California State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

California Medi-Cal

Medicaid Program: Medi-Cal

Program Administrator: California Dept. of Health Care Services (DHCS)

Regional Telehealth Resource Center: California Telehealth Resource Center (CTRC) 2001 P Street, Suite 100
Sacramento, CA 95811
(916) 341-3378 / (877) 590-8144
www.caltrc.org

STATE LAW/REGULATIONS MEDICAlO PROGRAM
Definition of telemedicine/telehealth
“Telehealth means the mode of delivering health care 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 health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.”

Source: CA Business & Professions Code Sec. 2290.5 (2012).

Telemedicine is “the ability of physicians and patients to connect via technology other than through virtual interactive physician/patient capabilities, especially enabling rural and out-of-area patients to be seen by specialists remotely.”

Source: CA Code of Reg. rttte 10 Sec. 6410. Telehealth [according to the Telehealth Advancement Act of 2011] “is the mode of delivering health care services and public health utilizing information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at the distant site.”

“Telemedicine [according to CMS] is the use of medical information exchanged from one site to another using interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time, interactive communication between the patient and physician or practitioner at the distant site to improve a patient’s health. Medi-Cal uses the term telemedicine when it makes a distinction from telehealth.”

Source: CA Department of Health Care Services. Medi-Cat Part 2 General Medicine Manual. Tetehealth. Pg. 1. (Dec. 2013) (Accessed Mar. 2017).
Live Video Reimbursement
Private payers may reimburse for live video. (See
“Private Payers” section).

Source: CA Health & Safety Code Sec. 1374.13 (2012).

(also see Medicaid column) Medi-Cal will reimbursement for services provided via live video.

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Teteheatth. Pg. 1. (Dec. 2013), (Accessed Mar. 2017).
Store and Forward Reimbursement
Private payers may reimburse for store and forward.

Source: CA Business & Professions Code Sec. 2290.5 (2012).

(also see Medicaid column) Medi-Cal will reimburse for store and forward services for tele-dermatology, tele-ophthalmology and teledentistry.

Source: Sec. 14132.725 of the Welfare and Institutions Code.

Source (tete-dermatotogy & tete-ophthatmotogy): CA Department of Health Care Services. Medi-Cat Part 2 General Medicine

STATE LAW/REGULATIONS MEDICAID PROGRAM
Manual. Telehealth. Pg. 5. (Dec. 2013), (Accessed Mar. 2017).

Allied dental professionals are not permitted to bill for teledentistry.

Live transmissions are only billable if the beneficiary requests it.

Specific list of acceptable CPT codes included in Denti- Cal Handbook.

Source: Denti-Cal Provider Handbook. (4-11 to 4-12) Pg. 111-112.
(Mar. 2017).
Remote Patient Monitoring Reimbursement
No reference found. No refere nce found.
Email/Phone/FAX
No reference found. Medi-Cal does not reimburse for telephone calls, electronic mail messages or facsimile transmissions.

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. Pg. 5. (Dec. 2013), (Accessed Mar. 2017).
Online Prescribing
Providers are prohibited from prescribing or dispensing dangero us drugs or dangerous dev ices on the Internet without an appropriate prior examina tion and medica l indication.

Source: CA Business & Professions Code Sec. 2242.1(a). No reference found.
Consent
The originating site provider must obtain and document verbal or written patient consent prior to service delivery.

CA Health & Safety Code Sec. 1374.13.

Occupational Therapy
Informed consent must be obtained by the occupational therapist prior to the use of telehealth to deliver services.

Source: CA Code of Regulations, Title 16, Div. 39, Art. 8, Sec. 4172.

Behavioral Sciences
A licensee must obtain informed consent from a client.

Source: CA Code of Regulations, Title 16, Div. 18, Art. 1, Sec. 1815.5. Provider must obtain oral consent from the patient and document it in the patient record.

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. Pg. 2. (Dec. 2013), (Accessed Mar. 2017).
Location
Health plans cannot limit the settings where services are provided. Settings are still subject to contract terms and conditions. The type of setting where services are provided is not limited.

