Telehealth, the umbrella under which telemedicine belongs, is defined in California as the use of information and communications technology to make health care information and services remotely available to patients via synchronous and asynchronous methods. It is an accepted legitimate mode of receiving healthcare services without the need for in-person interaction with the provider.
- California Telemedicine at a Glance
- Unmatched Feature of Telemedicine in California
- California State Telemedicine Laws and Policies
- E-prescription: Appropriate examination and medical indication required.
- Telepharmacy: Making medicines accessible to the underserved.
- Who can practice telemedicine in California?
- State Reimbursement Policy
- Public Health Emergency (PHE)
- 10 Top-rated Online Doctors and Telemedicine Providers in California
- Telemedicine Resources in California
California Telemedicine at a Glance
The State of California takes telemedicine seriously, and its legislators have always strived to make the same accessible and affordable to its residents and anyone located within the boundaries of the state. Several laws were submitted, debated on, and some were eventually passed.
The Telemedicine Development Act of 1996 was the first telehealth law to be passed, not just in California but also the rest of the country. To cope with the changing times (and the people’s changing needs), the Telehealth Advancement Act of 2011 was enacted. A few amendments and changes were made to address the need of California residents better.
The Medicaid program of California, known as Medi-Cal, has recently updated its telehealth feature and coverage. It has currently evolved to become one of the most progressive policies in the country. Residents are sure to get the most out of the state’s available telehealth services, given local legislation’s laws and guidelines.
Unmatched Feature of Telemedicine in California
What sets telemedicine in California apart from other states is the continuous efforts of its Department of Health Care Services to make telehealth services available through various modes, widening its reach farther into medically underserved locations in the State, expanding the reach of subspecialties that would have been impossible to connect with, and broadening the opportunities for patients to be served by providers with whom they are more compatible with in terms of culture, religion, language, and race while keeping it affordable at the same time.
California State Telemedicine Laws and Policies
Before engaging or delivering any health care service, the provider must first inform the patient or client that the service will be availed through telehealth and that the latter must show acceptance of this mode by giving his or her consent to it. The consent may be verbal or written, and at either instance, the provider must properly document the same and include it in the patient’s file. However, the consent given does not mean that the patient is barred from requesting and receiving health care services in person.
Other than the mandated consent, there is no need for the health care provider and patient or client to meet in person to establish a medical relationship as long as there are no physical examinations or tests to be performed. There is likewise no need to document existing barriers to an in-person consultation or reason why the patient availed of telemedicine services instead.
Failure on the part of any health care provider to observe protocols amounts to unprofessional conduct, and that he or she may be subjected to sanctions provided by state law. The same standard of care is expected from licensed professionals in providing services via telehealth as if they are practicing in-person. They uphold the same oath and responsibilities and are governed by the same laws and regulations. The same applies to information divulged during the telemedicine consultation. The provided standard covering the confidentiality and the right of patients to medical information must be observed.
A law has also been recently passed allowing the use of telehealth for examinations or assessments required for involuntary commitments.
Other professional boards in California have specific issuances for the practice of their field in telehealth. The Board of Occupational Therapy, for example, have set forth the following guidelines in addition to the mandatory obtaining of consent:
- The occupational therapist must have a valid and current board-issued license.
- Services may only be provided to clients or patients within the State.
- It must first be determined whether an in-person examination is the best option for the subject medical condition and under the given circumstances.
- The Occupational Therapy Practice Act must be strictly complied with.
The CA Board of Behavioral Sciences also laid down their guidelines to be observed in telehealth practice in marriage and family therapy, educational psychology, professional clinical counseling, and clinical social work:
- The client to whom services will be rendered shall be found in the State physically at the time of the service.
- The clinician or counselor must have a valid registration or license given by the Board, the registration number and type of which must be provided to the client.
- The health care provider must inform the client of the limitations and potential risks tied to being treated through telemedicine.
- A clinician or counselor licensed in the state of California may be allowed to provide services to clients in another state if and only if he or she qualifies for the standards and requirements outlined in the other state and if it also allows telehealth.
E-prescription: Appropriate examination and medical indication required.
When it comes to prescribing medications, California laws only require an appropriate examination and medical indication authorizing such prescription. Such examination can be done in telehealth through proper tools such as questionnaires or surveys and does not necessarily require a face-to-face interaction between the patient and the professional licensed to issue prescriptions. The online interaction doesn’t even have to be synchronous as long as the prescribed medication’s need can be ascertained.
