Today's Law As Amended


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SB-365 E-consult service.(2021-2022)



As Amends the Law Today


SECTION 1.
 (a) The Legislature finds and declares all of the following:
(1) Telehealth is an effective means to ensure patients can access safe and effective health care regardless of location.
(2) Electronic consultation services, which are also referred to as “e-consults,” are a method of telehealth used to provide patient-centered care and improve treating or requesting providers’ ability to better manage their patients’ care.
(3) The State Department of Health Care Services has an existing telehealth policy that allows for reimbursement for e-consult services delivered by consultant providers who are usually specialists.
(4) However, under that policy, reimbursement is not authorized for any requesting or treating providers, who are usually primary care providers. Moreover, federally qualified health centers and rural health clinics are prohibited from seeking reimbursement for e-consult services that their requesting or treating and consultant providers render.
(5) Current department policy limits the use of e-consult services, and thereby hinders access to care. These services provide a critical way to improve access to care in California’s safety net.
(6) E-consult services offer benefits to patients, including improved specialty visit wait times and patient satisfaction rates, and reduced costs associated with in-person office visits, including patient travel time, time off work, and associated required childcare.
(7) E-consult services offer benefits to primary care providers, including reinforcing the medical home, improving provider satisfaction, and addressing current and future patient issues through specialist consultation obtained through e-consult services.
(8) E-consult services also benefit specialists by improving the readiness and appropriateness of referrals, reducing no-show rates, improving provider satisfaction, and bettering overall access to specialty care.
(b) Therefore, it is the intent of the Legislature to enact legislation that would do both of the following:
(1) Ensure coverage and utilization of e-consult services under the Medi-Cal program.
(2) Recognize the benefits of e-consult services that have been found to have particular impact on the safety net population, including Medi-Cal beneficiaries and uninsured Californians.

SEC. 2.

 Section 14132.72 of the Welfare and Institutions Code is amended to read:

14132.72.
 (a) For purposes of this section, both of the following apply:
(a) (1)  For purposes of this section, the  The  definitions in subdivision (a) of Section 2290.5 of the Business and Professions Code shall apply. Code. 
(2) “Electronic consultation service,” or “e-consult service,” means an interprofessional health record assessment and management service initiated by a treating or requesting provider and delivered by a consultative provider, including a written report to the patient’s treating or requesting provider. An e-consult service ordinarily involves a treating or requesting provider sending information regarding the patient and a consultation request to a consultative provider, usually a specialist provider, 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.
(b) It is the intent of the Legislature to recognize the practice of telehealth as a legitimate means by which an individual may receive health care services from a health care provider without in-person contact with the provider.
(c) In-person contact between a health care provider and a patient shall not be required under the Medi-Cal program for services appropriately provided through telehealth, 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.  Nothing in this section or This section and  the Telehealth Advancement Act of 2011 shall be construed to  do not  conflict with or supersede the provisions of  former  Section 14091.3 of this code  or any other existing state laws or regulations related to reimbursement for services provided by a noncontracted provider.
(d) The department shall not require a health care provider to document a barrier to an in-person visit for Medi-Cal coverage of services provided via telehealth.
(e) For the purposes of payment for covered treatment or services provided through telehealth, the department shall not limit the type of setting where services are provided for the patient or by the health care provider.
(f) (1) An e-consult service shall be reimbursable under the Medi-Cal program for an enrolled provider, as described in subdivision (h) of Section 14043.1, including a federally qualified health center or rural health clinic, as defined in subsection (aa) of Section 1395x of Title 42 of the United States Code, and described in Section 14132.100, if a provider renders that service.
(2) The department shall seek any federal waivers and approvals necessary to implement this subdivision.
(3) This subdivision shall only be implemented to the extent that the department obtains necessary federal approval of federal matching funds.
(f) (g)  Nothing in this section shall be interpreted to  This section does not  authorize the department to require the use of telehealth when the health care provider has determined that it is not appropriate. inappropriate. 
(g) (h)  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.