AB 1241: Medi-Cal: telehealth.
- Session Year: 2023-2024
- House: Assembly
- Latest Version Date: 2023-09-08
Current Status:
Passed
(2023-09-08: Chaptered by Secretary of State - Chapter 172, Statutes of 2023.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
What does this bill do?
This bill requires Medi‑Cal providers who deliver services by video or audio‑only telehealth to keep and follow written protocols to either offer the same services in person or arrange and help facilitate a referral for in‑person care. It clarifies that facilitating a referral does not require the provider to schedule an appointment with a different provider for the patient.
The summary is provided by generative AI which can make mistakes. For original language, please view the details in the table below.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Under existing law, in-person, face-to-face contact is not required when covered health care services are provided by video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet certain criteria.
Existing law requires a provider furnishing services through video synchronous interaction or audio-only synchronous interaction, by a date set by the department, no sooner than January 1, 2024, to also either offer those services via in-person contact or arrange for a referral to, and a facilitation of, in-person care, as specified.
This bill would instead require, under the above-described circumstance, a provider to maintain and follow protocols to either offer those services via in-person contact or arrange for a referral to, and a facilitation of, in-person care. The bill would specify that the referral and facilitation arrangement would not require a provider to schedule an appointment with a different provider on behalf of a patient.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Under existing law, in-person, face-to-face contact is not required when covered health care services are provided by video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet certain criteria.
Existing law requires a provider furnishing services through video synchronous interaction or audio-only synchronous interaction, by a date set by the department, no sooner than January 1, 2024, to also either offer those services via in-person contact or arrange for a referral to, and a facilitation of, in-person care, as specified.
This bill would instead require, under the above-described circumstance, a provider to maintain and follow protocols to either offer those services via in-person contact or arrange for a referral to, and a facilitation of, in-person care. The bill would specify that the referral and facilitation arrangement would not require a provider to schedule an appointment with a different provider on behalf of a patient.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Under existing law, in-person, face-to-face contact is not required when covered health care services are provided by video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet certain criteria.
Existing law requires a provider furnishing services through video synchronous interaction or audio-only synchronous interaction, by a date set by the department, no sooner than January 1, 2024, to also either offer those services via in-person contact or arrange for a referral to, and a facilitation of, in-person care, as specified.
This bill would instead require, under the above-described circumstance, a provider to maintain the ability and follow protocols to either offer those services via in-person contact or arrange for a referral to, and a facilitation of, in-person care. The bill would specify that the referral and facilitation arrangement would not require a provider to schedule an appointment with a different provider on behalf of a patient.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Under existing law, in-person, face-to-face contact is not required when covered health care services are provided by video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet certain criteria. Existing
Existing law requires a provider furnishing services through video synchronous interaction or audio-only synchronous interaction, by a date set by the department, no sooner than January 1, 2024, to also either offer those services via in-person contact or arrange for a referral to, and a facilitation of, in-person care, as specified.
This bill would additionally authorize a provider to meet the above-described requirement by maintaining protocols for outpatient clinical referral to appropriate in-person care, when the standard of care cannot be met by video synchronous interaction or audio-only synchronous interaction. instead require, under the above-described circumstance, a provider to maintain the ability to either offer those services via in-person contact or arrange for a referral to, and a facilitation of, in-person care. The bill would specify that the referral and facilitation arrangement would not require a provider to schedule an appointment with a different provider on behalf of a patient.
Existing law provides for establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides that
Under existing law, in-person, face-to-face contact is not required when covered health care services are provided by video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities modalities, when those services and settings meet certain criteria. Existing law requires providers furnishing service a provider furnishing services through video synchronous interaction or audio-only synchronous interaction, by a date set by the department, no sooner than January 1, 2024, to also either offer those services via in-person contact or arrange for a referral to, and a facilitation of, in-person care, as specified.
This bill would additionally authorize a provider to meet the above-described requirement by maintaining protocols for patient outpatient clinical referral to appropriate in-person care, when the standard of care cannot be met by video synchronous interaction or audio-only synchronous interaction.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides that face-to-face contact is not required when covered health care services are provided by video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities when those services and settings meet certain criteria. Existing law requires providers furnishing service through video synchronous interaction or audio-only synchronous interaction, by a date set by the department, no sooner than January 1, 2024, to also either offer those services via in-person contact or arrange for a referral to, and a facilitation of, in-person care, as specified.
This bill would additionally authorize a provider to meet the above-described requirement by maintaining protocols for patient referral to appropriate in-person care, when the standard of care cannot be met by video synchronous interaction or audio-only synchronous interaction.
(a)For purposes of this section, the following definitions apply:
(1)Border community means border areas adjacent to the State of California where it is customary practice for California residents to use medical resources in adjacent areas outside the state. Under these circumstances, program controls and limitations are the same as for services rendered by health care providers within the state.
(2)Health care provider has the same meaning as set forth in paragraph (3) of subdivision (a) of Section 2290.5 of the Business and Professions Code, and shall be either enrolled as a Medi-Cal rendering provider, or a nonphysician medical practitioner affiliated with an enrolled Medi-Cal provider group. Health care provider also includes any provider type designated by the department pursuant to subparagraph (A) of paragraph (2) of subdivision (b). The enrolled Medi-Cal provider or provider group for which the health care provider renders services via telehealth shall meet all Medi-Cal requirements and shall be located in the state or a border community.
(3)Health care service plan has the same meaning as set forth in subdivision (f) of Section 1345 of the Health and Safety Code.
(4)Medi-Cal managed care plan has the same meaning as set forth in subdivision (j) of Section 14184.101.
(5)Network provider has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(6)Telehealth has the same meaning as set forth in paragraph (6) of subdivision (a) of Section 2290.5 of the Business and Professions Code.
(b)(1)Subject to subdivision (k), in-person, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for covered health care services and provider types designated by the department, when provided by video synchronous interaction, asynchronous store and forward, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)(A)In implementing this section, the department shall designate and periodically update the covered health care services and provider types, including required licensing and credentialing criteria, as applicable, which may be appropriately delivered via the telehealth modalities described in this subdivision.
(B)Applicable health care services appropriately provided through video synchronous interaction, asynchronous store and forward, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities are subject to billing, reimbursement, and utilization management policies imposed by the department. Subject to subdivision (k), utilization management protocols adopted by the department pursuant to this section shall be consistent with, and no more restrictive than, those authorized for health care service plans pursuant to Section 1374.13 of the Health and Safety Code.
(c)(1)(A)Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice.
(B)(i)The department may provide specific exceptions to the requirement specified in subparagraph (A), based on a Medi-Cal providers access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(ii)In making exceptions to the requirement specified in subparagraph (A), in addition to the provisions in clause (i), the department may also take into consideration the availability of broadband access based on speed standards set by the Federal Communications Commission, pursuant to Section 706 of the Telecommunications Act of 1996 (Pub. L. No. 104-104) or other applicable federal law or regulation.
(2)Effective on the date designated by the department pursuant to paragraph (1), a provider furnishing services through video synchronous interaction or audio-only synchronous interaction shall also maintain and follow protocols to do one of the following:
(A)Offer those services via in-person, face-to-face contact.
(B)(i)Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
(ii)Clause (i) does not require a provider to schedule an appointment with a different provider on behalf of a patient.
(3)In implementing this subdivision, the department shall consider additional recommendations from affected stakeholders regarding the need to maintain access to in-person services without unduly restricting access to telehealth services.
(4)A health care provider may establish a new patient relationship with a Medi-Cal beneficiary via video synchronous interaction consistent with any requirements imposed by the department.
(5)(A)A health care provider shall not establish a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, telephonic (audio-only) synchronous interaction, remote patient monitoring, or other virtual communication modalities, except as set forth in paragraph (4) of subdivision (g) of Section 14132.100.
(B)Notwithstanding the prohibition in subparagraph (A), the department may provide for specific exceptions to this prohibition, the department may provide for specific exceptions described in clauses (i) and (ii), which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(i)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined in subdivision (p) of Section 56.05 of the Civil Code, and when established in accordance with department-specific requirements and consistent with federal and state law, regulations, and guidance.
(ii)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests they do not have access to video, and when established in accordance with department-specific requirements and consistent with federal and state laws, regulations, and guidance.
(6)Subject to subdivision (k), the department may establish separate fee schedules for applicable health care services delivered via remote patient monitoring or other permissible virtual communication modalities.
(7)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(d)In addition to any existing law requiring beneficiary consent to telehealth, including, but not limited to, subdivision (b) of Section 2290.5 of the Business and Professions Code, all of the following shall be communicated by a health care provider to a Medi-Cal beneficiary, in writing or verbally, on at least one occasion prior to, or concurrent with, initiating the delivery of one or more health care services via telehealth to a Medi-Cal beneficiary: an explanation that beneficiaries have the right to access covered services that may be delivered via telehealth through an in-person, face-to-face visit; an explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn at any time by the Medi-Cal beneficiary without affecting their ability to access covered Medi-Cal services in the future; an explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted; and the potential limitations or risks related to receiving services through telehealth as compared to an in-person visit, to the extent any limitations or risks are identified by the provider.
(1)The provider shall document in the patient record the provision of this information and the patients verbal or written acknowledgment that the information was received.
(2)The department shall develop, in consultation with affected stakeholders, model language for purposes of the communication described in this subdivision.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(e)(1)The department shall develop, in consultation with affected stakeholders, an informational notice to be distributed to fee-for-service Medi-Cal beneficiaries and for use by Medi-Cal managed care plans in communicating to their enrollees. Information in the notice shall include, but not be limited to, all of the following:
(A)The availability of Medi-Cal covered telehealth services.
(B)The beneficiarys right to access all medically necessary covered services through in-person, face-to-face visits, and a providers and Medi-Cal managed care plans responsibility to offer or arrange for that in-person care, as applicable.
(C)An explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn by the Medi-Cal beneficiary at any time without affecting their ability to access covered Medi-Cal services in the future.
(D)An explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted.
(E)Notification of the beneficiarys right to make complaints about the offer of telehealth services in lieu of in-person care or about the quality of care delivered through telehealth.
(2)The informational notice shall be translated into threshold languages determined by the department pursuant to subdivision (b) of Section 14029.91 and provided in a format that is culturally and linguistically appropriate.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(f)(1)Subject to subdivision (k), the department shall reimburse health care providers of applicable health care services delivered via video synchronous interaction, synchronous audio-only modality, or asynchronous store and forward, as applicable, at payment amounts that are not less than the amounts the provider would receive if the services were delivered via in-person, face-to-face contact, so long as the services or settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)Subject to subdivision (k), for applicable health care services appropriately provided by a network provider via video synchronous interaction, audio-only synchronous interaction modality, or asynchronous store and forward, as applicable, to an enrollee of a Medi-Cal managed care plan, the Medi-Cal managed care plan shall reimburse the network provider at payment amounts that are not less than the amounts the network provider would have received if the services were delivered via in-person, face-to-face contact, unless the Medi-Cal managed care plan and network provider mutually agree to reimbursement in different amounts.
(g)On or before January 1, 2023, the department shall develop a research and evaluation plan that does all of the following:
(1)Proposes strategies to analyze the relationship between telehealth and the following: access to care, access to in-person care, quality of care, and Medi-Cal program costs, utilization, and program integrity.
(2)Examines issues using an equity framework that includes stratification by available geographic and demographic factors, including, but not limited to, race, ethnicity, primary language, age, and gender, to understand inequities and disparities in care.
(3)Prioritizes research and evaluation questions that directly inform Medi-Cal policy.
(h)Applicable health care services provided through asynchronous store and forward, video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities as described in this section shall comply with the privacy and security requirements contained in the federal Health Insurance Portability and Accountability Act of 1996 found in Parts 160 and 164 of Title 45 of the Code of Federal Regulations, the Medicaid State Plan, and any other applicable state and federal statutes and regulations.
(i)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, plan letters, provider bulletins, and similar instructions, without taking any further regulatory action.
(j)Consistent with the requirements of this section and subject to subdivision (k), a PACE organization approved by the department pursuant to Chapter 8.75 (commencing with Section 14591) may use video telehealth to conduct initial assessments and annual reassessments for eligibility for enrollment in the PACE program.
(k)The department shall seek any federal approvals it deems necessary to implement this section. This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(l)This section shall be operative on January 1, 2023, or on the operative date or dates reflected in the applicable federal approvals obtained by the department pursuant to subdivision (k), whichever is later.
(m)This section does not apply to health care services provided via telehealth in an FQHC or RHC visit as described in paragraph (4) of subdivision (g) of Section 14132.100.
