AB 1369: Out-of-state physicians and surgeons: telehealth: license exemption.
- Session Year: 2023-2024
- House: Assembly
- Latest Version Date: 2023-10-13
Current Status:
Passed
(2023-10-13: Chaptered by Secretary of State - Chapter 837, Statutes of 2023.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons. Existing law generally prohibits the practice of medicine without a physicians and surgeons certificate issued by the board.
Existing law authorizes a health care provider to deliver health care via telehealth to a patient pursuant to specified protocols and conditions. Existing law defines telehealth as the delivery of 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 patients health care, and that telehealth includes synchronous interactions and asynchronous store and forward transfers.
Under this bill, the David Hall Act, a person licensed as a physician and surgeon in another state, as specified, would be authorized to deliver health care via telehealth to an eligible patient who, among other requirements, has an immediately life-threatening disease or condition, as specified.
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons. Existing law generally prohibits the practice of medicine without a physicians and surgeons certificate issued by the board.
Existing law authorizes a health care provider to deliver health care via telehealth to a patient pursuant to specified protocols and conditions. Existing law defines telehealth as the delivery of 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 patients health care, and that telehealth includes synchronous interactions and asynchronous store and forward transfers.
Under this bill, the David Hall Act, a person licensed as a physician and surgeon in another state, as specified, would be authorized to deliver health care via telehealth to an eligible patient who, among other requirements, has an immediately life-threatening disease or condition, as specified.
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons. Existing law generally prohibits the practice of medicine without a physicians and surgeons certificate issued by the board.
Existing law authorizes a health care provider to deliver health care via telehealth to a patient pursuant to specified protocols and conditions. Existing law defines telehealth as the delivery of 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 patients health care, and that telehealth includes synchronous interactions and asynchronous store and forward transfers.
Under this bill, the David Hall Act, a person licensed as a physician and surgeon in another state, as specified, would be authorized to deliver health care via telehealth to an eligible patient who, among other requirements, has an immediately life-threatening disease or condition, as specified.
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons. Existing law generally prohibits the practice of medicine without a physicians and surgeons certificate issued by the board.
Existing law authorizes a health care provider to deliver health care via telehealth to a patient pursuant to specified protocols and conditions. Existing law defines telehealth telehealth as the delivery of 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 patients health care, and that telehealth includes synchronous interactions and asynchronous store and forward transfers.
Under this bill, a person licensed as a physician and surgeon in another state, as specified, who does not possess a certificate issued by the board would be authorized to deliver health care via telehealth to a an eligible patient who, among other requirements, has a disease or condition that is immediately life-threatening. an immediately life-threatening disease or condition, as specified.
Existing law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs and sets forth its powers and duties relating to the licensure and regulation of the practice of medicine by physicians and surgeons. Existing law generally prohibits the practice of medicine without a physicians and surgeons certificate issued by the board.
Existing law authorizes a health care provider to deliver health care via telehealth to a patient pursuant to specified protocols and conditions. Existing law defines telehealth as the delivery of 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 patients health care, and that telehealth includes synchronous interactions and asynchronous store and forward transfers.
Under this bill, a person licensed as a physician and surgeon in another state, as specified, who does not possess a certificate issued by the board would be authorized to deliver health care via telehealth to a patient who, among other requirements, has a disease or condition that is immediately life-threatening.
Existing law relating to health care practitioners requires a board, as defined, to report to the State Department of Health Care Services the name and license number of a person whose license has been revoked, suspended, surrendered, made inactive by the licensee, or placed in another category that prohibits the licensee from practicing the licensees profession, to prevent reimbursement by the state for Medi-Cal and Denti-Cal services provided after the cancellation of a providers professional license.This bill would make nonsubstantive changes to that reporting provision.Existing law relating to health care practitioners requires a board, as defined, to report to the State Department of Health Care Services the name and license number of a person whose license has been revoked, suspended, surrendered, made inactive by the licensee, or placed in another category that prohibits the licensee from practicing the licensees profession, to prevent reimbursement by the state for Medi-Cal and Denti-Cal services provided after the cancellation of a providers professional license.
This bill would make nonsubstantive changes to that reporting provision.
This act shall be known, and may be cited, as the David Hall Act.
SEC. 2.Section 2052.5 is added to the Business and Professions Code, to read:2052.5.(a)For purposes of this section, the following definitions apply:
(1)Eligible patient means a person who meets all of the following requirements:
(A)Has an immediately life-threatening disease or condition as defined in Section 111548.1 of the Health and Safety Code.
(B)Has given written informed consent for, or, if the person lacks the capacity to consent, their legally authorized representative has given written informed consent on their behalf for, both of the following:
(i)The use of an eligible out-of-state physician and surgeons telehealth health care services.
(ii)The release of certified medical records to their primary physician and surgeon by the out-of-state physician.
(C)Has not been accepted to participate in the clinical trial nearest to their home for the immediately life-threatening disease or condition identified in subparagraph (A) within one week of completion of the clinical trial application process, or, in the medical judgment of a physician and surgeon described in paragraph (3), it is unreasonable for the patient to participate in that clinical trial due to the patients current condition and stage of disease.
(D)Has documentation from their primary physician and surgeon attesting that they meet the requirements in subparagraphs (A), (B), and (C). The primary physician and surgeon may withdraw the documentation if there is a substantial change in the patients mental capacity to make informed decisions for their own care unless their legally authorized representative has given written informed consent on their behalf.
(2)Eligible out-of-state physician and surgeon means a person who is licensed as a physician and surgeon in another state in good standing with no history of prior discipline, and whose medical expertise is that of the eligible patients illness.
(3)Primary physician and surgeon means a physician and surgeon licensed under the Medical Practice Act (Chapter 5 (commencing with Section 2000)) or an osteopathic physician and surgeon licensed under the Osteopathic Act (Article 21 (commencing with Section 2450)).
(4)Telehealth has the same meaning as provided in Section 2290.5.
(b)Notwithstanding any other law, an eligible out-of-state physician and surgeon may practice medicine in the state if the practice is limited to delivering health care via telehealth to an eligible patient.
This act shall be known, and may be cited, as the David Hall Act.
SEC. 2.Section 2052.5 is added to the Business and Professions Code, to read:2052.5.(a)For purposes of this section, the following definitions apply:
(1)Eligible patient means a person who meets all of the following requirements:
(A)Has an immediately life-threatening disease or condition as defined in Section 111548.1 of the Health and Safety Code.
(B)Has given written informed consent for, or, if the person lacks the capacity to consent, their legally authorized representative has given written informed consent on their behalf for, both of the following:
(i)The use of an eligible out-of-state physician and surgeons telehealth health care services.
(ii)The release of certified medical records to their primary physician and surgeon by the out-of-state physician.
(C)Has not been accepted to participate in the clinical trial nearest to their home for the immediately life-threatening disease or condition identified in subparagraph (A) within one week of completion of the clinical trial application process, or, in the medical judgment of a physician and surgeon described in paragraph (3), it is unreasonable for the patient to participate in that clinical trial due to the patients current condition and stage of disease.
(D)Has documentation from their primary physician and surgeon attesting that they meet the requirements in subparagraphs (A), (B), and (C). The primary physician and surgeon may withdraw the documentation if there is a substantial change in the patients mental capacity to make informed decisions for their own care unless their legally authorized representative has given written informed consent on their behalf.
(2)Eligible out-of-state physician and surgeon means a person who is licensed as a physician and surgeon in another state in good standing with no history of prior discipline, and whose medical expertise is that of the eligible patients illness.
(3)Primary physician and surgeon means a physician and surgeon licensed under the Medical Practice Act (Chapter 5 (commencing with Section 2000)) or an osteopathic physician and surgeon licensed under the Osteopathic Act (Article 21 (commencing with Section 2450)).
(4)Telehealth has the same meaning as provided in Section 2290.5.
(b)Notwithstanding any other law, an eligible out-of-state physician and surgeon may practice medicine in the state if the practice is limited to delivering health care via telehealth to an eligible patient.
This act shall be known, and may be cited, as the David Hall Act.
SECTION 1.SEC. 2.Section 2052.5 is added to the Business and Professions Code, to read:2052.5.(a)For purposes of this section, the following definitions apply:
(1)Eligible patient means a person who meets all of the following requirements:
(A)Has an immediately life-threatening disease or condition as defined in Section 111548.1 of the Health and Safety Code.
(B)Has given written informed consent for, or, if the person lacks the capacity to consent, their legally authorized representative has given written informed consent on their behalf for, both of the following:
(i)The use of an eligible out-of-state physician and surgeons telehealth health care services.
(ii)The release of certified medical records to their primary physician and surgeon by the out-of-state physician.
