CTRC Legislative/Regulatory January 2016 Update

Please Note: CCHP has a pending legislation/regulation webpage located at the following link: http://cchpca.org/state-laws-and-reimbursement-policies

LEGISLATION

Approved Legislation

State Bill # Status Summary
California AB 250 7/6/15: Chaptered. This bill would expand the definition of “health care provider” for the purposes of the telehealth provision currently in law, to include a marriage and family therapist intern and trainee.
California SB 147 10/10/15: Chaptered. This bill would require the department to authorize a three year alternative payment methodology pilot project for FQHCs that would be implemented in any county and FQHC willing to participate.
California SB 464 9/30/15: Chaptered This bill would authorize certain health care providers to use a self-screening tool that will identify patient risk factors for the use of self-administered hormonal contraceptives by a patient, and, after an appropriate prior examination, to prescribe, furnish, or dispense, as applicable, self-administered hormonal contraceptives to the patient. The bill would authorize blood pressure, weight, height, and patient health history to be self-reported using the self-screening tool.
California SB 800 10/1/15: Chaptered This bill would authorize a marriage and family therapist intern and trainee to provide services via telehealth if he or she is supervised as required by the Act, and is acting within the scope authorized by the Act and in accordance with any regulations governing the use of telehealth promulgated by the Board of Behavioral Sciences.

 

Dead Legislation/Session Ended

California AB 648 9/11/15: Ordered to Inactive file. This bill would establish the Virtual Dental Home program to expand the virtual dental home model of community-based delivery of dental care to the residents of CA who are in greatest need, as prescribed. The bill would authorize the administrator of the program to, among other things, encourage development and expansion of the delivery of dental health services in community clinics and school programs, as prescribed.  The bill would appropriate $4,000,000 to the department for the purposes of this program.
California AB 1485 5/28/15: In Committee: Held under submission. (Asm. Appropriations) This bill would prohibit the Department from requiring a radiologist to be located in California as a condition of Medi-Cal provider enrollment or reimbursement for teleradiology services.
California SB 289 5/28/15: Held in Committee (Senate Appropriations) and under submission. This bill would require a health care service plan to cover telephonic and electronic patient management services provided by a physician or non-physician health care provider and reimburse those services based on their complexity and time expenditure.

 

REGULATION

Approved Regulation

Stat Reg. Status Summary
California Title 16 CCR Sections 1820; .5, .7; 1822 1/1/16: Effective this date Title: LPCCS Treatment of Couples and Families

Agency: Board of Behavioral Sciences

This rule would increase the number of hours of supervised experience toward the 3,000 hours required for licensure for a licensed professional clinical counselor, which can be obtained via telehealth from 250 to 375 hours.

 

Pending Regulation

Stat Reg. Status Summary
       
California Title 16 CCR Sec. 1815.5 7/10/15: Proposed rule notice

Comment Deadline: 8/24/15

Title:  Standards of Practice for Telehealth

Agency:  CA Board of Behavioral Sciences

This rule would establish Standards of Practice for telehealth.

California Title 16 CCR Section 4172 9/25/15: Proposed rule notice

Comment deadline: 11/9/15

Title:  Telehealth

Agency:  Board of Occupational Therapy

Clarifies that an occupational therapist does not need to obtain a patient’s/client’s consent for subsequent telehealth services once the patient initially consents to receive occupational therapy services via telehealth. Deletes informed from the language and otherwise reconstructs the language in the subsection to make it read better.

California Title 10 CCR Section 2240, .1 thru .7, .15, .16 12/18/15: Additional amendments made

Public Comment Deadline: 1/4/2016

Title: Provider Network Adequacy

Agency:  Department of Insurance

This rule would strengthen requirements regarding network design, demonstration of insurer compliance, submission of data that will support the analysis of emerging trends, as well as requirements regarding accuracy of provider directories and other consumer notices.  Among other requirements, it requires insurers to file a network adequacy report with the Department of Insurance that provides a description of the implementation and use of triage, telemedicine and health information technology to provide timely access to care.  It also provides for a waiver of the network access standards.  An application for such a waiver must include an explanation of alternatives that were considered, including but not limited to telemedicine or phone consultations (among other requirements).

California Title 10 CCR

Health Benefit Exchange

 

12/31/15: Emergency Rule Re-adoption

 

Agency: Health Benefit Exchange

Title: Eligibility and Enrollment Process – Individual Exchange

These regulations established the Health Benefit Exchange’s policies and procedures for eligibility determination and redetermination, enrollment, and termination.  Specific to telehealth, it refers to Section 2290.5 of the Business and Professions Code to define the term telemedicine or telehealth.

 

Adopted Emergency Rules (with expiration dates)

Stat Reg. Status Summary
California Title 10 CCR Section 2240, .1, .15, .16, .4, .5, .6, .7

 

7/27/15: Emergency rule adoption

Effective: 7/27/15

Expires: 1/26/2016

Title: Provider Network Adequacy

Agency: Department of Insurance

Updates the Department’s existing regulation, and addresses concerns regarding inadequate network access, non-network providers in network facilities, and inaccurate provider directories, by implementing the proposed amendments and additions in this regulation.  Section was added to require insurers to submit documents describing the implementation and use of triage, telemedicine and health information technology to provide timely access to care. This allows insurers to demonstrate alternative means of providing adequate access, as appropriate.

California Title 10 CCR Sec. 6428, 6430 2/5/15: Notice of Approval of Emergency Regulatory Action

Effective: 2/5/15

Expires: 2/5/17

Title: 2016 Qualified Health Plan Recertification/New Entrant

Agency: Health Benefit Exchange

Establishes the process and requirements for eligible health issuers in the individual and SHOP exchanges to submit proposed qualified health plans (QHP) for recertification and for new health issuer entrants who are eligible and elect to propose QHPs for the Plan Year 2016. Among the application questions, it asks health issuers strategies they use to implement, or intend to implement, to promote access and care coordination through the use of telemedicine (among other things).