Telemedicine in California

Posted by Michael Hsu on 6/10/20 8:52 AM
Michael Hsu

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California is a state with a long history of supporting telemedicine and telehealth as legitimate ways to deliver medical care to patients remotely. The adoption of telemedicine in California was born out of necessity. 

Prior to embracing telehealth, the state struggled with: 

  1. Disparities in access to healthcare 
  2. Aging population
  3. A shortage of medical professionals 

As a result, the state started looking to telemedicine as a viable solution in the ‘90s. 

California has passed multiple telehealth laws since then, and the state is actively working on developing legislation that will further improve accessibility and availability of telemedicine to its inhabitants. 

Let’s take a look at how California’s view of telemedicine and telehealth changed throughout the years, and what rules and regulations regarding remote medical care apply today.

The history of telemedicine in California

To better understand the current state of telemedicine in California, here’s a timetable of all the relevant events that led to the state having one of the most comprehensive telemedicine legislatures in the United States. 

UC Davis launches a telemedicine program — 1992

California’s first step into the field of telemedicine occurred back in 1992 when the University of California — Davis launched a telemedicine program for the purpose of fetal monitoring in rural areas. 

Quickly recognizing the value of telemedicine, Kaiser Permanente in Sacramento launched a home telemedicine program, aimed at providing other forms of medical care remotely. Blue Shield of California and the state’s prison system were also among the first to recognize the benefits of telemedicine and develop their own programs to further improve the accessibility of remote healthcare services. 

The Telemedicine Development Act — 1996

The state’s legislators quickly caught wind of the growing demand of telemedicine and sought to define the practice under law. The Senate Bill 1665 — better known as The Telemedicine Development Act — was enacted in 1996. 

The main goal was to further improve access to telemedicine. The Development Act accomplished this by imposing a specific requirement for health insurers. The Act stated that health plans were forbidden from requiring face-to-face contact between the providers and the patients for services delivered remotely. 

This meant that:

  1. Health plans had to cover telemedicine services in all instances in which those services would be covered if they were delivered in-person
  2. No prior patient-doctor relationship is required for providing remote healthcare, making it possible for providers to acquire new patients through telemedicine

This made telemedicine more appealing to both patients, who didn’t have to worry about additional medical fees, and clinical practices, that could treat more patients by implementing virtual appointments. 

That said, the Act did require healthcare professionals to obtain written patient consent prior to delivering any services via telemedicine.

The Telehealth Advancement Act — 2011

As technology advanced, it became obvious that the existing law needed to be updated to clarify previous definitions surrounding telemedicine and telehealth and provide new ones. The Bill replaced the term “telemedicine” with “telehealth.” 

The old legal terminology described telemedicine exclusively as delivering treatment through a two-way live video connection. With technological advancements, the rigid term proved to be a barrier to other forms of remote medical services.

The Advancement Act included store-and-forward technology as another form of reimbursable telemedicine service. This enabled providers to rely on telecommunication technology to share medical information when necessary, such as lab test results, and greatly facilitated telemedicine services. 

The biggest change that The Telehealth Advancement Act made was the fact that the law now mandated private payers to reimburse healthcare providers for telemedicine services. Prior to this, telemedicine services were only delivered to patients in licensed healthcare facilities. 

Although there were no explicit restrictions regarding the location where telemedicine takes place under the old law, Medi-Cal did limit telemedicine to four types of facilities: 

  1. Hospitals
  2. Clinics
  3. Physician offices
  4. Skilled nursing facilities

The majority of private payers misinterpreted that Medi-Cal’s limitations apply universally, resulting in telemedicine being delivered exclusively to these types of facilities. 

The Advancement Act clarified this and explicitly removed any location restrictions. The mandate dramatically increased the appeal of telemedicine for providers, given that they could deliver remote healthcare service to patients regardless of their location — even in their homes. 

Assembly Bill 1733 — 2013

The AB 1733 introduced several modifications to California’s telehealth policy. The most notable changes were:

  • Legally forbidding private healthcare plans from imposing an in-person visit requirement for telehealth reimbursement
  • Forbidding private healthcare plans from limiting reimbursement in any way based on patient site requirements

In addition, the Bill allotted $200 million for the improvement of medical education programs that were aimed at developing high-tech approaches to medical care delivery. This marked the state’s commitment to telehealth and signified that California values remote healthcare services as much as medical aid delivered in-person.

Assembly Bill 809 — 2015

The Bill 809 removed the previous requirement for written patient consent. This requirement complicated entering relationships with new patients via telemedicine, and was removed as it proved to be an unnecessary hindrance. 

Today, providers can obtain either verbal or written consent prior to delivering telemedicine services but must document and keep proof of consent for any patient that receives any form of remote medical care. 

