California Telehealth
Policy Coalition

CCHP convenes and leads a group of over 100 state and national entities dedicated to advancing California’s leadership in telehealth policy. The Coalition is made up of consumer groups, medical systems, payers, providers, and technology representatives.

Our origin story

In 2011, when AB 415, the Telehealth Advancement Act was winding its way through the legislative process, an ad hoc group of statewide organizations supporting the bill formed. This group, including the California Primary Care Association, the California Hospital Association and the California Rural Health Association, came together in meetings convened by CCHP in order to be apprised of any developments around AB 415 and share information with each other.

With the successful passage of AB 415, the group continued to meet and eventually evolved into the California Telehealth Policy Coalition. CCHP leads the Coalition and hosts monthly conference calls.

In recent years, the Coalition has decided to move beyond a mere information sharing group to become a more active collective participant in telehealth policy. The Coalition has developed a slate of telehealth policy goals and issues that it is working on in a continued effort to modernize California telehealth policy.

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Next meeting | Friday, September 17, 2021

Monthly Coalition
Meeting

We host monthly conference calls to discuss the latest California telehealth policy developments. Want to join us?

Meeting summaries
& materials

Get access to the full archive of agendas, slide decks, speaker bios, and other resources from both our annual and monthly meetings.

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Telehealth policy
in California

California is a leader in telehealth policy. It was one of the first states to pass telehealth legislation in 1996 and continues to drive sound policy to better connect health care providers with their patients.

California Policy

California was one of the first states to pass a telehealth law with the Telemedicine Development Act of 1996. At the time, the bill was considered progressive legislation and provided model language for other states.  However, in the decades that followed, telehealth law in California essentially remained unchanged, even as technology rapidly evolved.

In 2010, CCHP convened a national work group of telehealth and health policy leaders to examine whether California’s law still remained viable in the current environment.  In a nearly year-long process involving research, key informant interviews, meetings, and vetting of recommendations by the work group, CCHP produced a report of its findings as well as a series of recommendations for updating California’s telemedicine laws.

The recommendations in CCHP’s report became the basis of California’s Telehealth Advancement Act of 2011 (AB 415) and went into effect in January of 2012. Among its many improvements to California telehealth policy, it also created a better environment for Medi-Cal, the state Medicaid program, to provide telehealth-delivered services.

In recent years, the language put in place by AB 415 has been amended, with the most significant change occurring with the passage of AB 744 in 2019.  The most substantial revision, which applies to health plans issued, amended or renewed on or after January 1, 2021, requires payers to reimburse for telehealth services on the same basis and to the same extent, as well as at the same rate as an equivalent service when delivered in person.  The health plan cannot require the use of telehealth if the health care provider has determined that it is not appropriate nor does it limit the ability of the health plan and provider to negotiate the rate of reimbursement for a service. 

You can see a complete history of telehealth legislation in California in this timeline.

Medi-Cal

Medi-Cal is California’s Medicaid program, which is administered by the Department of Health Care Services (DHCS). Medi-Cal aims to provide health care services to about 13 million low-income individuals including families with children, seniors, persons with disabilities, foster care, pregnant women and low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS.  Funding comes equally from the State and federal governments. 

With the passage of the Telehealth Advancement Act of 2011 (AB 415), Medi-Cal was required to update their policies regarding telehealth.  AB 415 allowed Medi-Cal to expand services and reimbursement for telehealth delivered services, and as of August 2019, DHCS has taken advantage of this opportunity.  Medi-Cal is now allowing providers in fee-for-service to decide what modality (live video or store-and-forward) will be used to deliver eligible services to a Medi-Cal enrollee as long as the service is covered by Medi-Cal and meets all other Medi-Cal guidelines and policies, can be properly provided via telehealth, and meets the procedural and definition components of the appropriate CPT or HCPCS code.  

Additionally, Medi-Cal specifically allows the home to be an originating site and they will reimburse for one specific code for e-consult (as a sub-set of store-and-forward), as well as an e-visit, which is communication between a patient and provider through an online patient portal. 

With the onset of the COVID-19 public health emergency (PHE), DHCS implemented a number of telehealth flexibilities in its Medi-Cal policy that are exclusive to the existence of the federal PHE.  Looking ahead to post-COVID-19, DHCS has proposed revisions to its permanent telehealth policy.