(C)Has not been accepted to participate in the clinical trial nearest to their home for the immediately life-threatening disease or condition identified in subparagraph (A) within one week of completion of the clinical trial application process, or, in the medical judgment of a physician and surgeon described in paragraph (3), it is unreasonable for the patient to participate in that clinical trial due to the patients current condition and stage of disease.
(D)Has documentation from their primary physician and surgeon attesting that they meet the requirements in subparagraphs (A), (B), and (C). The primary physician and surgeon may withdraw the documentation if there is a substantial change in the patients mental capacity to make informed decisions for their own care unless their legally authorized representative has given written informed consent on their behalf.
(2)Eligible out-of-state physician and surgeon means a person who is licensed as a physician and surgeon in another state in good standing with no history of prior discipline, and whose medical expertise is that of the eligible patients illness.
(3)Primary physician and surgeon means a physician and surgeon licensed under the Medical Practice Act (Chapter 5 (commencing with Section 2000)) or an osteopathic physician and surgeon licensed under the Osteopathic Act (Article 21 (commencing with Section 2450)).
(4)Telehealth has the same meaning as provided in Section 2290.5.
(b)Notwithstanding any other law, an eligible out-of-state physician and surgeon may practice medicine in the state if the practice is limited to delivering health care via telehealth to an eligible patient.
(a)For purposes of this section, the following definitions apply:
(1)Eligible patient means a person who meets all of the following requirements:
(A)Has a disease or condition that is immediately life-threatening. an immediately life-threatening disease or condition as defined in Section 111548.1 of the Health and Safety Code.
(B)Has given written informed consent for, or, if the person lacks the capacity to consent, their legally authorized representative has given written informed consent on their behalf for, both of the following:
(i)The use of an eligible out-of-state physician and surgeons telehealth health care services.
(ii)The release of certified medical records to their primary physician and surgeon by the out-of-state physician.
(B)(C)Has not been accepted to participate in the clinical trial nearest to their home for the immediately life-threatening disease or condition identified in subparagraph (A) within one week of completion of the clinical trial application process, or, in the medical judgment of a physician and surgeon described in subparagraph (C), paragraph (3), it is unreasonable for the patient to participate in that clinical trial due to the patients current condition and stage of disease.
(C)(D)Has documentation from their primary physician and surgeon and a consulting physician and surgeon attesting that they meet the requirements in subparagraphs (A) and (B). (A), (B), and (C). The primary physician and surgeon may withdraw the documentation if there is a substantial change in the patients mental capacity to make informed decisions for their own care unless their legally authorized representative has given written informed consent on their behalf.
(2)Eligible out-of-state physician and surgeon means a person who is licensed as a physician and surgeon in another state that uses criteria substantially similar to the criteria used by the Medical Board of California. in good standing with no history of prior discipline, and whose medical expertise is that of the eligible patients illness.
(3)Primary physician and surgeon means a physician and surgeon licensed under the Medical Practice Act (Chapter 5 (commencing with Section 2000)) or an osteopathic physician and surgeon licensed under the Osteopathic Act (Article 21 (commencing with Section 2450)).
(3)(4)Telehealth has the same meaning as provided in Section 2290.5.
(b)Notwithstanding any other law, an eligible out-of-state physician and surgeon may practice medicine in the state if the practice is limited to delivering health care via telehealth to an eligible patient.
(a)For purposes of this section, the following definitions apply:
(1)Eligible patient means a person who meets all of the following requirements:
(A)Has a disease or condition that is immediately life-threatening.
(B)Has not been accepted to participate in the clinical trial nearest to their home for the immediately life-threatening disease or condition identified in subparagraph (A) within one week of completion of the clinical trial application process, or, in the medical judgment of a physician and surgeon described in subparagraph (C), it is unreasonable for the patient to participate in that clinical trial due to the patients current condition and stage of disease.
(C)Has documentation from their primary physician and surgeon and a consulting physician and surgeon attesting that they meet the requirements in subparagraphs (A) and (B).
(2)Eligible out-of-state physician and surgeon means a person who is licensed as a physician and surgeon in another state that uses criteria substantially similar to the criteria used by the Medical Board of California.
(3)Telehealth has the same meaning as provided in Section 2290.5.
(b)Notwithstanding any other law, an eligible out-of-state physician and surgeon may practice medicine in the state if the practice is limited to delivering health care via telehealth to an eligible patient.
SECTION 1.Section 683 of the Business and Professions Code is amended to read:683.(a)A board shall report, within 10 working days, to the State Department of Health Care Services the name and license number of a person whose license has been revoked, suspended, surrendered, made inactive by the licensee, or placed in another category that prohibits the licensee from practicing their profession. The purpose of the reporting requirement is to prevent reimbursement by the state for Medi-Cal and Denti-Cal services provided after the cancellation of a providers professional license.(b)Board, as used in this section, means the Dental Board of California, the Medical Board of California, the Board of Psychology, the California State Board of Optometry, the California State Board of Pharmacy, the Osteopathic Medical Board of California, the State Board of Chiropractic Examiners, the Board of Behavioral Sciences, the Podiatric Medical Board of California, and the California Board of Occupational Therapy.(c)This section shall become operative on January 1, 2015.(a)A board shall report, within 10 working days, to the State Department of Health Care Services the name and license number of a person whose license has been revoked, suspended, surrendered, made inactive by the licensee, or placed in another category that prohibits the licensee from practicing their profession. The purpose of the reporting requirement is to prevent reimbursement by the state for Medi-Cal and Denti-Cal services provided after the cancellation of a providers professional license.
(b)Board, as used in this section, means the Dental Board of California, the Medical Board of California, the Board of Psychology, the California State Board of Optometry, the California State Board of Pharmacy, the Osteopathic Medical Board of California, the State Board of Chiropractic Examiners, the Board of Behavioral Sciences, the California Podiatric Medical Board of Podiatric Medicine, California, and the California Board of Occupational Therapy.
(c)This section shall become operative on January 1, 2015.
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Date
|
Status
|
|---|---|
| Oct 13, 2023 | Chaptered by Secretary of State - Chapter 837, Statutes of 2023. |
| Oct 13, 2023 | Approved by the Governor. |
| Sep 13, 2023 | Enrolled and presented to the Governor at 3 p.m. |
| Sep 7, 2023 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 75. Noes 0. Page 3067.). |
| Sep 7, 2023 | Assembly Rule 77 suspended. (Page 3011.) |
| Sep 6, 2023 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after September 8 pursuant to Assembly Rule 77. |
| Sep 6, 2023 | Read third time. Passed. Ordered to the Assembly. (Ayes 36. Noes 0. Page 2429.). |
| Aug 28, 2023 | Read second time. Ordered to third reading. |
| Aug 24, 2023 | Read third time and amended. Ordered to second reading. |
| Aug 23, 2023 | Read second time. Ordered to third reading. |
| Aug 22, 2023 | Read third time and amended. Ordered to second reading. |
| Aug 15, 2023 | Read second time. Ordered to third reading. |
| Aug 14, 2023 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8. |
| Jun 26, 2023 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 10. Noes 1.) (June 26). Re-referred to Com. on APPR. |
| May 31, 2023 | In committee: Hearing postponed by committee. |
| May 17, 2023 | Referred to Com. on B., P. & E. D. |
| May 4, 2023 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 4, 2023 | Read third time. Passed. Ordered to the Senate. (Ayes 75. Noes 0. Page 1463.) |
| Apr 27, 2023 | Read second time. Ordered to Consent Calendar. |
| Apr 26, 2023 | From committee: Do pass. To Consent Calendar. (Ayes 16. Noes 0.) (April 26). |
| Apr 11, 2023 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 18. Noes 0.) (April 11). Re-referred to Com. on APPR. |
| Mar 27, 2023 | Re-referred to Com. on B. & P. |
| Mar 23, 2023 | Referred to Com. on B. & P. |
| Mar 23, 2023 | From committee chair, with author's amendments: Amend, and re-refer to Com. on B. & P. Read second time and amended. |
| Feb 18, 2023 | From printer. May be heard in committee March 20. |
| Feb 17, 2023 | Read first time. To print. |
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Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 7, 2023 | AB 1369 Bauer-Kahan Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Sep 6, 2023 | Assembly 3rd Reading AB1369 Bauer-Kahan By Roth | Senate Floor |
Passed |
|
| Jun 26, 2023 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Business, Professions and Economic Development |
Passed |
|
| May 4, 2023 | AB 1369 Bauer-Kahan Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| Apr 26, 2023 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 11, 2023 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Business and Professions |
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 Chronic Care Coalition | ** Support | |
| Every Life Foundation for Rare Diseases | * Support | Jun 26, 2023 |
| Everylife Foundation For Rare Diseases | ** Support | |
| Medical Board of California | ** Against | |
| Osteopathic Medical Board of California | ** Against | |
| The ALS Association | ** Support |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 1369
Author:(Bauer-Kahan)
As Amended Ver:August 24, 2023
Majority vote
SUMMARY
Authorizes an eligible out-of-state physician and surgeon to practice medicine in California without a California license if the practice is limited to delivering health care via telehealth to an eligible patient who has an immediately life-threatening disease or condition.
