California Legislature—2015–16 Regular Session

Assembly Bill No. 2507

Introduced by Assembly Member Gordon

February 19, 2016

An act to amend Section 2290.5 of the Business and Professions Code, to amend Section 1374.13 of the Health and Safety Code, and to amend Section 10123.85 of the Insurance Code, relating to telehealth.

LEGISLATIVE COUNSEL’S DIGEST

AB 2507, as introduced, Gordon. Telehealth: access.

(1) Existing law defines “telehealth” as the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site, and that facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers. Existing law requires that prior to the delivery of health care via telehealth, the health care provider initiating the use of telehealth inform the patient about the use of telehealth and obtain documented verbal or written consent from the patient for the use of telehealth.

This bill would add video communications, telephone communications, email communications, and synchronous text or chat conferencing to the definition of telehealth. The bill would also provide that the required prior consent for telehealth services may be digital as well as oral or written.

(2) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law prohibits health care service plans and health insurers from limiting the type of setting where services are provided for the patient or by the health care provider before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee, insured, subscriber, or policyholder and the plan or insurer, and between the plan or insurer and its participating providers or provider groups.

This bill would also prohibit a health care provider from requiring the use of telehealth when a patient prefers to receive health care services in person and would require health care service plans and health insurers to include coverage and reimbursement for services provided to a patient through telehealth to the same extent as though provided in person or by some other means, as specified. The bill would prohibit a health care service plan or health insurer from limiting coverage or reimbursement based on a contract entered into between the plan or insurer and an independent telehealth provider. The bill would prohibit a health care service plan or a health insurer from interfering with the physician-patient relationship based on the modality utilized for services appropriately provided through telehealth.

Because a willful violation of the bill’s provisions by a health care service plan would be a crime, it would impose a state-mandated local program.

(3) 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:

SECTION 1.  

Section 2290.5 of the Business and Professions
Code is amended to read:

2290.5.  

(a) For purposes of this division, the following
definitions begin delete shall end delete apply:

(1) “Asynchronous store and forward” means the transmission
of a patient’s medical information from an originating site to the
health care provider at a distant site without the presence of the
patient.

(2) “Distant site” means a site where a health care provider who
provides health care services is located while providing these
services via a telecommunications system.

(3) “Health care provider” means either of the following:

(A) A person who is licensed under this division.

(B) A marriage and family therapist intern or trainee functioning
pursuant to Section 4980.43.

(4) “Originating site” means a site where a patient is located at
the time health care services are provided via a telecommunications
system or where the asynchronous store and forward service
originates.

(5) “Synchronous interaction” means a real-time interaction
between a patient and a health care provider located at a distant
site.

(6) “Telehealth” means 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 while the patient is at the originating site and the health
care provider is at a distant site. Telehealth facilitates patient
self-management and caregiver support for patients and includes
synchronous interactions and asynchronous store and forward
begin delete transfers. end delete begin insert transfers, including, but not limited to, video
communications, telephone communications, email
communications, and synchronous text or chat conferencing. end insert

(b) Prior to the delivery of health care via telehealth, the health
care provider initiating the use of telehealth shall inform the patient
about the use of telehealth and obtain begin delete verbal or written end delete begin insert oral,
written, or digital end insert consent from the patient for the use of telehealth
as an acceptable mode of delivering health care services and public
health. The consent shall be documented.

(c) Nothing in this section shall preclude a patient from receiving
in-person health care delivery services during a specified course
of health care and treatment after agreeing to receive services via
telehealth.

(d) The failure of a health care provider to comply with this
section shall constitute unprofessional conduct. Section 2314 shall
not apply to this section.

(e) This section shall not be construed to alter the scope of
practice of any health care provider or authorize the delivery of
health care services in a setting, or in a manner, not otherwise
authorized by law.

(f) All laws regarding the confidentiality of health care
information and a patient’s rights to his or her medical information
shall apply to telehealth interactions.

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

(h) (1) Notwithstanding any other provision of law and for
purposes of this section, the governing body of the hospital whose
patients are receiving the telehealth services may grant privileges
to, and verify and approve credentials for, providers of telehealth
services based on its medical staff recommendations that rely on
information provided by the distant-site hospital or telehealth
entity, as described in Sections 482.12, 482.22, and 485.616 of
Title 42 of the Code of Federal Regulations.

(2) By enacting this subdivision, it is the intent of the Legislature
to authorize a hospital to grant privileges to, and verify and approve
credentials for, providers of telehealth services as described in
paragraph (1).

(3) For the purposes of this subdivision, “telehealth” shall
include “telemedicine” as the term is referenced in Sections 482.12,
482.22, and 485.616 of Title 42 of the Code of Federal Regulations.

SEC. 2.  

Section 1374.13 of the Health and Safety Code is
amended to read:

1374.13.  

(a) For the purposes of this section, the definitions
in subdivision (a) of Section 2290.5 of the Business and Professions
Code begin delete shall end delete apply.

