BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 809
AUTHOR: Logue
AMENDED: August 7, 2014
HEARING DATE: August 13, 2014
CONSULTANT: Marchand
SUBJECT : Healing arts: telehealth.
SUMMARY : Revises the informed consent requirements relating to
the delivery of health care via telehealth by permitting consent
to be made verbally or in writing, and by deleting the
requirement that the health care provider who obtains the
consent be at the originating site where the patient is
physically located. This bill contains an urgency clause that
will make this bill effective upon enactment.
Existing law:
1.Defines "telehealth" as the mode of delivering health care
services and public health via information and communication
technologies to facilitate the diagnosis, consultation,
treatment, education, care management, and self-management of
a patient's health care while the patient is at the
originating site and the health care provider is at a distant
site.
2.Requires the provider at the originating site (where the
patient is located), prior to the delivery of health care via
telehealth, to verbally inform the patient that telehealth may
be used, to obtain verbal consent from the patient for this
use, and to document the verbal consent in the patient's
medical record.
3.Specifies that the failure of a health care provider to comply
with the requirement to obtain verbal consent for the use of
telehealth constitutes unprofessional conduct, but excludes
violations from constituting a misdemeanor criminal offense.
This bill:
1.Deletes the requirement that the health care provider "at the
originating site" obtain informed consent prior to the use of
telehealth, and instead requires the health care provider who
is initiating the use of telehealth to obtain consent.
Continued---
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2.Deletes the requirement that the health care provider
"verbally" inform the patient about the use of telehealth, and
instead requires the provider to inform the patient, and
clarifies that consent can be obtained verbally or in written
form.
3.Deletes the requirement that the verbal consent be documented
in the patient's medical record, and instead just requires the
informed consent to be documented.
4.Specifies that nothing in the informed consent requirements
relating to telehealth precludes patients from receiving
in-person health care delivery services during a specified
course of health care and treatment after agreeing to receive
services via telehealth.
FISCAL EFFECT : This bill has been keyed non-fiscal.
PRIOR VOTES :
Assembly Health: 15- 0
Assembly Business, Professions and Consumer Protection:12- 0
Assembly Floor: 74- 0
Senate Business, Professions and Economic Development:10- 0
COMMENTS :
1.Author's statement. According to the author, this bill will
revise the existing consent requirements for the use of
telehealth. Health care providers will be able to acquire
either verbal or written consent for the initial use of
treatment via telehealth and be able to apply the consent to
future uses of telehealth as well. Furthermore, patients will
be able to initiate treatment via telehealth outside of the
provider's facility and provide consent as well. This will
enable patients and providers to take advantage of the
increased opportunities in telehealth provided by emerging
technologies.
2.Telehealth. Telehealth is a mode of delivering health care
services and public health using information and communication
technologies that enable the diagnosis, consultation,
treatment, education, care management, and self-management of
patients. It includes telemedicine, which is the diagnosis and
treatment of illness or injury, and other telehealth services
such as monitoring, communications, and education. Currently,
telehealth services are primarily delivered in three ways:
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a. Video conferencing, which is used for real-time
patient-provider consultations, provider-to-provider
discussions, and language translation services;
b. Patient monitoring, in which electronic devices transmit
patient health information to health care providers; and,
c. Store and forward technologies, which electronically
transmit pre-recorded videos and digital images, such as
X-rays, video clips, and photos, between primary care
providers and medical specialists.
Telehealth is commonly used to address the problems of
inadequate provider distribution and is used in the
development of health systems in rural and medically
underserved areas. It has the potential to reduce costs,
improve quality, change the conditions of practice, and
improve access to health care services.
1.California telehealth model statute recommendations. In 2010,
the Center for Connected Health Policy (CCHP) convened a
diverse work group of 25 prominent health care and policy
professionals to participate in a Telehealth Model Statute
Work Group. This group examined the barriers to the
integration of telehealth as a tool into California's health
care delivery system. A report was issued in February of 2011
that recommended modernizing state telemedicine and workforce
laws, to encourage more robust adoption of telehealth
technologies. The report, "Advancing California's Leadership
in Telehealth Policy: A Telehealth Model Statute & Other
Policy Recommendations," made 13 recommendations in four
categories: (1) revisions to the state's Telemedicine
Development Act of 1996 (TDA), focusing primarily on financial
incentives and informed consent; (2) recommendations to
incorporate telehealth into state workforce law; (3) statutory
recommendations to promote interoperability of technology and
consumer education; and, (4) recommendations on increasing
research and education efforts in telehealth technologies.
