BILL NUMBER: AB 2507 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 26, 2016
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 video communications, telephone
communications, email communications, and synchronous text or chat
conferencing communications and telephone
communications 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 it is not
appropriate 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
altering the provider-patient relationship based
on the modality utilized for services appropriately provided through
telehealth. 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.
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 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 transfers, including, but
not limited to, including video
communications, telephone communications, email communications, and
synchronous text or chat conferencing. communications
and telephone communications.
(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 oral, written, or
digital 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 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) A health care service plan shall not 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) A health care service plan shall not 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 law, 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.
(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. it is not
appropriate. Nothing in this section shall preclude a patient from
receiving in-person health care delivery services.
(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.
(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.
(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.
(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 alter the
provider-patient relationship based on the modality utilized
for services appropriately provided through telehealth.
(j) Notwithstanding any other law, this section shall not be
interpreted to prohibit a health care service plan from undertaking a
utilization review of telehealth services, provided that the
utilization review is made in the same manner as a utilization review
for equivalent services when provided in person or by other means.
(k) 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.
(l) 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.
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.
(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. it is not
appropriate. Nothing in this section shall preclude a patient from
receiving in-person health care delivery services.
(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.
(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.
(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.
(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 alter the provider-patient
relationship based on the modality utilized for services
appropriately provided through telehealth.
(i) Notwithstanding any other law, this section shall not be
interpreted to prohibit a health insurer from undertaking a
utilization review of telehealth services, provided that the
utilization review is made in the same manner as a utilization review
for equivalent services when provided in person or by other means.
(j) 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.
(k) 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.
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.