Amended in Assembly May 28, 2014

Amended in Assembly May 23, 2014

Amended in Assembly May 6, 2014

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. Telephone visits.

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, 2016, to cover telephone visits, as defined, provided by a physician. The bill would provide that a health care service plan or a health insurer is not required to reimburse separately for specified telephone visits, including a telephone visit begin delete for which reimbursement is already provided as part of a separate service or procedure, including, but not limited to, a surgical procedure end delete begin insert provided as part of a bundle of services reimbursed on a capitated basis end insert . Because a willful violation of the bill’s requirements by a health care service plan 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.  

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

1374.14.  

(a) A health care service plan shall, with respect to
plan contracts issued, amended, or renewed on or after January 1,
2016, cover telephone visits provided by a physician.

(b) This section shall not be construed to authorize a health care
service plan to require the use of telephone visits when the
physician has determined that providing services by telephone is
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 telephone visits.

(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) Notwithstanding subdivision (a), a health care service plan
shall not be required to reimburse separately for any of the
following:

(1) A telephone visit that is related to a service or procedure
provided to an established patient within a reasonable period of
time prior to the telephone visit, as recognized by the American
Medical Association, Current Procedural Terminology begin delete codes or
defined by the plan end delete begin insert codes end insert .

(2) A telephone visit that leads to a related service or procedure
provided to an established patient within a reasonable period of
time begin insert , or within an applicable postoperative period end insert , as recognized
by the American Medical Association, Current Procedural
Terminology codes begin delete or defined by the plan end delete .

begin delete

(3) A telephone visit for which reimbursement is already
provided as part of a separate service or procedure, including, but
not limited to, a surgical procedure.

end delete begin delete

(4)

end delete

begin insert (3) end insert  A telephone visit provided as part of a bundle of services
for which reimbursement is provided for on a capitated or prepaid
basis.

begin delete

(5)

end delete

begin insert (4) end insert  A telephone visit that is not initiated by the patient.

(g) Nothing in this section shall be construed to prohibit a health
care service plan from requiring begin insert reasonable end insert documentation specific
to telephone visits.

(h) For purposes of this section, the following definitions apply:

(1) “Established patient” means a patient begin delete for whom face-to-face
services have been provided by the physician practice prior to the
telephone visit. end delete begin insert who, within the three years immediately preceding
the telephone visit, has received professional services from the
provider or another provider of the exact same specialty and
subspecialty who belongs to the same group practice. end insert

(2) “Telephone visit” means evaluation and management
services that meets all of the following criteria:

(A) Do not require a face-to-face visit with the physician.

(B) Are provided remotely through live voice communication
to an established patient, or parents or guardians of a minor who
is an established patient.

(C) Are initiated by the patient, or the parents or guardians of
a minor who is a patient. For purposes of this section, “initiated
by the patient” excludes a visit for which a provider or staff
contacts a patient to initiate a service.

(D) Are recognized by the American Medical Association,
Current Procedural Terminology codes.

SEC. 2.  

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

10123.855.  

(a) A health insurer shall, with respect to policies
of health insurance issued, amended, or renewed on or after January
1, 2016, cover telephone visits provided by a physician.

(b) This section shall not be construed to authorize a health
insurer to require the use of telephone visits when the physician
has determined that providing services by telephone is 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 telephone visits.

(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) Notwithstanding subdivision (a), a health insurer shall not
be required to reimburse separately for any of the following:

(1) A telephone visit that is related to a service or procedure
provided to an established patient within a reasonable period of
time prior to the telephone visit, as recognized by the American
Medical Association, Current Procedural Terminology begin delete codes or
defined by the policy end delete begin insert codes end insert .

(2) A telephone visit that leads to a related service or procedure
provided to an established patient within a reasonable period of
time begin insert , or within an applicable postoperative period end insert , as recognized
by the American Medical Association, Current Procedural
Terminology codes begin delete or defined by the policy end delete .

begin delete

(3) A telephone visit for which reimbursement is already
provided as part of a separate service or procedure, including, but
not limited to, a surgical procedure.

(4)

end delete

begin insert (3) end insert  A telephone visit provided as part of a bundle of services
for which reimbursement is provided for on a capitated or prepaid
basis.

begin delete

(5)

end delete

begin insert (4) end insert  A telephone visit that is not initiated by the patient.

(g) Nothing in this section shall be construed to prohibit a health
insurer from requiring begin insert reasonable end insert documentation specific to
telephone visits.

(h) For purposes of this section, the following definitions apply:

(1) “Established patient” means a patient begin delete for whom face-to-face
services have been provided by the physician practice prior to the
telephone visit. end delete begin insert who, within the three years immediately preceding
the telephone visit, has received professional services from the
provider or another provider of the exact same specialty and
subspecialty who belongs to the same group practice. end insert

(2) “Telephone visit” means evaluation and management
services that meets all of the following criteria:

(A) Do not require a face-to-face visit with the physician.

(B) Are provided remotely through live voice communication
to an established patient, or parents or guardians of a minor who
is an established patient.

(C) Are initiated by the patient, or the parents or guardians of
a minor who is a patient. For purposes of this section, “initiated
by the patient” excludes a visit for which a provider or staff
contacts a patient to initiate a service.

(D) Are recognized by the American Medical Association,
Current Procedural Terminology codes.

SEC. 3.  

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.