BILL ANALYSIS                                                                                                                                                                                                    Ó



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          Date of Hearing:  April 19, 2016


                            ASSEMBLY COMMITTEE ON HEALTH


                                   Jim Wood, Chair


          AB 2507  
          (Gordon) - As Introduced February 19, 2016


          SUBJECT:  Telehealth:  access.


          SUMMARY:  Requires health care service plans (health plans) and  
          health insurers to reimburse telehealth services to the same  
          extent as services provided through in person.  Specifically,  
          this bill:  


          1)Requires a health plan or health insurer to 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.


          2)Requires a health plan or health insurer to reimburse a 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. 


          3)Authorizes a health plan or health insurer to subject the  
            coverage of services delivered via telehealth to copayments,  
            coinsurance, or deductible provided that the amounts charged  








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            are at least as favorable to the enrollee as those established  
            for the equivalent services when provided in person or by some  
            other means.  


          4)Prohibits a health plan or health insurer from limiting  
            coverage or reimbursement based on a contract entered into  
            between the health plan or health insurer and an independent  
            telehealth provider or interfering with the physician-patient  
            relationship.


          5)Revises the definition of telehealth to include video  
            communications, telephone communications, email  
            communications, and synchronous text or chat conferencing.


          6)Provides that the requirement of telehealth 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.  Requires telehealth services to be  
            physician or practitioner guided and patient-preferred.


          EXISTING LAW:  

          1)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. Telehealth facilitates patient self-management and  
            caregiver support for patients and includes synchronous  
            interactions and asynchronous store and forward transfers.

          2)Requires prior to the delivery of telehealth, the health care  
            provider initiating the use of telehealth to inform the  
            patient about the use of telehealth and obtain verbal or  








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            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 in the  
            patient's medical record.  

          3)States that all laws regarding the confidentiality of health  
            care information and a patient's rights to his or her medical  
            information apply to telehealth interactions. 

          4)Exempts a patient under the jurisdiction of the Department of  
            Corrections and Rehabilitation or any other correctional  
            facility. 

          5)Notwithstanding any other provision of law and for purposes of  
            1) through 4) above, 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  
            federal regulations. States legislative intent to authorize a  
            hospital to grant privileges to and verify and approve  
            credentials for providers of telehealth. 

          6)States that "telehealth" includes "telemedicine," as  
            specified. 

          7)Makes the failure of a health care provider to comply with 1)  
            through 6) above unprofessional conduct. 

          8)Provides that 1) through 7) above 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. 

          9)Prohibits a health plan from requiring in-person contact to  
            occur between a health care provider and a patient and  
            limiting the type of setting where services are provided for  
            the patient or by the health care provider before payment is  








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            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 plan, and between the health plan and its  
            participating providers or provider groups.
          FISCAL EFFECT:  This bill has not been analyzed by a fiscal  
          committee.


          COMMENTS:  

          1)PURPOSE OF THIS BILL.  According to the author, there have  
            been rapid developments in recent years in the delivery of  
            health care through telehealth.  Whether through improved  
            access to primary care physicians or cancer clinical trials,  
            strengthening behavioral health services in hospital emergency  
            departments and community clinics, or improving access to care  
            for both rural populations and vulnerable populations,  
            telehealth offers both the promise and the reality of improved  
            access to quality health care for all.  This bill removes  
            barriers to health care services provided via telehealth and  
            ensures patient access, choice, and convenience.  Increased  
            access to health care services through telehealth could also  
            result in cost reduction and cost savings.  This bill would  
            provide a viable telehealth reimbursement infrastructure in  
            California in order to improve access for the state's  
            residents to high quality health care at a time when more  
            Californians have health insurance.  This bill requires the  
            same coverage and reimbursement for services provided to a  
            patient through telehealth as though the patient received  
            equivalent services in person.  The modality or how the  
            service is delivered should not determine whether a service  
            should be covered or reimbursed.  Patients will benefit  
            through improved access to health care providers, the ability  
            to receive health care services in a faster and more  
            convenient manner, increased continuity and coordination of  
            care, reduction of lost work time and travel costs, and the  
            ability to remain near family and friends while receiving  
            health care services.  Providers will be able to offer  








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            services through telehealth with a guarantee they will be  
            appropriately reimbursed.  Providers will be incentivized to  
            fully build-out a vibrant, fully accessible telehealth  
            infrastructure to better serve Californians.  A fully  
            developed and supported telehealth infrastructure will provide  
            California with economic and social benefits by: reducing the  
            needs of patients to leave their home or work to obtain health  
            care services, helping to maintain a healthy and productive  
            workforce and overall population, and using the same modern  
            technologies California is pioneering.

