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AB-2164 E-Consult Services and Telehealth Assistance Program.(2019-2020)

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Date Published: 02/11/2020 09:00 PM
AB2164:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 2164


Introduced by Assembly Member Robert Rivas
(Principal coauthor: Assembly Member Wood)
(Coauthors: Assembly Members Flora, Eduardo Garcia, Mathis, Mayes, and Salas)

February 11, 2020


An act to add Article 10 (commencing with Section 100580) to Chapter 3 of Part 1 of Division 101 of the Health and Safety Code, relating to health care.


LEGISLATIVE COUNSEL'S DIGEST


AB 2164, as introduced, Robert Rivas. E-Consult Services and Telehealth Assistance Program.
Existing law establishes the State Department of Health Care Services, and requires the department to administer various health programs. Existing law authorizes the department to award grants for specified programs, including studies of various diseases and treatment methodologies.
This bill would create the E-Consult Services and Telehealth Assistance Program within the department to award grants, contingent upon an appropriation, to health center-controlled networks, health centers, and rural health clinics to conduct projects to implement and test the effectiveness of e-consult services and related telehealth services. The bill would require a health center-controlled network, health center, or rural health clinic to meet specified criteria to be eligible for a grant, and would require a project awarded a grant to address specified objectives. The bill would limit an awarded grant to a term of no more than 5 years. No later than 180 days after the completion of the last grant-funded projects, the bill would require the department to submit a report to the Legislature that, among other things, provides an overview of supported projects and identifies successes and failures.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 The Legislature finds and declares the following:
(a) Telehealth, or the delivery of health care services through electronic information technology, is an effective means to ensure patients, regardless of location, can access safe and effective health care. One method of telehealth to better serve patients and improve primary care providers’ scope of practice are e-consults, which are asynchronous electronic consultations between health care providers—often a specialist and primary care provider.
(b) E-consults help patients avoid long wait times, traveling great distances, and missed income or childcare expenditures, issues that have a greater impact on the safety net population. Growth of e-consult services improve access to specialty care, expand specialists’ bandwidth, and further educate primary care physicians at relatively low cost. To facilitate the adoption and continued use of e-consult services for Medi-Cal providers, the funding support designated in this bill is necessary to obtain equipment and technology, develop workflows, and provide training. This funding is the purpose of this legislation.
(c) To further avoid health inequities, the state shall ensure coverage and reimbursement parity is provided to both Medi-Cal primary care provider and Medi-Cal specialty care provider grant participants at distant sites who engage in asynchronous electronic consultations, for the purposes of securing the medical opinion and advice of specialty Medi-Cal providers. This reimbursement should be provided regardless of modality or setting.

SEC. 2.

 Article 10 (commencing with Section 100580) is added to Chapter 3 of Part 1 of Division 101 of the Health and Safety Code, to read:
Article  10. E-Consult Services and Telehealth Assistance Program

100580.
 The E-Consult Services and Telehealth Assistance Program is hereby created within the State Department of Health Care Services.

100581.
 For purposes of this article:
(a) “Certified EHR technology” means a qualified electronic health record as defined in Section 300jj(1) of Title 42 of the United States Code.
(b) “E-consult service” means synchronous or asynchronous, consultative, health-care-provider-to-health-care-provider communications that occur within a shared certified EHR technology or secure internet-based platform and are primarily intended to provide specialty expertise to treating clinicians without requiring a direct interaction between the patient and the specialist. An e-consult service ordinarily involves a treating clinician sending information regarding the patient and a consultation request to a specialist, who may then respond in any of a number of ways, including providing requested feedback, asking for additional information, recommending certain studies or examinations, or initiating the scheduling of an appointment.
(c) “Health center” means a center as defined in Section 254b(a) of Title 42 of the United States Code.
(d) “Health center-controlled network” means a network that is owned and controlled by health centers, as described in Section 254b(e)(1)(C) of Title 42 of the United States Code.
(e) “Primary care physician” is a physician who has the responsibility to provide initial and primary care to patients, to maintain the continuity of patient care, and to initiate a referral for specialist care. A primary care physician shall be either a physician who has limited their practice of medicine to general practice or who is a board-certified or board-eligible internist, pediatrician, obstetrician-gynecologist, or family practitioner.
(f) “Specialist” means a physician who is board certified or board eligible in the specialty of medical care provided.
(g) “Related telehealth services” means telehealth services arising out of or incident to an e-consult service, such as laboratory tests, diagnostic imaging, or a later interaction between a specialist and a patient.
(h) “Rural health clinic” means a clinic as defined in Section 1395x(aa)(2) of Title 42 of the United States Code.
(i) “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.