Absent the required examination, providers, even though licensed, are still prohibited to electronically prescribe and dispense medication and other dangerous drugs.
As for prescribing controlled substances, the licensed physician must first have an in-person meeting with the patient before he or she can legally make the prescription.
Telepharmacy: Making medicine accessible to the underserved.
To give much easier access to health care services, California has come up with a remote dispensing site pharmacy. This is where a supervising pharmacy oversees prescription medicines’ dispensing in a remote dispensing site pharmacy not more than 150 road miles away from it. Aside from dispensing, other pharmaceutical services such as patient counseling and review of all medications taken can likewise be provided on the site.
These services can be successfully provided through communication between the site and the supervising pharmacy via audio and video conferencing methods. It would be as if the pharmacist is present on the site and can oversee all the medications dispensed to the customer.
The remote dispensing site pharmacies are only made available to private individuals in medically underserved areas that do not have a pharmacy within ten road miles where the dispensing site is established. No unlicensed personnel is allowed to run the site; only licensed pharmacists or pharmacy technicians can engage in the practice of telepharmacy.
Who can practice telemedicine in California?
Out of the fifty states in the country, forty-nine require medical professionals, specifically physicians who wish to engage in the practice of telemedicine, to be licensed in the state where the patient they are attending to resides or is situated at the time of consultation. The same is also true for the District of Columbia, Puerto Rico, and the Virgin Islands.
Since California is not one of the members of the Interstate Medical Licensure Compact, health care providers must strictly be possessors of a California license.
There is no residency requirement, so it doesn’t matter where you are situated when rendering telehealth services as long as you have a valid and current California license.
To be eligible and to be allowed to practice telehealth in California, the provider must be:
- Licensed in the state of California
- Enrolled as a rendering provider under Medi-Cal or as a non-physician medical practitioner (NMP)
- Connected with a registered Medi-Cal provider group
- Located within the borders of the state
In teledentistry, allied dental professionals may provide services through telehealth but said services are limited within their scope and must always be supervised by a licensed dentist.
State Reimbursement Policy
Under federal law, telemedicine is not acknowledged as a distinct service covered by Medicaid. It all depends on the state whether they choose to have telemedicine services costs covered under Medicaid.
The local state equivalent of Medicaid in California is Medi-Cal. Although the former somehow governs and provides funds for the latter to make health care services available and affordable for low-income residents, Medi-Cal has its own rules to follow when considering services that should be covered.
The general rule is that all health care services, whether rendered in-person or through telehealth, will all be reimbursed at the same rate.
It is unlawful for the health care service plan provider to set a limitation regarding the setting under which a health care service is availed, nor is it legal for any plan provider to push the use of telehealth services against the advice of the health care professional that it is no longer appropriate under given circumstances before paying the same.
What services are reimbursed in the state of California?
- Live Video
- E-consults through e-mail, phone, or fax
X Remote Patient Monitoring
For Live Video, there is no limitation for eligible sites or types of settings. This means that telehealth services delivered in a hospital, clinic, or home are covered and are reimbursed. The facility and transmission fees are likewise reimbursed both at the originating and distant site.
In teledentistry, reimbursement for live video conferencing or synchronous transmissions is limited to one and a half hours only per day. Any minute beyond that is no longer covered.
California is one of the 15 states that cover store-and-forward (SAF) services under Medicaid. Clients or patients can now have their medical concerns, may it be through entered information, photos, images, laboratory results, audio or video recordings, forwarded electronically to their online doctors who can examine, evaluate, diagnose, and give advice accordingly.
For Store-and-Forward, only the facility fee is reimbursed, while the transmission fee is not covered. Teleophthalmology, teledentistry, and teledermatology services availed of through the store-and-forward mode are likewise reimbursed. The prerequisite of face-to-face interaction for the above-mentioned fields to avail of reimbursement has been removed. Denti-Cal is the one responsible for coverage and reimbursements in teledentistry.
E-consults through phone, e-mail, or fax are likewise reimbursable as such as long as:
- The provider has not seen the patient within 14 days before the consultation
- There is no recommendation for in-person consultation within 14 days after that
- The consultation did not last for more than five minutes, and there was no report written for the consultation
- There are records or written documentation either from the originating site or distant site about the service.
Telehealth services provided by substance use disorder (SUD) counselors licensed or certified are likewise reimbursed under Medi-Cal.
