Amended in Assembly April 26, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 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 amended, 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 videobegin delete communications, telephone communications, email communications, and synchronous text or chat conferencingend deletebegin insert communications and telephone communicationsend insert 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 whenbegin delete a patient prefers to receive health care services in personend deletebegin insert it is not appropriateend insert 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 frombegin delete interfering with the physician-patientend deletebegin insert altering the provider-patientend insert relationship based on the modality utilized for services appropriately provided through telehealth.begin insert The bill would provide that all laws regarding the confidentiality of health care information and a patient’s right to his or her medical information shall apply to telehealth services.end insert

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:

P3    1

SECTION 1.  

Section 2290.5 of the Business and Professions
2Code
is amended to read:

3

2290.5.  

(a) For purposes of this division, the following
4definitions apply:

5(1) “Asynchronous store and forward” means the transmission
6of a patient’s medical information from an originating site to the
7health care provider at a distant site without the presence of the
8patient.

9(2) “Distant site” means a site where a health care provider who
10provides health care services is located while providing these
11services via a telecommunications system.

12(3) “Health care provider” means either of the following:

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

14(B) A marriage and family therapist intern or trainee functioning
15pursuant to Section 4980.43.

16(4) “Originating site” means a site where a patient is located at
17the time health care services are provided via a telecommunications
18system or where the asynchronous store and forward service
19originates.

20(5) “Synchronous interaction” means a real-time interaction
21between a patient and a health care provider located at a distant
22site.

23(6) “Telehealth” means the mode of delivering health care
24services and public health via information and communication
25technologies to facilitate the diagnosis, consultation, treatment,
26education, care management, and self-management of a patient’s
27health care while the patient is at the originating site and the health
28care provider is at a distant site. Telehealth facilitates patient
29self-management and caregiver support for patients and includes
30synchronous interactions and asynchronous store and forward
31 transfers,begin delete including, but not limited to,end deletebegin insert includingend insert video
32
begin delete communications, telephone communications, email
33communications, and synchronous text or chat conferencing.end delete

34
begin insert communications and telephone communications.end insert

35(b) Prior to the delivery of health care via telehealth, the health
36care provider initiating the use of telehealth shall inform the patient
37about the use of telehealth and obtain oral, written, or digital
38consent from the patient for the use of telehealth as an acceptable
P4    1mode of delivering health care services and public health. The
2consent shall be documented.

3(c) Nothing in this section shall preclude a patient from receiving
4in-person health care delivery services during a specified course
5of health care and treatment after agreeing to receive services via
6telehealth.

7(d) The failure of a health care provider to comply with this
8section shall constitute unprofessional conduct. Section 2314 shall
9not apply to this section.

10(e) This section shall not be construed to alter the scope of
11practice of any health care provider or authorize the delivery of
12health care services in a setting, or in a manner, not otherwise
13authorized by law.

14(f) All laws regarding the confidentiality of health care
15information and a patient’s rights to his or her medical information
16shall apply to telehealth interactions.

17(g) This section shall not apply to a patient under the jurisdiction
18of the Department of Corrections and Rehabilitation or any other
19correctional facility.

20(h) (1) Notwithstanding any other provision of law and for
21purposes of this section, the governing body of the hospital whose
22patients are receiving the telehealth services may grant privileges
23to, and verify and approve credentials for, providers of telehealth
24services based on its medical staff recommendations that rely on
25information provided by the distant-site hospital or telehealth
26entity, as described in Sections 482.12, 482.22, and 485.616 of
27Title 42 of the Code of Federal Regulations.

28(2) By enacting this subdivision, it is the intent of the Legislature
29to authorize a hospital to grant privileges to, and verify and approve
30credentials for, providers of telehealth services as described in
31paragraph (1).

32(3) For the purposes of this subdivision, “telehealth” shall
33include “telemedicine” as the term is referenced in Sections 482.12,
34482.22, and 485.616 of Title 42 of the Code of Federal Regulations.

35

SEC. 2.  

Section 1374.13 of the Health and Safety Code is
36amended to read:

37

1374.13.  

(a) For the purposes of this section, the definitions
38in subdivision (a) of Section 2290.5 of the Business and Professions
39Code apply.

P5    1(b) It is the intent of the Legislature to recognize the practice
2of telehealth as a legitimate means by which an individual may
3receive health care services from a health care provider without
4in-person contact with the health care provider.

5(c) A health care service plan shall not require that in-person
6contact occur between a health care provider and a patient before
7payment is made for the covered services appropriately provided
8through telehealth, subject to the terms and conditions of the
9contract entered into between the enrollee or subscriber and the
10health care service plan, and between the health care service plan
11and its participating providers or provider groups.

12(d) A health care service plan shall not limit the type of setting
13where services are provided for the patient or by the health care
14provider before payment is made for the covered services
15appropriately provided through telehealth, subject to the terms and
16conditions of the contract entered into between the enrollee or
17subscriber and the health care service plan, and between the health
18care service plan and its participating providers or provider groups.

19(e) The requirements of this section shall also apply to health
20care service plan and Medi-Cal managed care plan contracts with
21the State Department of Health Care Services pursuant to Chapter
227 (commencing with Section 14000) or Chapter 8 (commencing
23with Section 14200) of Part 3 of Division 9 of the Welfare and
24Institutions Code.

25(f) Notwithstanding any law, this section shall not be interpreted
26to authorize a health care service plan to require the use of
27telehealth when the health care provider has determined that it is
28not appropriate.

