SB 1023: Reproductive health care coverage.

Session Year: 2017-2018
House: Senate

Version:

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 Department of Insurance. Existing law, among other things, states 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 health care provider.This bill would clarify that health care service plans, health insurers, and Medi-Cal managed care plans may cover sexual and reproductive health services that are provided appropriately through telehealth according to clinical guidelines.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law requires family planning services to be offered to all former, current, or potential Medi-Cal recipients of childbearing age and provided to all eligible individuals who voluntarily request the services. Existing law also establishes the Family Planning, Access, Care, and Treatment (Family PACT) Program, administered by the Office of Family Planning within the department, Planning, under which comprehensive clinical family planning services are provided to a person who has a family income at or below 200% of the federal poverty level, as revised annually, and who is eligible to receive these services.

This bill would clarify that the requirement to provide family planning benefits under the Medi-Cal program does not prohibit family planning services from being delivered through telehealth, including mobile telehealth delivered according to clinical guidelines. The bill would, beginning January 1, 2020, require the Family PACT Program to cover services provided by a Family PACT provider through direct video and telephonic communications with a provider and direct or asynchronous care provided through a smartphone application that is appropriate to be delivered remotely based on current clinical guidelines. Beginning January 1, 2020, the bill would allow Family PACT providers to determine program eligibility remotely and to enroll clients remotely, as specified, and would authorize the State Department of Health Care Services to develop program policies to support implementation of offsite eligibility determination and enrollment. The bill would, if a patient is ineligible for the Family PACT Program, but may be eligible for more comprehensive health care coverage through Medi-Cal or Covered California, require the Family PACT provider to share information with the patient about his or her coverage options, beginning January 1, 2020.

Discussed in Hearing