(a)For purposes of this section, the following definitions apply:
(1)Border community means border areas adjacent to the State of California where it is customary practice for California residents to use medical resources in adjacent areas outside the state. Under these circumstances, program controls and limitations are the same as for services rendered by health care providers within the state.
(2)Health care provider has the same meaning as set forth in paragraph (3) of subdivision (a) of Section 2290.5 of the Business and Professions Code, and shall be either enrolled as a Medi-Cal rendering provider, or a nonphysician medical practitioner affiliated with an enrolled Medi-Cal provider group. Health care provider also includes any provider type designated by the department pursuant to subparagraph (A) of paragraph (2) of subdivision (b). The enrolled Medi-Cal provider or provider group for which the health care provider renders services via telehealth shall meet all Medi-Cal requirements and shall be located in the state or a border community.
(3)Health care service plan has the same meaning as set forth in subdivision (f) of Section 1345 of the Health and Safety Code.
(4)Medi-Cal managed care plan has the same meaning as set forth in subdivision (j) of Section 14184.101.
(5)Network provider has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(6)Telehealth has the same meaning as set forth in paragraph (6) of subdivision (a) of Section 2290.5 of the Business and Professions Code.
(b)(1)Subject to subdivision (k), in-person, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for covered health care services and provider types designated by the department, when provided by video synchronous interaction, asynchronous store and forward, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)(A)In implementing this section, the department shall designate and periodically update the covered health care services and provider types, including required licensing and credentialing criteria, as applicable, which may be appropriately delivered via the telehealth modalities described in this subdivision.
(B)Applicable health care services appropriately provided through video synchronous interaction, asynchronous store and forward, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities are subject to billing, reimbursement, and utilization management policies imposed by the department. Subject to subdivision (k), utilization management protocols adopted by the department pursuant to this section shall be consistent with, and no more restrictive than, those authorized for health care service plans pursuant to Section 1374.13 of the Health and Safety Code.
(c)(1)(A)Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice.
(B)(i)The department may provide specific exceptions to the requirement specified in subparagraph (A), based on a Medi-Cal providers access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(ii)In making exceptions to the requirement specified in subparagraph (A), in addition to the provisions in clause (i), the department may also take into consideration the availability of broadband access based on speed standards set by the Federal Communications Commission, pursuant to Section 706 of the Telecommunications Act of 1996 (Pub. L. No. 104-104) or other applicable federal law or regulation.
(2)Effective on the date designated by the department pursuant to paragraph (1), a provider furnishing services through video synchronous interaction or audio-only synchronous interaction shall also maintain and follow protocols to do one of the following:
(A)Offer those services via in-person, face-to-face contact.
(B)(i)Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
(ii)Clause (i) does not require a provider to schedule an appointment with a different provider on behalf of a patient.
(3)In implementing this subdivision, the department shall consider additional recommendations from affected stakeholders regarding the need to maintain access to in-person services without unduly restricting access to telehealth services.
(4)A health care provider may establish a new patient relationship with a Medi-Cal beneficiary via video synchronous interaction consistent with any requirements imposed by the department.
(5)(A)A health care provider shall not establish a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, telephonic (audio-only) synchronous interaction, remote patient monitoring, or other virtual communication modalities, except as set forth in paragraph (4) of subdivision (g) of Section 14132.100.
(B)Notwithstanding the prohibition in subparagraph (A), the department may provide for specific exceptions to this prohibition, the department may provide for specific exceptions described in clauses (i) and (ii), which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(i)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined in subdivision (p) of Section 56.05 of the Civil Code, and when established in accordance with department-specific requirements and consistent with federal and state law, regulations, and guidance.
(ii)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests they do not have access to video, and when established in accordance with department-specific requirements and consistent with federal and state laws, regulations, and guidance.
(6)Subject to subdivision (k), the department may establish separate fee schedules for applicable health care services delivered via remote patient monitoring or other permissible virtual communication modalities.
(7)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(d)In addition to any existing law requiring beneficiary consent to telehealth, including, but not limited to, subdivision (b) of Section 2290.5 of the Business and Professions Code, all of the following shall be communicated by a health care provider to a Medi-Cal beneficiary, in writing or verbally, on at least one occasion prior to, or concurrent with, initiating the delivery of one or more health care services via telehealth to a Medi-Cal beneficiary: an explanation that beneficiaries have the right to access covered services that may be delivered via telehealth through an in-person, face-to-face visit; an explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn at any time by the Medi-Cal beneficiary without affecting their ability to access covered Medi-Cal services in the future; an explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted; and the potential limitations or risks related to receiving services through telehealth as compared to an in-person visit, to the extent any limitations or risks are identified by the provider.
(1)The provider shall document in the patient record the provision of this information and the patients verbal or written acknowledgment that the information was received.
(2)The department shall develop, in consultation with affected stakeholders, model language for purposes of the communication described in this subdivision.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(e)(1)The department shall develop, in consultation with affected stakeholders, an informational notice to be distributed to fee-for-service Medi-Cal beneficiaries and for use by Medi-Cal managed care plans in communicating to their enrollees. Information in the notice shall include, but not be limited to, all of the following:
(A)The availability of Medi-Cal covered telehealth services.
(B)The beneficiarys right to access all medically necessary covered services through in-person, face-to-face visits, and a providers and Medi-Cal managed care plans responsibility to offer or arrange for that in-person care, as applicable.
(C)An explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn by the Medi-Cal beneficiary at any time without affecting their ability to access covered Medi-Cal services in the future.
(D)An explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted.
(E)Notification of the beneficiarys right to make complaints about the offer of telehealth services in lieu of in-person care or about the quality of care delivered through telehealth.
(2)The informational notice shall be translated into threshold languages determined by the department pursuant to subdivision (b) of Section 14029.91 and provided in a format that is culturally and linguistically appropriate.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(f)(1)Subject to subdivision (k), the department shall reimburse health care providers of applicable health care services delivered via video synchronous interaction, synchronous audio-only modality, or asynchronous store and forward, as applicable, at payment amounts that are not less than the amounts the provider would receive if the services were delivered via in-person, face-to-face contact, so long as the services or settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)Subject to subdivision (k), for applicable health care services appropriately provided by a network provider via video synchronous interaction, audio-only synchronous interaction modality, or asynchronous store and forward, as applicable, to an enrollee of a Medi-Cal managed care plan, the Medi-Cal managed care plan shall reimburse the network provider at payment amounts that are not less than the amounts the network provider would have received if the services were delivered via in-person, face-to-face contact, unless the Medi-Cal managed care plan and network provider mutually agree to reimbursement in different amounts.
(g)On or before January 1, 2023, the department shall develop a research and evaluation plan that does all of the following:
(1)Proposes strategies to analyze the relationship between telehealth and the following: access to care, access to in-person care, quality of care, and Medi-Cal program costs, utilization, and program integrity.
(2)Examines issues using an equity framework that includes stratification by available geographic and demographic factors, including, but not limited to, race, ethnicity, primary language, age, and gender, to understand inequities and disparities in care.
(3)Prioritizes research and evaluation questions that directly inform Medi-Cal policy.
(h)Applicable health care services provided through asynchronous store and forward, video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities as described in this section shall comply with the privacy and security requirements contained in the federal Health Insurance Portability and Accountability Act of 1996 found in Parts 160 and 164 of Title 45 of the Code of Federal Regulations, the Medicaid State Plan, and any other applicable state and federal statutes and regulations.
(i)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, plan letters, provider bulletins, and similar instructions, without taking any further regulatory action.
(j)Consistent with the requirements of this section and subject to subdivision (k), a PACE organization approved by the department pursuant to Chapter 8.75 (commencing with Section 14591) may use video telehealth to conduct initial assessments and annual reassessments for eligibility for enrollment in the PACE program.
(k)The department shall seek any federal approvals it deems necessary to implement this section. This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(l)This section shall be operative on January 1, 2023, or on the operative date or dates reflected in the applicable federal approvals obtained by the department pursuant to subdivision (k), whichever is later.
(m)This section does not apply to health care services provided via telehealth in an FQHC or RHC visit as described in paragraph (4) of subdivision (g) of Section 14132.100.
(a)For purposes of this section, the following definitions apply:
(1)Border community means border areas adjacent to the State of California where it is customary practice for California residents to use medical resources in adjacent areas outside the state. Under these circumstances, program controls and limitations are the same as for services rendered by health care providers within the state.
(2)Health care provider has the same meaning as set forth in paragraph (3) of subdivision (a) of Section 2290.5 of the Business and Professions Code, and shall be either enrolled as a Medi-Cal rendering provider, or a nonphysician medical practitioner affiliated with an enrolled Medi-Cal provider group. Health care provider also includes any provider type designated by the department pursuant to subparagraph (A) of paragraph (2) of subdivision (b). The enrolled Medi-Cal provider or provider group for which the health care provider renders services via telehealth shall meet all Medi-Cal requirements and shall be located in the state or a border community.
(3)Health care service plan has the same meaning as set forth in subdivision (f) of Section 1345 of the Health and Safety Code.
(4)Medi-Cal managed care plan has the same meaning as set forth in subdivision (j) of Section 14184.101.
(5)Network provider has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(6)Telehealth has the same meaning as set forth in paragraph (6) of subdivision (a) of Section 2290.5 of the Business and Professions Code.
(b)(1)Subject to subdivision (k), in-person, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for covered health care services and provider types designated by the department, when provided by video synchronous interaction, asynchronous store and forward, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)(A)In implementing this section, the department shall designate and periodically update the covered health care services and provider types, including required licensing and credentialing criteria, as applicable, which may be appropriately delivered via the telehealth modalities described in this subdivision.
(B)Applicable health care services appropriately provided through video synchronous interaction, asynchronous store and forward, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities are subject to billing, reimbursement, and utilization management policies imposed by the department. Subject to subdivision (k), utilization management protocols adopted by the department pursuant to this section shall be consistent with, and no more restrictive than, those authorized for health care service plans pursuant to Section 1374.13 of the Health and Safety Code.
(c)(1)(A)Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice.
(B)(i)The department may provide specific exceptions to the requirement specified in subparagraph (A), based on a Medi-Cal providers access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(ii)In making exceptions to the requirement specified in subparagraph (A), in addition to the provisions in clause (i), the department may also take into consideration the availability of broadband access based on speed standards set by the Federal Communications Commission, pursuant to Section 706 of the Telecommunications Act of 1996 (Pub. L. No. 104-104) or other applicable federal law or regulation.
(2)Effective on the date designated by the department pursuant to paragraph (1), a provider furnishing services through video synchronous interaction or audio-only synchronous interaction shall also maintain the ability and follow protocols to do one of the following:
(A)Offer those services via in-person, face-to-face contact.
(B)(i)Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
(ii)Clause (i) does not require a provider to schedule an appointment with a different provider on behalf of a patient.
(3)In implementing this subdivision, the department shall consider additional recommendations from affected stakeholders regarding the need to maintain access to in-person services without unduly restricting access to telehealth services.
(4)A health care provider may establish a new patient relationship with a Medi-Cal beneficiary via video synchronous interaction consistent with any requirements imposed by the department.
(5)(A)A health care provider shall not establish a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, telephonic (audio-only) synchronous interaction, remote patient monitoring, or other virtual communication modalities, except as set forth in paragraph (4) of subdivision (g) of Section 14132.100.
(B)Notwithstanding the prohibition in subparagraph (A), the department may provide for specific exceptions to this prohibition, the department may provide for specific exceptions described in clauses (i) and (ii), which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(i)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined in subdivision (p) of Section 56.05 of the Civil Code, and when established in accordance with department-specific requirements and consistent with federal and state law, regulations, and guidance.
(ii)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests they do not have access to video, and when established in accordance with department-specific requirements and consistent with federal and state laws, regulations, and guidance.
(6)Subject to subdivision (k), the department may establish separate fee schedules for applicable health care services delivered via remote patient monitoring or other permissible virtual communication modalities.
(7)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(d)In addition to any existing law requiring beneficiary consent to telehealth, including, but not limited to, subdivision (b) of Section 2290.5 of the Business and Professions Code, all of the following shall be communicated by a health care provider to a Medi-Cal beneficiary, in writing or verbally, on at least one occasion prior to, or concurrent with, initiating the delivery of one or more health care services via telehealth to a Medi-Cal beneficiary: an explanation that beneficiaries have the right to access covered services that may be delivered via telehealth through an in-person, face-to-face visit; an explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn at any time by the Medi-Cal beneficiary without affecting their ability to access covered Medi-Cal services in the future; an explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted; and the potential limitations or risks related to receiving services through telehealth as compared to an in-person visit, to the extent any limitations or risks are identified by the provider.
(1)The provider shall document in the patient record the provision of this information and the patients verbal or written acknowledgment that the information was received.
