Bill Text: CA AB32 | 2021-2022 | Regular Session | Amended
Bill Title: Telehealth.
Spectrum: Moderate Partisan Bill (Democrat 23-3)
Status: (Passed) 2022-09-25 - Chaptered by Secretary of State - Chapter 515, Statutes of 2022. [AB32 Detail]
Download: California-2021-AB32-Amended.html
Amended
IN
Senate
June 20, 2022 |
Amended
IN
Assembly
May 24, 2021 |
Amended
IN
Assembly
April 22, 2021 |
Amended
IN
Assembly
February 12, 2021 |
Introduced by Assembly Members Aguiar-Curry and Robert Rivas (Coauthors: Assembly Members Arambula, Bauer-Kahan, (Coauthors: Senators Eggman, Gonzalez, and Wiener) |
December 07, 2020 |
LEGISLATIVE COUNSEL'S DIGEST
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
SECTION 1.
(a) The Legislature finds and declares all of the following:(a)For purposes of this division, the following definitions shall 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.
(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 any of the following:
(A)A person who is licensed under this division.
(B)An associate marriage and family therapist or marriage and family therapist trainee functioning pursuant to Section 4980.43.3.
(C)A qualified autism service provider or qualified autism service professional certified by a national entity pursuant to Section 1374.73 of the Health and Safety Code and Section 10144.51 of the Insurance Code.
(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, including, but not limited to, audiovideo, audio only, such as telephone, and other virtual communication, 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. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.
(b)Before 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 verbal or written 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)This section does not 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 a 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 the patient’s medical information shall apply to telehealth interactions.
(g)All laws and regulations governing professional
responsibility, unprofessional conduct, and standards of practice that apply to a health care provider under the health care provider’s license shall apply to that health care provider while providing telehealth services.
(h)This section shall not apply to a patient under the jurisdiction of the Department of Corrections and Rehabilitation or any other correctional facility.
(i)(1)Notwithstanding any other 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 2290.5 of the Business and Professions Code is amended to read:2290.5.
(a) For purposes of this division, the following definitions shall apply:(a)(1)A contract between a health care service plan and a health care provider for the provision of health care services to an enrollee or subscriber shall specify that the health care service plan shall reimburse the treating or consulting health care provider for the diagnosis, consultation, or treatment of an enrollee or subscriber appropriately delivered through telehealth services on the same basis and to the same extent that the health care service plan is responsible for reimbursement for the same service through in-person diagnosis, consultation, or treatment.
(2)This section does not limit the ability of a health care service plan and a health care provider to negotiate the rate of reimbursement for a health care service provided pursuant to a contract subject to this section. Services that are the same, as determined by the provider’s description of the service on the claim, shall be reimbursed at the same rate whether provided in person or through telehealth. When negotiating a rate of reimbursement for telehealth services for which no in-person equivalent exists, a health care service plan and the provider shall ensure the rate is consistent with subdivision (h) of Section 1367.
(3)This section does not require telehealth reimbursement to be unbundled from other capitated or bundled, risk-based payments.
(4)If a health care service plan delegates responsibility for the performance of the duties described in this section to a contracted entity, including a medical group or independent practice association, then the delegated entity shall comply with this section.
(5)The obligation of a health care service plan to comply with this section shall not be waived if the plan delegates services or activities that the plan is required to perform to its provider or another contracting entity. A plan’s implementation of this section shall be consistent with the requirements of the Health Care Providers’ Bill of Rights, and a material change in the obligations of a plan’s contracting network providers shall be considered a material change to the provider contract, within the meaning of subdivision (b) Section 1375.7.
(b)(1)A health care service plan contract shall specify that the health care service plan shall
provide coverage for health care services appropriately delivered through telehealth services on the same basis and to the same extent that the health care service plan is responsible for coverage for the same service through in-person diagnosis, consultation, or treatment. Coverage shall not be limited only to services delivered by select third-party corporate telehealth providers.
(2)This section does not alter the obligation of a health care service plan to ensure that enrollees have access to all covered services through an adequate network of contracted providers, as required under Sections 1367, 1367.03, and 1367.035, and the regulations promulgated thereunder.
(3)This section does not require a health care service plan to cover telehealth services provided by an out-of-network provider, unless coverage is required under other law.
(c)A health care service plan may offer a contract containing a copayment or coinsurance requirement for a health care service delivered through telehealth services, provided that the copayment
or coinsurance does not exceed the copayment or coinsurance applicable if the same services were delivered through in-person diagnosis, consultation, or treatment. This subdivision does not require cost sharing for services provided through telehealth.
(d)Services provided through telehealth and covered pursuant to this chapter shall be subject to the same deductible and annual or lifetime dollar maximum as equivalent services that are not provided through telehealth.