A telehealth service can only be reimbursed if it meets the following criteria:
- The service availed or rendered must be generally reimbursed under Medi-Cal.
- It must fall under the CPT or HCPCS codes used for reimbursement.
- Health care information confidentiality, data privacy, and the right to medical information should have been strictly observed.
As for providers who offer fee-for-service health care, they are free to decide between live video or SAF as the online consultation mode. The same will be reimbursed if the service is under the coverage of Medical.
By Private Payer or other health care service plan providers:
- Live Video
X E-consults through e-mail, phone, or fax
X Remote Patient Monitoring
Generally, under the Health and Safety Code, payment must be made by the health care service plan provider without the requirement of an in-person consultation as long as the service availed through telehealth is covered under the contract entered into by the parties concerned.
The said Code was further amended and now provides for the inclusion in any contract entered or renewed by January 1, 2021, providing any health care service such as consultation, diagnosis, and treatment provided through telehealth means shall be reimbursed in the same manner. The same extent as these services would warrant if provided in-person.
If there is a need for copayment or coinsurance for a certain telehealth service availed of, the subscriber cannot be made to pay an amount higher than what would be required in its in-person consultation equivalent.
However, in instances that a telehealth service has no equivalent in an in-person setting, the health insurer and health care provider may negotiate for the rate of reimbursement as long as the same is in line with the guidelines provided by law.
The coverage shall apply to all third-party corporate telehealth providers whose services are availed of by the subscriber as the previous limitation on select providers has been removed. This mandate does not apply to out-of-network providers.
Although there is no express law mandating telehealth services available through e-mail, phone, or fax, there is no law prohibiting the same reimbursement. It depends on the insurance company and the subscriber’s contract if the former chooses to cover it.
Who gets these reimbursements?
Although most telehealth services are reimbursed under Medi-Cal, not everyone is entitled to claim reimbursements. Under state law, only the following providers can qualify for reimbursements:
|AudiologistsCertified Registered Nurse AnesthetistsClinical Nurse SpecialistsClinical PsychologistsClinical Social WorkersDentistsDermatologistsMarriage, Family, and Child Counselors||Nurse-MidwivesNurse PractitionersOphthalmologistsPhysician AssistantsPhysiciansPodiatristsRegistered Dietitians or Nutrition ProfessionalsSpeech-language Pathologists|
Public Health Emergency (PHE)
The above-mentioned laws and reimbursement policies apply under normal circumstances and not during a Public Health Emergency (PHE). Below is a summary of Covid-19 telehealth temporary guidelines and coverage policies for your guidance:
- Out-of-state medical personnel delivering assistance within California will require the Director of the Emergency Medical Services Authority‘s approval. The request will come from a California hospital, medical facility, clinic, or other similar establishments.
- Out-of-state non-medical personnel will also require the Director of the Office of Emergency Services’ approval.
- HIPAA privacy requirements are relaxed. Using video conferencing platforms like Google Hangouts, Skype, and FaceTime are left to the healthcare provider’s discretion. Requirements for encryption are waived.
- Reimbursement rates for telemedicine availed services shall immediately be enforced similarly and equally with that of in-office consultations.
- Medi-Cal managed care health plans are now mandated to reimburse both phone-only and video consultations at the same rate for the provider’s mode to be medically appropriate for the patient.
- All telehealth services shall be made available to all residents regardless of whether they are established patients or not.
- Authorized telehealth providers may prescribe controlled substances even without an in-person examination. Telephone evaluations may suffice for prescribing buprenorphine to opioid use disorder patients.
- Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), which are not covered under Medi-Cal, can now bill Medicare for services rendered through telemedicine.
- Telehealth services rendered to uninsured individuals are now reimbursed by the federal government as long as the same is related to Covid-19.
10 Top-rated Online Doctors and Telemedicine Providers in California
There are a lot of telemedicine providers that offer their services nationwide. However, it is most beneficial to the patient to avail telehealth services from local state providers. You can be sure that the licensed physician allowed to practice in the state has extensive knowledge of relevant local state laws. Below is a list of the best telemedicine providers in the State and a list of the corresponding services they offer. This will help you easily find an online provider within the State that delivers top-quality care.
- Encrypted data transmission
- Board Certified Doctors
A monthly membership is required to avail of their services and only accommodate patients who are more than 18 years of age.
