BILL ANALYSIS Ó
AB 1771
Page 1
ASSEMBLY THIRD READING
AB 1771 (V. Manuel Pérez)
As Amended May 28, 2014
Majority vote
HEALTH 18-0 APPROPRIATIONS 12-0
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|Ayes:|Pan, Maienschein, |Ayes:|Gatto, Bocanegra, |
| |Ammiano, Chau, Bonilla, | |Bradford, |
| |Bonta, Chesbro, Gomez, | |Ian Calderon, Campos, |
| |Gonzalez, Roger | |Eggman, Gomez, Holden, |
| |Hernández, Lowenthal, | |Pan, Quirk, |
| |Waldron, Nazarian, | |Ridley-Thomas, Weber |
| |Nestande, Patterson, | | |
| |Ridley-Thomas, Wagner, | | |
| |Wieckowski | | |
| | | | |
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SUMMARY : Requires health plans and insurers to cover telephone
visits provided by a physician, effective January 1, 2016.
Specifically, this bill :
1)Exempts certain telephone visits from this requirement,
including:
a) 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 (CPT) codes;
b) A telephone visit that leads to a related service or
procedure provided to an established patient within a
reasonable period of time, or within an applicable
postoperative period, as recognized by CPT codes;
c) A telephone visit provided as part of a bundle of
services for which reimbursement is provided for on a
capitated or prepaid basis; and,
d) A telephone visit that is not initiated by the patient.
2)Requires a telephone visit that is covered under this bill to
meet all of the following criteria:
AB 1771
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a) Do not require a face-to-face visit with the physician;
b) Be provided remotely through live voice communication to
an established patient, meaning a patient 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, or a minor established
patient's parents or guardians;
c) Be initiated by the patient, or parents or guardians of
a minor patient; and,
d) Be recognized by CPT codes.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, estimated costs are as follows:
1)Costs of $500,000 to $2 million for provision of services
through California Public Employees' Retirement System benefit
plans (General Fund (GF)/federal/special/local funds). About
60% of this cost is state cost, while the rest is a local
cost. This range is based on assumptions related to
cost-sharing and percentage of visits billed.
2)Increased employer-funded premium costs in the private
insurance market of $6 million to $25 million.
3)Increased premium expenditures by employees and individuals
purchasing insurance of $5 million to $23 million, as well as
increased out-of-pocket expenditures of $2 million to $10
million.
COMMENTS : CPT codes, which are produced and copyrighted by the
American Medical Association, are commonly used to identify and
bill for medical procedures. CPT codes for non-face-to-face
encounters relate to existing patients only and have other
restrictions, including, for example, that they may not be
simply a follow-up question related to a visit in the previous
seven days. Telephone visits covered under this bill must be
recognized by a CPT code.
The California Medical Association, sponsor of this bill, states
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that telephonic and electronic patient management services
facilitate the diagnosis, consultation, treatment, education,
care management and self-management of the patient's health as
well as providing caregiver support. The California Primary
Care Association (CPCA) and Planned Parenthood Affiliates of
California support this bill as a way to support member clinic
efforts to better serve patients through the development and
expansion of telehealth capabilities, especially in underserved
and remote rural areas. CPCA states that maximizing the
efficient use of physician time is especially important since
only 16 of California's 58 counties have the federal
government's recommended supply of primary care providers.
Health plans and insurers were opposed to a previous version of
this bill, arguing that the mandated reimbursement will
dramatically and significantly increase the costs of coverage
and reimburse physicians for a basic and fundamental
communication tool that every provider should be using
regardless of coverage or reimbursement status. America's
Health Insurance Plans argued that reimbursing providers for
each and every service provided to a patient including phone
calls will subject patients to multiple copayments and other
cost sharing responsibilities for every such encounter. The
California Chamber of Commerce stated that this bill will add
new costs for services already being provided, driving up costs
and health insurance premiums, along with consumer cost sharing
charges, just for patients to be able to communicate with their
doctors.
Analysis Prepared by : Ben Russell / HEALTH / (916) 319-2097
FN: 0003898