Senate Amendments
- Clarify that "immediately life-threatening disease or condition" has the same meaning as that term is used in the Right to Try Act.
- Require written informed consent from the patient or their representative.
- Provide that an out-of-state physician's license from another state must be in good standing with no history of prior discipline, and the physician must have medical expertise in the patient's illness.
- Declare that the law enacted by the bill shall be known as the David Hall Act.
COMMENTS
Licensure of Physicians and Surgeons. All physicians and surgeons who practice in California are required to hold an active license from either the Medical Board of California (MBC) or the Osteopathic Medical Board of California (OMBC). Any person who practices or attempts to practice, or who advertises or holds themselves out as practicing, any system or mode of treating the sick or afflicted in California, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended certificate as a physician and surgeon in California or without being otherwise authorized to perform the act, is guilty of a crime. There are only a limited number of exceptions to this general prohibition against the unlicensed practice of medicine.
Telehealth. California first formally recognized the advent of new telehealth technologies in 1996 when the Legislature enacted SB 1665 (Thompson), the Telemedicine Development Act. This bill set standards for the use of what was then called "telemedicine" by health care practitioners and insurers. The bill prohibited health insurers from requiring face-to-face contact between a health care provider and patient for services appropriately provided through telemedicine. The bill also exempted out-of-state practitioners from the Medical Practice Act when consulting either within California or across state lines, with a licensed practitioner in California; however, it prohibited the out-of-state practitioner from having ultimate authority over the care or primary diagnosis of a patient in California.
Much of the Telemedicine Development Act was subsequently repealed and replaced in 2011 through the enactment of AB 415 (Logue), which established the Telehealth Advancement Act of 2011 to revise and update existing law to facilitate the advancement of telehealth as a service delivery mode in managed care and the Medi-Cal Program. The vernacular shift from "telemedicine" to "telehealth" reflected a general consensus among policymakers that telehealth is not itself a form of medicine, but simply a tool to deliver health care outside a traditional office visit. In California there is no distinction between in-person care and telehealth in terms of either the standard of care or the expectations of a physician-patient relationship.
Legally speaking, a physician or other practitioner is deemed to have provided care in whichever geographic place the patient is in at the time of receiving care. For example, if a physician in Chicago, Illinois is giving medical advice to a patient in Palo Alto, California through a telehealth platform, the state considers the physician to be practicing medicine in California. As such, that physician would need a license from the MBC or the OMBC to lawfully provide that care, regardless of whether they are physically within the borders of the state.
Patients with Terminal Diseases. In 2016, the Legislature enacted the Right to Try Act, which authorized the manufacturer of an investigational drug, biological product, or device not yet approved by the FDA to make that investigational drug available to a patient with a serious or immediately life-threatening disease. The patient must have considered all other treatment options currently approved by the FDA and been unable to participate in a relevant clinical trial. The investigational drug must also have been recommended by the patient's primary physician and a consulting physician.
Despite the provisions of the Right to Try Act, terminally ill patients are still limited by the Medical Practice Act's requirement that a physician located outside California must still be licensed by the MBC or OMBC to deliver care to California patients via telehealth. The author contends that this poses a significant issue when a physician outside California is the only person qualified to give specialty care to a patient with a rare, terminal disease.
Under current law, a patient wishing to receive care from a physician outside California has the following options. First, the patient can physically travel to a state where that physician is licensed. Next, under the Telemedicine Development Act, a patient's physician who is licensed in California can consult with an out-of-state physician via telehealth, as long as the California-licensed physician is ultimately responsible for the care. Finally, the out-of-state physician can apply for and obtain a license in California from the MBC.
The author of this bill contends that none of the above options are appropriate for patients who have a disease or condition that is immediately life-threatening. For these patients, it is impractical if not impossible for them to travel to another state, and there is not sufficient time for the out-of-state license to go through the California licensing process. This bill would allow patients to receive care directly from an out-of-state physician only under specified circumstances where the patient has not been accepted to participate in the clinical trial nearest to their home, or, in the medical judgment of their primary physician, it is unreasonable for the patient to participate in that clinical trial due to the patient's current condition and stage of disease.
According to the Author
"Terminally ill patients – especially those with rare diseases – should not be forced to travel for the specialty care they require. The delays and hoops that our current system poses can be the difference between life and death for such patients. A highly limited exemption to California licensure requirements for telehealth provisions to terminally ill patients is simply humane. It respects the rights of a terminally ill individual to try whatever they can to prolong, and even save, their life."
Arguments in Support
This bill is sponsored by the ALS Association, which writes: "The availability of telehealth as a tool to provide care, when an in-person visit isn't necessary, greatly reduces the physical burdens of travel for many people living with ALS. In fact, some of our ALS clinics in California retain telehealth as an option for care. If enacted into law, this legislation would also reduce the economic costs that out-of-state travel imposes on families living with ALS who seek care outside of California."
Arguments in Opposition
The Medical Board of California opposes this bill, writing: "Licensure is a vital form of consumer protection and ensures that physicians practicing in California have met the relevant statutory requirements to treat patients in this state. Without the requirement for licensure, the Board would be unaware of those who are treating patients in this state and would be unable to take disciplinary action against a physician who fails to treat their patients within the standard of care. Under the language of the bill, it is also unclear whether the home state of the physician in question would have authority to discipline that physician when treating Californians."
FISCAL COMMENTS
Pursuant to Senate Rule 28.8, negligible state costs.
VOTES:
ASM BUSINESS AND PROFESSIONS: 18-0-0
YES: Berman, Flora, Alanis, Alvarez, Bonta, Chen, Dixon, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McCarty, McKinnor, Stephanie Nguyen, Joe Patterson, Ting
ASM APPROPRIATIONS: 16-0-0
YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Robert Rivas, Sanchez, Weber, Wilson
ASSEMBLY FLOOR: 75-0-5
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, 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, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, 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, Ward, Weber, Wilson, Wood, Zbur, Rendon
ABS, ABST OR NV: Flora, McKinnor, Muratsuchi, Wallis, Wicks
SENATE FLOOR: 36-0-4
YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Grove, Hurtado, Jones, Laird, Limón, McGuire, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Stern, Umberg, Wiener, Wilk
ABS, ABST OR NV: Gonzalez, Menjivar, Smallwood-Cuevas, Wahab
UPDATED
VERSION: August 24, 2023
CONSULTANT: Robert Sumner / B. & P. / (916) 319-3301 FN: 0001885
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB 1369 |
THIRD READING
Bill No: AB 1369
Author: Bauer-Kahan (D)
Amended: 8/24/23 in Senate
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 10-1, 6/26/23
AYES: Roth, Nguyen, Archuleta, Ashby, Becker, Dodd, Eggman, Glazer, Niello, Wilk
NOES: Smallwood-Cuevas
NO VOTE RECORDED: Alvarado-Gil, Wahab
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 75-0, 5/4/23 (Consent) - See last page for vote
SUBJECT: Out-of-state physicians and surgeons: telehealth: license exemption
SOURCE: The ALS Association
DIGEST:
This bill authorizes a physician and surgeon licensed in another state in good standing with no history of prior discipline to practice medicine in this state if the practice is limited to delivering health care via telehealth to a patient who has an immediately life-threatening disease or condition, if the patient has provided written informed consent, the patient has not been accepted to participate in the clinical trial nearest to their home for the immediately life-threatening disease or condition, and the patient has documentation from their primary physician and surgeon attesting that they meet these requirements.
Senate Floor Amendments of 8/24/23 rename the bill “The David Hall Act”.
Senate Floor Amendments of 8/22/23 update the definition of eligible patient to provide further specificity as to who is eligible to receive services via telehealth from a physician licensed in another state; authorize a physician and surgeon to withdraw the documentation authorizing an eligible patient to receive services via telehealth from a physician licensed in another state if there is a substantial change in the patient’s mental capacity to make informed decisions for their own care unless their legally authorized representative has given written informed consent on their behalf and; add a qualifier to the definition of eligible physician and surgeon to include licensees of the Osteopathic Medical Board of California.
ANALYSIS:
Existing law:
- Establishes various practice acts in the Business and Professions Code (BPC) governed by various boards within the Department of Consumer Affairs (DCA) which provide for the licensing and regulation of health care professionals including physicians and surgeons (under the Medical Practice Act by the Medical Board of California (MBC)) and osteopathic physicians and surgeons (under the Osteopathic Medical Practice Act by the Osteopathic Medical Board of California (OMBC)), among others.