Initial consultations are with a well-screened clinical associate who will determine if your medical case requires to be forwarded to their licensed doctors or directly to an in-person medical facility. The clinical associates will ask questions to assess the subject medical concern better, and the patients can ask questions until they are fully satisfied that they now know what they need to know.
|They can help you with:||But not with:|
|Abdominal PainAllergiesColdDiabetesDermatological ProblemsEye ProblemsFluGastrointestinal Problems Hair Loss HeadachesInsomniaRashesReproductive Health Concerns Urinary Tract Infection (UTI)||AsthmaChronic Obstructive Pulmonary Disease (COPD)Dental IssuesEmergency Medical ConditionsPrescriptions for: controlled substances, diet pills, erectile dysfunction, injectables, medical marijuana, and psychiatric medications|
They can also help with renewing your prescriptions and laboratory tests. They will provide you with a tailored treatment plan according to your needs and follow-up on seeing if it is working.
- HIPAA Compliant
- Board-Certified Pediatricians
This is a Pediatric Urgent Care serving families in the State, including military families. They offer live video chats for consulting your medical concerns about your child. You can be sure that every virtual visit is timely and that you receive the highest quality of care every time.
To ensure that everything is medically taken care of when it comes to your child’s health, they will coordinate with your primary care physician to know the child’s medical history and previous treatments, if any.
Aside from common illnesses such as flu, colds, and fever, they also deal with the following:
- Learning and Developmental Concerns
- Dietary and Nutrition Guidance
- Newborn Care
- Minor Injuries
XpertCare utilizes VSee as their platform for communicating with their patients. Besides video consultations, parents can also upload photos or medical files before the video appointment to give the designated pediatrician time to review them. That way, you can maximize your video chat by not spending much of the time showing documents but communicating your medical concern. After each session, you’ll get detailed documentation of the visit.
One of their pediatricians, Dr. Lisa Di Enno, MD, FAAP, conducts a weekly live session through Facebook to answer any questions about the designated topic for the week.
- HIPAA Compliant
- Board Certified Doctors: Pediatricians, Internal Medicine, Family Medicine
They provide pediatric care, primary care, preventive care, and urgent care. Some of the conditions they treat and other services they offer include:
- Breast Exams
- Diet and Nutrition Counseling
- Heart Disease
- Mental Health
- Respiratory Syncytial Virus (RSV)
- Sexually Transmitted Infection (STI)
- Smoking Cessation
- UTI tests
They will prepare a comprehensive treatment plan based on their holistic assessment of your health and lifestyle. Although they generally prescribe medications, they cannot prescribe any that needs a triplicate prescription, such as anxiety medications and narcotics.
If you have a doctor that you are comfortable with, you can list him or her as your preferred doctor so that every time you book a virtual visit, you will get to see his or her schedule. They also do home visits or house calls just if you want a more in-depth examination of your lifestyle.
- HIPAA Compliant
- Board Certified Doctors
As their name would suggest, they give more – more time and more care to their patients. They will analyze your medical history, habits, and routines through video visits so that they can craft a treatment that will suit your lifestyle. Each patient is not just another patient.
At CareMore, the treatment process is not just between the patient and the physician. They have a team of clinicians that do not stop when they have given you a treatment plan. The team consists of primary care providers, extensivists, care coordinators, and case managers. Each one plays a role throughout the caring process. They see it to the end that you are fully cured and that there are no other symptoms or signs that should be of concern.
They have a health information resource center which you can access on their website. You can browse through articles on eating healthily, managing stress, removing health hazards at home, or stopping a bad habit like smoking. You may also opt to subscribe to Chronicles, which is their regularly published article.
- HIPAA Compliant
- Board Certified Doctors
Before officially engaging their services, you will be asked to answer their Online Patient Interview (OPI) questionnaire containing questions about basic information for the medical conditions they treat. They will then go through the same and give you an initial assessment informing you whether you need a prescription or if you need to be further evaluated by one of their doctors.
SmartDocMD caters to patients 18 years old and above who exhibit symptoms for these common and simple illnesses:
- Pink Eye
- Sinus Infections
- Upper Respiratory Infections
- Urinary Tract Infections
- Yeast Infections
- Vaginal Problems
If they could not treat your medical condition, they will help you find other treatment options.