Source: CA Department of Health Care Services. Medi-Cal Part 2

STATE LAW/REGULATtONS MEDICAID PROGRAM
Source : CA Health & Safety Code Sec. 1374.13 (2012). Genera/ Medicine Manual. Teleheatth. Pa. 1. (Dec. 2013), (Accessed Mar. 2017).
Cross-State Licensing
No reference found. No referencefound.
Private Payers
Private payers cannot require that in-person contact occur before payment is made for covered telehealth services, subject to contract terms and conditions.
Source: CA Health & Safety Code Sec. 1374.13 (2012). No reference found.
Site/Transmission Fee
No reference found. Medi-Cal will reimburse the originating site a facility fees, and originating and distant site for live video transmission costs.

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. Pg. 2. (Dec. 2013), (Accessed Mar. 2017).
Miscellaneous
The CA Board of Occupational Therapy adopted a new rule titled, “Standards of Practice for Telehealth,” to establish standards and expectations associated with the delivery of occupational therapy services via information and communication technology.

Any licensed health care provider or marriage and family therapist, intern or trainee is an authorized telehealth provider.

Source: CA Business and Professions Code Sec. 2290.5. Medi-Cal covers telehealth to the extent services are allowable and reimbursed according to the department’s telehealth manual in the California Children’s Services Program (CCS), Genetically Handicapped Person’s Program (GHPP) and Child Health and Disability Prevention Program (CHOP).

Source: CA Department of Health Care Services. Medi-Cal Special Programs FAQs. (Accessed Mar. 2017).

Telehealth services and supports are among the services and supports authorized to be included by individual program plans developed for disabled individuals by regional centers that contract with the State Department of Developmental Disabilities.

Source: Welfare and Institutions Code Sec. 4512.

Comments:

New Regulations Passed
⦁ CA Board of Occupational Therapy (Source: Title16, Div. 39, Sec. 4172)
⦁ CA Board of Behavioral Sciences (Source: CA Code of Regulations, Title 16, Div. 18, Art. 1, Sec.
1815.5)

Program Administrator: California Dept. of Health Care Services (DHCS)

Regional Telehealth Resource Center:

California Telehealth Resource Center (CTRC)
2001 P Street, Suite 100

Sacramento, CA 95811
(916) 341-3378 / (877) 590-8144
www.caltrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telehealth means the mode of delivering health care Telehealth [according to the Telehealth Advancement

services and public health via information and Act of 2011] “is the mode of delivering health care
communication technologies to facilitate the diagnosis, services and public health utilizing information and
consultation, treatment, education, care management, communication technologies to facilitate the diagnosis,
and self-management of a patient’s health care while the consultation, treatment, education, care management
patient is at the originating site and the health care and self-management of a patient’s health care while the
provider is at a distant site. Telehealth facilitates patient patient is at the originating site and the health care
self-management and caregiver support for patients and provider is at the distant site.”
includes synchronous interactions and asynchronous “Telemedicine [according to CMS] is the use of medical
store and forward transfers.”
information exchanged from one site to another using
Source: CA Business & Professions Code Sec. 2290.5 (2012). interactive telecommunications equipment that includes,
Telemedicine is “the ability of physicians and patients to at a minimum, audio and video equipment permitting
two-way, real-time, interactive communication between
connect via technology other than through virtual the patient and physician or practitioner at the distant
interactive physician/patient capabilities, especially site to improve a patient’s health. Medi-Cal uses the
enabling rural and out-of-area patients to be seen by term telemedicine when it makes a distinction from
specialists remotely.” telehealth.”
Source: CA Code of Reg. Title 10 Sec. 6410. Source: CA Department of Health Care Services. Medi-Cal Part 2

General Medicine Manual. Telehealth. (Sept. 2017) (Accessed
Oct. 2017).

Live Video Reimbursement

Private payers may reimburse for live video. (See Medi-Cal will reimbursement for services provided
“Private Payers” section). via live video.
Source: CA Health & Safety Code Sec. 1374.13 (2012). Services must be billed with modifiers GT or 95.
(also see Medicaid column) Source: CA Department of Health Care Services. Medi-Cal
Part 2 General Medicine Manual. Telehealth. (Sept. 2017),
(Accessed Oct. 2017).