          2)BACKGROUND. 

             a)   Telehealth.  According to the Health Resources and  
               Services Administration, telehealth is the use of  
               telecommunications and information technologies to share  
               information and provide clinical care, education, public  
               health and administrative services at a distance.   
               California law recognizes live video and store-and forward  
               (capture of medical information and transfer to providers  
               for later review).


             This bill would expand the definition of telehealth to also  
               include telephone, email and synchronous text and chat  
               conferencing as billable telehealth modalities.
             b)   California Health Benefits Review Program (CHBRP)  
               analysis.  AB 1996 (Thomson), Chapter 795, Statutes of  
               2002, requests the University of California to assess  
               legislation proposing a mandated benefit or service and  
               prepare a written analysis with relevant data on the  
               medical, economic, and public health impacts of proposed  
               health plan and health insurance benefit mandate  
               legislation.  CHBRP was created in response to AB 1996.  SB  
               125 (Hernandez), Chapter 9, Statutes of 2015, added an  
               impact assessment on essential health benefits, and  
               legislation that impacts health insurance benefit designs,  
               cost sharing, premiums, and other health insurance topics.   
               As indicated in the CHBRP analysis, this bill would require  








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               reimbursement parity for telehealth visits as compared to  
               equivalent in-person visits.  This bill is not limited in  
               scope to established patients, and may apply to any health  
               care provider.  CHBRP analyzed the potential impact of this  
               bill related to the following telehealth modalities:

               -      Live video (real-time interaction via video  
                 communication);
               -      Store-and-forward (capture and secure transmission  
                 of medical information, such as photo or x-rays, for  
                 review by a health care provider at a later time);


               -      Telephone; and, 


               -      Email, and synchronous text and chat. 

               In its review, CHBRP considered a 2013 survey from the  
               California Public Policy Institute which indicated that  
               most Californians (63%) use the Internet at least  
               occasionally, an increase of 21 percentage points since  
               2000.  Sixty-nine percent of Californians have high-speed  
               broadband access at home but differences in access are  
               apparent by income, education, race, ethnicity and  
               geographic location.  Nearly 93% of Californians report  
               having a cell phone, and 58% have a smart phone, with  
               younger age groups (18 to 34 years of age) more likely to  
               use a smart phone.  Smart phone usage also increases with  
               higher education and income levels.   Thirty-two percent of  
               Californians use the Interne to contact a health insurance  
               provider or medical professional (34%), whereas over half  
               (55%) seek out medical information online. 

               i)     Medical Effectiveness.  CHBRP indicates that the  
                 evidence related to medical effectiveness of telehealth  
                 varies by modality.  The scope of this bill applies to  
                 virtually all diseases and conditions. The telehealth  
                 literature generally focuses on a limited number of  








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                 conditions (e.g., dermatology, neurology,  
                 psychiatry/psychology) and may not be generalizable to  
                 other conditions.  Furthermore, a major challenge in  
                 assessing medical effectiveness of telehealth is the  
                 speed of technological advancements in the field, which  
                 often outpaces the research literature about these  
                 technologies. 

                  -         Live video:  There is clear and convincing  
                    evidence that these modalities are at least as  
                    effective as in-person care for both mental health  
                    services and dermatology. However, this evidence may  
                    not be generalizable to live video usage in other  
                    specialty areas. 
                  -         Store-and-forward:  For the areas studied  
                    (e.g., in dermatology), there is a low preponderance  
                    of evidence that medical care provided by  
                    store-and-forward is at least as effective as medical  
                    care provided in person. The evidence suggests that  
                    store-and-forward technology reduces wait times for  
                    specialty outpatient care. 


                  -         Telephone:  For the areas studied (e.g.,  
                    mental health), the studies of the effect of telephone  
                    consultations on subsequent utilization are  
                    inconsistent. Therefore, the evidence that medical  
                    care provided by telephone compared to medical care  
                    provided in person is ambiguous. Furthermore, it is  
                    unknown whether diagnoses made using these  
                    technologies are as accurate as diagnoses made during  
                    in-person visits.