(2)The department shall develop, in consultation with affected stakeholders, model language for purposes of the communication described in this subdivision.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(e)(1)The department shall develop, in consultation with affected stakeholders, an informational notice to be distributed to fee-for-service Medi-Cal beneficiaries and for use by Medi-Cal managed care plans in communicating to their enrollees. Information in the notice shall include, but not be limited to, all of the following:
(A)The availability of Medi-Cal covered telehealth services.
(B)The beneficiarys right to access all medically necessary covered services through in-person, face-to-face visits, and a providers and Medi-Cal managed care plans responsibility to offer or arrange for that in-person care, as applicable.
(C)An explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn by the Medi-Cal beneficiary at any time without affecting their ability to access covered Medi-Cal services in the future.
(D)An explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted.
(E)Notification of the beneficiarys right to make complaints about the offer of telehealth services in lieu of in-person care or about the quality of care delivered through telehealth.
(2)The informational notice shall be translated into threshold languages determined by the department pursuant to subdivision (b) of Section 14029.91 and provided in a format that is culturally and linguistically appropriate.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(f)(1)Subject to subdivision (k), the department shall reimburse health care providers of applicable health care services delivered via video synchronous interaction, synchronous audio-only modality, or asynchronous store and forward, as applicable, at payment amounts that are not less than the amounts the provider would receive if the services were delivered via in-person, face-to-face contact, so long as the services or settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)Subject to subdivision (k), for applicable health care services appropriately provided by a network provider via video synchronous interaction, audio-only synchronous interaction modality, or asynchronous store and forward, as applicable, to an enrollee of a Medi-Cal managed care plan, the Medi-Cal managed care plan shall reimburse the network provider at payment amounts that are not less than the amounts the network provider would have received if the services were delivered via in-person, face-to-face contact, unless the Medi-Cal managed care plan and network provider mutually agree to reimbursement in different amounts.
(g)On or before January 1, 2023, the department shall develop a research and evaluation plan that does all of the following:
(1)Proposes strategies to analyze the relationship between telehealth and the following: access to care, access to in-person care, quality of care, and Medi-Cal program costs, utilization, and program integrity.
(2)Examines issues using an equity framework that includes stratification by available geographic and demographic factors, including, but not limited to, race, ethnicity, primary language, age, and gender, to understand inequities and disparities in care.
(3)Prioritizes research and evaluation questions that directly inform Medi-Cal policy.
(h)Applicable health care services provided through asynchronous store and forward, video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities as described in this section shall comply with the privacy and security requirements contained in the federal Health Insurance Portability and Accountability Act of 1996 found in Parts 160 and 164 of Title 45 of the Code of Federal Regulations, the Medicaid State Plan, and any other applicable state and federal statutes and regulations.
(i)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, plan letters, provider bulletins, and similar instructions, without taking any further regulatory action.
(j)Consistent with the requirements of this section and subject to subdivision (k), a PACE organization approved by the department pursuant to Chapter 8.75 (commencing with Section 14591) may use video telehealth to conduct initial assessments and annual reassessments for eligibility for enrollment in the PACE program.
(k)The department shall seek any federal approvals it deems necessary to implement this section. This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(l)This section shall be operative on January 1, 2023, or on the operative date or dates reflected in the applicable federal approvals obtained by the department pursuant to subdivision (k), whichever is later.
(m)This section does not apply to health care services provided via telehealth in an FQHC or RHC visit as described in paragraph (4) of subdivision (g) of Section 14132.100.
(a)For purposes of this section, the following definitions apply:
(1)Border community means border areas adjacent to the State of California where it is customary practice for California residents to use medical resources in adjacent areas outside the state. Under these circumstances, program controls and limitations are the same as for services rendered by health care providers within the state.
(2)Health care provider has the same meaning as set forth in paragraph (3) of subdivision (a) of Section 2290.5 of the Business and Professions Code, and shall be either enrolled as a Medi-Cal rendering provider, or a nonphysician medical practitioner affiliated with an enrolled Medi-Cal provider group. Health care provider also includes any provider type designated by the department pursuant to subparagraph (A) of paragraph (2) of subdivision (b). The enrolled Medi-Cal provider or provider group for which the health care provider renders services via telehealth shall meet all Medi-Cal requirements and shall be located in the state or a border community.
(3)Health care service plan has the same meaning as set forth in subdivision (f) of Section 1345 of the Health and Safety Code.
(4)Medi-Cal managed care plan has the same meaning as set forth in subdivision (j) of Section 14184.101.
(5)Network provider has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(6)Telehealth has the same meaning as set forth in paragraph (6) of subdivision (a) of Section 2290.5 of the Business and Professions Code.
(b)(1)Subject to subdivision (k), in-person, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for covered health care services and provider types designated by the department, when provided by video synchronous interaction, asynchronous store and forward, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)(A)In implementing this section, the department shall designate and periodically update the covered health care services and provider types, including required licensing and credentialing criteria, as applicable, which may be appropriately delivered via the telehealth modalities described in this subdivision.
(B)Applicable health care services appropriately provided through video synchronous interaction, asynchronous store and forward, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities are subject to billing, reimbursement, and utilization management policies imposed by the department. Subject to subdivision (k), utilization management protocols adopted by the department pursuant to this section shall be consistent with, and no more restrictive than, those authorized for health care service plans pursuant to Section 1374.13 of the Health and Safety Code.
(c)(1)(A)Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice.
(B)(i)The department may provide specific exceptions to the requirement specified in subparagraph (A), based on a Medi-Cal providers access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(ii)In making exceptions to the requirement specified in subparagraph (A), in addition to the provisions in clause (i), the department may also take into consideration the availability of broadband access based on speed standards set by the Federal Communications Commission, pursuant to Section 706 of the Telecommunications Act of 1996 (Pub. L. No. 104-104) or other applicable federal law or regulation.
(2)Effective on the date designated by the department pursuant to paragraph (1), a provider furnishing services through video synchronous interaction or audio-only synchronous interaction shall also maintain the ability to do one of the following:
(A)Offer those services via in-person, face-to-face contact.
(B)(i)Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
(C)Maintain protocols for outpatient clinical referral to appropriate in-person care, consistent with recognized professional standards of practice, when the standard of care cannot be met by video synchronous interaction or audio-only synchronous interaction.(ii)Clause (i) does not require a provider to schedule an appointment with a different provider on behalf of a patient.
(3)In implementing this subdivision, the department shall consider additional recommendations from affected stakeholders regarding the need to maintain access to in-person services without unduly restricting access to telehealth services.
(4)A health care provider may establish a new patient relationship with a Medi-Cal beneficiary via video synchronous interaction consistent with any requirements imposed by the department.
(5)(A)A health care provider shall not establish a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, telephonic (audio-only) synchronous interaction, remote patient monitoring, or other virtual communication modalities, except as set forth in paragraph (4) of subdivision (g) of Section 14132.100.
(B)Notwithstanding the prohibition in subparagraph (A), the department may provide for specific exceptions to this prohibition, the department may provide for specific exceptions described in clauses (i) and (ii), which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(i)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined in subdivision (p) of Section 56.05 of the Civil Code, and when established in accordance with department-specific requirements and consistent with federal and state law, regulations, and guidance.
(ii)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests they do not have access to video, and when established in accordance with department-specific requirements and consistent with federal and state laws, regulations, and guidance.
(6)Subject to subdivision (k), the department may establish separate fee schedules for applicable health care services delivered via remote patient monitoring or other permissible virtual communication modalities.
(7)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(d)In addition to any existing law requiring beneficiary consent to telehealth, including, but not limited to, subdivision (b) of Section 2290.5 of the Business and Professions Code, all of the following shall be communicated by a health care provider to a Medi-Cal beneficiary, in writing or verbally, on at least one occasion prior to, or concurrent with, initiating the delivery of one or more health care services via telehealth to a Medi-Cal beneficiary: an explanation that beneficiaries have the right to access covered services that may be delivered via telehealth through an in-person, face-to-face visit; an explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn at any time by the Medi-Cal beneficiary without affecting their ability to access covered Medi-Cal services in the future; an explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted; and the potential limitations or risks related to receiving services through telehealth as compared to an in-person visit, to the extent any limitations or risks are identified by the provider.
(1)The provider shall document in the patient record the provision of this information and the patients verbal or written acknowledgment that the information was received.
(2)The department shall develop, in consultation with affected stakeholders, model language for purposes of the communication described in this subdivision.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(e)(1)The department shall develop, in consultation with affected stakeholders, an informational notice to be distributed to fee-for-service Medi-Cal beneficiaries and for use by Medi-Cal managed care plans in communicating to their enrollees. Information in the notice shall include, but not be limited to, all of the following:
(A)The availability of Medi-Cal covered telehealth services.
(B)The beneficiarys right to access all medically necessary covered services through in-person, face-to-face visits, and a providers and Medi-Cal managed care plans responsibility to offer or arrange for that in-person care, as applicable.
(C)An explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn by the Medi-Cal beneficiary at any time without affecting their ability to access covered Medi-Cal services in the future.
(D)An explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted.
(E)Notification of the beneficiarys right to make complaints about the offer of telehealth services in lieu of in-person care or about the quality of care delivered through telehealth.
(2)The informational notice shall be translated into threshold languages determined by the department pursuant to subdivision (b) of Section 14029.91 and provided in a format that is culturally and linguistically appropriate.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(f)(1)Subject to subdivision (k), the department shall reimburse health care providers of applicable health care services delivered via video synchronous interaction, synchronous audio-only modality, or asynchronous store and forward, as applicable, at payment amounts that are not less than the amounts the provider would receive if the services were delivered via in-person, face-to-face contact, so long as the services or settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)Subject to subdivision (k), for applicable health care services appropriately provided by a network provider via video synchronous interaction, audio-only synchronous interaction modality, or asynchronous store and forward, as applicable, to an enrollee of a Medi-Cal managed care plan, the Medi-Cal managed care plan shall reimburse the network provider at payment amounts that are not less than the amounts the network provider would have received if the services were delivered via in-person, face-to-face contact, unless the Medi-Cal managed care plan and network provider mutually agree to reimbursement in different amounts.
(g)On or before January 1, 2023, the department shall develop a research and evaluation plan that does all of the following:
(1)Proposes strategies to analyze the relationship between telehealth and the following: access to care, access to in-person care, quality of care, and Medi-Cal program costs, utilization, and program integrity.
(2)Examines issues using an equity framework that includes stratification by available geographic and demographic factors, including, but not limited to, race, ethnicity, primary language, age, and gender, to understand inequities and disparities in care.
(3)Prioritizes research and evaluation questions that directly inform Medi-Cal policy.
(h)Applicable health care services provided through asynchronous store and forward, video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities as described in this section shall comply with the privacy and security requirements contained in the federal Health Insurance Portability and Accountability Act of 1996 found in Parts 160 and 164 of Title 45 of the Code of Federal Regulations, the Medicaid State Plan, and any other applicable state and federal statutes and regulations.
(i)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, plan letters, provider bulletins, and similar instructions, without taking any further regulatory action.
(j)Consistent with the requirements of this section and subject to subdivision (k), a PACE organization approved by the department pursuant to Chapter 8.75 (commencing with Section 14591) may use video telehealth to conduct initial assessments and annual reassessments for eligibility for enrollment in the PACE program.
(k)The department shall seek any federal approvals it deems necessary to implement this section. This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(l)This section shall be operative on January 1, 2023, or on the operative date or dates reflected in the applicable federal approvals obtained by the department pursuant to subdivision (k), whichever is later.
(m)This section does not apply to health care services provided via telehealth in an FQHC or RHC visit as described in paragraph (4) of subdivision (g) of Section 14132.100.
(a)For purposes of this section, the following definitions apply:
(1)Border community means border areas adjacent to the State of California where it is customary practice for California residents to use medical resources in adjacent areas outside the state. Under these circumstances, program controls and limitations are the same as for services rendered by health care providers within the state.
(2)Health care provider has the same meaning as set forth in paragraph (3) of subdivision (a) of Section 2290.5 of the Business and Professions Code, and shall be either enrolled as a Medi-Cal rendering provider, or a nonphysician medical practitioner affiliated with an enrolled Medi-Cal provider group. Health care provider also includes any provider type designated by the department pursuant to subparagraph (A) of paragraph (2) of subdivision (b). The enrolled Medi-Cal provider or provider group for which the health care provider renders services via telehealth shall meet all Medi-Cal requirements and shall be located in the state or a border community.
(3)Health care service plan has the same meaning as set forth in subdivision (f) of Section 1345 of the Health and Safety Code.
(4)Medi-Cal managed care plan has the same meaning as set forth in subdivision (j) of Section 14184.101.
