Amended in Assembly March 11, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 1771

Introduced by Assembly Member V. Manuel Pérez

February 14, 2014

An act to add Section 1374.14 to the Health and Safety Code, and to add Section 10123.855 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 1771, as amended, V. Manuel Pérez. Telephonic and electronic patient management services.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Insurance Commissioner. Existing law prohibits a health care service plan or health insurer from requiring in-person contact between a health care provider and a patient before payment is made for covered services appropriately provided through telehealth, which is defined to mean the mode of delivering health care services via information and communication technologies, as specified.

This bill would require a health care service plan or a health insurer, with respect to contracts and policies issued, amended, or renewed on or after January 1, 2015, to cover physician telephonic and electronic patient management services and to reimburse those services at the same level and amount as face-to-face patient encounters with similar complexity and time expenditure. Because a willful violation of the bill’s requirements by a health care service plan or health insurer would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

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

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

SECTION 1.  

The Legislature hereby finds and declares all of
the following:

(a) The lack of primary and specialty care physicians continues
to be a significant barrier to individual access to health care
services, a barrier that will only be exacerbated by health care
reform efforts that will increase the number of insured individuals.

(b)  begin delete Telephonic end delete begin insert The term “telehealth,” as defined in Section
2290.5 of the Business and Professions Code, includes telephonic end insert
and electronic patient management begin delete is end delete begin insert , which means end insert the use of
electronic communication tools, such as the telephone and
electronic mail, to enable treating physicians to evaluate and
manage their existing patients in a manner recognized by the
American Medical Association, Current Procedural Terminology
codes.

(c) Telephonic and electronic patient management is an effective
strategy to address the problems associated with the physician
shortage in California, as it increases physician practice efficiency
through the reduction of unnecessary office visits and increases
productivity by allowing physicians to treat more patients.

(d) In addition, studies have shown that telephonic and electronic
patient management reduces costs and yields positive results for
health care payers due to the reduced use of costly services and
reported improvements in quality of care.

(e) Consumers of health care will benefit from telephonic and
electronic patient management in many ways, including expanded
access to physicians, faster and more convenient treatment, better
continuity of care, and reduced lost work time and health care
costs.

(f) While some begin delete third party-payers end delete begin insert third-party payers end insert reimburse
physicians for telephonic and electronic patient management, some
do not even though that reimbursement would assist in improving
the physical and economic health of the state.

SEC. 2.  

Section 1374.14 is added to the Health and Safety
Code, to read:

1374.14.  

(a) Notwithstanding any other law, a health care
service plan shall, with respect to plan contracts issued, amended,
or renewed on or after January 1, 2015, cover physician telephonic
and electronic patient management services and reimburse those
services at the same level and amount as face-to-face patient
encounters with similar complexity and time expenditure.

(b) This section shall not be construed to authorize a health care
service plan to require the use of telephonic and electronic patient
management services when the physician has determined that those
services are not medically appropriate.

(c) This section shall not be construed to alter the scope of
practice of a health care provider or authorize the delivery of health
care services in a setting, or in a manner, that is not otherwise
authorized by law.

(d) All laws regarding the confidentiality of health information
and a patient’s rights to his or her medical information shall apply
to begin delete telephone end delete begin insert telephonic end insert and electronic patient management services.

(e) This section shall not apply to a patient under the jurisdiction
of the Department of Corrections and Rehabilitation or any other
correctional facility.

(f) For purposes of this section, “telephonic and electronic
patient management services” means the use of electronic
communication tools, such as the telephone and electronic mail,
to enable treating physicians to evaluate and manage existing
patients in a manner recognized by the American Medical
Association, Current Procedural Terminology codes.

SEC. 3.  

Section 10123.855 is added to the Insurance Code, to
read:

10123.855.  

(a) Notwithstanding any other law, a health insurer
shall, with respect to policies of health insurance issued, amended,
or renewed on or after January 1, 2015, cover physician telephonic
and electronic patient management services and reimburse those
services at the same level and amount as face-to-face patient
encounters with similar complexity and time expenditure.

(b) This section shall not be construed to authorize a health
insurer to require the use of telephonic and electronic patient
management services when the physician has determined that those
services are not medically appropriate.

(c) This section shall not be construed to alter the scope of
practice of a health care provider or authorize the delivery of health
care services in a setting, or in a manner, that is not otherwise
authorized by law.

(d) All laws regarding the confidentiality of health information
and a patient’s rights to his or her medical information shall apply
to begin delete telephone end delete begin insert telephonic end insert and electronic patient management services.

(e) This section shall not apply to a patient under the jurisdiction
of the Department of Corrections and Rehabilitation or any other
correctional facility.

(f) For purposes of this section, “telephonic and electronic
patient management services” means the use of electronic
communication tools, such as the telephone and electronic mail,
to enable treating physicians to evaluate and manage existing
patients in a manner recognized by the American Medical
Association, Current Procedural Terminology codes.

SEC. 4.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.