Telemedicine in Focus: California

Answers to 10 common questions

With a population of approximately 39 million people, the Golden State is the most populous in the Union.  In addition, California is geographically huge and ranked third in total land area.  Physicians in California tend to live in the large metropolitan areas that hug the coastline.  Uneven distribution of doctors leaves rural communities underserved and creates a prime opportunity for telemedicine and telepsychiatry to flourish.  

The following are answers to 10 commonly asked questions about practicing telemedicine and telepsychiatry in California:

  1. What is the definition of telehealth in California?

According to the California business and professions code section 2290.5, “Telehealth means the motive delivering healthcare services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s healthcare while the patient is at the originating site and the healthcare provider is that a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.”

  1. Do doctors need to live in California in order to practice telemedicine or telepsychiatry?

No.  Physicians do not need to be California residents in order to practice telemedicine or telepsychiatry in this state.  However, they do need a valid and current California license in order to practice telemedicine or telepsychiatry on any patient that is physically located in California.

  1. Is telemedicine held to a different standard than in-person care?

No.  According to the Department of Health Care Services, “Telehealth is not a distinct service, but away the providers deliver healthcare to their patients that approximates in-person care. The standard of care is the same whether the patient is seen in-person or through telehealth.”

  1. Does California require an in-person visit in order to establish a patient-physician relationship?

No.  According to the Medical Board of California, telemedicine and telepsychiatry can establish a patient-physician relationship.  This is also reflected in reimbursement regulations: According to the California health and safety code section 1374.13, “No healthcare service plan shall require that in-person contact occur between a healthcare provider and the patient before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract…”.

Similarly, according to the California welfare and institutions code section 14132.72, “in-person contact between healthcare provider in a patient shall not be required under the Medi-Cal program for services appropriately provided through Telehealth…”  

  1. Is telehealth reimbursed in California?  Yes.

California has reimbursement parity rules for Medicaid and private insurance companies. Fortunately, Medi-Cal pays the same rate for professional medical services provided by telehealth as it does for in person services.

According to the California welfare and institutions code section 14132.72, healthcare providers are not required to document a barrier to an in person visit for Medi-Cal coverage of services provided via telehealth.

  1. What qualifies as a reimbursable service for Medi-Cal?

Medi-Cal provides reimbursement for services that are provided via interactive, live 2-way video that occurs in the real-time.  There is also reimbursement for the originating site fee and live video transmission costs.

However, Medi-Cal does not authorize reimbursement for telephone calls, electronic mail messages or facsimile transmissions.

Medi-Cal does not restrict the type of setting allowed for telehealth.     

  1. Is Informed Consent required for telehealth encounters?

Yes.  Medi-Cal requires that healthcare providers obtain oral consent from the patient for telehealth encounters.  This consent must also be documented in the patient’s medical record.  However, Medi-Cal no longer requires patient’s written consent for telehealth services.

  1. What are recent changes in telehealth regulations in California?

California has made some recent progress in their definition of “health care provider” by passing assembly bill 250.  Effective January 1, 2016, this bill expands the definition of “healthcare provider” to include not only those licensed under the business and professions code, but also marriage and family therapists interns and trainees (specific conditions apply. For more information, see assembly bill 250).

  1. What are some innovative ways California is embracing telehealth?

The State of California prison system has provided leadership in telemedicine, especially in the speciality of telemental health.  In recent years, the California Department of Corrections and Rehabilitation has had an approximately 400% growth of their telepsychiatry program.  They currently provide telepsychiatry to 13 different prison across the state of California from the border of Oregon to the southern deserts.

Correctional telepsychiatry in California represents one of the largest telemental health programs in the Nation.

In addition, the California Children’s Services Program, the Genetically Handicapped Person’s Program, and the Child Health and Disability Prevention Program include coverage of telehealth services.

  1. Where can I find more telehealth resources for California?

California is fortunate to have multiple organizations that are dedicated to the advancement of telehealth. One of these is the California Telehealth Resource Center (CTRC) which is supported by the US Department of Health and Human Services.  The CTRC provides policy updates, education, and information in order to advance the field of telehealth.

California is also home to the Center for Connected Health Policy, which is the national policy resource center.

Of course, the American Telemedicine Association is a central source for information regarding telemedicine.
For these and other helpful links, go to the Orbit Health Telepsychiatry resource page

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