                  -         E-mail, text and chat:  There is insufficient  
                    evidence to determine whether services provided by  
                    synchronous text and chat are as effective as medical  
                    care provided in person. CHBRP notes that the absence  
                    of evidence does not mean there is no effect; it means  








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                    the effect is unknown. 

               i)     Benefit Coverage, Utilization, and Cost.  This bill  
                 would apply to all state-regulated insurance, including  
                 DMHC Medi-Cal managed care.  CHBRP estimates that in  
                 2017, all 25.2 million Californians with state-regulated  
                 coverage would be subject to this bill.  CHBRP estimates  
                 that postmandate, usage of telehealth services with a low  
                 and high adoption scenario, ranging from 3.75% of total  
                 visits delivered via telehealth postmandate to 15% of  
                 total visits delivered via telehealth postmandate.  CHBRP  
                 estimates that in the first year postmandate, THIS BILL  
                 would increase overall health expenditures (premiums and  
                 out-of-pocket expenses by between $96.8 million (0.07%  
                 change) and $402.6 million (0.28% change).  CHBRP  
                 estimates premium increases to range from $0.24 to $1.33  
                 per member per month (PMPM) for DMHC-regulated plans,  
                 depending on the rate of adoption.  Increases range from  
                 $0.25 to $1.09 PMPM for CDI-regulated policies, depending  
                 on the rate of adoption.  Lastly, CHBRP assumes that  
                 out-of-pocket expenses would increase by between $15.5  
                 million (0.10%) and $64.8 million (0.40%), depending on  
                 the adoption of telehealth services.  In reaching the  
                 above estimates, CHBRP points out that this bill is not  
                 limited in scope to established patients and assumed that  
                 postmandate telehealth visits that replace existing  
                 in-person visits (substitute) and new (supplemental)  
                 visits that would not have taken place in person or would  
                 not have been billed as a telehealth visit.  

               ii)    Public Health.  Patient experience would improve, as  
                 providers increase their e-mail and telephone responses  
                 to patient-initiated inquiries.  The improvement is  
                 partly attributable to increased access to (specialty or  
                 primary) care, as well as improved convenience for  
                 patients, such as reduced wait times for some visits.


               For mental health and dermatology, evidence indicates that  








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                 outcomes for live videoconferencing and store-and-forward  
                 were equivalent to in-person care; however these results  
                 may not be generalizable to other conditions.  CHBRP  
                 estimates that utilization would increase from  
                 approximately 86,000 to 364,000 live videoconferencing  
                 encounters and from approximately 1 million to 4.4  
                 million store-and-forward encounters.  For those newly  
                 covered enrollees seeking mental health and dermatologic  
                 care via telehealth, CHBRP estimates that positive  
                 outcomes could occur for some with these conditions;  
                 however, the public health impact for other conditions is  
                 unknown.

               In the case of this bill, key social determinants of health  
                 that may be affected by the mandate include  
                 transportation, rural living, and socioeconomic  
                 characteristics (age, race/ethnicity, income, language).

               CHBRP estimates that, postmandate, travel costs and travel  
                 time would likely decrease for some urban and rural  
                 enrollees using newly-covered, patient-initiated  
                 telehealth services. As a result, some enrollees with  
                 transportation challenges may have better outcomes  
                 because they would no longer delay or avoid in-person  
                 visits by favoring telephonic or electronic  
                 communications with physicians; however, CHBRP is unable  
                 to quantify the exact impact due to a lack of data.

               It is unknown whether this bill would reduce disparities in  
                 access to care by ameliorating the effects of certain  
                 social determinants of health (transportation and  
                 geography).  As noted, barriers to care could be reduced  
                 for some; however, this bill also could exacerbate  
                 disparities in access to care for some enrollees with  
                 certain socioeconomic characteristics (e.g., age,  
                 language, income, etc.) that impede the use of telehealth  
                 modalities.  Lastly, it is unknown whether  
                 patient-initiated telehealth services would result in  
                 harms to patients.  An unknown finding could result in a  








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                 positive, negative or no impact.
               iii)   Impact on EHBs.  This bill would not exceed EHBs.   
                 Services would be delivered in a different way, via  
                 telehealth, rather than be considered a new benefit.