(5)Network provider has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(6)Telehealth has the same meaning as set forth in paragraph (6) of subdivision (a) of Section 2290.5 of the Business and Professions Code.
(b)(1)Subject to subdivision (k), in-person, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for covered health care services and provider types designated by the department, when provided by video synchronous interaction, asynchronous store and forward, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)(A)In implementing this section, the department shall designate and periodically update the covered health care services and provider types, including required licensing and credentialing criteria, as applicable, which may be appropriately delivered via the telehealth modalities described in this subdivision.
(B)Applicable health care services appropriately provided through video synchronous interaction, asynchronous store and forward, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities are subject to billing, reimbursement, and utilization management policies imposed by the department. Subject to subdivision (k), utilization management protocols adopted by the department pursuant to this section shall be consistent with, and no more restrictive than, those authorized for health care service plans pursuant to Section 1374.13 of the Health and Safety Code.
(c)(1)(A)Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice.
(B)(i)The department may provide specific exceptions to the requirement specified in subparagraph (A), based on a Medi-Cal providers access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(ii)In making exceptions to the requirement specified in subparagraph (A), in addition to the provisions in clause (i), the department may also take into consideration the availability of broadband access based on speed standards set by the Federal Communications Commission, pursuant to Section 706 of the Telecommunications Act of 1996 (Pub. L. No. 104-104) or other applicable federal law or regulation.
(2)Effective on the date designated by the department pursuant to paragraph (1), a provider furnishing services through video synchronous interaction or audio-only synchronous interaction shall also do one of the following:
(A)Offer those services via in-person, face-to-face contact.
(B)Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
(C)Maintain protocols for patient outpatient clinical referral to appropriate in-person care, consistent with recognized professional standards of practice, when the standard of care cannot be met by video synchronous interaction or audio-only synchronous interactions. interaction.
(3)In implementing this subdivision, the department shall consider additional recommendations from affected stakeholders regarding the need to maintain access to in-person services without unduly restricting access to telehealth services.
(4)A health care provider may establish a new patient relationship with a Medi-Cal beneficiary via video synchronous interaction consistent with any requirements imposed by the department.
(5)(A)A health care provider shall not establish a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, telephonic (audio-only) synchronous interaction, remote patient monitoring, or other virtual communication modalities, except as set forth in paragraph (4) of subdivision (g) of Section 14132.100.
(B)Notwithstanding the prohibition in subparagraph (A), the department may provide for specific exceptions to this prohibition, the department may provide for specific exceptions described in clauses (i) and (ii), which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(i)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined in subdivision (p) of Section 56.05 of the Civil Code, and when established in accordance with department specific department-specific requirements and consistent with federal and state law, regulations regulations, and guidance.
(ii)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests they do not have access to video, and when established in accordance with department specific department-specific requirements and consistent with federal and state laws, regulations regulations, and guidance.
(6)Subject to subdivision (k), the department may establish separate fee schedules for applicable health care services delivered via remote patient monitoring or other permissible virtual communication modalities.
(7)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(d)In addition to any existing law requiring beneficiary consent to telehealth, including, but not limited to, subdivision (b) of Section 2290.5 of the Business and Professions Code, all of the following shall be communicated by a health care provider to a Medi-Cal beneficiary, in writing or verbally, on at least one occasion prior to, or concurrent with, initiating the delivery of one or more health care services via telehealth to a Medi-Cal beneficiary: an explanation that beneficiaries have the right to access covered services that may be delivered via telehealth through an in-person, face-to-face visit; an explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn at any time by the Medi-Cal beneficiary without affecting their ability to access covered Medi-Cal services in the future; an explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted; and the potential limitations or risks related to receiving services through telehealth as compared to an in-person visit, to the extent any limitations or risks are identified by the provider.
(1)The provider shall document in the patient record the provision of this information and the patients verbal or written acknowledgment that the information was received.
(2)The department shall develop, in consultation with affected stakeholders, model language for purposes of the communication described in this subdivision.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(e)(1)The department shall develop, in consultation with affected stakeholders, an informational notice to be distributed to fee-for-service Medi-Cal beneficiaries and for use by Medi-Cal managed care plans in communicating to their enrollees. Information in the notice shall include, but not be limited to, all of the following:
(A)The availability of Medi-Cal covered telehealth services.
(B)The beneficiarys right to access all medically necessary covered services through in-person, face-to-face visits, and a providers and Medi-Cal managed care plans responsibility to offer or arrange for that in-person care, as applicable.
(C)An explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn by the Medi-Cal beneficiary at any time without affecting their ability to access covered Medi-Cal services in the future.
(D)An explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted.
(E)Notification of the beneficiarys right to make complaints about the offer of telehealth services in lieu of in-person care or about the quality of care delivered through telehealth.
(2)The informational notice shall be translated into threshold languages determined by the department pursuant to subdivision (b) of Section 14029.91 and provided in a format that is culturally and linguistically appropriate.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(f)(1)Subject to subdivision (k), the department shall reimburse health care providers of applicable health care services delivered via video synchronous interaction, synchronous audio-only modality, or asynchronous store and forward, as applicable, at payment amounts that are not less than the amounts the provider would receive if the services were delivered via in-person, face-to-face contact, so long as the services or settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)Subject to subdivision (k), for applicable health care services appropriately provided by a network provider via video synchronous interaction, audio-only synchronous interaction modality, or asynchronous store and forward, as applicable, to an enrollee of a Medi-Cal managed care plan, the Medi-Cal managed care plan shall reimburse the network provider at payment amounts that are not less than the amounts the network provider would have received if the services were delivered via in-person, face-to-face contact, unless the Medi-Cal managed care plan and network provider mutually agree to reimbursement in different amounts.
(g)On or before January 1, 2023, the department shall develop a research and evaluation plan that does all of the following:
(1)Proposes strategies to analyze the relationship between telehealth and the following: access to care, access to in-person care, quality of care, and Medi-Cal program costs, utilization, and program integrity.
(2)Examines issues using an equity framework that includes stratification by available geographic and demographic factors, including, but not limited to, race, ethnicity, primary language, age, and gender, to understand inequities and disparities in care.
(3)Prioritizes research and evaluation questions that directly inform Medi-Cal policy.
(h)Applicable health care services provided through asynchronous store and forward, video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities as described in this section shall comply with the privacy and security requirements contained in the federal Health Insurance Portability and Accountability Act of 1996 found in Parts 160 and 164 of Title 45 of the Code of Federal Regulations, the Medicaid State Plan, and any other applicable state and federal statutes and regulations.
(i)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, plan letters, provider bulletins, and similar instructions, without taking any further regulatory action.
(j)Consistent with the requirements of this section and subject to subdivision (k), a PACE organization approved by the department pursuant to Chapter 8.75 (commencing with Section 14591) may use video telehealth to conduct initial assessments and annual re-assessments reassessments for eligibility for enrollment in the PACE program.
(k)The department shall seek any federal approvals it deems necessary to implement this section. This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(l)This section shall be operative on January 1, 2023, or on the operative date or dates reflected in the applicable federal approvals obtained by the department pursuant to subdivision (k), whichever is later.
(m)This section does not apply to health care services provided via telehealth in an FQHC or RHC visit as described in paragraph (4) of subdivision (g) of Section 14132.100.
(a)For purposes of this section, the following definitions apply:
(1)Border community means border areas adjacent to the State of California where it is customary practice for California residents to use medical resources in adjacent areas outside the state. Under these circumstances, program controls and limitations are the same as for services rendered by health care providers within the state.
(2)Health care provider has the same meaning as set forth in paragraph (3) of subdivision (a) of Section 2290.5 of the Business and Professions Code, and shall be either enrolled as a Medi-Cal rendering provider, or a nonphysician medical practitioner affiliated with an enrolled Medi-Cal provider group. Health care provider also includes any provider type designated by the department pursuant to subparagraph (A) of paragraph (2) of subdivision (b). The enrolled Medi-Cal provider or provider group for which the health care provider renders services via telehealth shall meet all Medi-Cal requirements and shall be located in the state or a border community.
(3)Health care service plan has the same meaning as set forth in subdivision (f) of Section 1345 of the Health and Safety Code.
(4)Medi-Cal managed care plan has the same meaning as set forth in subdivision (j) of Section 14184.101.
(5)Network provider has the same meaning as set forth in Section 438.2 of Title 42 of the Code of Federal Regulations.
(6)Telehealth has the same meaning as set forth in paragraph (6) of subdivision (a) of Section 2290.5 of the Business and Professions Code.
(b)(1)Subject to subdivision (k), in-person, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for covered health care services and provider types designated by the department, when provided by video synchronous interaction, asynchronous store and forward, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)(A)In implementing this section, the department shall designate and periodically update the covered health care services and provider types, including required licensing and credentialing criteria, as applicable, which may be appropriately delivered via the telehealth modalities described in this subdivision.
(B)Applicable health care services appropriately provided through video synchronous interaction, asynchronous store and forward, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities are subject to billing, reimbursement, and utilization management policies imposed by the department. Subject to subdivision (k), utilization management protocols adopted by the department pursuant to this section shall be consistent with, and no more restrictive than, those authorized for health care service plans pursuant to Section 1374.13 of the Health and Safety Code.
(c)(1)(A)Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice.
(B)(i)The department may provide specific exceptions to the requirement specified in subparagraph (A), based on a Medi-Cal providers access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(ii)In making exceptions to the requirement specified in subparagraph (A), in addition to the provisions in clause (i), the department may also take into consideration the availability of broadband access based on speed standards set by the Federal Communications Commission, pursuant to Section 706 of the Telecommunications Act of 1996 (Pub. L. No. 104-104) or other applicable federal law or regulation.
(2)Effective on the date designated by the department pursuant to paragraph (1), a provider furnishing services through video synchronous interaction or audio-only synchronous interaction shall also do one of the following:
(A)Offer those services via in-person, face-to-face contact.
(B)Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
(C)Maintain protocols for patient referral to appropriate in-person care, consistent with recognized professional standards of practice, when the standard of care cannot be met by video synchronous interaction or audio-only synchronous interactions.
(3)In implementing this subdivision, the department shall consider additional recommendations from affected stakeholders regarding the need to maintain access to in-person services without unduly restricting access to telehealth services.
(4)A health care provider may establish a new patient relationship with a Medi-Cal beneficiary via video synchronous interaction consistent with any requirements imposed by the department.
(5)(A)A health care provider shall not establish a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, telephonic (audio-only) synchronous interaction, remote patient monitoring, or other virtual communication modalities, except as set forth in paragraph (4) of subdivision (g) of Section 14132.100.
(B)Notwithstanding the prohibition in subparagraph (A), the department may provide for specific exceptions to this prohibition, the department may provide for specific exceptions described in clauses (i) and (ii), which shall be developed in consultation with affected stakeholders and published in departmental guidance.
(i)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined in subdivision (n) (p) of Section 56.05 of the Civil Code, and when established in accordance with department specific requirements and consistent with federal and state law, regulations and guidance.
(ii)Notwithstanding the prohibition in subparagraph (A), a health care provider may establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests they do not have access to video, and when established in accordance with department specific requirements and consistent with federal and state laws, regulations and guidance.
(6)Subject to subdivision (k), the department may establish separate fee schedules for applicable health care services delivered via remote patient monitoring or other permissible virtual communication modalities.
(7)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(d)In addition to any existing law requiring beneficiary consent to telehealth, including, but not limited to, subdivision (b) of Section 2290.5 of the Business and Professions Code, all of the following shall be communicated by a health care provider to a Medi-Cal beneficiary, in writing or verbally, on at least one occasion prior to, or concurrent with, initiating the delivery of one or more health care services via telehealth to a Medi-Cal beneficiary: an explanation that beneficiaries have the right to access covered services that may be delivered via telehealth through an in-person, face-to-face visit; an explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn at any time by the Medi-Cal beneficiary without affecting their ability to access covered Medi-Cal services in the future; an explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted; and the potential limitations or risks related to receiving services through telehealth as compared to an in-person visit, to the extent any limitations or risks are identified by the provider.
(1)The provider shall document in the patient record the provision of this information and the patients verbal or written acknowledgment that the information was received.
(2)The department shall develop, in consultation with affected stakeholders, model language for purposes of the communication described in this subdivision.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(e)(1)The department shall develop, in consultation with affected stakeholders, an informational notice to be distributed to fee-for-service Medi-Cal beneficiaries and for use by Medi-Cal managed care plans in communicating to their enrollees. Information in the notice shall include, but not be limited to, all of the following:
(A)The availability of Medi-Cal covered telehealth services.