100582.
 (a) The department may award grants to eligible health center-controlled networks, health centers, and rural health clinics to conduct projects to implement and test the effectiveness of e-consult services and related telehealth services furnished at those networks, centers, and clinics for purposes of addressing the objectives described in subdivision (b). Funding for the grant program shall be contingent upon an appropriation in the annual Budget Act.
(b) A project conducted using a grant awarded pursuant to subdivision (a) shall address the following objectives:
(1) Improving patient access to specialty care.
(2) Reducing specialty care patient wait times.
(3) Reducing patient specialty referrals.
(4) Reducing patient miles traveled for specialty care consultations.
(5) Increasing support for primary care physicians and other providers of primary care as demonstrated by job satisfaction measures.
(6) Increasing patient satisfaction as demonstrated by quality surveys.
(7) Increasing health care cost savings.
(8) Other objectives the department may identify.
(c) A grant awarded pursuant to subdivision (a) shall be for a term of no more than five years.
(d) Grant funding awarded to a health center-controlled network, health center, or rural health clinic pursuant to subdivision (a) shall only be used for the following:
(1) Conducting assessments of a participating facility’s infrastructure, including broadband, equipment, and software, clinical objectives, and staffing plans.
(2) Based on assessment findings, developing and assisting in the execution of equipment and software procurement, defining clinical objectives, developing adequate staffing plans, and implementing e-consult services and related telehealth services program plans.
(3) Training participating facility staff to properly utilize technology and implement programs.
(4) Providing clinical workflow training to support program implementation.
(5) Providing integrated certified EHR technology capabilities to support live video, if applicable, and e-consult services.
(6) Integrating the facility with live e-consult service support providers and networks that meet the patient objectives of the network, center, or clinic.
(7) Procuring appropriate information technology and undertaking minor alterations of physical space.
(8) Otherwise carrying out the project to address the objectives described in subdivision (b).
(e) A location of a health center or rural health clinic shall qualify to participate in a program established pursuant to this section if the center or clinic can sufficiently demonstrate that the location meets both of the following criteria:
(1) Lacks sufficient access to care provided by specialists.
(2) Has not already implemented a program of e-consult services and related telehealth services similar to that described in this section.
(f) To be eligible to receive a grant pursuant to subdivision (a), an entity shall:
(1) Be either of the following:
(A) A health center-controlled network that demonstrates, to the satisfaction of the department, all of the following:
(i) Sufficient expertise and experience in the successful provision of the technical and other assistance required for health centers and rural health clinics to conduct a project in accordance with this section.
(ii) Evidence of sufficient binding participation commitments received from eligible health centers and rural health clinics.
(iii) The ability to assist eligible health centers and rural health clinics to conduct e-consult services with specialists and related telehealth services.
(iv) A likelihood of successfully accomplishing the program objectives as identified in subdivision (b).
(B) A health center or rural health clinic that demonstrates, to the satisfaction of the department, all of the following:
(i) Sufficient expertise and ability to implement on its own behalf the technical and other assistance required to conduct a project in accordance with this section.
(ii) A likelihood of successfully implementing a program of e-consult services with specialists and related telehealth services.
(iii) A likelihood of successfully accomplishing the program objectives as identified in subdivision (b).
(2) Submit to the department an application in a form and manner as determined by the department. An application shall demonstrate, to the satisfaction of the department, all of the following:
(A) In the case of an applicant that is a health center-controlled network, the intention of a sufficient minimum number of eligible health centers to participate in the program through the network and a plan for recruiting additional centers to participate.
(B) The qualification of proposed facility locations that will participate in the program.
(C) The requisite experience, expertise, and capacity.
(D) The likelihood of successfully accomplishing the program objectives as identified in subdivision (b).
(E) The internal program metrics that will be employed to demonstrate satisfaction of the program objectives and the information to be collected and provided to the department as necessary to conduct a program evaluation.
(g) No later than 180 days after the date of completion of the last projects funded under this section, the department shall submit to the Legislature a report, including an evaluation, on the projects that addresses all of the following:
(1) An overview of supported projects and identification of areas of success and failure.
(2) Policies, practices, and organizational approaches that either facilitate or impede the effective use of e-consult services, including personnel training and support, technology usability, workflow, and provider communication.
(3) Relative effectiveness of consultations provided by specialists in improving outcomes, quality of care, and efficiency with respect to different specialties, clinical conditions, complexity, patient types, or other issues.
(4) The extent to which information shared in the e-consult services process is sufficient, accurate, and actionable to effectively facilitate care improvement, and whether those bidirectional information flows can be standardized.
(5) The extent to which e-consults facilitate continuity of care.
(6) Any issues arising related to maintaining the privacy of personal health information, ensuring cybersecurity, and other information security issues.
(7) The extent to which e-consult services contribute to improved health outcomes and metrics that can facilitate that evaluation.
(8) Any unintended or adverse results from utilizing e-consult services.
(h) The report required to be submitted pursuant to subdivision (g) shall be submitted in compliance with Section 9795 of the Government Code.