- Defines “telehealth" for purposes of healing arts professionals regulated by various healing arts practice acts in Division 2 of the BPC 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. Requires, before the delivery of health care via telehealth, the health care provider initiating the use of telehealth to inform the patient 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 and public health. Requires the consent to be documented. Defines a health care provider as an individual licensed by one of the various healing arts practice acts in Division 2 of the BPC. Specifies that the failure to meet requirements to provide telehealth services constitutes unprofessional conduct and specifies that telehealth authorization according to outlined requirements does not authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law. (BPC § 2290.5)
- Provides that any person who practices or attempts to practice, or who advertises or holds themselves out as practicing, any system or mode of treating the sick or afflicted in California, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended certificate as a physician and surgeon in California or without being otherwise authorized to perform the act is guilty of a crime. (BPC § 2052)
- Requires the MBC to issue a physician’s and surgeon’s license to an applicant who is licensed in another state or a Canadian province if they have meet specified standards, including, among other requirements, that no disciplinary action has been taken against the applicant by any medical licensing authority and that the applicant has not been the subject of adverse judgments or settlements resulting from the practice of medicine that the board determines constitutes evidence of a pattern of negligence or incompetence. (BPC § 2135)
- Requires OMBC to issue an osteopathic physician’s and surgeon’s certificate on reciprocity to an applicant licensed in another state if they have met specified standards, including the same review of disciplinary action described in 4) above. (BPC § 2153.5)
- Enacts the Right to Try Act, which permits a manufacturer of a drug, biological product, or device that has not yet received federal or state approval to market to make the product available to eligible patients with an immediate life threatening condition, when the patient has considered all other treatment options currently approved by the United States Food and Drug Administration and the patient has received a recommendation from their primary physician and a consulting physician for an investigational drug, biological product, or device, they have given written consent, and they have not been accepted to participate in the nearest clinical trial to their home for the immediately life-threatening disease or condition or, in the treating physician’s medical judgment, it is unreasonable for the patient to participate in that clinical trial due to the patient’s current condition and stage of disease. Defines “Immediately life-threatening disease or condition” as a stage of disease in which there is a reasonable likelihood that death will occur within a matter of months. Prohibits a state regulatory board from revoking, failing to renew, or taking any other disciplinary action against a physician’s license based on the physician’s recommendation to an eligible patient regarding, or prescription for or treatment with, an investigational drug, biological product, or device if the recommendation or prescription is consistent with protocol approved by the physician’s institutional review board or an accredited independent institutional review board. Specifies that “Consulting physician” means a physician and surgeon licensed under the Medical Practice Act or an osteopathic physician and surgeon licensed under the Osteopathic Act. (Health and Safety Code §§ 111548 et seq.)
This bill establishes the David Hall Act which authorizes a physician and surgeon licensed in another state in good standing with no history of prior discipline to practice medicine in this state if the practice is limited to delivering health care via telehealth to a patient who has an immediately life-threatening disease or condition, if the patient has provided written informed consent, the patient has not been accepted to participate in the clinical trial nearest to their home for the immediately life-threatening disease or condition, and the patient has documentation from their primary physician and surgeon attesting that they meet these requirements.
Background
Physicians and surgeons who practice in California are required to hold an active license from either the MBC or the OMBC, and health care providers offering health care services to patients located in California via telehealth are required to hold an active license issued by a California healing arts program. Pursuant to BPC Section 2290.5, licensees are held to the same standard of care, and retain the same responsibilities of providing informed consent, ensuring the privacy of medical information, and any other duties associated with practicing medicine, regardless of whether they are practicing via telehealth or face-to-face, in-person visits.
Telehealth includes several components, one of which is online practice. MBC reported in its 2021 Sunset Report to the Legislature that one of the most frequent violations involved physicians and surgeons treating California patients via telehealth from another state without having a California license. MBC noted at the time that as technology has advanced, more complaints have been received regarding care provided via telehealth, including complaints of unlicensed practice, inappropriate care, and the corporate practice of medicine. MBC advised that with future advances in technology, including applications available on electronic devices and more, this will continue to be an issue. Complaints about care received through telehealth follow the same investigative and prosecutorial process as all other complaints; MBC noted an increase in the number of complaints regarding the use of telehealth, including the online aspect of telehealth.
California patients are not currently prohibited from seeking services from physicians in another state if they do so in-person in that other state or if they do so through a licensed physician in this state. Telehealth delivery across state lines has been a focus of recent discussion in a number of states. According to the Federation of State Medical Boards, as of June 2023 all state boards, plus the medical boards of District of Columbia, Puerto Rico, and the Virgin Islands, require that physicians engaging in telemedicine are licensed in the state in which the patient is located, or are registered in the state, if the state has a registry for interstate practice. Eight states issue a special purpose license, telemedicine license or certificate to practice telemedicine across state lines. Eight states require physicians to register or receive a waiver if they wish to practice across state lines. Four states offer pro bono, limited referral services, or extraterritorial licenses for interstate practice. Two states allows for consultative services to be rendered across state lines. Alaska, for example, allows individuals with suspected or diagnosed life-threatening conditions, to be treated by an out-of-state physician as long as they have a referral from their Alaska-licensed physician, among other requirements. In Vermont, beginning on July 1, 2023, a health care professional who is not otherwise licensed, certified, or registered to practice in that state may obtain a Telehealth Registration to provide health care services in Vermont via telehealth to a total of not more than 10 unique patients or clients for a period of not more than 120 consecutive days from the date the Telehealth Registration was issued or practitioners may obtain a Telehealth License to provide healthcare services in Vermont via telehealth to a total of not more than 20 unique patients or clients located in Vermont during the two-year license term. Delaware allows practitioners licensed outside of the state to render services to Delaware patients by telemedicine so long as their license in good standing in all jurisdictions in which they are licensed, not under investigation or subject to an administrative complaint, and they first obtain an interstate telehealth registration. In Georgia, the medical board is authorized to issue telemedicine licenses to physicians who are licensed in other states who hold a full and unrestricted license to practice medicine in another state – the telemedicine license is limited to the practice of telemedicine and cannot be used to practice medicine physically in Georgia unless an emergency. Kansas registers physicians who apply for an receive a waiver to practice telemedicine to treat patients located in the state of Kansas.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
SUPPORT: (Verified 8/24/23)
The ALS Association (source)
ATA Action
California Chronic Care Coalition
Everylife Foundation for Rare Diseases
OPPOSITION: (Verified 8/24/23)
Medical Board of California
Osteopathic Medical Board of California
ARGUMENTS IN SUPPORT: Supporters note that many rare disease patients, especially those who are terminally ill, face physical and financial constraints in traveling to receive care. Fortunately, advancements in telehealth platforms are making it easier for providers to diagnose, monitor, and treat diseases, without requiring those patients to travel long distances or take extensive time away from their work and families. Importantly, telehealth services can enable access to care across state boundaries, allowing rare disease patients to meet with expert physicians in other states. AB 1369 provides an exemption to medical licensure requirements when providers treat terminally ill patients, providing desperately-needed access to medical care to the patients who need it most. According to the supporters, the narrowly tailored exemption to California’s licensure requirements for telehealth for terminally ill patients created by AB 1369 represents a lifeline for Californians with terminal diseases. It respects the rights of terminally ill individuals to try whatever they can to prolong or save their lives.
ARGUMENTS IN OPPOSITION: According to the Medical Board of California, “Without the requirement for licensure, the Board would be unaware of those who are treating patients in this state and would be unable to take disciplinary action against a physician who fails to treat their patients within the standard of care. Under the language of the bill, it is also unclear whether the home state of the physician in question would have authority to discipline that physician when treating Californians. In addition, the definition of an eligible physician is vague. It appears that the physician in question would be the one to determine for themselves if they are qualified. Further, the bill does not disqualify physicians with a history of disciplinary action against them. Establishing an exemption for licensure to treat patients with a life-threatening disease or condition is not necessary. The Board is concerned that eliminating the normative requirement for licensure reduces the certainty that a fragile patient population will receive treatment consistent with the standard of care.”