Various Assembly Bills — 2019

In 2019, Governor Gavin Newsom signed multiple Bills that marked California the most pro-telehealth state in the U.S. 

Assembly Bill 744 — This bill mandated that payers would reimburse healthcare providers for telemedicine services “on the same basis and to the same extent” as they would for in-person services. This positioned telehealth as equally valuable to in-person medical treatment, and payers could no longer “haggle” for lower coverage rates for telehealth services.

Assembly Bill 1264 — The main objective of this Bill was to facilitate online prescriptions. It defined “asynchronous communication between the patient and the provider” as a valid way of establishing a doctor-patient relationship, which is a requirement for any type of medication prescription. Put simply, this Bill allowed telehealth providers to issue online prescriptions without requiring the patients to come in for an in-person evaluation.

Assembly Bill 1494 — The Bill enabled healthcare providers to leverage telehealth to provide medical services to Medicaid patients during and immediately after an emergency. Telephone consultations were included in said services.

Assembly Bill 24 — The Bill mandates that, as of 2023, healthcare clinics on California State University or University of California campuses must provide access to telemedicine abortion services.

Who can provide telehealth in California

Although California’s telehealth laws do not specify who is eligible to provide remote medical services, Medi-Cal — the state’s Medicaid program — does explicitly say which providers are eligible for reimbursement. 

Medical professionals that qualify for telehealth reimbursement are:

  • Physicians 
  • Physician assistants 
  • Nurse practitioners 
  • Nurse-midwives
  • Clinical nurse specialists 
  • Registered dietitians or nutrition professionals 
  • Clinical psychologists 
  • Clinical social workers 
  • Dentists 
  • Dermatologists 
  • Ophthalmologists 
  • Speech-language pathologists 
  • Audiologists 
  • OTs and PTs

Cross-state telemedicine licensing

Despite the fact that the state of California is evidently a strong advocate of telehealth, it did not propose legislation to join the Interstate Medical Licensure Compact. 

This means that providers licensed outside of California are not allowed to practice telemedicine in the state. That right is reserved strictly for medical professionals with an active Californian medical license.

Patient consent requirements

Since 2015, written consent is no longer a requirement for providing telehealth services in California. This is in line with the idea that in-person visits are no longer necessary to establish a valid doctor-patient relationship. 

Today, healthcare providers can obtain verbal consent from patients prior to delivering telehealth services. When a patient joins a virtual appointment, they must agree to receive remote medical services, and the provider must document and maintain the consent. 

The state law also requires the originating site to acquire patient consent prior to medical care. Although this requirement might seem redundant, it does serve a purpose. In the event that they require special care that can only be delivered by a different provider remotely, patients at a medical facility must first consent to receiving those services via telehealth.

Prescription requirements

As we’ve mentioned, the state of California is quite lenient when it comes to online medical prescriptions. All healthcare providers eligible to provide telehealth services can also issue prescriptions to aid with the treatment of patients admitted via telehealth. 

That said, there are a few restrictions. If the prescribed medications fall under the category of dangerous drugs or dangerous devices, the provider must first perform a detailed in-person examination.

Documenting telemedicine encounters

California state law doesn’t specify anything regarding documenting telemedicine, or rather — telehealth encounters. That said, given that the AB 744 treats telehealth services the same way as in-person medical care, providers should store and maintain medical data as if the services were delivered in-person. 

Telehealth providers should maintain and update their electronic health records (EHRs) regardless, to keep track of their patient’s medical history and ensure efficient delivery of remote healthcare services.

On top of that, HIPAA rules also state that telemedicine and telehealth providers should have a backup archive that allows access to PHI in the event of an emergency, such as a power outage. 

These are things you should consider when choosing a telehealth solution. If you opt for a solution that doesn’t integrate with your EHR, you will have to manually enter all the data after each telehealth visit or at the end of your shift. At the same time, if the solution doesn’t provide a backup archive by default, you will have to search for a third-party provider who can provide such services in a HIPAA compliant manner.

We thought about all this when creating Curogram — a platform specifically designed to help medical professionals leverage modern communication technology to treat patients remotely.

Curogram integrates with over 700 EHRs, so all the relevant medical data is automatically imported into your electronic health records. 

This allows your medical staff to focus on providing care to patients, rather than spending valuable time on administrative tasks. The platform also comes with automatic data backup and built-in security, privacy, and technical safeguards, ensuring your telemedicine practice is 100% HIPAA compliant.