               iv)    Long-term impacts.  CHBRP assumes that technology  
                 will continue to drive changes in telehealth.  This  
                 includes increased penetration of electronic health  
                 records (EHR), associated patient portals and office  
                 management systems; increased use of mobile and remote  
                 communication devices (such as cellular telephones and or  
                 medical devices) and their applications; increased  
                 broadband coverage, which not only allows better Internet  
                 coverage, but also easier and more rapid transfer of  
                 large data files; and, increased demand for these types  
                 of services from consumers, insurers, and providers.   
                 CHBRP projects that this trend, along with changes in  
                 reimbursement, would likely increase use of telephone,  
                 e-mail, and other telehealth services between patients  
                 and providers; however, the impact of telehealth on  
                 health outcomes requires further study.

             a)   Other states.  According to CHBRP, in 2015, state  
               legislatures in 42 states introduced over 200  
               telehealth-related bills. States vary greatly in the  
               definition and regulation of telehealth.  Forty-eight  
               states and the District of Columbia have a codified  
               definition of telehealth (or telemedicine) in law,  
               regulations or in their Medicaid programs while Rhode  
               Island and New Jersey do not have an established legal  
               definition for telehealth.  The vast majority of states  
               (47) and the District of Columbia reimburse for some type  
               of telehealth service in their Medicaid programs. This is  
               an increase from 44 state Medicaid programs in 2014.  Among  
               these states, live video is the most commonly reimbursed  
               form of telehealth, with all 47 states reimbursing for live  
               video.  However, the terms and conditions related to live  
               video reimbursement vary widely across states. As of July  
               2015, California is one of nine states that reimburses for  








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               store-and-forward in its Medicaid program; the other states  
               are Alaska, Arizona, Illinois, Minnesota, Mississippi, New  
               Mexico, Oklahoma, and Virginia. Sixteen states' Medicaid  
               programs reimburse for remote patient monitoring;  
               California does not.  Four states' Medicaid programs  
               (Alaska, Illinois, Minnesota, and Mississippi) reimburse  
               for live video, store-and-forward, and remote patient  
               monitoring.


             Thirty-one states and the District of Columbia have laws in  
               place which regulate telehealth reimbursement among private  
               payers.  Washington State has passed such legislation  
               scheduled to go into effect January 1, 2017.  There is much  
               variation among these laws; some do not require  
               reimbursement while some require reimbursement parity  
               between telehealth services and the same service delivered  
               in-person.  At least 23 states have "full parity" in place  
               wherein both coverage and reimbursement for telehealth  
               services are comparable to in-person services.
             b)   Federal Requirements.  Medicare payment for telehealth  
               services is established in Section 1834 (m) of the Social  
               Security Act.  Medicare reimbursement for telehealth  
               services is conditioned on the originating site (location  
               of the patient) being located in a non-metro county or in a  
               primary care or mental health geographic Health  
               Professional Shortage Area.  Medicare reimburses for  
               synchronous live video and for in a demonstration program  
               in Alaska or Hawaii, reimburses for asynchronous  
               store-and-forward.  Medicare does not pay for telephone or  
               e-mail encounters.

             c)   Department of Veterans Affairs.  According to CHBRP, the  
                                                                                              federal Department of Veterans Affairs (VA) has an Office  
               of Telehealth Services and is considered a leader in the  
               integration and use of the technologies.  The VA defines  
               telehealth to include clinical video telehealth, store and  
               forward, and home telehealth (chronic disease management  
               through remote patient monitoring for conditions  such as  








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               diabetes, chronic heart failure, chronic obstructive  
               pulmonary disease, depression, or post-traumatic stress  
               disorder.  The VA also has secure messaging features that  
               allow patients to communicate via a web portal or their  
               mobile devices, and mobile health, defined as smart phone  
               applications for self-management or health conditions.   
               Email is not included in the VA's definition of telehealth.

             d)   Kaiser Permanente. Kaiser Permanente Northern California  
               (KPNC) is a unique example of an integrated health care  
               delivery system using all four telehealth modalities. KPNC  
               serves approximately 3.4 million enrollees through 8,000  
               physicians and 21 hospitals. In 2008, KPNC implemented an  
               inpatient and ambulatory care EHR system that includes more  
               than 100 patient-centered Internet, mobile, and live  
               videoconferencing applications enabling members to review  
               disease-specific information; access personal health  
               information; make appointments, order refills, exchange  
               secure e-mail messages with providers; and participate in  
               virtual care in lieu of an office visit. KPNC's number of  
               virtual visits grew from 4.1 million in 2008 to 10.5  
               million in 2013, and telephone visits increased from about  
               640,000 in 2008 to more than 2.3 million in 2013. KPNC  
               estimates that by 2016, virtual visits (e-mail, telephone,  
               video) would outnumber in-person office visits, which have  
               remained constant since 2008.

             e)   Rural Health Disparities and Travel Barriers in  
               California.  In its analysis, CHBRP must include a  
               discussion of disparities under the broader umbrella of  
               social determinants of health (SDoH).  SDoH include factors  
               outside of the traditional medical care system that  
               influence health status and health outcomes. In the case of  
               this bill, evidence shows that disparities in certain  
               determinants including geographic location, (accessible)  
               transportation and access to and use of technology.


