January 31, 2024
Patients must have a life-threatening condition.
As of January 1, 2024, California Assembly Bill (AB) 1369 permits a physician or surgeon who is licensed in another state to provide care via telehealth to a patient who has an immediate life-threatening condition. Physicians and other providers should be aware of the bill’s requirements that make a patient and provider eligible.
How this affects you and your patients
Effects of the bill include:
- Expanded access to care for patients via telehealth.
- California physicians and other in-state providers have broader resources available because they can now consult with out-of-state telehealth providers who aren’t licensed in California.
- Facilities may wish to contract with out-of-state providers who meet the bill’s eligibility requirements to provide care via telehealth as described in the bill. Claims for Medi-Cal members would be covered at Medi-Cal rates.
- The eligible patient’s primary physician and surgeon must provide documentation to the patient attesting that the patient meets the following requirements:1
- Has an immediate life-threatening disease or condition as defined in Section 111548.1 of the Health and Safety Code.
- Has given written informed consent for, or, if the person lacks the capacity to consent, their legally authorized representative has given written informed consent on their behalf for, both of the following:
- The use of an eligible out-of-state physician and surgeon’s telehealth health care services.
- The release of certified medical records to their primary physician and surgeon by the out-of-state physician.
- Has not been accepted to participate in the clinical trial nearest to their home for the immediate life-threatening disease or condition identified in subparagraph A within one week of completion of the clinical trial application process, or, in the medical judgment of a physician and surgeon described in the bill’s paragraph 3, it is unreasonable for the patient to participate in that clinical trial due to the patient’s current condition and stage of disease.
The requirements apply to in-state physicians and surgeons, as well as in-state osteopathic physicians or surgeons. For more information, access the bill online at Assembly Bill No. 1369.
Additional information
Relevant sections of the Wellcare Provider Manual have been revised to reflect the information contained in this update as applicable. The manual is available online at www.wellcare.com/California/Providers/Medicare.
If you have questions regarding the information contained in this update, contact 866‑999‑3945.
1Assembly Bill 1369, Chapter 837.