AB 415 (Logue), Chapter 547, Statutes of 2011, incorporated
some, but not all, of the recommendations of the CCHP report.
One of the recommendations in the report, for example, was to
remove the requirement necessitating an additional informed
consent waiver be obtained prior to any telehealth services
being rendered. This bill, while not deleting the informed
consent requirement, is attempting to reduce the burden of
this telehealth-specific informed consent by permitting the
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consent to be obtained by the provider at the distant site,
and allowing the consent to be obtained in verbal or written
form.
2.Prior legislation. AB 1733 (Logue) applied existing provisions
of law, prohibiting health care service plans from requiring
in-person contact between a provider and a patient prior to
paying for telehealth services, to additional types of
Medi-Cal managed care plans, including the Program of
All-Inclusive Care for the Elderly, and requires all health
care practitioners providing telehealth services to be subject
to specified provisions of the Medical Practice Act relating
to telehealth.
AB 415 (Logue), Chapter 547, Statutes of 2011, established the
Telehealth Advancement Act of 2011 to revise and update
existing law to facilitate the advancement of telehealth as a
service delivery mode in managed care and the Medi-Cal
program. Among other provisions, AB 415 updated and defined
terminology related to telehealth, removed various
requirements imposed by health care service plans, health
insurers, and Medi-Cal for patients to receive health care
services through telehealth, and removed the sunset date
authorizing teleopthalmology and teledermatology by store and
forward in the Medi-Cal program.
AB 175 (Galgiani), Chapter 419, Statutes of 2010, for the
purposes of Medi-Cal reimbursement, expanded, until January 1,
2013, the definition of "teleophthalmology and teledermatology
by store and forward" to include services of an optometrist
who is trained to diagnose and treat eye diseases.
AB 2120 (Galgiani), Chapter 260, Statutes of 2008, extended the
Medi-Cal telemedicine reimbursement authorization until
January 1, 2013.
AB 329 (Nakanishi), Chapter 386, Statutes of 2007, authorized
the Medical Board of California (MBC) to establish a pilot
program to expand the practice of telemedicine, and to convene
a working group. AB 329 specifies that the purpose of the
pilot program was to develop methods, using a telemedicine
model, of delivering health care to those with chronic
diseases and delivering other health information, and required
MBC to make recommendations regarding its findings to the
Legislature within one calendar year of the commencement date
of the pilot program. MBC issued the final report of this
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pilot program in April of 2014.
AB 1224 (Hernandez), Chapter 507, Statutes of 2007, added
optometrists to the list of health care providers covered
under laws governing telemedicine services.
SB 1665 (Thompson), Chapter 864, Statutes of 1996, established
TDA to set standards for the use of telemedicine by health
care practitioners and insurers. TDA specified, in part, that
face-to-face contact between a health care provider and a
patient shall not be required under the Medi-Cal Program for
services appropriately provided through telemedicine, when
those services are otherwise covered by the Medi-Cal program,
and required a health care practitioner to obtain verbal and
written consent prior to providing services through
telemedicine.
3.Support. Planned Parenthood Affiliates of California (PPAC)
states in support that this bill permits consent to be given
either written or verbally, which accommodates different
telehealth situations and modalities. PPAC states that this
bill also eliminates the requirement that the health care
provider initiating the use of telehealth be physically at the
originating site with the patient. According to PPAC, as
technology advances, telehealth will include models where
patients communicate directly with a distant provider and are
not physically present in a provider's office. As amended,
PPAC states that this bill now encompasses mobile applications
that directly connect patients with providers.
MBC also supports this bill, stating that it will allow the
Telemedicine Advancement Act of 2011 to be better implemented,
which will help to improve access to care via telehealth and
further the Board's mission of improving access to care. The
National Multiple Sclerosis Society - California Action
Network states in support that this bill will continue to
assure that people with chronic diseases have access to health
care through telehealth services.
SUPPORT AND OPPOSITION :
Support: Association of California Healthcare Districts
Board of Behavioral Sciences
Medical Board of California
National Multiple Sclerosis Society
Occupational Therapy Association of California
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Planned Parenthood Affiliates of California
Oppose: None received.
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