BILL ANALYSIS �
AB 1310
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CONCURRENCE IN SENATE AMENDMENTS
AB 1310 (Bonta)
As Amended August 22, 2014
Majority vote
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|ASSEMBLY: |78-0 |(May 30, 2013) |SENATE: |35-0 |(August 26, |
| | | | | |2014) |
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Original Committee Reference: HEALTH
SUMMARY : Requires a health care provider licensed in California
but located outside of California to meet specified requirements
as a condition of enrolling in Medi-Cal and receiving or
reimbursement for telehealth services provided to Medi-Cal
beneficiaries located in California at the time of service.
The Senate amendments removed all provisions of this bill that
left the Assembly and added new language.
EXISTING LAW :
1)Authorizes services to be provided to Medi-Cal beneficiaries
through telehealth and prohibits in-person contact between a
provider and a beneficiary if the service is appropriately
provided through telehealth.
2)Authorizes the Department of Health Care Services (DHCS) to
provide, by regulation and consistent with federal Medicaid
law, for the care and treatment of persons eligible for
Medi-Cal 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.
AS PASSED BY THE ASSEMBLY , this bill revised provisions relating
to the Medi-Cal pediatric subacute care program.
FISCAL EFFECT : According to the Senate Appropriations Committee
this bill would have:
1)One-time costs likely less than $50,000 to revise existing
regulations by DHCS (General Fund (GF) and federal funds).
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2)Unknown, though likely minor, increase in administrative costs
for investigations of out-of-state Medi-Cal providers (GF and
federal funds). If DHCS performs an investigation of an
out-of-state Medi-Cal provider (for example, because of
concerns about improper billing), the costs to conduct onsite
inspections of records would be more expensive than would be
the case with an instate provider. It does not seem likely
that there will be a very large number of out-of-state
providers of telehealth services under this bill. Therefore,
the actual additional investigation costs are not likely to be
significant in any given year.
3)Unknown increase in usage of Medi-Cal services due to the
availability of more providers (GF and federal funds). By
authorizing out-of-state providers to provide services through
telehealth, the bill increases the number of potential
Medi-Cal providers. For services like radiology through
telehealth, this bill is not likely to increase overall demand
for services, because radiology services will almost always be
provided when needed by a patient, whether the provider is in
state or out-of-state. On the other hand, there are certain
medical services for which Medi-Cal beneficiaries can have
difficult locating a provider. This can be an issue of
particular concern in rural areas. In those cases, allowing
additional providers may increase overall utilization of
services. It is important to note that the low provider rates
paid by Medi-Cal and the costs to set up and maintain
telehealth capabilities are likely to limit utilization of
telehealth by providers.
COMMENTS : According to the author, telehealth uses electronic
information and telecommunications for long-distance clinical
health care, patient and professional health-related education,
public health and health administration. Existing law currently
prohibits DHCS from limiting the type of setting where services
are provided for the patient or by the health care provider, for
purposes of payment for Medi-Cal covered telehealth services.
However, the author notes, DHCS is currently denying claims for
services provided to patients, located in California at the time
of service, by a California-licensed provider who is located
out-of-state. The author argues these denials are based on a
misinterpretation of existing law that is meant to apply to
patients, but DHCS is incorrectly applying this to providers.
The author states this bill is necessary to clarify existing law
to ensure that Medi-Cal beneficiaries have equivalent access to
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telehealth services as their privately insured counterparts, by
expressly allowing for the provision of telehealth services
across state lines, as long as the providers are
California-licensed health care professionals.
This bill would only apply to medical provides who provide
services through fee-for-service Medi-Cal and bill the state for
services. In the Medi-Cal managed care system, providers are
not required to enroll with DHCS as Medi-Cal providers in order
to provide services to a Medi-Cal managed care plan.
According to the sponsors of this bill, Virtual Radiologic, DHCS
had historically allowed out-of-state medical providers who are
licensed to practice in California to enroll in the Medi-Cal
program (necessary in order to bill the program for services).
However, recently, DHCS has begun denying applications for
enrollment by out-of-state providers.
The California Nurses Association (CNA) opposes this bill as
they state concerns this bill will likely result in Medi-Cal
funds needed within California to support in-state Medi-Cal
providers and facilities, being sent out-of-state or perhaps
even outside of the country. CNA argues even with the increased
demand for healthcare services as a result of healthcare reform,
there is no evidence of a need to recruit out-of-state
specialists and send healthcare dollars that could otherwise
support the expansion of services within the state to areas
outside of California.
This bill was substantially amended in the Senate and the
subject matter has not been heard in an Assembly policy
committee this legislative session.
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097
FN: 0005464