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                                                                                 Center for Connected Health Policy

           California


           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                              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
            store and forward transfers.”                      “Telemedicine [according to CMS] is the use of medical
                                                               information exchanged from one site to another using
            Source: CA Business & Professions Code Sec. 2290.5 (2012).   interactive telecommunications equipment that includes,
                                                               at a minimum, audio and video equipment permitting
            Telemedicine is “the ability of physicians and patients to   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. Pg. 1. (Dec. 2013).

            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).   Source: CA Department of Health Care Services. Medi-Cal
                                                               Part 2 General Medicine Manual.  Telehealth. Pg. 1. (Dec.
            (also see Medicaid column)                         2013).
            Store and Forward Reimbursement
            Private payers may reimburse for store and forward.   Medi-Cal will reimburse for store and forward services
                                                               for tele-dermatology, tele-ophthalmology and
            Source: CA Business & Professions Code Sec. 2290.5 (2012).   teledentistry.

            (also see Medicaid column)                         Source: Sec. 14132.725 of the Welfare and Institutions Code.

                                                               Source (tele-dermatology & tele-ophthalmology): CA Department
                                                               of Health Care Services. Medi-Cal Part 2 General Medicine
                                                               Manual.  Telehealth. Pg. 5. (Dec. 2013).

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            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. Pg. 5. (Dec. 2013).
            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
                                                               General Medicine Manual.  Telehealth. Pg. 2. (Dec. 2013).
            Occupational Therapy
            Oral informed consent must be obtained by the
            originating site prior to the use of telehealth to deliver
            health services.

            Source: CA Code of Regulations, Title 16, Div. 39, Art. 8, Sec.
            4172.

            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.
            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. Pg. 1. (Dec. 2013).
            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

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               General Medicine Manual.  Telehealth. Pg. 2. (Dec. 2013).
            Miscellaneous
            The CA Board of Occupational Therapy adopted a new   Medi-Cal covers telehealth to the extent services are
            rule titled, “Standards of Practice for Telehealth,” to   allowable and reimbursed according to the department’s
            establish standards and expectations associated with   telehealth manual in the California Children’s Services
            the delivery of occupational therapy services via   Program (CCS), Genetically Handicapped Person’s
            information and communication technology.          Program (GHPP) and Child Health and Disability
                                                               Prevention Program (CHDP).

                                                               Source: CA Department of Health Care Services. Medi-Cal Special
                                                               Programs FAQs.
                                                               http://www.dhcs.ca.gov/provgovpart/Pages/FAQ-Telehealth-
                                                               Programs.aspx (accessed Jan. 7, 2015).

                                                               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)












































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