Other programs that have updated policies as of August 2019 include:

  • Indian Health Services, Memorandum of Agreement (IHS-MOAs) 
  • Family Plan, Access, Care and Treatment (Family PACT)
  • Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
  • Local Education Agency
  • Vision Care
  • Denti-Cal

Stay up to date on Medi-Cal’s current telehealth policy >

California Children’s Services & Genetically Handicapped Persons Program

In 2013, the Department of Health Care Services (DHCS) released a letter in which they referred providers to the Medi-Cal provider bulletins and provider manual for the Department’s policies for the California Children’s Services (CCS) and Genetically Handicapped Persons Program (GHPP).  However, in December 2017 the California Department of Health Care Services (DHCS) issued a letter to CCS and GHPP administrators, medical consultants, and staff regarding new telehealth service codes. The letter indicates that upon approval of a CCS/GHPP service authorization request (SAR), providers can bill for a series of specific CPT/HCPCS codes when delivered via telehealth, which were not previously eligible for reimbursement. These codes are now reimbursable in addition to the codes already listed in the Medi-Cal provider manual for the CCS and GHPP programs. The letter does note that the codes must be billed with the appropriate telehealth modifiers and follow other guidelines listed in the Medi-Cal Telehealth Provider Manual.

Medi-Cal Provider Manuals

Additional DHCS Resources

More resources

Telehealth Advancement Act

Authored by Assemblyman Dan Logue (R-Lake Wildwood), the Telehealth Advancement Act of 2011 (AB 415) became law on January  1, 2012.  AB 415 updated legal definitions of telehealth, streamlined medical approval processes for telehealth-delivered services, and broadened the types of allowed telehealth-delivered services.

AB 415 drew from CCHP’s Telehealth Model Statute Report, which recommended modernizing state telemedicine and workforce laws to encourage more robust adoption of telehealth technologies.  CCHP provided nonpartisan technical support to Assemblyman Logue and the bill’s sponsor, the California State Rural Health Association.

Assemblyman Logue gained impressive bipartisan support for the bill with four Democratic co-authors:  Wesley Chesbro (D-North Coast), Cathleen Galgiani (D-Livingston), Richard Pan (D-Natomas), and V. Manuel Pérez (D-Coachella).  The bill passed out of both California legislative houses with no opposition and was signed by Governor Jerry Brown.

Elements of the Telehealth Advancement Act of 2011

AB 415 replaces the outdated legal term of “telemedicine” with “telehealth.”

Telemedicine under the old law’s terminology was defined as the practice of medicine via live video connections between patients and providers in separate locations, or via “data communications.” As technological advances resulted in new telehealth treatment options, this legal definition grew obsolete and became a barrier to implementing these advancements.

For example, while the old law referenced data communications, it did not explicitly include in its definitions the use of store-and-forward technologies, a prominent type of telehealth service delivery. Store-and-forward connects primary care providers (PCPs) and medical specialists via secure high-speed, high-definition communications systems that work like emails with attachments. This type of telehealth speeds patients’ treatment while removing the need for patient travel and provides valuable disease-specific education for PCPs.

While a separate section of the old law allowed store-and-forward, providers seeking reimbursement for these services encountered difficulties from the lack of a clear and explicit presence in its definitions. For example, Medi-Cal would only cover teledermatology, teleophthalmology, and specific diagnostic teleoptometry services, a restriction that some private payers adopted as well. In addition, the old law did not include chronic disease management programs, which use electronic home monitoring systems to monitor patients’ vital signs.

Telehealth, the new legal term, refers to the general technology-enabled delivery of health services rather than a specific medical practice. This shift allows for a far broader range of eligible services than the old law, and includes future telehealth technologies in its encompassing, innovative definition.

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.” – California Business and Professions Code Sec. 2290.5

AB 415 removes limits on the locations where telehealth services may take place. Under the old law, telemedicine appointments had to take place only in licensed health care facilities, such as hospitals or physician offices. There were no explicit restrictions on locations beyond the licensed facility requirement, but this limitation would preclude telehealth being used in such places as the home.

Additionally, Medi-Cal policy restricted telemedicine delivery to four types of licensed facilities only: hospitals, clinics, physician offices, and skilled nursing facilities. Some private payers followed suit, cementing the perception that these were the only facilities where telemedicine could occur.