Curogram EHR integrations

eClinicalWorks

Athena

Epic

Cerner

DrChrono

NextGen

Practice Fusion

CareCloud

Kareo

OfficeAlly

See More Integrations Here

 

Telemedicine reimbursement in California

Under California state law, private payers must reimburse telehealth providers for services delivered through live video. Although the law doesn’t explicitly forbid any telehealth modalities, it is clear that only two-way video communication is considered reimbursable, while other forms — such as email or telephone consultation — may be used as an aid for telehealth services. 

In other words, private payers are not obligated under law to pay for: 

  • Telephone consultations
  • Email consultation

This is why the vast majority of providers only use these forms of communication to help with virtual appointment scheduling, rather than to deliver care.

Medi-Cal will also reimburse providers for services delivered via two-way video communication. It also specifies that said services must be billed with a GT or 95 modifiers. One exception to this rule is an emergency situation, in which Medi-cal will also reimburse providers for phone and email consultations. 

Regarding store-and-forward technology, California state law includes it in the definition of telehealth since 2011, so it is reimbursed the same way as services delivered through live video. Medi-Cal will only reimburse store-and-forward if the technology is used to deliver teledermatology, teleophthalmology, or teledentistry services.

Interesting to note, Medi-Cal also pays both the originating and the distant site a transmission fee for up to 90 minutes per day, per patient. 

Regarding self-pay patients, the California state law dictates that patients should reimburse the telehealth providers in the same manner as they would if the services were delivered in-person. This, along with the fact that no in-person contact is necessary for establishing a doctor-patient relationship, is a good incentive for healthcare providers. 

Telehealth providers in California can expect to receive the same payment for their services as if they delivered them in-person. They can also further increase their revenue by establishing an easy connection with new telehealth patients. 

California telehealth policy changes in response to COVID-19

In response to the COVID-19 emergency, California updated some of its telehealth policies to make remote healthcare services as accessible as possible. 

Medi-Cal allowed for telehealth services delivered over the phone to be reimbursed in the same way as if they were delivered in-person. The changes also stated that managed care plans must cover all services provided via telehealth if the provider deems it’s medically necessary and appropriate to provide said services remotely.

Among the notable changes is also the limited waiver on cross-state licensing. During the emergency, medical facilities and staffing agencies in California can request a waiver if they find it necessary to utilize out-of-state licensed providers. 

They still need to submit their request and gain approval from the Emergency Medical Services (EMS) Authority before relying on professionals from other states to provide appropriate medical care via telehealth to their patients. 

Have a successful telemedicine start in California with Curogram

If you’re looking for a fully HIPAA compliant telehealth solution to provide the much-needed remote medical care to patients during and after the COVID-19 emergency — Curogram is the perfect solution. 

As we’ve mentioned, our telemedicine platform complies with all HIPAA rules and comes with built-in safeguards to help ensure that you’re providing remote medical care to patients in accordance with all applicable laws.

Apart from handling the legal and technical side of things, Curogram is extremely convenient and easy to use. You can set up a virtual clinic and host live, two-way video appointments with patients, in under 24 hours. 

Curogram also allows you to communicate easily with both existing and prospective patients, facilitates medical staff collaborations, and allows you to send and receive PHI in a secure environment — all from a single dashboard.

Why medical professionals choose Curogram for telemedicine 

Integrates with over 700 EHRs

Curogram fully supports EHR integration, so all the relevant data is automatically entered into your electronic health records. Say goodbye to tedious administrative tasks and admit more patients daily! 

Provides a two-way messaging platform

Send fully-automated SMS appointment reminders and reduce no-shows by 75%! Patients can simply reply to the message if they have any inquiries or want to reschedule.

Facilitates internal communications and file sharing

Curogram comes with a secure messaging platform that enables your medical staff to communicate and share PHI in a secure, HIPAA compliant environment. 

Mimics in-person workflow environments

Virtual clinics you set up with Curogram are outfitted with virtual waiting rooms. Medical assistants can tend to patients and gather the necessary medical data prior to the appointment. Doctors can see when the patient is ready and can quickly initiate the video call with a single click of a button. 

Start your free trial today and see why clinics, doctors, and patients love Curogram!

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.

Telemedicine by State in the US

Alabama

Indiana

Nebraska

South Carolina

Alaska

Iowa

Nevada

South Dakota

Arizona

Kansas

New Hampshire

Tennessee

Arkansas

Kentucky

New Jersey

Texas

California

Louisiana

New Mexico

Utah

Colorado

Maine

New York

Vermont

Connecticut

Maryland

North Carolina

Virginia

Delaware

Massachusetts 

North Dakota

Washington

Florida

Michigan

Ohio

West Virginia

Georgia

Minnesota

Oklahoma

Wisconsin

Hawaii

Mississippi

Oregon

Wyoming

Idaho

Missouri

Pennsylvania

 

Illinois

Montana

Rhode Island

 

Topics: telemedicine

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