(e)The definitions in subdivision (a) of Section 2290.5 of the Business and Professions Code apply to this section.
(a)(1)A contract between a health insurer and a health care provider for an alternative rate of payment pursuant to Section 10133 shall specify that the health insurer shall reimburse the treating or consulting health care provider for the diagnosis, consultation, or treatment of an insured or policyholder appropriately delivered through telehealth services on the same basis and to the same extent that the health insurer is responsible for reimbursement for the same service through in-person diagnosis, consultation, or treatment.
(2)This section does not limit the ability of a health insurer and a health care provider to negotiate the rate of reimbursement for a health care service provided pursuant to a contract subject to this section. Services that are the same, as determined by the provider’s description of the service on the claim, shall be reimbursed at the same rate whether provided in person or through telehealth. When negotiating a rate of reimbursement for telehealth services for which no in-person equivalent exists, a health insurer and the provider shall ensure the rate is consistent with subdivision (a) of Section 10123.137.
(3)If a health insurer delegates responsibility for the performance of the duties described in this section to a contracted entity, including a medical group or independent practice association, then the delegated entity shall comply with this section.
(4)The obligation of a health insurer to comply with this section shall not be waived if the insurer delegates services or activities that the insurer is required to perform to its provider or another contracting entity. An insurer’s implementation of this section shall be consistent with the requirements of the Health Care Providers’ Bill of Rights, and a material change in the obligations of an insurer’s contracting network providers shall be considered a material change to the provider contract, within the meaning of subdivision (b) Section 10133.65.
(b)(1)A policy of health insurance that provides benefits through contracts with providers at alternative rates of payment shall specify that the health insurer shall provide coverage for health care services appropriately delivered through telehealth services on the same basis and to the same extent that the health insurer
is responsible for coverage for the same service through in-person diagnosis, consultation, or treatment. Coverage shall not be limited only to services delivered by select third-party corporate telehealth providers.
(2)This section does not alter the existing statutory or regulatory obligations of a health insurer to ensure that insureds have access to all covered services through an adequate network of contracted providers, as required by Sections 10133 and 10133.5 and the regulations promulgated thereunder.
(3)This section does not require a health insurer to deliver health care services through telehealth services.
(4)This section does not require a health insurer to cover telehealth services provided by an out-of-network provider, unless coverage is required under other law.
(c)A health insurer may offer a policy containing a copayment or coinsurance requirement for a health care service delivered through telehealth services, provided that the copayment or coinsurance does not exceed the copayment or coinsurance applicable if the same services were delivered through in-person diagnosis, consultation, or treatment. This subdivision does not require cost sharing for services provided through telehealth.
(d)Services provided through telehealth and covered pursuant to this chapter shall be subject to the same deductible and annual or lifetime dollar maximum as equivalent services that are not provided through telehealth.
(e)The definitions in subdivision (a) of Section 2290.5 of the Business and Professions Code apply to this section.
SEC. 5.SEC. 3.
Section 14087.95 of the Welfare and Institutions Code is amended to read:14087.95.
(a) A county contracting with the department pursuant to this article shall be exempt from Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code for purposes of carrying out the contracts.SEC. 6.SEC. 4.
Section 14092.4 is added to the Welfare and Institutions Code, immediately following Section 14092.35, to read:14092.4.
(a) To enroll individuals in Medi-Cal programs that permit onsite enrollment and recertification of individuals by a provider or county eligibility worker as applicable, the following shall apply:SEC. 5.
Section 14132.100 of the Welfare and Institutions Code is amended to read:14132.100.
(a) The federally qualified health center services described in Section 1396d(a)(2)(C) of Title 42 of the United States Code are covered benefits.SEC. 7.SEC. 6.
Section 14132.721 is added to the Welfare and Institutions Code, immediately following Section 14132.72, to read:14132.721.
(a) Notwithstanding any other law,(c)(1)Notwithstanding the in-person requirements of Section 14132.100, if an enrolled clinic is also a federally qualified health center or a rural health center, the definition of “visit” set forth in subdivision (g) of Section 14132.100 includes a telehealth encounter to the same extent it includes an
in-person encounter.
(2)Health care services furnished through audio-only telehealth, including by telephone, by a federally qualified health center or a rural health clinic, other than mental health services that are excluded from the benefits provided by county mental health plans under the specialty mental health services waiver, shall be reimbursed pursuant to Section 14132.722.
(d)
(e)
(f)
(g)
(h)
SEC. 8.SEC. 7.
Section 14132.722 is added to the Welfare and Institutions Code, immediately following Section 14132.721, to read:(a)(1)Except as described in paragraph (2), the department shall indefinitely continue the telehealth flexibilities in place during the COVID-19 pandemic, including those implemented pursuant to Section 14132.723.
