BILL ANALYSIS �
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THIRD READING
Bill No: AB 809
Author: Logue (R), et al.
Amended: 8/7/14 in Senate
Vote: 27 - Urgency
SENATE BUSINESS, PROF. & ECON. DEVELOP. COMM. : 10-0, 6/17/13
AYES: Lieu, Emmerson, Block, Corbett, Galgiani, Hernandez,
Hill, Padilla, Wyland, Yee
SENATE HEALTH COMMITTEE : 8-0, 8/13/14
AYES: Hernandez, Morrell, Beall, DeSaulnier, Evans, Monning,
Nielsen, Wolk
NO VOTE RECORDED: De Le�n
ASSEMBLY FLOOR : 74-0, 5/13/13 - See last page for vote
SUBJECT : Healing arts: telehealth
SOURCE : Author
DIGEST : This bill 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.
ANALYSIS :
Existing law:
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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. Telehealth facilitates patient self-management and
caregiver support for patients and includes synchronous
interactions and asynchronous store and forward transfers.
2. Requires a health care provider to verbally inform the
patient that telehealth may be used, obtain verbal consent
from the patient for this use and requires the verbal consent
to be documented in the patient's medical record.
3. Establishes that failure to inform the patient that
telehealth may be used and to obtain their informed consent
constitutes unprofessional conduct.
4. States that all laws regarding the confidentiality of health
care information and a patient's rights to his/her medical
information apply to telehealth interactions.
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.
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
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course of health care and treatment after agreeing to receive
services via telehealth.
Background
Telehealth . Telehealth is the practice of health care by using
information and communication technologies such as audio, video
or data communications to facilitate in diagnosis, consultation,
treatment, education or management of a patient's health care.
These types of communications include real time face-to-face
interactions with the patient (synchronous) or near real time
where the patient is not present (asynchronous) two-way transfer
of medical information. Telehealth helps reduce barriers by
connecting patients and providers over great distances (e.g.,
those in remote parts of the state, those with disabilities or
those with dialects not commonly found in their area).
Telemedicine Development Act of 1996 (TDA) . The TDA was
established by
SB 1665 (Thompson, Chapter 864, Statutes of 1996), making
California one of the first states to utilize telemedicine (now
referred to as "telehealth"). The purpose of the TDA was to
reach underserved populations who, due to geographic and/or
economic barriers, could not access health care.
Insurance reimbursement . Included in the TDA was the
requirement that health insurers establish reimbursement
policies for telemedicine providers. It required every
insurer issuing group or individual policies of disability
insurance to reimburse claims for those expenses within 30
working days after the receipt of claim unless contested;
prohibited health care service disability insurers,
non-profit plans and the Medi-Cal program, from requiring
face-to-face contact between patient and physician as a
condition of payment for services and required service plans
to adopt reimbursement policies to compensate telemedicine
services. In 2000, AB 2877 (Thomson, Chapter 93) was passed
which indefinitely extended the provisions for telemedicine
coverage by Medi-Cal.
Patient protections . In 1997, the TDA was amended to
exclude from the definition of telemedicine telephone
conversations and electronic mail messages between a health
care practitioner and a patient. The law also extended the
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rights granted to a patient of telemedicine to the patient's
legal representative and it revised protections granted to
patients of telemedicine to require application of existing
laws regarding patient access to medical information and
copies of medical records and surrogate decision-making.
Executive Orders related to telemedicine . In 2006 and 2007, a
number of Executive Orders that provides funding for
telemedicine went into effect.
Executive Order S-12-06 allocated $240 million to achieve full
information exchange between health care providers and
stakeholders within 10 years.
Executive Order S-23-06 established a broadband task force to
promote broadband internet access and usage.
Executive Order S-06-07 advanced the adoption of health
information technology, increased transparency of quality and
pricing information and promoted quality and efficiency of
health care services.
Teleheath Advancement Act of 2011 . In 2011, the TDA of 1996 was
updated (AB 415, Logue, Chapter 547). The law replaced the term
"telemedicine" with "telehealth." It allowed for the provision
of a broader range of telehealth services, expansion of
teleheatlh providers to include all licensed healthcare
professionals, expansion of telehealth care settings and the
ability for California hospitals to establish medical
credentials for telehealth providers more easily.
Comments
According to the author's office, 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local:
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No
SUPPORT : (Verified 8/13/14)
Association of California Healthcare Districts
Board of Behavioral Sciences
Medical Board of California
National Multiple Sclerosis Society
Occupational Therapy Association of California
Planned Parenthood Affiliates of California
ARGUMENTS IN SUPPORT : Planned Parenthood Affiliates of
California (PPAC) states 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
Telehealth Advancement Act of 2011 to be better implemented,
which will help to improve access to care via telehealth and
further MBC's mission of improving access to care.
The National Multiple Sclerosis Society - California Action
Network states that this bill will continue to assure that
people with chronic diseases have access to health care through
telehealth services.
ASSEMBLY FLOOR : 74-0, 5/13/13
AYES: Achadjian, Alejo, Atkins, Bigelow, Bloom, Blumenfield,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Ch�vez, Chesbro, Conway, Cooley,
Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox, Frazier,
Beth Gaines, Garcia, Gatto, Gordon, Gorell, Gray, Grove,
Hagman, Hall, Harkey, Roger Hern�ndez, Jones, Jones-Sawyer,
Levine, Linder, Logue, Maienschein, Mansoor, Medina, Melendez,
Mitchell, Morrell, Mullin, Muratsuchi, Nazarian, Nestande,
Olsen, Pan, Patterson, Perea, V. Manuel P�rez, Quirk,
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Quirk-Silva, Rendon, Salas, Skinner, Stone, Ting, Torres,
Wagner, Waldron, Weber, Wieckowski, Wilk, Williams, Yamada,
John A. P�rez
NO VOTE RECORDED: Allen, Ammiano, Gomez, Holden, Lowenthal,
Vacancy
MW:d:n 8/14/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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