(B)The beneficiarys right to access all medically necessary covered services through in-person, face-to-face visits, and a providers and Medi-Cal managed care plans responsibility to offer or arrange for that in-person care, as applicable.
(C)An explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn by the Medi-Cal beneficiary at any time without affecting their ability to access covered Medi-Cal services in the future.
(D)An explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted.
(E)Notification of the beneficiarys right to make complaints about the offer of telehealth services in lieu of in-person care or about the quality of care delivered through telehealth.
(2)The informational notice shall be translated into threshold languages determined by the department pursuant to subdivision (b) of Section 14029.91 and provided in a format that is culturally and linguistically appropriate.
(3)This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
(f)(1)Subject to subdivision (k), the department shall reimburse health care providers of applicable health care services delivered via video synchronous interaction, synchronous audio-only modality, or asynchronous store and forward, as applicable, at payment amounts that are not less than the amounts the provider would receive if the services were delivered via in-person, face-to-face contact, so long as the services or settings meet the applicable standard of care and meet the requirements of the service code being billed.
(2)Subject to subdivision (k), for applicable health care services appropriately provided by a network provider via video synchronous interaction, audio-only synchronous interaction modality, or asynchronous store and forward, as applicable, to an enrollee of a Medi-Cal managed care plan, the Medi-Cal managed care plan shall reimburse the network provider at payment amounts that are not less than the amounts the network provider would have received if the services were delivered via in-person, face-to-face contact, unless the Medi-Cal managed care plan and network provider mutually agree to reimbursement in different amounts.
(g)On or before January 1, 2023, the department shall develop a research and evaluation plan that does all of the following:
(1)Proposes strategies to analyze the relationship between telehealth and the following: access to care, access to in-person care, quality of care, and Medi-Cal program costs, utilization, and program integrity.
(2)Examines issues using an equity framework that includes stratification by available geographic and demographic factors, including, but not limited to, race, ethnicity, primary language, age, and gender, to understand inequities and disparities in care.
(3)Prioritizes research and evaluation questions that directly inform Medi-Cal policy.
(h)Applicable health care services provided through asynchronous store and forward, video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities as described in this section shall comply with the privacy and security requirements contained in the federal Health Insurance Portability and Accountability Act of 1996 found in Parts 160 and 164 of Title 45 of the Code of Federal Regulations, the Medicaid State Plan, and any other applicable state and federal statutes and regulations.
(i)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means of all-county letters, plan letters, provider bulletins, and similar instructions, without taking any further regulatory action.
(j)Consistent with the requirements of this section and subject to subdivision (k), a PACE organization approved by the department pursuant to Chapter 8.75 (commencing with Section 14591) may use video telehealth to conduct initial assessments and annual re-assessments for eligibility for enrollment in the PACE program.
(k)The department shall seek any federal approvals it deems necessary to implement this section. This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(l)This section shall be operative on January 1, 2023, or on the operative date or dates reflected in the applicable federal approvals obtained by the department pursuant to subdivision (k), whichever is later.
(m)This section does not apply to health care services provided via telehealth in an FQHC or RHC visit as described in paragraph (4) of subdivision (g) of Section 14132.100.
|
Date
|
Status
|
|---|---|
| Sep 8, 2023 | Chaptered by Secretary of State - Chapter 172, Statutes of 2023. |
| Sep 8, 2023 | Approved by the Governor. |
| Aug 30, 2023 | Enrolled and presented to the Governor at 2:15 p.m. |
| Aug 24, 2023 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 76. Noes 0. Page 2781.). |
| Jun 29, 2023 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after July 1 pursuant to Assembly Rule 77. |
| Jun 29, 2023 | Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0. Page 1829.). |
| Jun 27, 2023 | Read second time. Ordered to Consent Calendar. |
| Jun 26, 2023 | From committee: Be ordered to second reading file pursuant to Senate Rule 28.8 and ordered to Consent Calendar. |
| Jun 7, 2023 | From committee: Do pass and re-refer to Com. on APPR with recommendation: To Consent Calendar. (Ayes 12. Noes 0.) (June 7). Re-referred to Com. on APPR. |
| May 24, 2023 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH. |
| May 10, 2023 | Referred to Com. on HEALTH. |
| Apr 27, 2023 | In Senate. Read first time. To Com. on RLS. for assignment. |
| Apr 27, 2023 | Read third time. Passed. Ordered to the Senate. (Ayes 79. Noes 0. Page 1366.) |
| Apr 20, 2023 | Read second time. Ordered to Consent Calendar. |
| Apr 19, 2023 | From committee: Do pass. To Consent Calendar. (Ayes 14. Noes 0.) (April 19). |
| Mar 29, 2023 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 14. Noes 0.) (March 28). Re-referred to Com. on APPR. |
| Mar 27, 2023 | Re-referred to Com. on HEALTH. |
| Mar 23, 2023 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Mar 13, 2023 | Re-referred to Com. on HEALTH. |
| Mar 9, 2023 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Mar 2, 2023 | Referred to Com. on HEALTH. |
| Feb 17, 2023 | From printer. May be heard in committee March 19. |
| Feb 16, 2023 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 24, 2023 | AB 1241 Weber Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Jun 29, 2023 | Consent Calendar AB1241 Weber | Senate Floor |
Passed |
|
| Jun 7, 2023 | Do pass, but first be re-referred to the Committee on [Appropriations] with the recommendation: To Consent Calendar | Senate Standing Committee on Health |
Passed |
|
| Apr 27, 2023 | AB 1241 Weber Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| Apr 19, 2023 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Mar 28, 2023 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| ATA Action | ** Support | |
| California Academy Of Family Physicians | ** Support | |
| California Health Coalition Advocacy | ** Support | |
| California Retired Teachers Association | ** Support | |
| California State Association of Psychiatrists | ** Support | |
| Californians for Accessible Connected Care | ** Support | |
| Govern for California | ** Support | |
| Hazel Health | ** Support | |
| Health Net | ** Support | |
| Teladoc Health | ** Support | |
| Teladoc Health | * Indeterminate | Mar 28, 2023 |
| Teledoc Health | ** Support | |
| Welbehealth | ** Support |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 1241
Author:(Weber)
As Amended Ver:May 24, 2023
Majority vote
SUMMARY
Clarifies two provisions of current law requiring a provider furnishing services through video or audio telehealth to offer services in-person or facilitate in-person care, including clarifying that current law does not require a provider to schedule an appointment with a different provider on behalf of a patient.
Senate Amendments
Require a provider to maintain and follow protocols to either offer services in-person or facilitate in-person care, rather than maintain the ability to do so.
COMMENTS
- Telehealth in Medi-Cal. Telehealth is a mode of delivering health care services remotely using information technology. The three primary modalities are video, audio (including telephone), and asynchronous store and forward, which can be used when a real-time interaction is not needed.
Telehealth utilization increased rapidly in response to the COVID-19 pandemic. According to data published by the Department of Health Care Services (DHCS), prior to the onset of the COVID-19 pandemic, telehealth represented around 300 claims per 100,000 Medi-Cal member months. By April 2020, telehealth claims increased dramatically to over 12,000 claims per 100,000 member months and remained relatively stable through March 2021. Following March 2021, telehealth claims per 100,000 member months remained significantly higher than pre-COVID-19 pandemic levels but declined from the peak to around 7,700 claims per 100,000 member months.
- Medi-Cal Telehealth Policy and Policy Development Process. Prior to the COVID-19 pandemic, DHCS expanded the availability of telehealth in Medi-Cal by allowing most clinically appropriate services to be provided through telehealth. During the COVID-19 pandemic, DHCS implemented additional telehealth flexibilities to allow Medi-Cal providers meet the health care needs of enrollees.
Pursuant to AB 133 (Committee on Budget), Chapter 143, Statutes of 2021, DHCS convened a Telehealth Advisory Workgroup to advise on the development post-public health emergency (PHE) telehealth policies. Per statute, the workgroup included representatives of the California Medical Association, the California Primary Care Association, the California Association of Public Hospitals, the County Behavioral Health Directors Association, Medi-Cal managed care plans, Planned Parenthood Affiliates of California, Essential Access Health, and other subject matter experts and other affected stakeholders. DHCS issued a solicitation and received approximately 90 responses, and selected approximately 30 additional organizations and individuals that represented a cross-section of stakeholders. Three publicly accessible workgroup meetings were held in the fall of 2021 and additional workgroup input was solicited via an electronic survey. In December 2021, DHCS published a report summarizing the outcomes of the advisory workgroup.
As part of the 2022-23 Governor's Budget, DHCS proposed post-PHE telehealth policies through budget trailer bill language. According to DHCS, all post-PHE policy proposals were guided by a set of principles, which included equity, access, standard of care, patient choice, confidentiality, stewardship, and payment appropriateness. These proposals, which reflected input from the advisory workgroup, maintained the broad availability of telehealth in Medi-Cal.
After this significant stakeholder effort and legislative agreement on final trailer bill language, Medi-Cal telehealth policies were codified through the 2022-23 health trailer bill, SB 184 (Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2022, with minor changes made subsequently by AB 32 (Aguilar-Curry), Chapter 515, Statutes of 2022. These bills continue coverage and payment parity for services offered through video and audio telehealth for Medi-Cal covered benefits and services, as long as the provider is able to meet the standard of care, subject to billing, reimbursement and utilization management policies developed by DHCS. These bills also establish new patient protections, further discussed below, regarding patient consent, beneficiary choice of telehealth modality, and preserving access to in-person care.
- Medi-Cal Telehealth Policies. Current Medi-Cal telehealth policies, as established through last year's budget and legislative processes and DHCS policy, maintain and expand Medi-Cal coverage of telehealth. Medi-Cal covers clinically appropriate services through audio and video modalities at payment parity with in-person services, as well as coverage of other services and modalities like e-consult and brief virtual communication. Medi-Cal policies also establish certain restrictions and protections, including enhanced consent requirements and limitations on establishment of a new patient relationship via telehealth. The following additional patient protections are scheduled to go into effect no sooner than January 1, 2024:
- Patient Choice of Telehealth Modality: DHCS will phase in an approach that requires a provider offer both video and audio-only telehealth to ensure patients have their choice of telehealth modality. DHCS is developing guidance on exceptions to this requirement, to include exceptions based on a Medi-Cal provider's lack of access to adequate broadband speeds to effectively stream video.
- Patient Right to In-Person Services: DHCS will phase in an approach where providers who offer services via telehealth will be required to either offer those same services in-person or arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
- Changes Proposed in This Bill. This bill relates to telehealth policies established to ensure a patient right to in-person services. As noted above, current law requires providers who offer services via telehealth to either offer those same services in-person or link the enrollee to in-person care. This bill clarifies the application of this provision to address concerns that this "facilitation of in-person care" provision would require a provider to work with a different provider's scheduling system to set up appointments. It also intends to clarify a provider must maintain and follow protocols to offer a referral or facilitation of in-person care. This will not be necessary in every circumstance, as it will depend on the appropriateness and patient need for such a referral or facilitation of in-person care.
According to the Author
This bill is intended to ensure Medi-Cal patients retain the ability to receive services through telehealth. The author states that requirements set to go into effect on January 1, 2024, would create a separate, administratively burdensome standard for providers to offer telehealth services to Medi-Cal patients that is different from when the provider offers the same in-person services. The author states that current law requires that Medi-Cal telehealth providers must be able to offer patients services in-person or have access to other providers' schedules to book the patient an in-person appointment. The author indicates this is unrealistic and will disqualify many California-licensed providers from offering telehealth services through Medi-Cal. The author concludes this bill intends to clarify these provisions to remove barriers to providing telehealth.
Arguments in Support
Teledoc Health, the bill's sponsor, supports this bill as a means to ensure existing law does not impede California licensed health care providers in the Medi-Cal program from offering telehealth services to patients. The California Retired Teachers Association supports this bill, stating all patients should maintain the same quality of care, regardless of whether they are virtual or in-person.
Arguments in Opposition
There is no known opposition.
FISCAL COMMENTS
According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.
VOTES:
ASM HEALTH: 14-0-1
YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner Horvath, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber
ABS, ABST OR NV: Wendy Carrillo
ASM APPROPRIATIONS: 14-0-2
YES: Holden, Megan Dahle, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Robert Rivas, Sanchez, Weber, Wilson
ABS, ABST OR NV: Bryan, Pellerin
ASSEMBLY FLOOR: 79-0-1
YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones- Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon
ABS, ABST OR NV: Jim Patterson
SENATE FLOOR: 39-0-1
YES: Allen, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk
ABS, ABST OR NV: Alvarado-Gil
UPDATED
VERSION: May 24, 2023
CONSULTANT: Lisa Murawski / HEALTH / (916) 319-2097 FN: 0001184
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB 1241 |
CONSENT
Bill No: AB 1241
Author: Weber (D)
Amended: 5/24/23 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 12-0, 6/7/23
AYES: Eggman, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 79-0, 4/27/23 (Consent) - See last page for vote
SUBJECT: Medi-Cal: telehealth
SOURCE: Teladoc Health
DIGEST:
This bill clarifies that Medi-Cal providers of telehealth services are not required to schedule an appointment with a different provider in order to meet the requirement in existing law that they facilitate in-person care. Rephrases the telehealth provider requirement under the Medi-Cal program to offer or facilitate in-person care as a requirement that telehealth providers maintain and follow protocols to offer or facilitate in-person care.
