medi-Cal. Telemedicine is a
growing model for health care delivery that is used to
improve health care access in rural and underserved
communities. The lack of primary care practitioners,
specialty providers, and transportation continues to be
significant barriers to access to health care services in
medically underserved rural and urban areas. This bill
addresses these problems by retaining teledermatology and
teleophthalmology as procedures for which physicians can
utilize "store and forward" technology and receive Medi-Cal
reimbursement.
STAFF ANALYSIS OF SENATE BILL 136 (Yee) Page
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Background
"Telemedicine" is defined as the practice of health care
delivery, diagnosis, consultation, treatment, transfer of
medical data, and education using interactive audio, video,
or data communications. Telemedicine does not include a
telephone conversation or an electronic mail message
between a health care provider and a patient. In
traditional telemedicine, a physician at a distant site is
able to interview the patient and examine the patient via
closed circuit television. The telemedicine provisions in
current law were added by SB 1665 (Thompson), Chapter 864,
Statutes of 1996.
In 2005, DHCS sponsored AB 354 (Cogdill) to allow Medi-Cal
reimbursement for
teleophthalmology and teledermatology by store and forward.
Teleophthalmology and teledermatology by store and forward
is the transmission of a patient's medical information,
which is then reviewed at a later time by a physician at a
distant site who is trained in ophthalmology or dermatology
(or by an optometrist for teleophthalmology). The
physician or optometrist at the distant site reviews the
medical information without the patient being present.
In February 2009, DHCS provided to the Legislature a report
entitled "Medi-Cal Telemedicine Benefits: Store and Forward
Teleophthalmology and Teledermatology" in response to
statutory reporting requirement in AB 354. According to
the DHCS 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.
The Center for Connected Health Policy (CCHP), a non-profit
planning and strategy organization working to remove policy
STAFF ANALYSIS OF SENATE BILL 136 (Yee) Page
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barriers that prevent the integration of telehealth
technologies into California's health care system, is
supporting a yearlong research project that examines
California's teledermatology workforce, with a focus on the
2006 Medi-Cal teledermatology reimbursement law. CCHP
seeks to explore whether the law creates operational
efficiencies for dermatologists, or addresses access
barriers for medically underserved communities.
Related bills
AB 415 (Logue) makes numerous changes to state telemedicine
statutes, including changing references to "telemedicine"
to "telehealth," revising health plan, health insurance and
Medi-Cal provisions relating to telemedicine, and making
permanent Medi-Cal coverage for teleophthalmology and
teledermatology by store and forward. AB 415 is scheduled
to be heard in the Assembly Health Committee on May 3,
2011.
Prior legislation
SB 1665 (Thompson), Chapter 864, Statutes of 1996, the
Telemedicine Development Act of 1996 (Act), sets standards
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 is not required under the Medi-Cal program for
services appropriately provided through telemedicine, when
those services are otherwise covered by the Medi-Cal
program. SB 1665 requires a health care practitioner to
obtain verbal and written consent prior to providing
services through telemedicine.
AB 354 (Cogdill), Chapter 449, Statutes of 2005, provided
that, from July 1, 2006 until January 1, 2009, face-to-face
contact between a health care provider and a patient is not
required under the Medi-Cal program for store and forward
teleophthalmology and teledermatology.
AB 1224 (Hernandez), Chapter 507, Statutes of 2007, added
optometrists to the list of health care providers covered
under laws governing telemedicine services.
AB 2120 (Galgiani), Chapter 260, Statutes of 2008, extended
the sunset date of AB 354 from January 1, 2009 until
January 1, 2013.
STAFF ANALYSIS OF SENATE BILL 136 (Yee) Page
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AB 175 (Galgiani), Chapter 419, Statutes of 2009, expands
the definition of teleophthalmology and
teledermatology by store and forward to include the
services of an optometrist.
POSITIONS
Support: None received.
Oppose: None received.
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