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

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Date Published: 07/11/2019 09:00 PM
AB1494:v94#DOCUMENT

Amended  IN  Senate  July 11, 2019
Amended  IN  Senate  June 13, 2019
Amended  IN  Assembly  May 16, 2019
Amended  IN  Assembly  April 11, 2019
Amended  IN  Assembly  March 28, 2019

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 Sections 14132.723 and 14132.724 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 1494, as amended, 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 and federal approval is obtained, that neither face-to-face contact nor a patient’s physical presence on the premises of an enrolled community clinic, clinic is required for services provided by the clinic to a Medi-Cal beneficiary during or immediately following a proclamation declaring a state of emergency. 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 during or immediately following a state of emergency. 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.
The bill would require the department, on or before March 1, 2020, to establish a stakeholder process to assist the department in developing guidance for those entities to facilitate reimbursement for the above-described services, and, on or before July 1, 2020, to issue the specified guidance, including certain instructions on the submission of claims for telehealth or telephonic services. The bill would authorize the department to implement the provisions by various means, including provider bulletins, and would require the department to adopt regulations, for purposes of the guidance, by January 1, 2024.
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 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 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 during or immediately following a state of emergency.
(b) For purposes of this section, the following terms have the following meanings:
(1) (A) “Enrolled community clinic” means 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 clinic operated by the state or any of its political subdivisions, including, but not limited to, the University of California or a city or county that is exempt from licensure under subdivision (b) 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.
(B) An outpatient setting that operates as a federally qualified health center (FQHC) or a rural health center (RHC) shall qualify as an enrolled community clinic, regardless of its license type or license-exempt status.
(2) “Immediately following” means within up to 90 calendar days after the conclusion of the proclaimed state of emergency. emergency, as deemed appropriate by the department. Under extraordinary circumstances, including, but not limited to, the destruction of an enrolled location, as described in subdivision (a), the department may extend, in its discretion or at the direction of the Governor, the period of time immediately following the conclusion of a state of emergency beyond 90 calendar days and for as long as is necessary for the health and safety of the public.
(3) (A) “Premises” means either of the following, as applicable:
(i) A site located within the four walls of the enrolled community clinic, and at the address listed either on the primary care clinic license or in the provider master file.
(ii) A site located within the four walls of the enrolled fee-for-service Medi-Cal provider, clinic, or facility, and at the address listed either on its license or in the provider master file.
(B) For purposes of an FQHC or RHC, “premises” include a site located outside of the four walls of the FQHC or RHC, and at an address other than the address listed on its license or in the provider master file, but within the boundaries of the proclamation declaring the state of emergency.
(4) “Telehealth” has the same meaning as provided in Section 2290.5 of the Business and Professions Code.
(c) The following services shall be reimbursable when provided by an enrolled community clinic or an enrolled provider, clinic, or facility approved by the department pursuant to paragraph (2) of subdivision (a) during or immediately following a state of emergency:
(1) Telehealth services, including services provided by the enrolled community clinic or approved enrolled provider, clinic, or facility at a distant site location, whether on or off the premises, to a Medi-Cal beneficiary located at an originating site, which includes the beneficiary’s home, temporary shelter, or any other location, if the services are provided somewhere located within the boundaries of the proclamation declaring the state of emergency.
(2) Telephonic services.
(3) Covered benefit services that are otherwise reimbursable to an FQHC or RHC, but that are provided somewhere off the premises, including, but not limited to, at a temporary shelter, a Medi-Cal beneficiary’s home, or any location other than the premises, but within the boundaries of the proclamation declaring the state of emergency.
(d) For purposes of paragraph (1) of subdivision (c), and consistent with Section 14132.72, the department shall ensure its reimbursement policies reflect the intent of the Legislature to authorize reimbursement for 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. This subdivision does not limit reimbursement for, or coverage of, or reduce access to, services provided through telehealth on or before the enactment of this section.
(e) 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, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action.
(f) The department shall seek federal approval of any necessary state plan amendments or waivers to implement this section.

SEC. 2.