ANALYSIS:
Existing law:
- Defines “telehealth” as the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care. Includes asynchronous store and forward transfers (transmitting a patient’s medical information from an originating site to a health care provider at a distant site) and synchronous interaction (a real-time interaction between patient and provider located at different sites). [BPC §2290.5]
- Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which low-income individuals are eligible for medical coverage. [WIC §14000, et seq.]
- Specifies that in-person, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for covered health care services and provider types designated by DHCS, using telehealth as defined in 1) above or through audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet the applicable standard of care and meet the requirements of the service code being billed. [WIC §14132.725]
- Requires, pursuant to an effective date designated by DHCS that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio telehealth to also offer those same health care services via video telehealth to preserve beneficiary choice. [WIC §14132.725]
- Requires, effective on the date designated by DHCS pursuant to 4) above, a provider furnishing services through video or audio-only telehealth to also do one of the following:
- Offer those services via in-person, face-to-face contact; or
- Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
This bill:
- Rephrases the Medi-Cal telehealth provider requirement in existing law to offer or arrange for and facilitate in-person care as a requirement that telehealth providers maintain and follow protocols to offer or arrange for and facilitate in-person care.
- Specifies that Medi-Cal providers of telehealth services are not required to schedule an appointment with a different provider on behalf of the patient in order to meet the requirement that they arrange for and facilitate in-person care to a different provider.
Comments
- Author’s statement. According to the author, this bill is intended to ensure Medi-Cal patients retain the ability to receive services through telehealth. The current requirements, set to go into effect on January 1, 2024, would create a separate, administratively burdensome standard for providers to offer telehealth services to Medi-Cal patients that is different from when the provider offers the same in-person services. The current law requires that Medi-Cal telehealth providers must be able to offer patients services in-person or have access to other providers’ schedules to book the patient an in-person appointment. This is unrealistic and will disqualify many California-licensed providers from offering telehealth services through Medi-Cal. This bill intends to clarify these provisions to remove barriers to providing telehealth.
- Telehealth in Medi-Cal. Medi-Cal’s telehealth policy was established pursuant to the Telemedicine Development Act of 1996 (Thompson, Chapter 864, Statutes of 1996) and updated in compliance with Assembly Bill 415 (Logue, Chapter 547, Statutes of 2011), known as the Telehealth Advancement Act of 2011. In 2019, DHCS undertook a policy review process, following extensive stakeholder engagement and public comment, to inform policy refinement. The revised 2019 policy afforded flexibility to licensed providers to make clinically appropriate decisions regarding the use of synchronous and asynchronous telehealth modalities. The finalized policy was published in the Medi-Cal provider manual and disseminated to Medi-Cal managed care plans via an All Plan Letter. In 2020, due to the COVID-19 public health emergency, DHCS implemented additional broad flexibilities relative to telehealth modalities via blanket waivers and Disaster Relief state plan amendments. This enabled Medi-Cal’s health care delivery systems to meet the health care needs of Medi-Cal beneficiaries where in-person encounters were not recommended or available. Such expansions included expanding which providers could use telehealth, allowing telehealth to be used for new patients, allowing many services to be provided audio-only, expanding payment parity for telehealth services, waiving site limitations for federally qualified health centers (FQHCs) and rural health centers (RHCs), and expanding access through non-public technology platforms.
In 2021, several of these COVID-19 flexibilities were extended via budget trailer bill AB 133 (Committee on Budget, Chapter 143, Statutes of 2021), along with a requirement for DHCS to convene a Telehealth Advisory Workgroup to inform the development of telehealth policies beyond the public health emergency. The workgroup met four times throughout 2021 and 2022 and as a result, DHCS published a report covering the following policy areas, many of which were subsequently incorporated into SB 184 (Committee on Budget and Fiscal Review, Chapter 47, Statutes of 2022):
- Baseline coverage of synchronous and asynchronous telehealth;
- Payment parity;
- Virtual communications and check-ins;
- FQHCs and RHCs;
- Establishing new patients via telehealth;
- Telehealth modifiers billing and coding;
- Patient consent;
- Telephonic Evaluation & Management and Assessment and Management CPT Codes;
- Third Party Corporate Telehealth Providers;
- Utilization review;
- Patient choice of modality;
- Right to in-person services; and,
- Network Adequacy.
As a result of these efforts by DHCS and the Legislature, according to the California Health Care Foundation in a recent report on the experiences of Californians with low incomes, California has some of the most expansive Medicaid telehealth coverage and reimbursement policies in the nation. That report found after in-depth interviews with 73 individuals, 51 of whom were Medi-Cal recipients, telehealth effectively removes barriers, such as financial costs and transportation challenges, which have impeded their access to care in the past. Participants report that accessing telehealth visits works well, especially when links for logging in are sent via email or text prior to visits. The ease of access to telehealth visits allows patients to make and keep appointments that they might not have been able to do in person. A notable minority of participants lack access to technology for video visits. People with disabilities, with mental health conditions, and who identify as transgender or nonbinary were especially likely to say that access to telehealth is important to them. Much of the focus of the report was on telehealth experience with the interviewees’ usual community providers, rather than third-party telehealth providers, and the interviewees overwhelmingly want to choose themselves whether to have an in-person or telehealth visit.
- Implementation of telehealth provider requirements to offer in-person services or arrange for and facilitate a referral. Some of the requirements of SB 184 will not be implemented until DHCS sets a date (no sooner than January 1, 2024), including the requirement for telehealth providers to offer in-person services or to arrange for and facilitate a referral. During the AB 133 Telehealth Advisory Workgroup, concerns were raised that third-party telehealth providers should follow certain protocols, such as having an ability to refer to a local in-person provider in order to ensure patient choice and access. DHCS stated in its report on the workgroup that the workgroup was in general agreement that enabling enrollees to access third-party telehealth providers could help alleviate workforce shortages, especially for specialty providers, and that it would be beneficial for such providers to have connections with – or the ability to refer enrollees to – local in-person services. DHCS also stated that when refining this policy approach, it will consider how best to align with parameters set forth in AB 457 (Santiago, Chapter 439 Statutes of 2021), which regulates commercial plans where applicable, including: disclosing the availability of receiving services in person; ensuring that medical records from an encounter are shared with the Medi-Cal enrollee’s primary care provider, while considering state and federal privacy regulations in regards to record-sharing; informing Medi-Cal enrollees of service availability in-network and in-person; and, collecting and reporting data on telehealth service utilization. DHCS stated its intent to address concerns that third-party telehealth providers may reduce continuity of care and to balance increasing access to care while not limiting patient access to in-person care. Some of these provisions, including the disclosure requirements about the availability of in-person services, were included in SB 184, but many of the other suggestions around record sharing and data collection were not. DHCS noted in 2022 post-COVID-19 telehealth policy recommendations that because third-party telehealth providers without a physical location in California are not required to designate their status as such with DHCS if they subcontract with a Medi-Cal provider, DHCS is currently unable to monitor or evaluate services provided to Medi-Cal enrollees by third-party telehealth providers.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
SUPPORT: (Verified 6/27/23)
Teladoc Health (source)
ATA Action
California Academy of Family Physicians
California Health Coalition Advocacy
California Retired Teachers Association
California State Association of Psychiatrists
Californians for Accessible Connected Care
Govern for California
Hazel Health
Health Net
WelbeHealth
OPPOSITION: (Verified 6/27/23)
None received
ARGUMENTS IN SUPPORT: Sponsors Teladoc Health state that the Medi-Cal requirement that telehealth providers offer or arrange for an in-person appointment is more restrictive than the requirements for commercial health plans. Telehealth providers are not generally able to book an in-person appointment with another provider as they do not have access to other providers’ schedules. They also point out that over 11 million Californians live in an area with a shortage of primary care providers. Supporters ATA Action, the American Telemedicine Association’s affiliated trade organization, state that under the pending language, California-licensed telehealth providers without a brick-and-mortar presence in California would not be able to deliver services to California patients if they do not have access to – or the bandwidth to meet – the requisite scheduling capabilities to comply with the hot handoff requirements. Additionally, any telehealth provider with an instate office location who hopes to avoid the burdensome referral obligations placed on providers would only be able to see patients within reasonable travelling distance. These kinds of arbitrary and clinically unsubstantiated geographic barriers are precisely what telehealth technologies are designed to eliminate.
ASSEMBLY FLOOR: 79-0, 4/27/23
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon
NO VOTE RECORDED: Jim Patterson
Prepared by: Jen Flory / HEALTH / (916) 651-4111
6/28/23 11:07:37
**** END ****
SENATE COMMITTEE ON HEALTH
Senator Dr. Susan Talamantes Eggman, Chair
BILL NO: AB 1241
AUTHOR: | Weber | ||
VERSION: | May 24, 2023 | ||
HEARING DATE: | June 7, 2023 | ||
CONSULTANT: | Jen Flory | ||
SUBJECT: Medi-Cal: telehealth
SUMMARY:
Clarifies that Medi-Cal providers of telehealth services are not required to schedule an appointment with a different provider in order to meet the requirement in existing law that they facilitate in-person care. Rephrases the telehealth provider requirement under the Medi-Cal program to offer or facilitate in-person care as a requirement that telehealth providers maintain and follow protocols to offer or facilitate in-person care.
Existing law:
- Defines “telehealth” as the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care. Includes asynchronous store and forward transfers (transmitting a patient’s medical information from an originating site to a health care provider at a distant site) and synchronous interaction (a real-time interaction between patient and provider located at different sites). [BPC §2290.5]
- Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which low-income individuals are eligible for medical coverage. [WIC §14000, et seq.]
- Specifies that in-person, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for covered health care services and provider types designated by DHCS, using telehealth as defined in 1) above or through audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet the applicable standard of care and meet the requirements of the service code being billed. [WIC §14132.725]
- Requires, pursuant to an effective date designated by DHCS that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio telehealth to also offer those same health care services via video telehealth to preserve beneficiary choice. [WIC §14132.725]
- Requires, effective on the date designated by DHCS pursuant to 4) above, a provider furnishing services through video or audio-only telehealth to also do one of the following:
- Offer those services via in-person, face-to-face contact; or
- Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
This bill:
- Rephrases the Medi-Cal telehealth provider requirement in existing law to offer or arrange for and facilitate in-person care as a requirement that telehealth providers maintain and follow protocols to offer or arrange for and facilitate in-person care.
- Specifies that Medi-Cal providers of telehealth services are not required to schedule an appointment with a different provider on behalf of the patient in order to meet the requirement that they arrange for and facilitate in-person care to a different provider.
FISCAL EFFECT:
This bill was not keyed as fiscal.
COMMENTS:
- Author’s statement. According to the author, this bill is intended to ensure Medi-Cal patients retain the ability to receive services through telehealth. The current requirements, set to go into effect on January 1, 2024, would create a separate, administratively burdensome standard for providers to offer telehealth services to Medi-Cal patients that is different from when the provider offers the same in-person services. The current law requires that Medi-Cal telehealth providers must be able to offer patients services in-person or have access to other providers’ schedules to book the patient an in-person appointment. This is unrealistic and will disqualify many California-licensed providers from offering telehealth services through Medi-Cal. This bill intends to clarify these provisions to remove barriers to providing telehealth.
- Telehealth in Medi-Cal. Medi-Cal’s telehealth policy was established pursuant to the Telemedicine Development Act of 1996 (Thompson, Chapter 864, Statutes of 1996) and updated in compliance with Assembly Bill 415 (Logue, Chapter 547, Statutes of 2011), known as the Telehealth Advancement Act of 2011. In 2019, DHCS undertook a policy review process, following extensive stakeholder engagement and public comment, to inform policy refinement. The revised 2019 policy afforded flexibility to licensed providers to make clinically appropriate decisions regarding the use of synchronous and asynchronous telehealth modalities. The finalized policy was published in the Medi-Cal provider manual and disseminated to Medi-Cal managed care plans via an All Plan Letter. In 2020, due to the COVID-19 public health emergency, DHCS implemented additional broad flexibilities relative to telehealth modalities via blanket waivers and Disaster Relief state plan amendments. This enabled Medi-Cal’s health care delivery systems to meet the health care needs of Medi-Cal beneficiaries where in-person encounters were not recommended or available. Such expansions included expanding which providers could use telehealth, allowing telehealth to be used for new patients, allowing many services to be provided audio-only, expanding payment parity for telehealth services, waiving site limitations for federally qualified health centers (FQHCs) and rural health centers (RHCs), and expanding access through non-public technology platforms.