(2)(A)The department shall reimburse each federally qualified health center and rural health clinic for health care services furnished through audio-only telehealth, including telephone, at the applicable prospective payment system per-visit rate, consistent with Section 14132.721, until the earlier of January 1, 2025, or the date that the federally qualified health center or rural health clinic elects to participate in an alternative payment methodology described in subdivision (d).
(B)Notwithstanding subparagraph (A), mental health services that are excluded from the benefits provided by county mental health plans under the specialty mental health services waiver, furnished through audio-only telehealth, shall continue to be reimbursed at the applicable prospective payment system per-visit rate indefinitely, except if the federally qualified health center or rural health clinic elects an alternative payment methodology that covers those services.
(b)(1)By January 2022, the department shall convene an advisory group that includes representatives from community health centers, designated public hospitals, Medi-Cal managed care plans, consumer groups, labor
organizations, behavioral health providers, counties, health care districts formed pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, and other Medi-Cal providers. The department shall utilize any potential federal funding or other nonstate general funding that may be available to support the implementation of this subdivision.
(2)The advisory group shall provide input to the department on the development of a revised Medi-Cal telehealth policy that promotes all of the following principles:
(A)Telehealth shall be used as a means to promote timely and patient-centered access to health care.
(B)Patients, in conjunction with their providers, shall be offered their choice of service delivery mode. Patients shall retain the right to receive health care in person.
(C)Confidentiality and security of patient information shall be protected.
(D)Usual standard of care requirements shall apply to services provided via telehealth, including quality, safety, and clinical effectiveness.
(E)The department shall consider disparities in the utilization of, and access to, telehealth, and shall support patients and providers in increasing access to the technologies needed to use telehealth.
(F)When the care provided during a telehealth visit is commensurate with what would have been provided in person, payment shall also be commensurate.
(c)(1)
14132.722.
(a) By July(2)
(d)(1)The department, in consultation with affected stakeholders, including, but not limited to, the California Association of Public Hospitals and Health Systems and the California Primary Care Association, shall develop one or more federally permissible alternative payment models, consistent with Section 1396a(bb)(6) of Title 42 of the United States Code, that federally qualified health centers and rural health clinics may elect to participate in.
(2)(A)The alternative payment models shall be designed to enable the continued provision of high-quality health care, while furthering the goals of the Medi-Cal program to improve access and equity, and incentivize and support clinic infrastructure improvements.
(B)To the extent that an alternative payment model includes a separate per-visit payment rate for audio-only telehealth visits, that payment rate shall be less than the rate the federally qualified health center or rural health clinic receives for an in-person visit. This subparagraph shall not apply with respect to mental health services furnished through audio-only telehealth that are excluded from the benefits provided by county mental health plans under the specialty mental health services waiver.
(3)The department shall submit and seek federal approval of the state plan amendment necessary for the implementation of this subdivision, to be effective no later than January 1, 2025. This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and not otherwise jeopardized.
SEC. 8.
Section 14132.725 of the Welfare and Institutions Code is repealed.(a)To the extent that federal financial participation is available, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for health care services provided by asynchronous store and forward, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code. Services appropriately provided through the store and forward process are subject to billing and reimbursement policies developed by the department.
(b)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, and make specific this section by means
of all-county letters, provider bulletins, and similar instructions.
SEC. 9.
Section 14132.725 is added to the Welfare and Institutions Code, to read:14132.725.
(a) For purposes of this section, the following definitions apply:SEC. 10.
Section 14132.731 of the Welfare and Institutions Code is repealed.(a)A Drug Medi-Cal certified provider shall receive reimbursement for individual counseling services provided through telehealth, as defined in Section 2290.5 of the Business and Professions Code, by a licensed practitioner of the healing arts or a registered or certified alcohol or other drug counselor, when medically necessary and in accordance with the Medicaid state plan.
(b)This section shall be implemented only to the extent federal financial participation is available and only if any necessary federal approvals have been obtained.
(c)The department shall adopt regulations by July 1, 2022, to implement this section in accordance with the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(d)Notwithstanding the rulemaking provisions of the Administrative Procedure Act, the department may, if it deems it appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department, until regulations are adopted.
SEC. 11.
Section 14132.731 is added to the Welfare and Institutions Code, to read:14132.731.
(a) (1) This subdivision applies to either of the following:SEC. 12.
Section 14197 of the Welfare and Institutions Code is amended to read:14197.
(a) It is the intent of the Legislature that the department implement and monitor compliance with the time and distance requirements set forth in Sections 438.68, 438.206, and 438.207 of Title 42 of the Code of Federal Regulations and this section, to ensure that all Medi-Cal managed care covered services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as those standards were enacted in May 2016.(f)
(g)
(h)
(i)
(j)
(k)