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AB-1771 Telephone visits.(2013-2014)

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Amended  IN  Senate  June 24, 2014
Amended  IN  Senate  June 09, 2014
Amended  IN  Assembly  May 28, 2014
Amended  IN  Assembly  May 23, 2014
Amended  IN  Assembly  May 06, 2014
Amended  IN  Assembly  March 11, 2014

CALIFORNIA LEGISLATURE— 2013–2014 REGULAR SESSION

Assembly Bill
No. 1771

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   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.