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AB-1494 Medi-Cal: telehealth: state of emergency.(2019-2020)

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Date Published: 02/22/2019 09:00 PM
AB1494:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill No. 1494


Introduced by Assembly Member Aguiar-Curry
(Coauthors: Assembly Members Levine and Wood)
(Coauthors: Senators Dodd and McGuire)

February 22, 2019


An act to add Section 14132.723 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 1494, as introduced, Aguiar-Curry. Medi-Cal: telehealth: state of emergency.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Under existing law, in-person contact between a health care provider and a patient is not required under the Medi-Cal program for services appropriately provided through telehealth, as defined, subject to reimbursement policies adopted by the department to compensate a licensed health care provider who provides health care services through telehealth that are otherwise reimbursed pursuant to the Medi-Cal program. Existing law, for purposes of payment for covered treatment or services provided through telehealth, prohibits the department from limiting the type of setting where services are provided for the patient or by the health care provider.
This bill would provide, only to the extent that federal financial participation is available, that neither face-to-face contact nor a patient’s physical presence on the premises of an enrolled community clinic, is required for services provided by the clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as specified. The bill would authorize the department to apply this provision to services provided by another enrolled fee-for-service Medi-Cal provider, clinic, or facility. The bill would require that telehealth services, telephonic services, and other specified services be reimbursable when provided by one of those entities during or immediately following a state of emergency, as specified.
This bill would require the department to seek federal approval of any necessary state plan amendments or waivers to implement these provisions, and would authorize the department to implement the provisions by all-county letters, provider bulletins, or similar instructions.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 14132.723 is added to the Welfare and Institutions Code, to read:

14132.723.
 (a) (1) Notwithstanding any other law, and only to the extent that federal financial participation is available, neither face-to-face contact nor a patient’s physical presence on the premises shall be required for services provided by an enrolled community clinic to a Medi-Cal beneficiary during or immediately following a state of emergency, as described in Section 8628.5 of the Government Code.
(2) Notwithstanding any other law, and only to the extent that federal financial participation is available, the department may apply paragraph (1) to services provided by another enrolled fee-for-service Medi-Cal provider, clinic, or facility.
(b) For purposes of this section, the following terms shall have the following meanings:
(1) “Enrolled community clinic” shall mean a community clinic licensed under subdivision (a) of Section 1204 of the Health and Safety Code, an intermittent clinic exempt from licensure under subdivision (h) of Section 1206 of the Health and Safety Code, a tribal clinic exempt from licensure under subdivision (c) of Section 1206 of the Health and Safety Code, or an outpatient setting conducted, maintained, or operated by a federally recognized Indian Tribe, Tribal Organization, or Urban Indian Organization, as defined in Section 1603 of Title 25 of the United States Code, that is certified, as applicable, and enrolled in good standing as a Medi-Cal provider or, in the case of an intermittent site, is added to a parent clinic’s provider master file under Section 14043.15. An outpatient setting that operates as a federally qualified health center (FQHC) or a rural health center (RHC) shall also qualify as an enrolled community clinic, regardless of its license type or license-exempt status.
(2) “Immediately following” shall mean within 90 calendar days after the conclusion of the proclaimed state of emergency. Under extraordinary circumstances, including, but not limited to, the destruction of an enrolled community clinic site, or the destruction of a Medi-Cal provider site, clinic, or facility approved by the department pursuant to paragraph (2) of subdivision (a), the department may determine in its discretion or at the direction of the Governor that the period of time immediately following the conclusion of a state of emergency should be extended beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
(3) “Premises” shall mean either of the following, as applicable:
(A) A site located within the four walls of the enrolled community clinic, at the address listed on the primary care clinic license or listed in the provider master file.
(B) A site located within the four walls of the enrolled fee-for-service Medi-Cal provider, clinic, or facility, at the address listed on its license or listed in the provider master file.
(4) “Telehealth” shall have the same meaning as that term is defined in Section 2290.5 of the Business and Professions Code.
(c) The following services shall be reimbursable when provided by an enrolled community clinic during or immediately following a state of emergency:
(1) Telehealth services.
(2) Telephonic services.
(3) All covered benefit services that are otherwise reimbursable to an enrolled community clinic but that are provided somewhere other than on the enrolled community clinic’s premises, including, but not limited to, services provided at a temporary shelter, a patient’s home, or any location other than the location identified on the primary care clinic license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
(d) For an enrolled fee-for-service Medi-Cal provider, clinic, or facility that has been approved by the department pursuant to paragraph (2) of subdivision (a), the following services shall be reimbursable when provided by that provider, clinic, or facility during or immediately following a state of emergency:
(1) Telehealth services.
(2) Telephonic services.
(3) All covered benefit services that are otherwise reimbursable to the Medi-Cal provider, clinic, or facility but that are provided somewhere other than on the provider’s, clinic’s, or facility’s premises, including, but not limited to, services provided at a temporary shelter, a patient’s home, or any location other than the location identified on the license or in the provider master file, if the services are provided somewhere located within the boundaries of the emergency proclamation.
(e) For purposes of paragraph (1) of subdivision (c) and paragraph (1) of subdivision (d), and consistent with Section 14132.72, the department shall ensure its reimbursement policies reflect the intent of the Legislature to permit reimbursement for all telehealth services appropriately provided by an enrolled community clinic, or, if approved by the department pursuant to paragraph (2) of subdivision (a), by an enrolled fee-for-service Medi-Cal provider, clinic, or facility, respectively, during or immediately following a state of emergency. Nothing in this subdivision is intended to limit reimbursement for, or coverage of, or to reduce access to, services provided through telehealth on or before the enactment of this section.
(f) 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, or similar instructions.
(g) The department shall seek federal approval of any necessary state plan amendments or waivers to implement this section.