             Residents of rural communities in California experience  








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               poorer health status compared to residents of urban  
               communities, such as higher self-reported poor health  
               status (6.1% in rural vs. 4.4% in urban), recent mental  
               health issues (37.8% rural vs. 34.1% urban), physical  
               health issues (52.8% rural vs. 40.3% urban) and recent  
               inability to engage in work, recreation, or self-care  
               (27.0% rural vs. 21.4% urban) (CalSORH, 2013). Travel  
               barriers and inadequate provider-patient ratios are  
               telehealth-relevant factors that contribute to rural health  
               disparities (Iezzoni et al., 2006; Weinhold and Gurtner,  
               2014). About 14% (5.2 million) of California's 37.7 million  
               residents live in rural areas (CalSORH, 2013) and in about  
               two-thirds of counties, the number of physicians per capita  
               is less than what is considered adequate to meet demand  
               (CHCF, 2012). 

             Telehealth may help to overcome some of the disparities in  
               health care by redistributing knowledge and expertise when  
               and where it is needed, including rural areas of California  
               (Nesbitt, 2012).  However, telehealth has yet to meet rural  
               demand according to one study. Of 60 California rural  
               health clinics surveyed in 2012, less than half (47%) used  
               telehealth; 47% used live videoconferencing, 5% used  
               store-and-forward, and 3% used home monitoring.  Cost of  
               equipment and lack of arrangements with specialists were  
               the primary obstacles to clinic participation (52% and 48%,  
               respectively) (CHCF, 2012). About half of the clinics used  
               the Internet to contact other providers, but just 12% did  
               so to contact patients (CHCF, 2012).  In recognition of the  
               ongoing challenge to provide accessible clinical services  
               to rural residents, the federal Office of Rural Health  
               Policy established an Office for the Advancement of  
               Telehealth to promote telehealth grants and programming for  
               clinical care, education, and public health in rural areas.
          1)SUPPORT.  According to the sponsor, Stanford Health Care, this  
            bill seeks to fulfill the promise of telehealth and further  
            improves access to health care by ensuring that providers and  
            recipients of telehealth services have guaranteed coverage and  
            reimbursement for telehealth services that are physician or  








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            practitioner-guided and retains patient choice.


          The California Primacy Care Association points out that with  
            this bill, providers will be incentivized to fully build-on a  
            vibrant, fully accessible telehealth infrastructure to better  
            serve Californians.  

          The American Association for Marriage and Family Therapy,  
            California Division, opines that the provision expressly  
            prohibiting health care providers from forcing patients into  
            telehealth services when the patient has a preference for  
            in-person treatment forges a balance between ensuring access  
            to health care via telehealth while protecting patients who  
            wants to be seen in person.

          Adventist Health, John Muir Health El Camino Hospital indicate  
            that existing law does not guarantee health care providers  
            will be reimbursed for telehealth services, and this bill  
            removes this barrier and improves patient access, choice, and  
            convenience to quality healthcare.

          The Association of California Healthcare Districts indicates  
            that rural and underserved areas have a difficult time  
            recruiting health professionals to their areas, and this bill  
            is one solution to this problem.  A reliable reimbursement  
            mechanism ensures that telehealth services are available  
            across the state, particularly in rural areas where healthcare  
            districts operate.
          2)OPPOSITION.  The California Association of Health Plans, the  
            Association of California Life and Health Insurance Companies  
            and America's Health Insurance Plans indicate that they have  
            taken important steps over the last decade to address the  
            critical issues of increasing access to innovative, quality  
            health care products, and cost control mechanisms that better  
            allow individuals and small businesses to obtain coverage in  
            the private market.  This bill threatens the efforts of all  
            health care stakeholders to provide consumers with meaningful  
            health care choices and affordable coverage options.