(b) It is the intent of the Legislature to recognize the practice
of telehealth as a legitimate means by which an individual may
receive health care services from a health care provider without
in-person contact with the health care provider.

(c)  begin delete No end delete begin insert A end insert health care service plan shall begin insert not end insert require that in-person
contact occur between a health care provider and a patient before
payment is made for the covered services appropriately provided
through telehealth, subject to the terms and conditions of the
contract entered into between the enrollee or subscriber and the
health care service plan, and between the health care service plan
and its participating providers or provider groups.

(d)  begin delete No end delete begin insert A end insert health care service plan shall begin insert not end insert limit the type of
setting where services are provided for the patient or by the health
care provider before payment is made for the covered services
appropriately provided through telehealth, subject to the terms and
conditions of the contract entered into between the enrollee or
subscriber and the health care service plan, and between the health
care service plan and its participating providers or provider groups.

(e) The requirements of this section shall also apply to health
care service plan and Medi-Cal managed care plan contracts with
the State Department of Health Care Services pursuant to Chapter
7 (commencing with Section 14000) or Chapter 8 (commencing
with Section 14200) of Part 3 of Division 9 of the Welfare and
Institutions Code.

(f) Notwithstanding any begin delete other provision, end delete begin insert law, end insert this section shall
not be interpreted to authorize a health care service plan to require
the use of telehealth when the health care provider has determined
that it is not appropriate.

begin insert

(g) Notwithstanding any law, this section shall not be interpreted
to authorize a health care provider to require the use of telehealth
when a patient prefers to be treated in an in-person setting.
Telehealth services should be physician- or practitioner-guided
and patient-preferred.

end insert begin insert

(h) A health care service plan shall include in its plan contract
coverage and reimbursement for services provided to a patient
through telehealth to the same extent as though provided in person
or by some other means.

end insert begin insert

(1) A health care service plan shall reimburse the health care
provider for the diagnosis, consultation, or treatment of the
enrollee when the service is delivered through telehealth at a rate
that is at least as favorable to the health care provider as those
established for the equivalent services when provided in person
or by some other means.

end insert begin insert

(2) A health care service plan may subject the coverage of
services delivered via telehealth to copayments, coinsurance, or
deductible provided that the amounts charged are at least as
favorable to the enrollee as those established for the equivalent
services when provided in person or by some other means.

end insert begin insert

(i) A health care service plan shall not limit coverage or
reimbursement based on a contract entered into between the health
care service plan and an independent telehealth provider or
interfere with the physician-patient relationship based on the
modality utilized for services appropriately provided through
telehealth.

end insert

SEC. 3.  

Section 10123.85 of the Insurance Code is amended
to read:

10123.85.  

(a) For purposes of this section, the definitions in
subdivision (a) of Section 2290.5 of the Business and Professions
Code shall apply.

(b) It is the intent of the Legislature to recognize the practice
of telehealth as a legitimate means by which an individual may
receive health care services from a health care provider without
in-person contact with the health care provider.

(c) No health insurer shall require that in-person contact occur
between a health care provider and a patient before payment is
made for the services appropriately provided through telehealth,
subject to the terms and conditions of the contract entered into
between the policyholder or contractholder and the insurer, and
between the insurer and its participating providers or provider
groups.

(d) No health insurer shall limit the type of setting where
services are provided for the patient or by the health care provider
before payment is made for the covered services appropriately
provided by telehealth, subject to the terms and conditions of the
contract between the policyholder or contract holder and the
insurer, and between the insurer and its participating providers or
provider groups.

(e) Notwithstanding any other provision, this section shall not
be interpreted to authorize a health insurer to require the use of
telehealth when the health care provider has determined that it is
not appropriate.

begin insert

(f) Notwithstanding any law, this section shall not be interpreted
to authorize a health care provider to require the use of telehealth
when a patient prefers to be treated in an in-person setting.
Telehealth services should be physician- or practitioner-guided
and patient-preferred.

end insert begin insert

(g) A health insurer shall include in its policy coverage and
reimbursement for services provided to a patient through telehealth
to the same extent as though provided in person or by some other
means.

end insert begin insert

(1) A health insurer shall reimburse the health care provider
for the diagnosis, consultation, or treatment of the insured when
the service is delivered through telehealth at a rate that is at least
as favorable to the health care provider as those established for
the equivalent services when provided in person or by some other
means.

end insert begin insert

(2) A health insurer may subject the coverage of services
delivered via telehealth to copayments, coinsurance, or deductible
provided that the amounts charged are at least as favorable to the
insured as those established for the equivalent services when
provided in person or by some other means.

end insert begin insert

(h) A health insurer shall not limit coverage or reimbursement
based on a contract entered into between the health insurer and
an independent telehealth provider or interfere with the
physician-patient relationship based on the modality utilized for
services appropriately provided through telehealth.

end insert

SEC. 4.  

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