In 2021, several of these COVID-19 flexibilities were extended via budget trailer bill AB 133 (Committee on Budget, Chapter 143, Statutes of 2021), along with a requirement for DHCS to convene a Telehealth Advisory Workgroup to inform the development of telehealth policies beyond the public health emergency. The workgroup met four times throughout 2021 and 2022 and as a result, DHCS published a report covering the following policy areas, many of which were subsequently incorporated into SB 184 (Committee on Budget and Fiscal Review, Chapter 47, Statutes of 2022):
- Baseline coverage of synchronous and asynchronous telehealth;
- Payment parity;
- Virtual communications and check-ins;
- FQHCs and RHCs;
- Establishing new patients via telehealth;
- Telehealth modifiers billing and coding;
- Patient consent;
- Telephonic Evaluation & Management and Assessment and Management CPT Codes;
- Third Party Corporate Telehealth Providers;
- Utilization review;
- Patient choice of modality;
- Right to in-person services; and,
- Network Adequacy.
As a result of these efforts by DHCS and the Legislature, according to the California Health Care Foundation in a recent report on the experiences of Californians with low incomes, California has some of the most expansive Medicaid telehealth coverage and reimbursement policies in the nation. That report found after in-depth interviews with 73 individuals, 51 of whom were Medi-Cal recipients, telehealth effectively removes barriers, such as financial costs and transportation challenges, which have impeded their access to care in the past. Participants report that accessing telehealth visits works well, especially when links for logging in are sent via email or text prior to visits. The ease of access to telehealth visits allows patients to make and keep appointments that they might not have been able to do in person. A notable minority of participants lack access to technology for video visits. People with disabilities, with mental health conditions, and who identify as transgender or nonbinary were especially likely to say that access to telehealth is important to them. Much of the focus of the report was on telehealth experience with the interviewees’ usual community providers, rather than third-party telehealth providers, and the interviewees overwhelmingly want to choose themselves whether to have an in-person or telehealth visit.
- Implementation of telehealth provider requirements to offer in-person services or arrange for and facilitate a referral. Some of the requirements of SB 184 will not be implemented until DHCS sets a date (no sooner than January 1, 2024), including the requirement for telehealth providers to offer in-person services or to arrange for and facilitate a referral. During the AB 133 Telehealth Advisory Workgroup, concerns were raised that third-party telehealth providers should follow certain protocols, such as having an ability to refer to a local in-person provider in order to ensure patient choice and access. DHCS stated in its report on the workgroup that the workgroup was in general agreement that enabling enrollees to access third-party telehealth providers could help alleviate workforce shortages, especially for specialty providers, and that it would be beneficial for such providers to have connections with – or the ability to refer enrollees to – local in-person services. DHCS also stated that when refining this policy approach, it will consider how best to align with parameters set forth in AB 457 (Santiago, Chapter 439 Statutes of 2021), which regulates commercial plans where applicable, including: disclosing the availability of receiving services in person; ensuring that medical records from an encounter are shared with the Medi-Cal enrollee’s primary care provider, while considering state and federal privacy regulations in regards to record-sharing; informing Medi-Cal enrollees of service availability in-network and in-person; and, collecting and reporting data on telehealth service utilization. DHCS stated its intent to address concerns that third-party telehealth providers may reduce continuity of care and to balance increasing access to care while not limiting patient access to in-person care. Some of these provisions, including the disclosure requirements about the availability of in-person services, were included in SB 184, but many of the other suggestions around record sharing and data collection were not. DHCS noted in 2022 post-COVID-19 telehealth policy recommendations that because third-party telehealth providers without a physical location in California are not required to designate their status as such with DHCS if they subcontract with a Medi-Cal provider, DHCS is currently unable to monitor or evaluate services provided to Medi-Cal enrollees by third-party telehealth providers.
- Prior legislation. SB 184 (Committee on Budget and Fiscal Review, Chapter 47, Statutes of 2022) among other provisions, prohibits face-to-face requirements for Medi-Cal services provided by video synchronous interaction, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities when those services and settings meet certain criteria. SB 184 requires providers to also offer services in person or arrange for a referral to in-person care and authorizes providers to establish patient relationships via video synchronous interaction. SB 184 also sets requirements on fee schedules, minimum reimbursements, consent standards, privacy and security compliance, and adds telehealth modalities to the FQHC/RHC “visit” definition.
AB 32 (Aguiar-Curry, Chapter 515, Statutes of 2022) permits DHCS to allow new patients to be established with health care providers in the Medi-Cal program using audio-only synchronous and other telehealth modalities.
AB 133 (Committee on Budget, Chapter 143, Statutes of 2021) among other provisions, extended, until December 31, 2022, flexibilities in reimbursement for care provided to Medi-Cal beneficiaries via telehealth, including through audio-only modalities, implemented during the COVID-19 public health emergency, and requires DHCS to convene a Telehealth Advisory Workgroup.
AB 457 (Santiago, Chapter 439 Statutes of 2021) establishes requirements on health plans and insurers that offer telehealth through a third-party corporate telehealth provider, including disclosing the availability of receiving the services on an in-person basis or via telehealth from the enrollee’s or insured’s primary care provider, treating specialist or other contracting health professional, clinic, or health facility, and, reminders of cost-sharing for services from noncontracted providers.
AB 2164 (Robert Rivas of 2020) would have required a "visit" for purposes of reimbursement by Medi-Cal to include a visit by an FQHC/RHC patient and a health care provider using telehealth through synchronous interaction or asynchronous store and forward, and would have authorized FQHCs/RHCs to establish a patient through synchronous interaction or asynchronous store and forward as of the date of service. AB 2164 would have sunsetted 180 days after the state of emergency for the COVID-19 pandemic has been terminated by proclamation of the Governor or by concurrent resolution of the Legislature. AB 2164 was vetoed by Governor Newsom who wrote, “While I am supportive of utilizing telehealth to increase access to primary and specialty care services, DHCS is currently in the process of evaluating its global telehealth policy to determine what temporary flexibilities should be extended beyond the COVID-19 pandemic. . . Further, the cost of these changes is also more appropriately considered alongside other policy changes in the budget process next year.”
AB 744 (Aguiar-Curry, Chapter 867, Statutes of 2019) requires health care contracts after January 1, 2021, to cover and reimburse diagnosis, consultation, or treatment delivered through telehealth to the same extent that the plan or insurer is responsible for coverage and reimbursement for the same service provided through in-person diagnosis, consultation, or treatment. AB 744 prohibits face-to-face requirements for Medi-Cal services that are appropriately provided by store and forward, to the extent that federal financial participation (FFP) is available, subject to billing and reimbursement policies developed by DHCS.
AB 1494 (Aquiar-Curry, Chapter 829, Statutes of 2019) prohibits requirements for face-to-face contact or a patient’s physical presence on the premises of an enrolled community clinic for services provided to a Medi-Cal beneficiary during or immediately following a state of emergency. AB 1494 required DHCS, on or before July 1, 2020, to issue and publish on its website guidance to facilitate reimbursement for services provided by enrolled community clinics to a Medi-Cal beneficiary during or immediately following a state of emergency.
AB 1174 (Bocanegra, Chapter 662, Statutes of 2014) expands the scope of practice for a dental assistants in extended functions and dental hygienists to better enable the practice of teledentistry in accordance with the findings of a Health Workforce Pilot Program, and authorized Medi-Cal payments for teledentistry services provided to Medi-Cal enrollees.
AB 415 (Logue, Chapter 547, Statutes of 2011) establishes the Telehealth Advancement Act of 2011 to revise and updated existing law to facilitate the advancement of telehealth as a service delivery mode in managed care and the Medi-Cal Program.
- Support. Sponsors Teladoc Health state that the Medi-Cal requirement that telehealth providers offer or arrange for an in-person appointment is more restrictive than the requirements for commercial health plans. Telehealth providers are not generally able to book an in-person appointment with another provider as they do not have access to other providers’ schedules. They also point out that over 11 million Californians live in an area with a shortage of primary care providers. Supporters ATA Action, the American Telemedicine Association’s affiliated trade organization, state that under the pending language, California-licensed telehealth providers without a brick-and-mortar presence in California would not be able to deliver services to California patients if they do not have access to – or the bandwidth to meet – the requisite scheduling capabilities to comply with the hot handoff requirements. Additionally, any telehealth provider with an instate office location who hopes to avoid the burdensome referral obligations placed on providers would only be able to see patients within reasonable travelling distance. These kinds of arbitrary and clinically unsubstantiated geographic barriers are precisely what telehealth technologies are designed to eliminate.
SUPPORT AND OPPOSITION:
Support: Teladoc Health (sponsor)
ATA Action
California Academy of Family Physicians
California Health Coalition Advocacy
California Retired Teachers Association
California State Association of Psychiatrists
Californians for Accessible Connected Care
Govern for California
Health Net
WelbeHealth
Oppose: None received
-- END --
Date of Hearing: April 19, 2023
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Chris Holden, Chair
ABPCA Bill Id:AB 1241
Author:(Weber) – As Amended Ver:March 23, 2023
Policy Committee: | Health | Vote: | 14 - 0 |
|
| ||
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill recasts the current requirement for a Medi-Cal provider offering video or audio telehealth services to also provide or facilitate in-person care, as instead a requirement to either maintain the ability to provide in-person care, or arrange for a referral to, and facilitation of, in-person care. This bill clarifies the provider is not required to schedule an appointment with a different provider on behalf a patient.
FISCAL EFFECT:
No state costs.
COMMENTS:
- Purpose. According to the author:
The single purpose of [this bill] is to improve access to high quality health care for our most vulnerable and underserved communities in the Medi-Cal program. Currently, there are over 11 million Californians who live in an area with a shortage of primary care providers…
[This bill] corrects the provision in existing law that serves as a barrier for California-licensed health care providers in the Medi-Cal program to offer telehealth services to patients. Requirements set to go into effect on January 1, 2024 would create a separate, administratively burdensome standard for providers to offer telehealth services to Medi-Cal patients that is different from when the provider offers the same in-person services. These requirements will create a confusing dual standard that discourages providers from caring for Medi-Cal patients via telehealth or participating in the Medi-Cal program as telehealth providers.
- Background. According to data published by the Department of Health Care Services (DHCS), before the onset of the COVID-19 pandemic, telehealth represented around 300 claims per 100,000 Medi-Cal member months. By April 2020, telehealth claims increased dramatically to over 12,000 claims per 100,000 member months and remained relatively stable through March 2021. Following March 2021, telehealth claims per 100,000 member months declined from the peak but remained significantly higher than pre-COVID-19 pandemic levels to around 7,700 claims per 100,000 member months.
Prior to the COVID-19 pandemic, DHCS expanded the availability of telehealth in Medi-Cal by allowing most clinically appropriate services to be provided through telehealth. During the COVID-19 pandemic, DHCS implemented additional telehealth flexibilities to allow Medi-Cal providers to meet the health care needs of enrollees.
Pursuant to AB 133 (Committee on Budget), Chapter 143, Statutes of 2021, DHCS convened a Telehealth Advisory Workgroup to advise on the development of post-public health emergency telehealth policies. After significant stakeholder effort and legislative agreement on trailer bill language, Medi-Cal telehealth policies were codified through the 2022-23 health trailer bill, SB 184 (Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2022, with minor changes made subsequently by AB 32 (Aguiar-Curry), Chapter 515, Statutes of 2022. The laws established by these bills continue coverage and payment parity for services offered through video and audio telehealth for Medi-Cal covered benefits and services, subject to DHCS policies. These laws also establish new patient protections regarding patient consent, beneficiary choice of telehealth modality, and access to in-person care.
DHCS will also, no sooner than January 1, 2024, phase in a right to in-person services. Providers who offer services via telehealth will be required to either offer those same services in-person or arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081
Date of Hearing: March 28, 2023
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 1241
Author:(Weber) – As Amended Ver:March 23, 2023
SUBJECT: Medi-Cal: telehealth.
SUMMARY: Clarifies two provisions of current law requiring a provider furnishing services through video or audio telehealth to offer services in-person or facilitate in-person care. Specifically, this bill:
- Recasts the current-law requirement for providers offering services via telehealth to also provide or facilitate in-person care, as a requirement to maintain the ability to provide or facilitate in-person care.
