Amended in Senate August 22, 2014

Amended in Senate July 1, 2014

Amended in Senate June 10, 2014

Amended in Assembly May 24, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 1310

Introduced by Assembly Member Bonta

(Principal coauthor: Assembly Member Brown)

February 22, 2013

An act to amend Sections 14122 and 14132.72 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1310, as amended, Bonta. Medi-Cal: telehealth.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law prohibits a requirement of in-person contact between a health care provider and patient under the Medi-Cal program for any service otherwise covered by the Medi-Cal program when the service is appropriately provided by telehealth, as defined. Existing law, for purposes of payment of covered treatment or services provided through telehealth, prohibits the department from limiting the type of setting where services are provided for the patient or by the health care provider.

This bill would begin delete prohibit the department from requiring a health care provider licensed in California to be located in California as a condition of Medi-Cal provider enrollment or reimbursement for telehealth services provided to Medi-Cal beneficiaries located in California at the time of service. end delete begin insert require, effective July 1, 2015, in order for a health care provider that is not located in California to be enrolled in Medi-Cal for the purpose of providing health care services by way of telehealth for beneficiaries receiving care in California, the provider to meet end insert begin insert specified conditions and criteria, including that the provider be enrolled and in good standing in the Medicaid program for the state where the provider is located, be enrolled in good standing in Medicare, or be enrolled in good standing in both programs, and that the provider not be located outside the United States of America. end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 14122 of the Welfare and Institutions
Code is amended to read:

14122.  

(a) The department may provide, by regulation and
consistent with the requirements of the Federal Social Security
Act, for the care and treatment, or both, of persons eligible for
medical assistance pursuant to Sections 14005.1, 14005.4, and
14005.7 by providers in another state in those cases where
out-of-state care or treatment is rendered on an emergency basis
or is otherwise in the best interests of the person under the
circumstances.

(b) This section shall not apply to services provided pursuant
to Section 14132.72.

SEC. 2.  

Section 14132.72 of the Welfare and Institutions Code
is amended to read:

14132.72.  

(a) For purposes of this section, the definitions in
subdivision (a) of Section 2290.5 of the Business and Professions
Code shall apply.

(b) It is the intent of the Legislature to recognize the practice
of telehealth as a legitimate means by which an individual may
receive health care services from a health care provider without
in-person contact with the provider.

(c) In-person contact between a health care provider and a
patient shall not be required under the Medi-Cal program for
services appropriately provided through telehealth, subject to
reimbursement policies adopted by the department to compensate
a licensed health care provider who provides health care services
through telehealth that are otherwise reimbursed pursuant to the
Medi-Cal program.  Nothing in this section or the Telehealth
Advancement Act of 2011 (Chapter 547 of the Statutes of 2011)
shall be construed to conflict with or supersede the provisions of
any other existing state laws or regulations related to
reimbursement for services provided by a noncontracted provider.

(d) The department shall not require a health care provider to
document a barrier to an in-person visit for Medi-Cal coverage of
services provided via telehealth.

begin delete

(e) The department shall not require a health care provider
licensed in California to be located in California as a condition of
Medi-Cal provider enrollment or reimbursement for telehealth
services provided to Medi-Cal beneficiaries located in California
at the time of service.

end delete begin insert

(e) (1) Effective July 1, 2015, in order for a health care provider
that is not located in California to be enrolled in Medi-Cal for the
purpose of providing health care services by way of telehealth for
beneficiaries receiving care in California, that provider, shall, at
a minimum, meet all of the following conditions and criteria:

end insert begin insert

(A) The provider shall be licensed pursuant to Division 2
(commencing with Section 500) of the Business and Professions
Code or the Osteopathic Initiative Act, or by the relevant California
licensing entity or board to perform the medical services provided
through telehealth.

end insert begin insert

(B) The provider shall be enrolled and in good standing in the
Medicaid program for the state where the provider is located, be
enrolled in good standing in Medicare, or be enrolled in good
standing in both programs.

end insert begin insert

(C) The provider shall not be located outside the United States
of America.

end insert begin insert

(D) The provider shall satisfy all requirements for enrollment
and participation in the Medi-Cal program, and other statutory
requirements for providing telehealth services.

end insert begin insert

(E) The provider shall consent to Medi-Cal acting through the
state Medicaid program where the provider is located and the
Medicare program with respect to any issues concerning the
provider’s enrollment or participation in Medi-Cal.

end insert begin insert

(F) The provider shall consent to jurisdiction and venue in
Sacramento, California, for any and all legal proceedings in any
way related to the provider’s enrollment in Medi-Cal, including,
but not limited to, formal or informal proceedings, as well as
administrative, civil, and criminal proceedings.

end insert begin insert

(2) This subdivision shall be implemented only to the extent
permitted by federal law and to the extent that federal financial
participation is available.

end insert

(f) For the purposes of payment for covered treatment or services
provided through telehealth, the department shall not limit the type
of setting where services are provided for the patient or by the
health care provider.

(g) Nothing in this section shall be interpreted to authorize the
department to require the use of telehealth when the health care
provider has determined that it is not appropriate.

(h) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement, interpret, and make specific this
section by means of all-county letters, provider bulletins, and
similar instructions.