The Osteopathic Medical Board of California states that “the proposed licensure exemption in this bill poses a risk to public safety and violates the foundations upon which telemedicine was built on in California…From a policy perspective, telemedicine was created cautiously to balance the potential convenience of video or phone visits with the standard of care requirement for caring for a patient and patient safety. This bill does not balance patient needs and public safety.” OMBC writes that “this bill exempts individuals from being criminally charged for unlicensed practice and fined up to $10,000 and imprisonment not to exceed a year” and that “this bill proposes is to allow these out of state unlicensed telemedicine physicians to provide care for life threatening conditions, which is beyond the scope of practice envisioned for telemedicine to provide. This dramatic scope expansion is not only a red flag, but also a significant threat to patient safety. Life threatening conditions require in person treatment not video chats level care. Life threatening conditions are when patients are most at risk of harm and would open them up to being victims of negligence precisely because the telemedicine physician is unable to provide the immediate level of care for a life-threatening condition. The standard of care for a life-threatening condition would require close monitoring by a licensed physician who has the ability to order diagnostic tests that monitor the patient’s condition. An unlicensed out of state physician would not be able to order and receive such test results that are critical to monitoring life threatening conditions. An unlicensed out of state physician would be unable to respond effectively to health emergencies, which could lead to negligence in the provision of care to patients.”
According to the OMBC, “patients harmed by these unlicensed out of state telemedicine physicians would have no recourse against them civilly or criminally or otherwise because the harm occurred in California and no entity in California has jurisdiction over these unlicensed out of state physicians. This would open a huge loophole in protecting patient safety and regulating physicians who provide care to patients in California. The lack of requirements and restrictions in this bill are out of step with the way California typically handles out of state business. From a business perspective, at a minimum, all out of state businesses are required to consent provide legal jurisdiction through registering with the Secretary of the State so in the event of lawsuit out of state businesses can be sued for business conducted in the state. To protect public safety in health care, the law must provide a legal connection to the state and licensure by a regulatory board and currently that legal connection is licensure by either the Medical Board of California or the Osteopathic Medical Board of California.”
ASSEMBLY FLOOR: 75-0, 5/4/23
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, 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, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, 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, Ward, Weber, Wilson, Wood, Zbur, Rendon
NO VOTE RECORDED: Flora, McKinnor, Muratsuchi, Wallis, Wicks
Prepared by: Sarah Mason / B., P. & E.D. /
8/31/23 10:17:30
**** END ****
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Richard Roth, Chair
2023 - 2024 Regular
Bill No: Hearing Date: June 26, 2023
Author: | |||
Version: | March 23, 2023 | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Sarah Mason | ||
Subject:
SUMMARY: Authorizes a physician and surgeon licensed in another state that uses criteria substantially similar to the criteria used by the Medical Board of California to practice medicine in this state if the practice is limited to delivering health care via telehealth to a patient who has a disease or condition that is immediately life-threatening, the patient has not been accepted to participate in the clinical trial nearest to their home for the immediately life-threatening disease or condition, and the patient has documentation from their primary physician and surgeon and a consulting physician and surgeon attesting that they meet these requirements.
Existing law:
- Establishes various practice acts in the Business and Professions Code (BPC) governed by various boards within the Department of Consumer Affairs (DCA) which provide for the licensing and regulation of health care professionals including physicians and surgeons (under the Medical Practice Act by MBC) and osteopathic physicians and surgeons (under the Osteopathic Medical Practice Act by the Osteopathic Medical Board of California (OMBC)), among others.
- Defines “Telehealth" for purposes of healing arts professionals regulated by various healing arts practice acts in Division 2 of the Business and Professions Code (BPC) 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. Requires, before the delivery of health care via telehealth, the health care provider initiating the use of telehealth to inform the patient 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 and public health. Requires the consent to be documented. Defines a health care provider as an individual licensed by one of the various healing arts practice acts in Division 2 of the BPC. Specifies that the failure to meet requirements to provide telehealth services constitutes unprofessional conduct and specifies that telehealth authorization according to outlined requirements does not authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law. (BPC § 2290.5)
- Provides that any person who practices or attempts to practice, or who advertises or holds themselves out as practicing, any system or mode of treating the sick or afflicted in California, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended certificate as a physician and surgeon in California or without being otherwise authorized to perform the act is guilty of a crime. (BPC § 2052)
- Requires the MBC to issue a physician’s and surgeon’s license to an applicant who is licensed in another state or a Canadian province if they have meet specified standards, including, among other requirements, that no disciplinary action has been taken against the applicant by any medical licensing authority and that the applicant has not been the subject of adverse judgments or settlements resulting from the practice of medicine that the board determines constitutes evidence of a pattern of negligence or incompetence. (BPC § 2135)
- Requires OMBC to issue an osteopathic physician’s and surgeon’s certificate on reciprocity to an applicant licensed in another state if they have met specified standards, including the same review of disciplinary action described in 4) above. (BPC § 2153.5)
- Enacts the Right to Try Act, which permits a manufacturer of a drug, biological product, or device that has not yet received federal or state approval to market to make the product available to eligible patients with an immediate life threatening condition, when the patient has considered all other treatment options currently approved by the United States Food and Drug Administration and the patient has received a recommendation from their primary physician and a consulting physician for an investigational drug, biological product, or device, they have given written consent, and they have not been accepted to participate in the nearest clinical trial to their home for the immediately life-threatening disease or condition or, in the treating physician’s medical judgment, it is unreasonable for the patient to participate in that clinical trial due to the patient’s current condition and stage of disease. Defines “Immediately life-threatening disease or condition” as a stage of disease in which there is a reasonable likelihood that death will occur within a matter of months. Prohibits a state regulatory board from revoking, failing to renew, or taking any other disciplinary action against a physician’s license based on the physician’s recommendation to an eligible patient regarding, or prescription for or treatment with, an investigational drug, biological product, or device if the recommendation or prescription is consistent with protocol approved by the physician’s institutional review board or an accredited independent institutional review board. Specifies that “Consulting physician” means a physician and surgeon licensed under the Medical Practice Act or an osteopathic physician and surgeon licensed under the Osteopathic Act. (Health and Safety Code §§ 111548 et seq.)
This bill authorizes a physician and surgeon licensed in another state that uses criteria substantially similar to the criteria used by the Medical Board of California to practice medicine in this state if the practice is limited to delivering health care via telehealth to a patient who has a disease or condition that is immediately life-threatening, the patient has not been accepted to participate in the clinical trial nearest to their home for the immediately life-threatening disease or condition, and the patient has documentation from their primary physician and surgeon and a consulting physician and surgeon attesting that they meet these requirements.
FISCAL EFFECT:
This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations, the bill will not result in state costs.
COMMENTS:
- Purpose. The ALS Association is the Sponsor of this bill. According to the Author,
“There are clear circumstances in which terminally ill patients in California seek medical care via an out-of-state provider because an in-state provider doesn’t suffice, most notably when:
- Treatment is only available outside of California. For some terminal conditions, particularly with rare diseases, specialized treatment is limited to a finite number of facilities that serve the entire country or one provider facility is the leading care center in the entire country for a particular type of treatment. In such instances, in-state provider care is insufficient.
- To obtain an independent second opinion from an out-of-state specialist. It is not uncommon for terminal patients to consult well-known specialists outside of California for further understanding of their diagnosis or treatment options that may provide a better outcome or quality of life while they are still living. When a leading specialist practices outside of California (and does not have a California medical license), an in-state provider is insufficient for such purposes. Currently, a California patient’s only option to seek an unbiased second opinion from a specialist located out-of-state is to physically travel for an in-person visit. Under current law, virtual care is only allowed via an out-of-state provider who is not licensed in California when in consultation with a licensed, California-based provider who has the ultimate authority over the care or primary diagnosis of the patient. This directly conflicts with the patient’s intent to seek an objective, independent second opinion from the well-known specialist who is located out-of-state. AB 1369 would correct this injustice by allowing the terminally ill patient to receive virtual care from the out-of-state specialist without consultation from an in-state provider.
- An existing relationship with an out-of-state provider. Some patients who have recently relocated to California or who spend significant time outside California (i.e., for work or school) already have an established trusted doctor-patient relationship with an out-of-state provider. If diagnosed with a terminal illness, these patients need to maintain this relationship since it takes time to locate and establish a trusted relationship with a new in-state provider, especially for certain specialties in which there is an existing provider shortage or extended wait-time to be seen. A patient who is diagnosed with a terminal illness cannot afford to compromise their care while waiting to establish a new in-state provider.”
The Author advises that “Remote care is necessary for terminally ill patients for a variety of reasons, including:
- Ensure access to medical facilities and specialists. Physical access to care is a real challenge for patients who reside in rural areas and especially those in need of specialty care since the number of specialist providers and facilities are limited in scope and geography. The burden of travel – within or out-of-state – for terminally ill patients who reside in rural areas to visit a facility or specialist in-person is increasingly difficult or impossible.