29(g) Notwithstanding any law, this section shall not be interpreted
30to authorize a health care provider to require the use of telehealth
31whenbegin delete a patient prefers to be treated in an in-person setting.
32Telehealth services should be physician- or practitioner-guided
33and patient-preferred.end delete
begin insert it is not appropriate. Nothing in this section
34shall preclude a patient from receiving in-person health care
35delivery services.end insert

36(h) A health care service plan shall include in its plan contract
37coverage and reimbursement for services provided to a patient
38through telehealth to the same extent as though provided in person
39or by some other means.

P6    1(1) A health care service plan shall reimburse the health care
2provider for the diagnosis, consultation, or treatment of the enrollee
3when the service is delivered through telehealth at a rate that is at
4least as favorable to the health care provider as those established
5for the equivalent services when provided in person or by some
6other means.

7(2) A health care service plan may subject the coverage of
8services delivered via telehealth to copayments, coinsurance, or
9deductible provided that the amounts charged are at least as
10favorable to the enrollee as those established for the equivalent
11services when provided in person or by some other means.

12(i) A health care service plan shall not limit coverage or
13reimbursement based on a contract entered into between the health
14care service plan and an independent telehealth provider orbegin delete interfere
15with the physician-patientend delete
begin insert alter the provider-patientend insert relationship
16based on the modality utilized for services appropriately provided
17through telehealth.

begin insert

18
(j) Notwithstanding any other law, this section shall not be
19interpreted to prohibit a health care service plan from undertaking
20a utilization review of telehealth services, provided that the
21utilization review is made in the same manner as a utilization
22review for equivalent services when provided in person or by other
23means.

end insert
begin insert

24
(k) This section shall not be construed to alter the scope of
25practice of any health care provider or authorize the delivery of
26health care services in a setting, or in a manner, not otherwise
27authorized by law.

end insert
begin insert

28
(l) All laws regarding the confidentiality of health care
29information and a patient’s right to his or her medical information
30shall apply to telehealth services.

end insert
31

SEC. 3.  

Section 10123.85 of the Insurance Code is amended
32to read:

33

10123.85.  

(a) For purposes of this section, the definitions in
34subdivision (a) of Section 2290.5 of the Business and Professions
35Code shall apply.

36(b) It is the intent of the Legislature to recognize the practice
37of telehealth as a legitimate means by which an individual may
38receive health care services from a health care provider without
39in-person contact with the health care provider.

P7    1(c) No health insurer shall require that in-person contact occur
2between a health care provider and a patient before payment is
3made for the services appropriately provided through telehealth,
4subject to the terms and conditions of the contract entered into
5between the policyholder or contractholder and the insurer, and
6 between the insurer and its participating providers or provider
7groups.

8(d) No health insurer shall limit the type of setting where
9services are provided for the patient or by the health care provider
10before payment is made for the covered services appropriately
11provided by telehealth, subject to the terms and conditions of the
12contract between the policyholder or contract holder and the
13insurer, and between the insurer and its participating providers or
14provider groups.

15(e) Notwithstanding any other provision, this section shall not
16be interpreted to authorize a health insurer to require the use of
17telehealth when the health care provider has determined that it is
18not appropriate.

19(f) Notwithstanding any law, this section shall not be interpreted
20to authorize a health care provider to require the use of telehealth
21whenbegin delete a patient prefers to be treated in an in-person setting.
22Telehealth services should be physician- or practitioner-guided
23and patient-preferred.end delete
begin insert it is not appropriate. Nothing in this section
24shall preclude a patient from receiving in-person health care
25delivery services.end insert

26(g) A health insurer shall include in its policy coverage and
27reimbursement for services provided to a patient through telehealth
28to the same extent as though provided in person or by some other
29means.

30(1) A health insurer shall reimburse the health care provider for
31the diagnosis, consultation, or treatment of the insured when the
32service is delivered through telehealth at a rate that is at least as
33favorable to the health care provider as those established for the
34equivalent services when provided in person or by some other
35means.

36(2) A health insurer may subject the coverage of services
37 delivered via telehealth to copayments, coinsurance, or deductible
38provided that the amounts charged are at least as favorable to the
39insured as those established for the equivalent services when
40provided in person or by some other means.

P8    1(h) A health insurer shall not limit coverage or reimbursement
2based on a contract entered into between the health insurer and an
3independent telehealth provider orbegin delete interfere with the
4physician-patientend delete
begin insert alter the provider-patientend insert relationship based on
5the modality utilized for services appropriately provided through
6telehealth.

begin insert

7
(i) Notwithstanding any other law, this section shall not be
8interpreted to prohibit a health insurer from undertaking a
9utilization review of telehealth services, provided that the
10utilization review is made in the same manner as a utilization
11review for equivalent services when provided in person or by other
12means.

end insert
begin insert

13
(j) This section shall not be construed to alter the scope of
14practice of any health care provider or authorize the delivery of
15health care services in a setting, or in a manner, not otherwise
16authorized by law.

end insert
begin insert

17
(k)  All laws regarding the confidentiality of health care
18 information and a patient’s right to his or her medical information
19shall apply to telehealth services.

end insert
20

SEC. 4.  

No reimbursement is required by this act pursuant to
21Section 6 of Article XIII B of the California Constitution because
22the only costs that may be incurred by a local agency or school
23district will be incurred because this act creates a new crime or
24infraction, eliminates a crime or infraction, or changes the penalty
25for a crime or infraction, within the meaning of Section 17556 of
26the Government Code, or changes the definition of a crime within
27the meaning of Section 6 of Article XIII B of the California
28Constitution.



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