- Clarifies current law does not require a provider to schedule an appointment with a different provider on behalf of a patient in order to facilitate in-person care.
EXISTING LAW:
- Establishes the Medi-Cal Program, administered by the Department of Health Care Services (DHCS), to provide comprehensive health benefits to low-income individuals who meet specified eligibility criteria. [Welfare and Institutions Code (WIC) §14000 et seq.]
- Establishes a schedule of benefits under the Medi-Cal program. [WIC §14132]
- Defines “telehealth” to:
- Mean the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care; and,
- Include synchronous interactions and asynchronous store and forward transfers. [Business and Professions Code § 2290.5 (a)(6)]
- Establishes policies on Medi-Cal coverage for health care services provided through telehealth, including the following:
- Specifies in-person, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for covered health care services and provider types designated by DHCS, when those services and settings meet the applicable standard of care and meet the requirements of the service code being billed;
- Requires, pursuant to an effective date designated by DHCS that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio telehealth to also offer those same health care services via video telehealth to preserve beneficiary choice; and,
- Requires, effective on the date designated by DHCS pursuant to b) above, a provider furnishing services through video or audio-only telehealth to also do one of the following:
- Offer those services via in-person, face-to-face contact.
- Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care. [WIC §14132.725]
- Establishes Medi-Cal telehealth policy specific to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), which largely mirrors telehealth policy established in WIC §14132.725, described in 4) above, that applies to other provider types. [WIC §14132.100]
FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, this bill is intended to ensure Medi-Cal patients retain the ability to receive services through telehealth. The author states that requirements set to go into effect on January 1, 2024, would create a separate, administratively burdensome standard for providers to offer telehealth services to Medi-Cal patients that is different from when the provider offers the same in-person services. The author states that current law requires that Medi-Cal telehealth providers must be able to offer patients services in-person or have access to other providers’ schedules to book the patient an in-person appointment. The author indicates this is unrealistic and will disqualify many California-licensed providers from offering telehealth services through Medi-Cal. The author concludes this bill intends to clarify these provisions to remove barriers to providing telehealth.
- BACKGROUND.
- Telehealth in Medi-Cal. Telehealth is a mode of delivering health care services remotely using information technology. The three primary modalities are video, audio (including telephone), and asynchronous store and forward, which can be used when a real-time interaction is not needed.
Telehealth utilization increased rapidly in response to the COVID-19 pandemic. According to data published by DHCS, prior to the onset of the COVID-19 pandemic, telehealth represented around 300 claims per 100,000 Medi-Cal member months. By April 2020, telehealth claims increased dramatically to over 12,000 claims per 100,000 member months and remained relatively stable through March 2021. Following March 2021, telehealth claims per 100,000 member months remained significantly higher than pre-COVID-19 pandemic levels but declined from the peak to around 7,700 claims per 100,000 member months. - Medi-Cal Telehealth Policy and Policy Development Process. Prior to the COVID-19 pandemic, DHCS expanded the availability of telehealth in Medi-Cal by allowing most clinically appropriate services to be provided through telehealth. During the COVID-19 pandemic, DHCS implemented additional telehealth flexibilities to allow Medi-Cal providers meet the health care needs of enrollees.
Pursuant to AB 133 (Committee on Budget), Chapter 143, Statutes of 2021, DHCS convened a Telehealth Advisory Workgroup to advise on the development post-public health emergency (PHE) telehealth policies. Per statute, the workgroup included representatives of the California Medical Association, the California Primary Care Association, the California Association of Public Hospitals, the County Behavioral Health Directors Association, Medi-Cal managed care plans, Planned Parenthood Affiliates of California, Essential Access Health, and other subject matter experts and other affected stakeholders. DHCS issued a solicitation and received approximately 90 responses, and selected approximately 30 additional organizations and individuals that represented a cross-section of stakeholders. Three publicly accessible workgroup meetings were held in the fall of 2021 and additional workgroup input was solicited via an electronic survey. In December 2021, DHCS published a report summarizing the outcomes of the advisory workgroup.
As part of the 2022-23 Governor’s Budget, DHCS proposed post-PHE telehealth policies through budget trailer bill language. According to DHCS, all post-PHE policy proposals were guided by a set of principles, which included equity, access, standard of care, patient choice, confidentiality, stewardship, and payment appropriateness. These proposals, which reflected input from the advisory workgroup, maintained the broad availability of telehealth in Medi-Cal.
After this significant stakeholder effort and legislative agreement on final trailer bill language, Medi-Cal telehealth policies were codified through the 2022-23 health trailer bill, SB 184 (Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2022, with minor changes made subsequently by AB 32 (Aguilar-Curry), Chapter 515, Statutes of 2022. These bills continue coverage and payment parity for services offered through video and audio telehealth for Medi-Cal covered benefits and services, as long as the provider is able to meet the standard of care, subject to billing, reimbursement and utilization management policies developed by DHCS. These bills also establish new patient protections, further discussed below, regarding patient consent, beneficiary choice of telehealth modality, and preserving access to in-person care. - Medi-Cal Telehealth Policies. Current Medi-Cal telehealth policies, as established through last year’s budget and legislative processes and DHCS policy, are summarized as follows:
- Provider Requirements: A health care provider rendering Medi-Cal covered benefits and services via telehealth must be:
- Licensed in California or otherwise authorized by law; and,
- Enrolled as a Medi-Cal rendering provider or be a non-physician medical practitioner affiliated with an enrolled Medi-Cal provider group.
- Provider Requirements: A health care provider rendering Medi-Cal covered benefits and services via telehealth must be:
- Telehealth in Medi-Cal. Telehealth is a mode of delivering health care services remotely using information technology. The three primary modalities are video, audio (including telephone), and asynchronous store and forward, which can be used when a real-time interaction is not needed.
Unlicensed providers designated by DHCS may provide services through telehealth, as specified in the Medi-Cal Provider Manual.
- Telehealth Covered Services: Telehealth services are reimbursable if the health care provider believes that the service being provided is clinically appropriate. The telehealth service must meet the procedural definition of the Current Procedural Terminology or Healthcare Common Procedure Coding System code associated with the service, as well as follow any additional guidance provided by DHCS (e.g., through the Medi-Cal Provider Manual).
- Telehealth Covered Modalities: Medi-Cal reimburses for telehealth visits conducted via audio-only telehealth (i.e., telephone), video telehealth, or through asynchronous telehealth (i.e., store and forward and e-consults).
- Telehealth Payment Parity: The amount paid by Medi-Cal, through both fee-for-service and Medi-Cal managed care plans, for a service rendered via any telehealth modality is the same as the amount paid for the applicable service when rendered in-person.
- Coverage of e-Consults, Brief Virtual Communications & Check-ins: Medi-Cal reimburses for brief communications of a provider with another practitioner or with a patient not physically present.
- Telehealth Modifiers: Providers must designate telehealth modality with an appropriate modifier when billing for telehealth services.
- Establishment of New Patients via Telehealth: A health care provider may establish a relationship with a new patient via video visits. Medi-Cal policies limit reimbursement for audio-only visits that establish a relationship with a new patient to certain circumstances (e.g., when the visit is related to “sensitive services,” including behavioral health and reproductive health services, , or when the patient requests an audio-only modality or attests they do not have access to video). Additional exceptions may be made by DHCS in consultation with stakeholders.
- Patient Consent. A health care provider must inform the patient once prior to the initial delivery of telehealth services about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services. Statute specifies information that must be shared with a patient.
Statute also establishes two policies that are not currently implemented, which will be implemented no sooner than January 1, 2024.
- Patient Choice of Telehealth Modality: No sooner than January 1, 2024, DHCS will phase in an approach that requires a provider offer both video and audio-only telehealth to ensure patients have their choice of telehealth modality. DHCS is developing guidance on exceptions to this requirement, to include exceptions based on a Medi-Cal provider’s lack of access to adequate broadband speeds to effectively stream video.
- Patient Right to In-Person Services: No sooner than January 1, 2024, DHCS will phase in an approach where providers who offer services via telehealth will be required to either offer those same services in-person or arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.
- Changes Proposed in This Bill. This bill relates to telehealth policies established to ensure a patient right to in-person care. As noted above, current law requires providers who offer services via telehealth to either offer those same services in-person or link the enrollee to in-person care. This bill clarifies the application of this provision to address concerns that this “facilitation of in-person care” provision would require a provider to work with a different provider’s scheduling system to set up appointments. It also intends to clarify a provider must maintain the ability to offer a referral or facilitation of in-person care, but this will not be done in every circumstance depending on the appropriateness and patient need for such a referral or facilitation of in-person care.
- DHCS Medi-Cal Research and Evaluation Plan. With an intent to better understand the use of telehealth across Medi-Cal populations, DHCS published a Telehealth Research and Evaluation Plan in December 2022. The plan describes DHCS’ current state of telehealth data collection processes and capabilities, and outlines opportunities to conduct and support more comprehensive data collection and analyses in the future. DHCS indicates the Research and Evaluation Plan will serve as a path for DHCS to assess the impact of telehealth on utilization, access, quality, outcomes, equity, and provider and enrollee experience, which could inform future telehealth policy development.
- Third-Party Telehealth Providers and Concerns about Potential Fragmentation of Care. During the DHCS Telehealth Advisory Workgroup deliberations, members discussed the benefits and potential unintended consequences of expanded access and utilization to telehealth care. Workgroup members shared comments and concerns about preserving access to in-person care while expanding telehealth, integration of services provided through telehealth with someone’s usual source of care, and the role of third-party telehealth providers. For instance, one consumer advocate emphasized the importance of ensuring telehealth providers providing services to California communities have an anchor in the local community. Another workgroup member commented that for out-of-state providers who are contracted with in-state purchasers, it is the role of the purchaser to ensure that out-of-state providers are making the appropriate referrals and providing the appropriate health care data.
Workgroup members noted that out-of-state and third-party telehealth providers may help ease current and potential workforce shortages. Additionally, members raised concerns about third-party telehealth providers targeting low-acuity services and potentially not connecting in local in-person services, thereby resulting in fragmented information- sharing and disjointed care. A workgroup member representing a research and policy organization raised concerns telehealth providers may refer patients to urgent care centers or the emergency room, thereby increasing costs and fragmentation.
The Legislature has also considered the role and responsibilities of third-party telehealth providers. AB 457 (Santiago), Chapter 439, Statutes of 2021, established requirements on health plans and health insurers intended to ensure care offered through third-party telehealth providers remain coordinated with a patient’s primary care providers, and established. Legislative findings and declarations established in AB 457 state, “third-party telehealth corporations should coordinate with a patient’s usual source of care and contribute to the longitudinal patient record in order to be part of a comprehensive, integrated health care system.”
- SUPPORT. Teledoc Health, the bill’s sponsor, supports this bill as a means to ensure existing law does not impede California licensed health care providers in the Medi-Cal program from offering telehealth services to patients. The California Retired Teachers Association supports this bill, stating all patients should maintain the same quality of care, regardless of whether they are virtual or in-person.
- RELATED LEGISLATION. AB 1022 (Mathis) expands the ability of an approved Program of All-Inclusive Care for the Elderly organization, which provides Medi-Cal and Medicare services, authority to use video telehealth to conduct all assessments, as specified. AB 1022 is pending in the Assembly Health Committee.
- PREVIOUS LEGISLATION.
- AB 133 requires DHCS to convene a telehealth advisory workgroup, as specified.
- SB 184 establishes Medi-Cal telehealth policy, including coverage, reimbursement patient consent standards, informational notices, DHCS authority to designate providers who may provide services through telehealth, treatment of telehealth for network adequacy purposes and a research and evaluation plan.
- AB 32 establishes Medi-Cal coverage for establishment of new patients through audio telehealth under specified circumstances, including for reproductive health and behavioral health services, and clarified DHCS shall consider a Medi-Cal provider’s access to broadband at specified speeds, in establishing exceptions to the requirement that providers offering audio-only telehealth also offer video telehealth.
- AB 457 establishes the Protection of Patient Choice in Telehealth Provider Act, which requires a health care service plan and a health insurer to comply with specified notice and consent requirements if the plan or insurer offers a service via telehealth to an enrollee or an insured through a third-party corporate telehealth provider, required plans and insurers to ensure health care data is shared between third-party telehealth providers and primary care providers, and required plans and insurer to report on utilization of third-part corporate telehealth providers. AB 457 did not apply to Medi-Cal managed care plans.
REGISTERED SUPPORT / OPPOSITION:
Support
Teledoc Health (sponsor)
American Telemedicine Association (ATA) Action
California Retired Teachers Association
Californians for Accessible Connected Care
Opposition
None on file.
Analysis Prepared by: Lisa Murawski / HEALTH / (916) 319-2097
Discussed in Hearing
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Bill Author
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