AB 415 explicitly removed limits on the locations for telehealth, allowing for any type of telehealth to be covered regardless of where it takes place. This can include patient care management programs that employ home monitoring devices, in-home patient medical appointments, and physician reviews in any location for store-and-forward cases. However, AB 415 only allows for the expanded types of location and does not mandate that a payer pay for services taking place in these other types of facilities.

AB 415 eliminates the ban on email or telephone-delivered services. Prior to AB 415, California law contained an explicit exclusion of email or telephone-delivered services.  AB 415 removed this restriction, but also did not specifically include email or telephone within the definition of telehealth. While reimbursement for services provided via email or telephone is no longer prohibited and allows a payer to reimburse for it, it is not mandated.

AB 415 includes all California-licensed health professionals as telehealth providers. Under the old law, only these medical professionals could provide telehealth services:

  • Physicians
  • Surgeons
  • Podiatrists
  • Clinical psychologists
  • Marriage, family and child counselors
  • Dentists
  • Ophthalmologists
  • Optometrists (in limited scope)

The Act expands this list to include all professionals licensed under Division 2 of the State’s healing arts statute, allowing for expanded provider use of telehealth services and expanded access to needed services.

AB 415 allows California hospitals to streamline medical credentialing for telehealth providers. Federal regulations called “privileging by proxy” allow hospitals and other telehealth-engaged entities to accept the credentialing paperwork of each facility’s practitioners. This process quickens approvals for practitioners, and eliminates expensive and often cumbersome credentialing processes.

The CMS rules also allow non-hospital telehealth sites, such as physician offices and ambulatory centers, to use the same processes for telehealth service delivery at a hospital, as long as those services meet the hospital’s conditions of practice. AB 415 aligns California law with the CMS regulations.

California regulators encountered confusion about whether existing state regulations conflicted with the federal regulation (which is optional), and whether the state’s hospitals would still have to go through full credentialing processes for all telehealth practitioners. An amendment to AB 415 helped clear up the confusion, and streamlined the process for establishing medical credentials of telehealth providers within the state.

AB 415 removes two restrictive Medi-Cal regulations on telehealth services. First, AB 415 eliminated a Medi-Cal rule requiring providers to document that a beneficiary had a “barrier” to an in-person visit before telehealth could be used. Providers widely viewed this rule as a disincentive to using telehealth.

Second, AB 415 removed a sunset date that would have eliminated Medi-Cal coverage of store-and-forward services for teledermatology, teleophthalmology and teleoptometry.

AB 415 changes telehealth’s additional written patient consent requirement to verbal consent. Providers found that the written consent form stigmatized the use of telehealth, and created an unnecessary barrier to care. AB 415 replaces the written consent with a verbal consent.  This establishes parity between services provided in person, and those provided via telehealth.

Changes since AB 415

Since the passage of AB 415, there have been three bills that have made amendments to California’s telehealth policy.  The first, AB 809, passed in 2014, clarifies patient consent can be obtained orally or in written form and that it doesn’t need to be obtained for every distinct visit with a particular patient. The second, AB 1174 which also passed in the 2014 legislative session, requires Denti-Cal to provide coverage for store-and-forward teledentistry.

Finally, in 2019, with the help of the California Telehealth Policy Coalition, AB 744 was passed to greatly strengthen California’s private payer law.  It provided explicit parity in the services that must be covered by insurers when delivered via telehealth, and beginning in 2021 it also provides for payment parity as well.  Additionally, it prohibits coverage from being limited to services delivered by a select third-party corporate telehealth provider.

AB 744 also updated various telehealth definitions including removing obsolete references to originating site and distant site, as well as references limiting store-and-forward in Medi-Cal to teleophthalmology, teledermatology, or teledentristry and requiring notification of the right to receive interactive communication with the distant specialist physician, optometrist, or dentist. Lastly, AB 744 clarified that in addition to licensed providers, qualified autism service professionals were eligible to provide services via telehealth, while separate legislation added marriage and family therapists as eligible providers as well.

You can see a complete history of telehealth legislation in California in this timeline.

Further reading

Featured Coalition policy fact sheets, resources & webinars

We regularly publish recommendations, explainers, and other resources to help guide Coalition members and the public on California’s telehealth policy.

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State actions in California as a result of COVID-19

As a result of the COVID-19 pandemic, many states have taken action to temporarily remove policy barriers to utilizing telehealth.

view california covid-19 state actions >


Latest legislation and regulation updates for California

We track bills that address various telehealth topics as they make their way through the California legislative and regulatory processes.

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