 Section 14132.724 is added to the Welfare and Institutions Code, to read:

14132.724.
 (a) (1) On or before March 1, 2020, the department shall establish a stakeholder process to assist the department in developing guidance for enrolled community clinics and other enrolled fee-for-service Medi-Cal providers, clinics, or facilities that are subject to Section 14132.723 in order to facilitate reimbursement for services provided pursuant to Section 14132.723, whether those services are provided at a health facility, a shelter, the Medi-Cal beneficiary’s home, or any other location within the boundaries of the emergency proclamation for the state of emergency, as described in Section 8628.5 of the Government Code.
(2) The stakeholder process shall include, but is not limited to, the department conducting at least two meetings with stakeholders.
(A) The stakeholders shall include, but are not limited to, all of the following:
(i) Representatives of licensed community clinics, public hospitals, and Medi-Cal managed care plans that contract with the department under the Medi-Cal program.
(ii) At least two representatives of federally qualified health centers or rural health centers, or both.
(iii) At least one outpatient setting exempt from licensure, such as an intermittent clinic, as defined in subdivision (h) of Section 1206 of the Health and Safety Code.
(B) The director shall ensure that representatives from the applicable programs within the department engage in the stakeholder process, meaningfully address any issues or concerns raised by stakeholders, and work to resolve any identified obstacles.
(b) On or before July 1, 2020, the department shall issue, and shall publish on its internet website, the guidance developed pursuant to the stakeholder process described in subdivision (a). The guidance shall include, at a minimum, all of the following information:
(1) Instructions, including examples, describing how enrolled community clinics and other enrolled fee-for-service Medi-Cal providers, clinics, or facilities submit claims for telehealth or telephonic services, as described in Section 14132.723, to Medi-Cal beneficiaries located outside the premises of the enrolled community clinic or other enrolled fee-for-service Medi-Cal provider, clinic, or facility during or immediately following a state of emergency.
(2) Direction to Medi-Cal managed care plans on paying any claims submitted in accordance with the guidance issued under this section, including that Medi-Cal managed care plans contracting with the department under the Medi-Cal program are responsible for ensuring their delegated payers comply with all applicable federal and state laws, regulations, contract requirements, and any department-issued guidance related to the provision of services by enrolled community clinics or other providers, clinics, or facilities during or immediately following a state of emergency.
(3) (A) Identification of services, provided during or immediately following a state of emergency, that may be provided solely through a telephonic visit, and identification of services that require other forms of telehealth, such as a live, synchronous video interaction, asynchronous store and forward, or an interactive telecommunications system.
(B) Identification of telephonic, facsimile, email, or remote patient monitoring devices that may be used and reimbursed as part of a Medi-Cal covered service, including, but not limited to, laboratory, x-ray, or physician services, subject to any required federal approvals or waivers sought under subdivision (d).
(4) Policies for ensuring prompt payment of claims submitted by enrolled community clinics or other enrolled fee-for-service Medi-Cal providers, clinics, or facilities for services provided during or immediately following a state of emergency, including, but not limited to, the temporary waiver of documentation requirements and streamlined billing or appeal processes for commonly owned entities.
(c) For purposes of this section, the following terms have the following meanings:
(1) “Asynchronous store and forward” has the same meaning as provided in Section 2290.5 of the Business and Professions Code.
(2) “Immediately following” has the same meaning as provided in Section 14132.723.
(3) “Interactive telecommunications system” has the same meaning as provided in Section 410.78 of Title 42 of the Code of Federal Regulations.
(4) “Premises” has the same meaning as provided in Section 14132.723.
(5) “Telehealth” has the same meaning as provided in Section 2290.5 of the Business and Professions Code.
(d) The department shall seek federal approval of any necessary state plan amendments or waivers to implement this section, including, but not limited to, any demonstration program or similar opportunities allowing a telephonic visit to be used as a substitute for other forms of telehealth, such as synchronous video interaction, asynchronous store and forward, or an interactive telecommunications system.
(e) 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, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action. The department shall adopt regulations by January 1, 2024, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.