- Reduce risk of exposure. Terminally ill patients are immunocompromised, which prevents them from doing many normal societal activities safely, including travel to in-person medical visits, in order to avoid exposure. The availability of telehealth has greatly reduced risk of exposure for immunocompromised patients in California since telehealth reduces the need for them to have to physically travel within the state to receive care, just as it would help maintain safety for terminally ill patients who receive care from an out-of-state provider.
- Mobility restrictions. Mobility issues are a huge impediment for many terminally ill patients who are physically weak or totally disabled and whose only current option to receive care from an out-of-state provider is to travel in-person. Mobility restrictions create an additional burden for terminally ill patients who must rely on caregiver assistance to help them.
- Financial barriers. Travel costs are another big concern since the cost is often exorbitant or prohibitive for those who must travel to receive medical care. The vast majority of terminally ill patients already have significant medical care costs to pay for, including costs for caregivers who must travel with them. Costs may also include lost wages for caregivers and paying for care for other dependents while the patient and caregiver must travel for in-person medical visits.
According to the Author, “If AB 1369 becomes law, remote care with an out-of-state provider can also be extremely beneficial in allowing vulnerable, terminally ill patients in California to conduct an initial virtual screening consultation to assess whether physical travel out-of-state is warranted for further in-person care. Also, maintaining continuity of care though virtual visits in between in-person visits can greatly reduce the physical, financial and emotional burdens of having to travel out-of-state for every visit. There is no doubt that telemedicine provides a more convenient and much-needed alternative for medical care that can be done virtually, greatly enhancing patient safety while reducing patient and caregiver time, energy and costs.”
- Background. Physicians and surgeons who practice in California are required to hold an active license from either the MBC or the OMBC, and health care providers offering health care services to patients located in California via telehealth are required to hold an active license issued by a California healing arts program. Pursuant to BPC Section 2290.5, licensees are held to the same standard of care, and retain the same responsibilities of providing informed consent, ensuring the privacy of medical information, and any other duties associated with practicing medicine, regardless of whether they are practicing via telehealth or face-to-face, in-person visits.
Telehealth includes several components, one of which is online practice. MBC reported in its 2021 Sunset Report to the Legislature that one of the most frequent violations involved physicians and surgeons treating California patients via telehealth from another state without having a California license. MBC noted at the time that as technology has advanced, more complaints have been received regarding care provided via telehealth, including complaints of unlicensed practice, inappropriate care, and the corporate practice of medicine. MBC advised that with future advances in technology, including applications available on electronic devices and more, this will continue to be an issue. Complaints about care received through telehealth follow the same investigative and prosecutorial process as all other complaints; MBC noted an increase in the number of complaints regarding the use of telehealth, including the online aspect of telehealth.
California patients are not currently prohibited from seeking services from physicians in another state if they do so in-person in that other state or if they do so through a licensed physician in this state. Telehealth delivery across state lines has been a focus of recent discussion in a number of states. According to the Federation of State Medical Boards, as of June 2023 all state boards, plus the medical boards of District of Columbia, Puerto Rico, and the Virgin Islands, require that physicians engaging in telemedicine are licensed in the state in which the patient is located, or are registered in the state, if the state has a registry for interstate practice. Eight states issue a special purpose license, telemedicine license or certificate to practice telemedicine across state lines. Eight states require physicians to register or receive a waiver if they wish to practice across state lines. Four states offer pro bono, limited referral services, or extraterritorial licenses for interstate practice. Two states allows for consultative services to be rendered across state lines. Alaska, for example, allows individuals with suspected or diagnosed life-threatening conditions, to be treated by an out-of-state physician as long as they have a referral from their Alaska-licensed physician, among other requirements. In Vermont, beginning on July 1, 2023, a health care professional who is not otherwise licensed, certified, or registered to practice in that state may obtain a Telehealth Registration to provide health care services in Vermont via telehealth to a total of not more than 10 unique patients or clients for a period of not more than 120 consecutive days from the date the Telehealth Registration was issued or practitioners may obtain a Telehealth License to provide healthcare services in Vermont via telehealth to a total of not more than 20 unique patients or clients located in Vermont during the two-year license term. Delaware allows practitioners licensed outside of the state to render services to Delaware patients by telemedicine so long as their license in good standing in all jurisdictions in which they are licensed, not under investigation or subject to an administrative complaint, and they first obtain an interstate telehealth registration. In Georgia, the medical board is authorized to issue telemedicine licenses to physicians who are licensed in other states who hold a full and unrestricted license to practice medicine in another state – the telemedicine license is limited to the practice of telemedicine and cannot be used to practice medicine physically in Georgia unless an emergency. Kansas registers physicians who apply for an receive a waiver to practice telemedicine to treat patients located in the state of Kansas.
- Arguments in Support. The ALS Association writes that “People with ALS have complex health care needs and face high out-of-pocket costs. They become increasingly dependent on round-the-clock care as their disease progresses and their muscle function needed to move, speak and swallow declines. Professional and family caregiving is essential to their daily needs and survival. As mobility becomes increasingly restricted, travel – even to a local ALS clinic for care – can be exacerbating for someone living with ALS. It is also daunting for caregivers who must accompany and assist them. The availability of telehealth as a tool to provide care, when an in-person visit isn’t necessary, greatly reduces the physical burdens of travel for many people living with ALS. In fact, many of our ALS clinics in California retain telehealth as an option for care. If enacted into law, this legislation would also reduce the economic costs that out-of-state travel impose on families living with ALS who receive care outside of California.”
According to EveryLife Foundation for Rare Diseases “Many rare disease patients, especially those who are terminally ill, face physical and financial constraints in traveling to receive care. Fortunately, advancements in telehealth platforms are making it easier for providers to diagnose, monitor, and treat diseases, without requiring those patients to travel long distances or take extensive time away from their work and families. Importantly, telehealth services can enable access to care across state boundaries, allowing rare disease patients to meet with expert physicians in other states. AB 1369 would provide an exemption to medical licensure requirements when providers treat terminally ill patients, providing desperately-needed access to medical care to the patients who need it most.
For a condition to be considered rare, it must have fewer than 200,000 cases nationwide. Due to the small prevalence of individual rare diseases, specialty care is largely regionalized and the resources, technology, and specialized providers for those with rare diseases are increasingly becoming available only in certain states and cities. As a result, many rare disease patients must frequently travel far to seek care, especially specialty care outside their state. A 2019 survey found that 39% of rare disease patients had to travel more than 60 minutes for care. In some instances, approximately 17% of survey respondents, rare disease families face the need to permanently relocate just to be closer to the few experts for their condition.1 For individuals with terminal rare diseases, many of whom face mobility challenges and other severe health challenges, this traveling is especially daunting and physically burdensome. Rare disease patients and families must also navigate how to manage travel expenses and expenses from multiple inpatient and outpatient encounters, costs for prescription therapies and medical devices, and support services that are critical for their health and well-being. These costs can quickly add up. The National Economic Burden of Rare Disease Study determined the overall annual economic cost of rare diseases exceeded $966 billion in the year 2019 alone. The study also found that in 2019, among individuals with the 379 rare diseases studied, the average adult incurred over $1,300 in travel expenses alone while seeking care or attending clinical travels. Undoubtedly, the ability of physicians to reach rare disease patients in a convenient and cost-effective manner is an important step to reducing this economic burden and improving overall care.
California telehealth laws should be clarified to better enable access to care for Californians living with terminal illnesses, including terminal rare diseases.”
The California Chronic Care Coalition notes that “The narrowly tailored exemption to California’s licensure requirements for telehealth for terminally ill patients created by AB 1369 represents a lifeline for Californians with terminal diseases. It respects the rights of terminally ill individuals to try whatever they can to prolong or save their lives.”
- Arguments in Opposition. According to the Medical Board of California, “Without the requirement for licensure, the Board would be unaware of those who are treating patients in this state and would be unable to take disciplinary action against a physician who fails to treat their patients within the standard of care. Under the language of the bill, it is also unclear whether the home state of the physician in question would have authority to discipline that physician when treating Californians. In addition, the definition of an eligible physician is vague. It appears that the physician in question would be the one to determine for themselves if they are qualified. Further, the bill does not disqualify physicians with a history of disciplinary action against them. Establishing an exemption for licensure to treat patients with a life-threatening disease or condition is not necessary. The Board is concerned that eliminating the normative requirement for licensure reduces the certainty that a fragile patient population will receive treatment consistent with the standard of care.”