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          3)RELATED LEGISLATION.  SB 289 (Mitchell) of 2015, would have  
            required health plans or health insurers to cover telephonic  
            and electronic patient management services provided by a  
            physician or non-physician health care provider and reimburse  
            those services based on their complexity and time expenditure.  
             SB 289 was held in the Senate Appropriations Committee.

          4)PREVIOUS LEGISLATION.  

             a)   AB 1771 (V. Manuel Pérez), of 2014, would have required  
               health plans and health insurers, with respect to plan  
               contracts and insurance policies issued, amended, or  
               renewed on or after January 1, 2016, to cover telephone  
               visits provided by a physician.  AB 1771 was held in the  
               Senate Appropriations Committee. 

             b)   AB 809 (Logue), Chapter 404, Statutes of 2014, revises  
               the informed consent requirements relating to the delivery  
               of health care via telehealth by permitting consent to be  
               made verbally or in writing, and by deleting the  
               requirement that the health care provider who obtains the  
               consent be at the originating site where the patient is  
               physically located.

             c)   AB 1733 (Logue), Chapter 782, Statutes of 2012,  
               specifies that the prohibition on requiring in-person  
               contact also applies to other health care service plan  
               contracts with the Department of Health Care Services  
               (DHCS) for services under the Medi-Cal program, and  
               publicly supported programs other than Medi-Cal, as well as  
               to the organizations implementing the PACE program.

             d)   AB 415 (Logue), Chapter 547, Statutes of 2011, among  
               other provisions, prohibits DHCS from requiring that a  
               health care provider document a barrier to an in-person  
               visit prior to paying for services provided via telehealth  
               to a Medi-Cal beneficiary.  Repeals the prohibition of  
               paying for a service provided by telephone or facsimile and  








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               would instead prohibit DHCS from limiting the type of  
               setting where services are provided for the patient.  
               Prohibits health plans and insurers from requiring 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 of the relevant contract.  Repeals the prohibition  
               for paying for a service provided by telephone or facsimile  
               and would instead prohibit health plans and insurers from  
               limiting the type of setting where services are provided  
               for the patient or by the health care provider. 

             e)   SB 1665 (Thompson), Chapter 864, Statutes of 1996,  
               established the Telemedicine Development Act (TDA) to set  
               standards for the use of telemedicine by health care  
               practitioners and insurers.  TDA specifies, in part, that  
               face-to-face contact between a health care provider and a  
               patient shall not be required under the Medi-Cal program  
               for services appropriately provided through telemedicine,  
               when those services are otherwise covered by the Medi-Cal  
               program, and requires a health care practitioner to obtain  
               verbal and written consent prior to providing services  
               through telemedicine.  

          5)Amendments.  The author has agreed to amend this bill to do  
            the following:

             a)   Narrow the scope of this bill to apply only to video and  
               telephonic communications;
             b)   Clarify that the bill shall not be interpreted to  
               prohibit a health plan to undertake a utilization review of  
               telehealth services, provided the utilization review is  
               equivalent in application when provided in person or by  
               some other means;


             c)   Clarify that this bill does not alter the scope of  
               practice of any health care providers; and,









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             d)   Maintain the confidentiality of healthcare information  
               and the patient's right to his or her medical information  
               applies to telehealth services.

          REGISTERED SUPPORT / OPPOSITION:

          Support



          Stanford Health Care (sponsor)
          AARP California
          Adventist Health
          ALS Association Golden West Chapter
          American Association for Marriage and Family Therapy
          Association of California Healthcare Districts
          California Academy of Family Physicians
          California Association of Health Plans
          California Children's Hospital
          California Life Sciences Association
          California Medical Association
          California Primary Care Association
          Center for Information Technology Research in the Interest of  
          Society
          Center for Technology and Aging
          The Children's Partnership
          El Camino Hospital
          Health Care Interpreters Network
          John Muir Health
          Lucile Packard Children's Hospital
          National Multiple Sclerosis Society


          Occupational Therapy Association of California
          Providence Health & Services
          Sutter Health










                                                                    AB 2507


                                                                    Page  18







          Opposition



          America's Health Insurance Plans
          Association of California Life and Health Insurance Companies
          California Association of Health Plans
          California Chamber of Commerce
          California Right to Life Committee, Inc.


          Analysis Prepared by:Rosielyn Pulmano / HEALTH / (916) 319-2097