The history of California telehealth law begins with the Telemedicine Development Act of 1996 (TDA). This statute forms the foundation for state telehealth law.
The TDA prohibits health plans and health insurers, public and private, from requiring face-to-face contact between patient and provider for services appropriately provided through telemedicine. This includes Medi-Cal, the state's Medicaid program. However, it excludes provider-patient contact by telephone or e-mail.
State law also specifically requires Medi-Cal to cover tele-ophthalmology and tele-dermatology services via store & forward technology.
Subsequent telehealth legislation in California, for the most part, has amended and extended provisions of the original TDA.
Telemedicine Development Act of 1996, SB 1665 (Thompson, M.), Chapter 864, Statutes of 1996
- Defines "telemedicine" as the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video or data communications;
- Prohibits, as of Jan. 1, 1997, health plan contracts or health insurance policies from requiring face-to-face contact between providers and patients for services appropriately provided by telemedicine, subject to all terms and conditions of the contract or policy, except that health plans and insurers are not required to pay for consultations provided via telephone or fax;
- Extends health plan and insurer prompt payment and claims processing requirements, and the related procedures health plans and insurers must have in place, to telemedicine;
- Requires telemedicine services to be considered in determining compliance with the access to care standards imposed on health plans under the Knox-Keene Health Care Service Plan Act of 1975;
- Prohibits until Jan. 1, 2001, for purposes of Medi-Cal, and subject to federal financial participation, a requirement of face-to-face contact for services otherwise covered by the Medi-Cal program, and appropriately provided through telemedicine, subject to billing and reimbursement policies developed by the California Department of Health Services (DHS);
- Extends the face-to-face prohibition to Medi-Cal contracting health plans only to the extent that both of the following apply: a) Telemedicine services are covered by, and reimbursed under, the Medi-Cal fee-for-service program; and, b) Medi-Cal managed care plan contracts are amended to add coverage for telemedicine services and to make any appropriate capitation rate adjustments;
- Requires the Medi-Cal program to pursue private or federal funding to conduct an evaluation of the cost-effectiveness and the quality of telemedicine services provided in Medi-Cal;
- Requires health care providers, as defined, who have ultimate authority over the care or diagnosis of a patient, to obtain the written informed consent of patients prior to providing telemedicine services, except in an emergency where a patient cannot give consent, as specified. Specifies that information about risks and benefits of telemedicine must be provided verbally to patients, guarantees patients access to all medical information transmitted during a telemedicine consultation, and defines as unprofessional conduct the failure of a health care provider to obtain informed consent for telemedicine;
- Exempts from California physician licensing laws physicians outside of California when in actual consultation within the state, or or when consulting across state lines with a physician licensed in California. States that the Act shall not be construed as altering the scope of practice of any health care provider; and,
- Makes legislative findings and declarations related to the potential for telemedicine to address major challenges in health care access, costs and quality.
SB 922 (Thompson, M.), Chapter 199, Statutes of 1997
- Clarifies that neither an electronic mail message nor a telephone consultation are included in the definition of telemedicine;
- Revises the telemedicine informed consent requirements, including allowing a patient’s legal representative to provide verbal and written consent. Eliminates the guarantee to patients of all medical information transmitted during a telemedicine consultation, and instead specifies that existing patient access to medical information and medical records apply to telemedicine consultations.
AB 2780 (Gallegos), Chapter 310, Statutes of 1998 Budget trailer bill
- Sets standards for the audio and visual telemedicine systems and equipment used for telemedicine services covered by Medi-Cal so that, at a minimum, the systems have the capability to meet the procedural definition of the Current Procedural Terminology Fourth Edition (CPT-4) codes and the equipment meets specified quality standards;
- Revises the TDA to include a definition of “interactive,” as used in the definition of telemedicine, defining it as an audio, video, or data communication involving a real time (syncronous) or near real time (asynchronous) two-way transfer of medical data and information.
AB 2877 (Thomson, H.), Chapter 93, Statutes of 2000 Budget trailer bill
- Eliminates the scheduled 2001 end date for telemedicine coverage in Medi-Cal, which was originally contained in the TDA, and makes permanent Medi-Cal coverage for telemedicine.
AB 442 (Committee on Budget), Chapter 1161, Statutes of 2002 Budget trailer bill
- Requires California DHS to allow psychiatrists to receive fee-for-service reimbursement for telemedicine services in Medi-Cal until June 30, 2004, or until the state Department of Mental Health develops a reimbursement method for psychiatric services in Medi-Cal that is feasible for mental health plans, primary care providers, and psychiatrists providing the services, whichever is later.
AB 116 (Nakano), Chapter 20, Statutes of 2003
- Applies the informed consent provisions of the TDA to dentists, podiatrists, psychologists, marriage and family therapists, and clinical social workers.
AB 354 (Cogdill), Chapter 449, Statutes of 2005
- Extends the prohibition against the requirement of face-to-face contact between a health care provider and a patient for Medi-Cal to “store and forward” teleopthamology and teledermatology services, from July 1, 2006 to Jan. 1, 2009.
AB 329 (Nakanishi), Chapter 386, Statutes of 2007
- Authorizes the Medical Board of California (MBC) to establish a pilot program to expand the practice of telemedicine, and to implement the program by convening a working group. Specifies the purpose of the pilot program to develop methods, using a telemedicine model, of delivering health care to those with chronic diseases, and delivering other health information. Requires MBC to make recommendations regarding its findings to the Legislature within one calendar year of the commencement date of the pilot program.
AB 1224 (Hernandez), Chapter 507, Statutes of 2007
- Applies the informed consent provisions of the TDA to optometrists.
AB 234 (Eng), Chapter 586, Statutes of 2007
- Provides that no more than 125 hours of experience providing psychotherapy services via telemedicine may count toward the 3,000 hours of experience required to receive a Marriage and Family Therapist license.
AB 2120 (Galgiani), Chapter 260, Statutes of 2008
- Extends until Jan. 1, 2013 Medi-Cal coverage for teleopthamology and teledermatology, via store and forward technologies.
AB 175 (Galgiani), Chapter 419, Statutes of 2009
- Includes within the definition of teleopthamology and teledermatology store and forward services for Medi-Cal coverage consults by optometrists who are trained to diagnose and treat eye disease.