Bill Text: CA AB1771 | 2013-2014 | Regular Session | Amended
Bill Title: Telephone visits.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2014-08-14 - In committee: Held under submission. [AB1771 Detail]
Download: California-2013-AB1771-Amended.html
BILL NUMBER: AB 1771 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 24, 2014
AMENDED IN SENATE JUNE 9, 2014
AMENDED IN ASSEMBLY MAY 28, 2014
AMENDED IN ASSEMBLY MAY 23, 2014
AMENDED IN ASSEMBLY MAY 6, 2014
AMENDED IN ASSEMBLY MARCH 11, 2014
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. Telephone visits.
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, 2016, to cover telephone visits, as
defined, provided by a physician contracted
physician or a contracted qualified nonphysician health care provider
. The bill would provide that a health care service plan or a
health insurer is not required to reimburse separately for specified
telephone visits, including a telephone visit provided as part of a
bundle of services reimbursed on a capitated or prepaid
basis or using an episode-based payment methodology in
a specified manner . Because a willful violation of the bill's
requirements by a health care service plan 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:
SECTION 1. Section 1374.14 is added to the Health and Safety Code,
to read:
1374.14. (a) A health care service plan shall, with respect to
plan contracts issued, amended, or renewed on or after January 1,
2016, cover telephone visits provided by a physician
contracted physician or a contracted qualified
nonphysician health care provider .
(b) This section shall not be construed to authorize a health care
service plan to require the use of telephone visits when the
physician or nonphysician health care provider has
determined that providing services by telephone is not medically
appropriate.
(c) This section shall not be construed to alter the scope of
practice of a health care provider or authorize the delivery of
health care services in a setting, or in a manner, that is not
otherwise authorized by law.
(d) All laws regarding the confidentiality of health information
and a patient's rights to his or her medical information shall apply
to telephone visits.
(e) This section shall not apply to a patient under the
jurisdiction of the Department of Corrections and Rehabilitation or
any other correctional facility.
(f) Notwithstanding subdivision (a), a health care service plan
shall not be required to reimburse separately for any of the
following:
(1) A telephone visit that is related to a service or procedure
provided to an established patient within a reasonable period of time
prior to the telephone visit, as recognized by the American Medical
Association, Current Procedural Terminology codes.
(2) A telephone visit that leads to a related service or procedure
provided to an established patient within a reasonable period of
time, or within an applicable postoperative period, as recognized by
the American Medical Association, Current Procedural Terminology
codes.
(3) A telephone visit provided as part of a bundle of services for
which reimbursement is provided for on a capitated or prepaid basis
or for which reimbursement is provided for using an episode-based
payment methodology.
(4) A telephone visit that is not initiated by the patient.
(g) Nothing in this section shall be construed to prohibit a
health care service plan from requiring reasonable documentation
specific to telephone visits.
(h) For purposes of this section, the following definitions apply:
(1) "Established patient" means a patient who, within the three
years immediately preceding the telephone visit, has received
professional services from the provider or another provider of the
exact same specialty and subspecialty who belongs to the same group
practice.
(2) "Nonphysician health care provider" means a provider, other
than a physician, who is licensed pursuant to Division 2 (commencing
with Section 500) of the Business and Professions Code.
(2)
(3) "Telephone visit" means evaluation and management
services that meets all of the following criteria:
(A) Do not require a face-to-face visit with the physician or
nonphysician health care provider .
(B) Are provided remotely through live voice communication to an
established patient, or parents or guardians of a minor who is an
established patient.
(C) Are initiated by the patient, or the parents or guardians of a
minor who is a patient. For purposes of this section, "initiated by
the patient" excludes a visit for which a provider or staff contacts
a patient to initiate a service.
(D) Are recognized by the American Medical Association, Current
Procedural Terminology codes.
SEC. 2. Section 10123.855 is added to the Insurance Code, to read:
10123.855. (a) A health insurer shall, with respect to policies
of health insurance issued, amended, or renewed on or after January
1, 2016, cover telephone visits provided by a contracted
physician or a contracted qualified nonphysician health care
provider .
(b) This section shall not be construed to authorize a health
insurer to require the use of telephone visits when the physician
or nonphysician health care provider has determined that
providing services by telephone is not medically appropriate.
(c) This section shall not be construed to alter the scope of
practice of a health care provider or authorize the delivery of
health care services in a setting, or in a manner, that is not
otherwise authorized by law.
(d) All laws regarding the confidentiality of health information
and a patient's rights to his or her medical information shall apply
to telephone visits.
(e) This section shall not apply to a patient under the
jurisdiction of the Department of Corrections and Rehabilitation or
any other correctional facility.
(f) Notwithstanding subdivision (a), a health insurer shall not be
required to reimburse separately for any of the following:
(1) A telephone visit that is related to a service or procedure
provided to an established patient within a reasonable period of time
prior to the telephone visit, as recognized by the American Medical
Association, Current Procedural Terminology codes.
(2) A telephone visit that leads to a related service or procedure
provided to an established patient within a reasonable period of
time, or within an applicable postoperative period, as recognized by
the American Medical Association, Current Procedural Terminology
codes.
(3) A telephone visit provided as part of a bundle of services for
which reimbursement is provided for on a capitated or
prepaid basis or for which reimbursement is provided for using an
episode-based payment methodology separate
reimbursement is not consistent with the American Medical
Association, Current Procedural Terminology codes .
(4) A telephone visit that is not initiated by the patient.
(g) Nothing in this section shall be construed to prohibit a
health insurer from requiring reasonable documentation specific to
telephone visits.
(h) For purposes of this section, the following definitions apply:
(1) "Established patient" means a patient who, within the three
years immediately preceding the telephone visit, has received
professional services from the provider or another provider of the
exact same specialty and subspecialty who belongs to the same group
practice.
(2) "Nonphysician health care provider" means a provider, other
than a physician, who is licensed pursuant to Division 2 (commencing
with Section 500) of the Business and Professions Code.
(2)
(3) "Telephone visit" means evaluation and management
services that meets all of the following criteria:
(A) Do not require a face-to-face visit with the physician or
nonphysician health care provider .
(B) Are provided remotely through live voice communication to an
established patient, or parents or guardians of a minor who is an
established patient.
(C) Are initiated by the patient, or the parents or guardians of a
minor who is a patient. For purposes of this section, "initiated by
the patient" excludes a visit for which a provider or staff contacts
a patient to initiate a service.
(D) Are recognized by the American Medical Association, Current
Procedural Terminology codes.
SEC. 3. 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.
