Existing law establishes the State Department of Health Care Services, and requires the department to administer various health programs. Existing law authorizes the department to award grants for specified programs, including studies of various diseases and treatment methodologies.
Existing law provides for the Medi-Cal program, which is administered by the department, under which qualified low-income individuals receive health care services, including federally qualified health center (FQHC) services and rural health clinic (RHC) services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. FQHC and RHC services are reimbursed, to the extent that federal financial participation is obtained, to providers on a per-visit basis, and a "visit" is defined as a face-to-face encounter between a patient of an FQHC or RHC and specified health care professionals, including dental providers.
Existing law prohibits a requirement of in-person contact between a health care provider and a Medi-Cal patient when the service may be provided by telehealth, and, for purposes of telehealth, prohibits the department from limiting the type of setting where Medi-Cal services are provided. Existing law authorizes, to the extent that federal financial participation is available, the use of health care services by store and forward under the Medi-Cal program, subject to billing and reimbursement policies developed by the department, and prohibits a requirement of in-person contact between a health care provider and a Medi-Cal patient when these services are provided by store and forward.
This bill would provide that an FQHC or RHC "visit" includes an encounter between an FQHC or RHC patient and a health care provider using telehealth by synchronous real time or asynchronous store and forward. The bill would clarify, for purposes of an FQHC or RHC visit, that face-to-face contact between a health care provider and a patient is not required for an FQHC or RHC to bill for telehealth by synchronous real time or asynchronous store and forward if specified requirements are met, including that a billable provider in the Medi-Cal program, and who is employed by the FQHC or RHC, supervises or provides the services for that patient via telehealth by synchronous real time or asynchronous store and forward.
This bill would also create the E-Consult Services and Telehealth Assistance Program within the department to award grants, contingent upon an appropriation, to health center-controlled networks, health centers, and rural health clinics to conduct projects to implement and test the effectiveness of e-consult services and related telehealth services. The bill would require a health center-controlled network, health center, or rural health clinic to meet specified criteria to be eligible for a grant, and would require a project awarded a grant to address specified objectives. The bill would limit an awarded grant to a term of no more than 5 years. No later than 180 days after the completion of the last grant-funded projects, the bill would require the department to submit a report to the Legislature that, among other things, provides an overview of supported projects and identifies successes and failures.

Statutes affected:
05/11/20 - Amended Assembly: 14132.100 WIC