California was one of the first states to enact telemedicine parity laws. (Learn More)
The definition of telemedicine used by California rules out the use of certain forms of electronic communication. (Learn More) In California, private payers cannot require in-person contact before approving telemedicine sessions in most cases. (Learn More)
Medicaid covers telemedicine services, but it offers a limited list of covered providers. (Learn More)
The location where the service provider delivers the service or where the patient can receive the service is open. There are no major specifications made on these locations by Medicaid or the State of California, making access to telemedicine convenient. Private payers may limit where providers can deliver telemedicine services within their policy contract. (Learn More)
Providers must be licensed within the state of California. (Learn More) Consent to be treated must be obtained. (Learn More) Telemedicine prescriptions cannot be made without first evaluating the patient. (Learn More)
Overall, California tends to make telemedicine services accessible and convenient for most people. (Learn More)
Telemedicine in California
California was one of the first states to enact telemedicine parity laws, with the first parity law passed in California in 1996.
The state has a long history of attempting to emphasize the importance of telemedicine for patients who may be stricken with mobility issues or challenged by poor access to health care.
California continues to pursue legislation to expand access to telemedicine services, including an attempt to adopt a program of telehealth in public school systems and refining how these services are delivered.
Lack of Uniformity
Although there are clear advantages to telemedicine, such as serving patients in rural areas, immediately serving patients who are in need, and catering to patients with mobility issues, there is a surprising lack of uniformity in the regulations regarding telemedicine procedures from state to state.
Be aware of the specific regulations within your state to benefit from the advantages of telemedicine.
If you want to learn more information regarding telemedicine policies within California, check these sources:
- Center for Connected Health Policy – California
- The Medical Board of California: Practicing Medicine Through Telehealth Technology
- University of California Davis Center for Health and Technology
California’s Definition of Telemedicine
According to the state of California, telemedicine is the use of medical information that is exchanged from one location to another location, using interactive telecommunication equipment, including audio and video equipment. Only two-way real-time interactive communication between the patient and practitioner qualifies.
Parity Law
As mentioned above, California was one of the first states to enact a telemedicine parity law. This mandates private insurance payer reimbursement for telemedicine services, but the services that are covered and the amount or percentage covered are dependent on the insurance policy and the stipulations within it.
Parity laws regarding telemedicine state that telemedicine services must be covered at a rate equivalent to the same service provided in an in-person environment. Health plans cannot limit the settings where services are provided unless the acceptable settings for specific services are stipulated within the contract terms of your policy.
In-Person Contact
In some states, private insurance providers may require that you first see a potential telemedicine provider in person before the provider can actually deliver telemedicine services to you. In California, unless it is formally stated within the insurance contract or policy, private insurance payers cannot make you first have an in-person session with your provider before you can be covered for telemedicine services.
Medi-Cal
Medi-Cal, California’s Medicaid program, utilizes the definition of teleservices as specified above and does not reimburse for email messages, fax transmissions, or telephone calls. It does reimburse for live telemedicine for dentistry services, dermatology services, and ophthalmology services in addition to other services covered by Medicaid.
It also reimburses for store-and-forward services within these areas. This is the collection of clinical data that is transmitted from one site to another site for evaluation.
Medi-Cal does have limitations on who can provide telemedicine services. Services can only be provided by the following:
- Licensed physicians or physician assistants
- Nurse practitioners or clinical nurse specialists
- Nurse midwives or certified registered nurse anesthetists
- Dentists
- Dermatologists
- Ophthalmologists
- Clinical psychologists
- Clinical social workers
- Speech language pathologists
- Occupational therapists and physical therapists
- Audiologists
Where Services Can Be Provided
Some states place limitations on where providers of telemedicine services can deliver the services or where patients can receive telemedicine services. Medi-Cal does not have specifications or limitations on where providers or patients must be located during telemedicine sessions.
Likewise, the parity laws enacted in California do not allow private insurance providers to make these limitations either, unless there is a reason stipulated within the patient’s policy. This allows for telemedicine services in the state of California to be easily accessed by patients and for quick and efficient delivery of these services by potential providers.
Interstate Providers
Providers performing telemedicine services in California must have a California license to perform that service.
California is not a member of the Interstate Medical Licensure Compact, and interstate providers are not allowed to engage in telemedicine services in California.
Consent Specifications
Medicaid providers must get patient consent and document the consent in their medical record before providing services.
The state regulations also require that the site where the patient is during the treatment must obtain consent prior to treatment being initiated. The consent to be treated must be documented within the patient record at the site where the service is received.
Prescriptions
The prescription of medications over telemedicine are still a bit vague in California.
Providers cannot prescribe “dangerous drugs,” which most likely includes controlled substances, without a prior examination and demonstrated medical necessity. The concept of medical necessity means that the treatment is deemed appropriate for the patient based on research studies or clinical standards of care.
Conclusions
California was one of the first states to address the delivery of telemedicine services. It has mandated that private insurance companies must pay for telemedicine services. Medi-Cal offers a limited range of covered telemedicine services.
California continues to expand the use of telemedicine services for people who can benefit from them.
References
The State Telehealth Laws. (September 2018). Center for Connected Health Policy.
Practicing Medicine Through Telehealth Technology. (2019). The Medical Board of California.
Telehealth and Digital Health: Innovations in Accessible Patient Care. (2019). University of California Davis Center for Health and Technology
The IMLC. (2019). Interstate Medical Licensure Compact.