Store and Forward Reimbursement

Private payers may reimburse for store and forward. Medi-Cal will reimburse for store and forward services
Source: CA Business & Professions Code Sec. 2290.5 (2012). for tele-dermatology, tele-ophthalmology and
teledentistry.
(also see Medicaid column) Source: Sec. 14132.725 of the Welfare and Institutions Code.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source (tele-dermatology & tele-ophthalmology): CA Department
of Health Care Services. Medi-Cal Part 2 General Medicine
Manual. Telehealth. (Sept. 2017), (Accessed Oct. 2017).
Allied dental professionals are not permitted to bill for
teledentistry.
Live transmissions are only billable if the beneficiary
requests it.
Specific list of acceptable CPT codes included in Denti-
Cal Handbook.
Source: Denti-Cal Provider Handbook. (4-11 to 4-12) Pg. 111-112.
(Oct. 2017).

Remote Patient Monitoring Reimbursement

No reference found. No reference found.

Email/Phone/FAX

No reference found. Medi-Cal does not reimburse for telephone calls,
electronic mail messages or facsimile transmissions.
Source: CA Department of Health Care Services. Medi-Cal Part 2
General Medicine Manual. Telehealth. (Sept. 2017), (Accessed
Oct. 2017).

Online Prescribing

Providers are prohibited from prescribing or dispensing No reference found.
dangerous drugs or dangerous devices on the Internet
without an appropriate prior examination and medical
indication.
Source: CA Business & Professions Code Sec. 2242.1(a).

Consent

The originating site provider must obtain and document Provider must obtain oral consent from the patient and
verbal or written patient consent prior to service delivery. document it in the patient record.
CA Health & Safety Code Sec. 1374.13. Source: CA Department of Health Care Services. Medi-Cal Part 2
Occupational Therapy General Medicine Manual. Telehealth. (Sept. 2017), (Accessed
Oct. 2017).
Informed consent must be obtained by the occupational
therapist prior to the use of telehealth to deliver services.
Source: CA Code of Regulations, Title 16, Div. 39, Art. 8, Sec.
4172.
Behavioral Sciences
A licensee must obtain informed consent from a client.
Source: CA Code of Regulations, Title 16, Div. 18, Art. 1, Sec.
1815.5.

Location

Health plans cannot limit the settings where services are The type of setting where services are provided is not
provided. Settings are still subject to contract terms and limited.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

conditions.
Source: CA Department of Health Care Services. Medi-Cal Part 2

Source: CA Health & Safety Code Sec. 1374.13 (2012). General Medicine Manual. Telehealth. (Sept. 2017), (Accessed
Oct. 2017).

Cross-State Licensing

No reference found. No reference found.

Private Payers

Private payers cannot require that in-person contact No reference found.
occur before payment is made for covered telehealth
services, subject to contract terms and conditions.
Source: CA Health & Safety Code Sec. 1374.13 (2012).

Site/Transmission Fee

No reference found. Medi-Cal will reimburse the originating site a facility
fees, and originating and distant site for live video
transmission costs.
Source: CA Department of Health Care Services. Medi-Cal Part 2
General Medicine Manual. Telehealth. (Sept. 2017), (Accessed
Oct. 2017).

Miscellaneous

The CA Board of Occupational Therapy adopted a new Reimbursement for HCPCS Code G0508 and G0509, a
rule titled, “Standards of Practice for Telehealth,” to “telehealth consultation”.
establish standards and expectations associated with
the delivery of occupational therapy services via Source: CA Department of Health Care Services. Medi-Cal Part 2
information and communication technology. General Medicine Manual. Telehealth. (Sept. 2017), (Accessed
Oct. 2017).
Any licensed health care provider or marriage and family Medi-Cal covers telehealth to the extent services are
therapist, intern or trainee is an authorized telehealth allowable and reimbursed according to the department’s
provider.
telehealth manual in the California Children’s Services

Source: CA Business and Professions Code Sec. 2290.5. Program (CCS), Genetically Handicapped Person’s
Program (GHPP) and Child Health and Disability
Prevention Program (CHDP).
Source: CA Department of Health Care Services. Medi-Cal Special
Programs FAQs. (Accessed Oct. 2017).
Telehealth services and supports are among the
services and supports authorized to be included by
individual program plans developed for disabled
individuals by regional centers that contract with the
State Department of Developmental Disabilities.
Source: Welfare and Institutions Code Sec. 4512.

Comments:

New Regulations Passed

CA Board of Occupational Therapy (Source: Title 16, Div. 39, Sec. 4172)

CA Board of Behavioral Sciences (Source: CA Code of Regulations, Title 16, Div. 18, Art. 1, Sec.

1815.5)

© 2017 Public Health Institute Center for Connected Health Policy

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