The Osteopathic Medical Board of California states that “the proposed licensure exemption in this bill poses a risk to public safety and violates the foundations upon which telemedicine was built on in California…From a policy perspective, telemedicine was created cautiously to balance the potential convenience of video or phone visits with the standard of care requirement for caring for a patient and patient safety. This bill does not balance patient needs and public safety.” OMBC writes that “this bill exempts individuals from being criminally charged for unlicensed practice and fined up to $10,000 and imprisonment not to exceed a year” and that
“this bill proposes is to allow these out of state unlicensed telemedicine physicians to provide care for life threatening conditions, which is beyond the scope of practice envisioned for telemedicine to provide. This dramatic scope expansion is not only a red flag, but also a significant threat to patient safety. Life threatening conditions require in person treatment not video chats level care. Life threatening conditions are when patients are most at risk of harm and would open them up to being victims of negligence precisely because the telemedicine physician is unable to provide the immediate level of care for a life-threatening condition. The standard of care for a life-threatening condition would require close monitoring by a licensed physician who has the ability to order diagnostic tests that monitor the patient’s condition. An unlicensed out of state physician would not be able to order and receive such test results that are critical to monitoring life threatening conditions. An unlicensed out of state physician would be unable to respond effectively to health emergencies, which could lead to negligence in the provision of care to patients.
The sponsors claim it is for California based patients with life threatening conditions, too sick to travel, not enrolled in a local clinical trial and that have the patient’s physician’s consent to get care from an out of state physician through telemedicine. If they are being cared for by a California license physician locally, why does the patient need to connect with telemedicine physician from out of state? Why does the patient need telemedicine if they have a local physician(s) who is caring for their condition? Why does the bill make a sweeping scope change in required licensure and telemedicine for a limited population of patients? There is no requirement in the bill that the telemedicine physician even have the expertise of the condition being treated nor if the patient needs to be enrolled in an out of state clinical trial. If the patient were enrolled in an out of state clinical trial, the bill doesn’t even require that the telemedicine doctor providing the care work for the clinical trial or even be in the same state as the clinical trial. The proposed language for such a narrow patient population is too sweeping an exemption that would make a gaping hole in the scope of practice requirement for licensure. The facts are neither compelling nor make sense for not otherwise requiring telemedicine physicians to be licensed in California when caring for California patients. Required licensure is a reasonable requirement.
The major public safety consequent of this bill is the fact that these unlicensed out of state physicians would not be regulated by the Board; the board would not have enforcement jurisdiction over them for purposes of pursuing disciplinary actions to protect public safety. This exemption would prevent OMBC and Medical Board of California from protecting patient safety. Patients harmed by these unlicensed out of state telemedicine physicians would have no recourse against them civilly or criminally or otherwise because the harm occurred in California and no entity in California has jurisdiction over these unlicensed out of state physicians. This would open a huge loophole in protecting patient safety and regulating physicians who provide care to patients in California.
It is worth emphasizing that licensure should not be viewed as simply an administrative hassle for physicians to practice medicine in California. Licensure requirements are set by the Legislature to protect public safety and ensure competency and avoid fraudulent licensure so that every patient can feel confident that they are being cared for by a competent physician. Licensure also is the mechanism that provides the Board with enforcement jurisdiction to investigate and bring disciplinary actions against physicians who violate the law. Without licensure, there is no regulation of physicians who are allowed to practice in California without a license and there is no recourse for patient harm against the out of state unlicensed physician. Patients are left unprotected by this bill.
The lack of requirements and restrictions in this bill are out of step with the way California typically handles out of state business. From a business perspective, at a minimum, all out of state businesses are required to consent provide legal jurisdiction through registering with the Secretary of the State so in the event of lawsuit out of state businesses can be sued for business conducted in the state. To protect public safety in health care, the law must provide a legal connection to the state and licensure by a regulatory board and currently that legal connection is licensure by either the Medical Board of California or the Osteopathic Medical Board of California.”
- Policy Considerations. This bill applies a similar model previously established for patients with a serious or immediately life-threatening disease to access experimental treatments to now allow patients with a serious or immediately life-threatening disease to receive telehealth services from a licensed physician in another state. However, unlike the Right to Try Act, the bill does not require the patient’s primary or a consulting physician to recommend telehealth services from a provider located in another state, and the patient does not have to provide written informed consent to receive those services. The bill also only specifies that the physician and surgeon be licensed “in another state that uses criteria substantially similar to the criteria used by the Medical Board of California” which implies that only medical doctors, rather than osteopathic physicians, would be eligible to provide services to California patients, since the two boards use different criteria for licensure, and since a number of other states also have separate board for the regulation of osteopathic physicians. Unlike most states that allow a pathway for out-of-state physician licensees to practice and to provide telehealth services to patients in those states, the bill omits the requirement under current law for MBC to license an individual currently licensed in another state, as well as the requirement outlined in OMBC reciprocity provisions that there must not be disciplinary action taken against the physician by any medical licensing authority and that the physician has not been the subject of adverse judgments or settlements resulting from the practice of medicine that the constitutes evidence of a pattern of negligence or incompetence. While MBC or OMBC could conceivably still take action against an individual providing telehealth services to patients with a serious or immediately life-threatening disease if the individual is not licensed in another state or if they provide services beyond telehealth, the Author should continue working with stakeholders, including MBC and OMBC, to ensure that the provisions of this measure are clear and establish implementable patient safety requirements for the physicians who may be providing important services to vulnerable Californians.
SUPPORT AND OPPOSITION:
Support:
The ALS Association
ATA Action
California Chronic Care Coalition
Everylife Foundation for Rare Diseases
Opposition:
Medical Board of California
Osteopathic Medical Board of California
-- END --
Date of Hearing: April 26, 2023
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Chris Holden, Chair
ABPCA Bill Id:AB 1369
Author:(Bauer-Kahan) – As Amended Ver:March 23, 2023
Policy Committee: | Business and Professions | Vote: | 18 - 0 |
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Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill allows a physician who is licensed in another state to deliver health care via telehealth to a patient who has a disease that is immediately life-threatening and cannot participate in a clinical trial, as specified.
FISCAL EFFECT:
No state costs.
COMMENTS:
- Purpose. This bill is sponsored by the ALS Association. According to the author:
Terminally ill patients – especially those with rare diseases – should not be forced to travel for the specialty care they require. The delays and hoops that our current system poses can be the difference between life and death for such patients. A highly limited exemption to California licensure requirements for telehealth provisions to terminally ill patients is simply humane. It respects the rights of a terminally ill individual to try whatever they can to prolong, and even save, their life.
- Background. Under existing law, a physician is deemed to be providing care in the location the patient is when receiving care. For example, if a physician in Illinois is giving medical advice to a patient in California through a telehealth platform, the state considers the physician to be practicing medicine in California, and that physician would need a license from the Medical Board of California (MBC) or the Osteopathic Medical Board of California (OMBC) to lawfully provide that care.
Patients with Terminal Diseases. AB 1668 (Calderon), Chapter 684, Statutes of 2016, known as the Right to Try Act, authorized the manufacturer of an investigational drug, biological product, or device not yet approved by the US Food and Drug Administration (FDA) to make that investigational treatment available to a patient with a serious or immediately life-threatening disease. The patient must have considered all FDA-approved treatment options and been unable to participate in a relevant clinical trial, and the patient’s primary physician and a consulting physician must also have recommended the investigational treatment.
Despite the provisions of the Right to Try Act, terminally ill patients are still limited by the Medical Practice Act’s requirement that a physician located outside California be licensed by the MBC or OMBC to treat a California patient via telehealth. The author contends this requirement poses a significant issue when a physician outside California is the only person qualified to give specialty care to a patient with a rare, terminal disease.
Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081
Date of Hearing:
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Marc Berman, Chair
ABPCA Bill Id:AB 1369
Author:(Bauer-Kahan) – As Amended Ver:March 23, 2023
SUBJECT: Out-of-state physicians and surgeons: telehealth: license exemption.
SUMMARY: Authorizes an eligible out-of-state physician and surgeon to practice medicine in California without a license if the practice is limited to delivering health care via telehealth to an eligible patient who has a disease or condition that is immediately life-threatening.
EXISTING LAW:
- Enacts the Medical Practice Act, which provides for the licensure and regulation of physicians and surgeons by the Medical Board of California (MBC). (Business and Professions Code (BPC) §§ 2000 et seq.)
