Disparities in access to care, an aging population, and a shortage of healthcare providers led forward-thinkers to begin considering telemedicine as a viable solution. Eventually, legislators stepped in to provide regulatory support for this booming area of healthcare delivery.
The University of California – Davis launched a telemedicine program that focused on fetal monitoring in rural communities. Shortly after, Kaiser Permanente in Sacramento launched a home telemedicine program — Blue Cross of California and the prison system followed suit by developing their own telemedicine programs.
To keep up with growing demand for telemedicine, Senate Bill 1665 was enacted (also known as the “Telemedicine Development Act of 1996”). It imposed several requirements, most notably that healthcare plans were not allowed to require face-to-face contact between a patient and healthcare provider for services delivered by telemedicine. It also required that every patient who receives care via telemedicine sign a written consent form.
The existing law regulating telemedicine was repealed by AB 415 and replaced with the “Telehealth Advancement Act of 2011.” It clarified several definitions surrounding telehealth service delivery and included store-and-forward technologies as a reimbursable form of care by any provider. Most importantly, it mandated private payer reimbursement for telemedicine services. This was a huge win for healthcare providers in California. Until this bill was passed, telemedicine appointments could only take place in licensed healthcare facilities. AB 415 removed limits on the locations for telehealth.
Among many other modifications, AB 1733 allotted $200 million for capital improvements that expanded medical education programs, particularly emphasizing those aimed at developing high-tech approaches to care delivery like telemedicine. It specifically forbid private healthcare plans from mandating that an in-person visit takes place in order to receive telehealth reimbursement. The bill also forbid private healthcare plans from limiting reimbursement based on patient site-requirements.
The most recent legislation passed in California around telemedicine was AB 809, a bill that lifted the requirement for written patient consent. As of today, verbal or written consent must be obtained and documented for any patient receiving telehealth-delivered care.
Section 1374.13 of the California Health & Safety Code requires private payers to reimburse for services provided through real-time face-to-face videoconferencing.
Section 2290.5 of the California Business & Professions Code states that private payers may reimburse for care delivered through store-and-forward.
Currently, no legislation exists regarding the reimbursement of care delivered by email, phone or fax. Insurance plans may reimburse for this form of care delivery, but it is not mandated.
Section 1374.13 of the California Health & Safety Code forbids health plans from limiting reimbursement based on patient setting. Patients receiving care via telemedicine may be located anywhere and physicians will still be reimbursed for remote visits.
Private payers do not require practitioners to document that a patient has a valid barrier to receiving in-person care in order to receive reimbursement for telemedicine visits.
California’s state Medicaid program
As outlined in page 1 of the manual, Medi-Cal reimburses for real-time audio and videoconferencing.
As of 2013 and in accordance with page 5 of the manual, Med-Cal only reimburses for store-and-forward services provided for teledermatology, teledentistry, and teleophthalmology
No legislation exists regarding the reimbursement of care delivered using remote patient monitoring devices. This will likely be discussed as a future amendment.
According to page 5 of the manual, Medi-Cal does not reimburse for phone calls, electronic mail messages, or fax communication between patients and providers.
As outlined in page 1 of the manual, there are no patient site requirements for telehealth services that limit reimbursement.
According to page 2 of the manual, Medi-Cal does reimburse originating sites a facility fee and both originating and distant sites for live video transmission costs.
Since AB 415 went into effect, Medi-Cal no longer requires practitioners to document that a patient has a valid barrier to receiving in-person care in order to be reimbursed for telemedicine visits.
Yes! Unless you are prescribing a controlled substance, a patient-physician relationship may be established over telemedicine in the state of California.
In California, there is no legislation requiring provider to see patients in person in order to provide telemedicine care to them. New relationships may be established and continued over telehealth, assuming the patient does not require an in-person physical examination.
Yes, the Medical Board of California has established that the same standard of care applies to telemedicine as is does for in-person healthcare delivery.
It’s not uncommon to come across certain state legislation that distinguishes “telemedicine” from “telehealth.” However, the two essentially mean the same thing and are often used interchangeably.
Yes! The Medicare Chronic Care Management (CCM) program reimburses providers $42 per month for delivering remote care to patients with two or more chronic conditions.
California law defines telehealth as “the mode of delivering health care services and public health … while the patient is at the originating site and the health care provider is at a distant site.”
In California, telemedicine is defined as “the ability of physicians and patients to connect via technology other than through virtual interactive physician/patient capabilities, especially enabling rural and out-of-area patients to be seen by specialists remotely.”
Store-and-forward refers to the electronic transmission of medical information, such as digital images, documents, and pre-recorded videos through secure messaging.
mHealth stands for mobile health. mHealth involves digitally transmitting health information from patient to provider or vice versa. It typically involves the use of smartphones or tablets and downloadable health apps.
CMS uses this term when referring to the location of a practitioner who is providing telemedicine care to a patient at an originating site. As with originating sites, neither Medi-cal nor private payers in California base reimbursement on distant site location.
Remote patient monitoring (RPM) uses digital technologies to collect medical and other forms of health data from patients. It is then electronically transmitted to a health care provider in a different location for assessment.
Let Chiron Health handle the regulations and reimbursement
