Telemedicine Regulations in California
The practice of telemedicine is becoming increasingly popular throughout the United States. California was one of the first states in America to pass telemedicine regulations. Its implementation of telehealth was initially aimed at eliminating disparities in care throughout the state. It was also deemed the best way to service an aging population and overcome a healthcare provider shortage. It was only a matter of time before lawmakers become involved to provide regulatory support.
The History of Telemedicine in California
- 1992, The University of California – Davis launched the first telehealth program: California’s first telemedicine application was to provide fetal monitoring within rural communities. That same year, Sacramento’s Kaiser Permanente launched the first home telehealth program. California’s prison system and Blue Cross developed their own telemedicine programs.
- 1996, The Telemedicine Development Act: The act’s legislation stated that services delivered using telemedicine did not require face-to-face contact between patients and healthcare providers. It also mandated that all patients sign a consent form before receiving telehealth care.
- 2011, The Telehealth Advancement Act: The 2011 act made more transparent the definitions used in telemedicine. It also included payer reimbursement for virtual services. The bill also enabled virtual appointments to take place outside of licensed healthcare facilities.
- 2013, The Assembly Bill 1733: This bill allocated $200 million to improving medical education programs, emphasizing telemedicine. It prohibited healthcare plans from stating that in-person visits had to take place for providers to receive reimbursement. It also banned private health plans from reducing reimbursement based on patient location requirements.
2015, Assembly Bill 809: This bill removed the mandate for written patient consent. Patients are now permitted to give verbal all written permission before receiving telemedicine care. Additional Regulations Governing California Telehealth
Here are some additional regulations that telehealth therapists should be aware of. During the first virtual visit with a client, a therapist must:
- Obtain patient consent, as clarified above.
- Make the client aware of any potential risks or limitations involved with telemedicine.
- Provide the patient with the therapist’s license type and number.
- Identify crisis resources that are local to the client.
Additionally, at each virtual appointment, the therapist must:
- Obtain and not the client’s full name and location.
- Make a full assessment of whether or not telemedicine is suitable for the client.
- Adhere to best practices for security and confidentiality.
Expanded Telemedicine Laws in California
In 2019, two new bills that affected the delivery of telehealth services became law. The new legislation:
- Remote prescribing: Allows telehealthcare providers to prescribe medications without having to see a patient in person. Prescription drugs may be prescribed and dispensed to patients as long as a virtual examination and the medications are indicated. It also states that no real-time interaction between the patient and healthcare provider is required before a remote prescription. For example, a healthcare provider may use self-screening tools or questionnaires to conduct a patient examination before prescribing.
- Payment parity: Mandates equal reimbursement for telemedicine services under commercial plans. Patients must reimburse telemedicine healthcare providers on the same basis as services that are provided in person. Insurance companies and healthcare providers may negotiate rates of reimbursement. However, services that are the same must be reimbursed at the same rate, whether in person or via telemedicine. Any telemedicine services provided by an out-of-network provider don’t need to be covered by an insurer. Quick Guide for Telemedicine Reimbursements
- Medicaid coverage: Restrictions on Medicaid coverage of store-and-forward services. Face-to-face contact is no longer required for any of these technologies.
California Telehealth Policy Coalition Legislative Briefing Watch Video ▶️
Frequently Asked Questions About Telemedicine Regulations in California
Here are some common FAQs about California Telehealth:
As a California healthcare practitioner, can I offer telehealth services to new patients?
Yes, you can. You can establish a telemedicine relationship with a patient in California at any time. There is only one exception. You must not be prescribing a controlled substance.
How frequently must I see the patient in person?
While you are required to see a patient before providing telehealth in some states, in California, you are not. There is no legislation mandating that a healthcare provider sees a patient in-person to provide telemedicine. If the patient does not need an in-person examination, you may continue to see him or her via virtual appointments.
What types of telemedicine services does Medi-Cal cover?
Medi-Cal has a specific telemedicine policy. It gives allows practitioners to determine which services are appropriate based on the following factors:
- Evidence-based medicine
- Best practices
To deliver either:
- Face-to-face telemedicine
- Two-way real-time communication
- Store and forward services
All telehealth services provided must meet these definitions and HCPS or CPT standards.
As an out-of-state provider, does Medi-Cal allow me to provide telehealth services?
To provide telehealth service in California, you must be licensed to practice in that state. You must also be registered as a Medi-Cal rendering provider. You must also be in affiliation with a group of enrolled Medi-Cal providers. The group must meet all enrollment requirements and must be located in the state of California. You may provide telemedicine services in California without a California license if employed by a tribal healthcare program.
Do I need a patient’s consent before providing telehealth services?
California law mandates that telemedicine providers use the technology to obtain patient consent before any virtual consultation. Practitioners are also required to maintain the appropriate documentation. Documentation of either verbal or written permission should be kept on record by providers at both the distant and originating locations.
If you are a healthcare practitioner and you would like to find out more about state regulations about telehealth, you can find them here:
- The California Telehealth Resource Center (CTRC): The CTRC is a federally designated resource. It helps healthcare providers to maintain their telemedicine programs.
- The Center for Connected Health Policy (CCHP): The CCHP is a federally designated resource. It assists lawmakers and state agencies regarding telemedicine policies.