- Provides that protection of the public shall be the highest priority for both the MBC in exercising its licensing, regulatory, and disciplinary functions, and that whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount. (BPC § 2001.1)
- Entrusts the MBC with responsibility for, among other things, the enforcement of the disciplinary and criminal provisions of the Medical Practice Act; the administration and hearing of disciplinary actions; carrying out disciplinary actions appropriate to findings made by a panel or an administrative law judge; suspending, revoking, or otherwise limiting certificates after the conclusion of disciplinary actions; and reviewing the quality of medical practice carried out by physician and surgeon certificate holders under the jurisdiction of the board. (BPC § 2004)
- Provides that any person who practices or attempts to practice, or who advertises or holds themselves out as practicing, any system or mode of treating the sick or afflicted in California, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended certificate as a physician and surgeon in California or without being otherwise authorized to perform the act is guilty of a crime. (BPC § 2052)
- Prohibits any person who does not have a valid, unrevoked, and unsuspended certificate as a physician and surgeon from the MBC from using the words “doctor” or “physician” or otherwise implying that they are a physician and surgeon. (BPC § 2054)
- Empowers the MBC to take action against persons guilty of violating the Medical Practice Act. (BPC § 2220)
- 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. (BPC § 2290.5)
- Enacts the Right to Try Act, which makes an investigational drug, biological product, or device that is not yet approved by the United States Food and Drug Administration (FDA) available to patients with a serious or immediately life-threatening disease, when that patient has considered all other treatment options currently approved by the FDA, has been unable to participate in a relevant clinical trial, and for whom the investigational drug has been recommended by the patient's primary physician and a consulting physician. (Health and Safety Code §§ 111548 et seq.)
THIS BILL:
- Authorizes an eligible out-of-state physician and surgeon to practice medicine in California without a license from the MBC if the practice is limited to delivering health care via telehealth to an eligible patient.
- Defines “eligible patient” as a person who has a disease or condition that is immediately life-threatening; who has not been accepted to participate in the clinical trial nearest to their home for that disease or condition within one week of completion of applying, or cannot reasonably participate in that trial due to the patient’s condition and stage of disease; and who has documentation from their primary physician and a consulting physician attesting that they meet those requirements.
- Defines “eligible out-of-state physician and surgeon” as a person who is licensed as a physician and surgeon in another state that uses criteria substantially similar to the criteria used by the MBC.
FISCAL EFFECT: Unknown; this bill is keyed fiscal by the Legislative Counsel.
COMMENTS:
Purpose. This bill is sponsored by the ALS Association. According to the author:
“Terminally ill patients – especially those with rare diseases – should not be forced to travel for the specialty care they require. The delays and hoops that our current system poses can be the difference between life and death for such patients. A highly limited exemption to California licensure requirements for telehealth provisions to terminally ill patients is simply humane. It respects the rights of a terminally ill individual to try whatever they can to prolong, and even save, their life.”
Background.
Regulation of Physicians and Surgeons. Physicians and surgeons in California are regulated by one of two entities: the MBC or the Osteopathic Medical Board of California (OMBC). The MBC licenses and regulates about 153,000 physicians while the OMBC licenses and regulates slightly over 12,000. Generally speaking, most provisions governing discipline for unprofessional conduct by the MBC also apply to the OMBC. The majority of the MBC’s staff and resources are dedicated to its enforcement program. The MBC receives approximately 10,000 complaints per year. Statute requires the MBC to prioritize the investigation of certain complaints, including sexual misconduct with a patients.
All physicians and surgeons who practice in California are required to hold an active license from either the MBC or the OMBC. Any person who practices or attempts to practice, or who advertises or holds themselves out as practicing, any system or mode of treating the sick or afflicted in California, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended certificate as a physician and surgeon in California or without being otherwise authorized to perform the act, is guilty of a crime. There are only a limited number of exceptions to this general prohibition against the unlicensed practice of medicine.
Telehealth. California first formally recognized the advent of new telehealth technologies in 1996 when the Legislature enacted SB 1665 (Thompson), the Telemedicine Development Act. This bill set standards for the use of what was then called “telemedicine” by health care practitioners and insurers. The bill prohibited health insurers from requiring face-to-face contact between a health care provider and patient for services appropriately provided through telemedicine. The bill also exempted out-of-state practitioners from the Medical Practice Act when consulting either within California or across state lines, with a licensed practitioner in California; however, it prohibited the out-of-state practitioner from having ultimate authority over the care or primary diagnosis of a patient in California.
Much of the Telemedicine Development Act was subsequently repealed and replaced in 2011 through the enactment of AB 415 (Logue), which established the Telehealth Advancement Act of 2011 to revise and update existing law to facilitate the advancement of telehealth as a service delivery mode in managed care and the Medi-Cal Program. The vernacular shift from “telemedicine” to “telehealth” reflected a general consensus among policymakers that telehealth is not itself a form of medicine, but simply a tool to deliver health care outside a traditional office visit. In California there is no distinction between in-person care and telehealth in terms of either the standard of care or the expectations of a physician-patient relationship.
Legally speaking, a physician or other practitioner is deemed to have provided care in whichever geographic place the patient is in at the time of receiving care. For example, if a physician in Chicago, Illinois is giving medical advice to a patient in Palo Alto, California through a telehealth platform, the state considers the physician to be practicing medicine in California. As such, that physician would need a license from the MBC or the OMBC to lawfully provide that care, regardless of whether they are physically within the borders of the state.
Patients with Terminal Diseases. In 2016, the Legislature enacted the Right to Try Act, which authorized the manufacturer of an investigational drug, biological product, or device not yet approved by the FDA to make that investigational drug available to a patient with a serious or immediately life-threatening disease. The patient must have considered all other treatment options currently approved by the FDA and been unable to participate in a relevant clinical trial. The investigational drug must also have been recommended by the patient’s primary physician and a consulting physician.
Despite the provisions of the Right to Try Act, terminally ill patients are still limited by the Medical Practice Act’s requirement that a physician located outside California must still be licensed by the MBC or OMBC to deliver care to California patients via telehealth. The author contends that this poses a significant issue when a physician outside California is the only person qualified to give specialty care to a patient with a rare, terminal disease.
Under current law, a patient wishing to receive care from a physician outside California has the following options. First, the patient can physically travel to a state where that physician is licensed. Next, under the Telemedicine Development Act, a patient’s physician who is licensed in California can consult with an out-of-state physician via telehealth, as long as the California-licensed physician is ultimately responsible for the care. Finally, the out-of-state physician can apply for and obtain a license in California from the MBC.
The author of this bill contends that none of the above options are appropriate for patients who have a disease or condition that is immediately life-threatening. For these patients, it is impractical if not impossible for them to travel to another state, and there is not sufficient time for the out-of-state license to go through the California licensing process. This bill would allow patients to receive care directly from an out-of-state physician only under specified circumstances where the patient has not been accepted to participate in the clinical trial nearest to their home, or, in the medical judgment of their primary physician, it is unreasonable for the patient to participate in that clinical trial due to the patient’s current condition and stage of disease.
Current Related Legislation. AB 765 (Wood) prohibits any person who is not a licensed physician and surgeon from using various medical specialty titles or otherwise implying that they are a physician and surgeon. This bill is pending in this committee.
AB 1395 (Garcia) requires the MBC to issue a license to applicants for participation in the Licensed Physicians and Dentists from Mexico Pilot Program who do not currently possess federal documentation but otherwise meet the pilot program’s requirements. This bill is pending in the Assembly Committee on Appropriations.
Prior Related Legislation. AB 1668 (Calderon, Chapter 684, Statutes of 2016) enacted the Right to Try Act.
AB 415 (Logue, Chapter 547, Statutes of 2011) enacted the Telehealth Advancement Act of 2011.
SB 1665 (Thompson, Chapter 864, Statutes of 1996) enacted the Telemedicine Development Act of 1996.
ARGUMENTS IN SUPPORT:
This bill is sponsored by the ALS Association, which writes: “The availability of telehealth as a tool to provide care, when an in-person visit isn’t necessary, greatly reduces the physical burdens of travel for many people living with ALS. In fact, some of our ALS clinics in California retain telehealth as an option for care. If enacted into law, this legislation would also reduce the economic costs that out-of-state travel imposes on families living with ALS who seek care outside of California.”
ARGUMENTS IN OPPOSITION:
None on file.
POLICY ISSUE(S) FOR CONSIDERATION:
While the author’s argument for this bill is cogent, there remain unresolved questions as to what administrative recourse would be available to a patient if an out-of-state physician violates the standard of care in the provision of services to that patient via telehealth. Because under the terms of the bill, the MBC would have no authority over the physician, there would likely be no ability for the board to take disciplinary action or other measures to protect the public. At the same time, it is unclear whether the regulatory board within the state where the physician is licensed would have jurisdiction if the care is deemed to not have occurred within that state. As this bill continues to move through the process, the author may wish to consider mechanisms for ensuring that public protection is not compromised by allowing physicians to practice medicine without any oversight or accountability.
REGISTERED SUPPORT:
The ALS Association (Sponsor)
ATA Action
REGISTERED OPPOSITION:
None on file.
Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301
Discussed in Hearing
1MIN
Assembly Floor
2MIN
Senate Floor
18MIN
Senate Standing Committee on Business, Professions and Economic Development
10MIN
Assembly Standing Committee on Business and Professions
Bill Author
Bill Co-Author(s):