Amended in Assembly May 6, 2014

Amended in Assembly March 11, 2014

California Legislature—2013–14 Regular Session

Assembly BillNo. 1771


Introduced by Assembly Member V. Manuel Pérez

February 14, 2014


An act to add Section 1374.14 to the Health and Safety Code, and to add Section 10123.855 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 1771, as amended, V. Manuel Pérez. Telephonic and electronic patient management services.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Insurance Commissioner. Existing law prohibits a health care service plan or health insurer from requiring in-person contact between a health care provider and a patient before payment is made for covered services appropriately provided through telehealth, which is defined to mean the mode of delivering health care services via information and communication technologies, as specified.

This bill would require a health care service plan or a health insurer, with respect to contracts and policies issued, amended, or renewed on or after January 1, 2015, to cover physician telephonic and electronic patient management servicesbegin insert, as defined,end insert and to reimburse those servicesbegin delete at the same level and amount as face-to-face patient encounters withend deletebegin insert based on theirend insert similar complexity and time expenditure. Because a willful violation of the bill’s requirements by a health care service planbegin delete or health insurerend delete would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

begin delete
P2    1

SECTION 1.  

The Legislature hereby finds and declares all of
2the following:

3(a) The lack of primary and specialty care physicians continues
4to be a significant barrier to individual access to health care
5services, a barrier that will only be exacerbated by health care
6reform efforts that will increase the number of insured individuals.

7(b) The term “telehealth,” as defined in Section 2290.5 of the
8Business and Professions Code, includes telephonic and electronic
9patient management, which means the use of electronic
10communication tools, such as the telephone and electronic mail,
11to enable treating physicians to evaluate and manage their existing
12patients in a manner recognized by the American Medical
13Association, Current Procedural Terminology codes.

14(c) Telephonic and electronic patient management is an effective
15strategy to address the problems associated with the physician
16shortage in California, as it increases physician practice efficiency
17through the reduction of unnecessary office visits and increases
18productivity by allowing physicians to treat more patients.

19(d) In addition, studies have shown that telephonic and electronic
20patient management reduces costs and yields positive results for
21health care payers due to the reduced use of costly services and
22reported improvements in quality of care.

23(e) Consumers of health care will benefit from telephonic and
24electronic patient management in many ways, including expanded
25access to physicians, faster and more convenient treatment, better
P3    1continuity of care, and reduced lost work time and health care
2costs.

3(f) While some third-party payers reimburse physicians for
4telephonic and electronic patient management, some do not even
5though that reimbursement would assist in improving the physical
6and economic health of the state.

end delete
7

begin deleteSEC. 2.end delete
8begin insertSECTION 1.end insert  

Section 1374.14 is added to the Health and Safety
9Code
, to read:

10

1374.14.  

(a) begin deleteNotwithstanding any other law, a end deletebegin insertA end insert health care
11service plan shall, with respect to plan contracts issued, amended,
12or renewed on or after January 1, 2015, cover physician telephonic
13and electronic patient management services and reimburse those
14servicesbegin delete at the same level and amount as face-to-face patient
15encounters with similarend delete
begin insert based on theirend insert complexity and time
16expenditure.

17(b) This section shall not be construed to authorize a health care
18service plan to require the use of telephonic and electronic patient
19management services when the physician has determined that those
20services are not medically appropriate.

21(c) This section shall not be construed to alter the scope of
22practice of a health care provider or authorize the delivery of health
23care services in a setting, or in a manner, that is not otherwise
24authorized by law.

25(d) All laws regarding the confidentiality of health information
26and a patient’s rights to his or her medical information shall apply
27to telephonic and electronic patient management services.

28(e) This section shall not apply to a patient under the jurisdiction
29of the Department of Corrections and Rehabilitation or any other
30correctional facility.

31(f) For purposes of this section, “telephonic and electronic
32patient management services” meansbegin delete the use of electronic
33communication tools, such as the telephone and electronic mail,
34to enable treating physicians to evaluate and manage existing
35patients in a mannerend delete
begin insert non-face-to-face telephone services and online
36medical evaluation, asend insert
recognized by the American Medical
37Association, Current Procedural Terminology codes.

38

begin deleteSEC. 3.end delete
39begin insertSEC. 2.end insert  

Section 10123.855 is added to the Insurance Code, to
40read:

P4    1

10123.855.  

(a) begin deleteNotwithstanding any other law, a end deletebegin insertA end insert health
2insurer shall, with respect to policies of health insurance issued,
3amended, or renewed on or after January 1, 2015, cover physician
4telephonic and electronic patient management services and
5reimburse those servicesbegin delete at the same level and amount as
6face-to-face patient encounters with similarend delete
begin insert based on theirend insert
7 complexity and time expenditure.

8(b) This section shall not be construed to authorize a health
9insurer to require the use of telephonic and electronic patient
10management services when the physician has determined that those
11services are not medically appropriate.

12(c) This section shall not be construed to alter the scope of
13practice of a health care provider or authorize the delivery of health
14care services in a setting, or in a manner, that is not otherwise
15authorized by law.

16(d) All laws regarding the confidentiality of health information
17and a patient’s rights to his or her medical information shall apply
18to telephonic and electronic patient management services.

19(e) This section shall not apply to a patient under the jurisdiction
20of the Department of Corrections and Rehabilitation or any other
21correctional facility.

22(f) For purposes of this section, “telephonic and electronic
23patient management services” meansbegin delete the use of electronic
24communication tools, such as the telephone and electronic mail,
25to enable treating physicians to evaluate and manage existing
26patients in a mannerend delete
begin insert non-face-to-face telephone services and online
27medical evaluation, asend insert
recognized by the American Medical
28Association, Current Procedural Terminology codes.

29

begin deleteSEC. 4.end delete
30begin insertSEC. 3.end insert  

No reimbursement is required by this act pursuant to
31Section 6 of Article XIII B of the California Constitution because
32the only costs that may be incurred by a local agency or school
33district will be incurred because this act creates a new crime or
34infraction, eliminates a crime or infraction, or changes the penalty
35for a crime or infraction, within the meaning of Section 17556 of
36the Government Code, or changes the definition of a crime within
37the meaning of Section 6 of Article XIII B of the California
38Constitution.



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