You will be guided by an artificial intelligence called SmartDocAI during the initial steps. The assessment, result, and triage are free of charge. The information they provide will help you decide whether you need to seek further treatment. If you decide to consult with one of their licensed physicians, the latter can electronically send your prescription, if any, to your chosen pharmacy. They issue a doctor’s excuse note just in case you missed school or work during your appointment. SmartDocMD gives back to the community by donating to charities and free clinics every time they treat patients.
- HIPAA Compliant
- Board Certified Doctors
You can access their website or use the app downloaded from the App Store and Google Play.
They can help you with the following medical conditions:
- Cold and Flu
- Impotence and Infertility
- Urgent Care Treatment
- Skin Problems
Have the list of your medications ready just in case the doctor might need to see them before prescribing any additional medications for you or if he or she needs to make changes with your existing medication regimen. For prescription purposes, you can choose which pharmacy to have electronic copies sent to for your medications or refills. As the law provides, they cannot prescribe narcotics and other controlled substances if only virtual consultations were conducted.
Just in case you might need to see a doctor, they also have three locations within California, specifically in West Covina, Glendale, and Pasadena. You can easily book in-office visits through their online platform or your current online doctor.
Their telemedicine services are for everyone – for teens, adults, children, and seniors, in Southern California.
- HIPAA Compliant
- Licensed psychiatrists, therapists, and psychiatric nurse practitioners
If you are looking for a telemedicine provider solely dedicated to psychiatry and mental health, TelepsychHealth is the right platform to visit as long as you are located anywhere in the state of California. All services are rendered through videoconferencing by their easy to reach and approachable licensed psychiatrists. They give their clients psychological and psychiatric assessments to determine the proper care and treatment method. They provide therapy and take their time enlightening patients and concerned loved ones about their mental health status and how to go about the treatment. They also offer medication management for those who are taking more than one type of drug.
They observe collaborative care psychiatry or what is also known as integrated care. The treatment plan intersects with all aspects of one’s overall health. Your primary care provider is included in the equation. The patient-physician relationship can be initiated and established online. There is no need for in-person visits for one to avail of telepsychiatry. All virtual visits are done through Zoom, and you are free to invite family members who you think would help you in your journey towards better mental health.
- HIPAA Compliant
- Board-Certified Pediatricians
This is another telemedicine platform that focuses on urgent pediatric care within the State. Tiny Pediatrics’ specialty revolves around urgent care for common kids’ illnesses such as but not limited to the following:
- Runny Nose
- Sore throat
These are the usual conditions that you can discuss with your physician during phone consultations. They likewise provide guidelines on the proper dosage of fever medicine for children and other helpful medical information directly linked to HealthyChildren.org. You can read about symptoms such as constipation, earache, rashes, and many others to have at least minimum knowledge of whether these conditions should be given concern or not.
You will be connected with a state-licensed pediatrician who will examine, diagnose, and treat your child for the symptoms they exhibit. You can be sure to receive expert pediatric advice and be given appropriate prescriptions for your child. You may opt to have the medications delivered at your doorstep or pick them up at your chosen pharmacy.
You can expect to be booked on the same day for phone and video consultations. They also do house calls just in case you want an in-person follow-up within the comforts of your home after your virtual visit.
- Privacy-secured system
- Licensed psychiatrists, clinical psychologists, clinical social workers, and therapists
The Board-certified clinicians at SoCalPsych help children, adolescents, adults, couples, and families when it comes to behavioral health care. If you are a new patient, complete the packet and medical consent form. This way, your virtual consultation will focus more on the subject rather than on formalities.
They offer a wide variety of psychiatry and psychotherapy services such as:
- Adult Psychiatry
- Behavioral Health Services
- Child and Adolescent Psychiatry
- Child, Adolescent, and Adult Therapy
- Eating and Sexual Problems
- Marriage and Family Therapy
- Psychiatric Consultation Services
Your telemedicine session or television, as they call it, all happens through their online platform; no need to download any app. They currently have eleven doctors who manage their virtual rooms, from which you can choose from. If English is not the language you are fluent in or if you do not fully understand it, they can match you with a provider who is bilingual. Language is not a barrier to your access to quality healthcare.
- HIPAA Compliant
- Board Certified Doctors and Physician Assistants
Users may opt to have their telemedicine consultations with TembiHealth via a simple telephone call or video conferencing. There’s no need to download any app to engage their services. You can schedule a session for yourself, your child, your partner, or any other member of your family. You (or the individual you are booking the consultation for) must be physically located in the state of California to access their California-licensed physicians.
They treat more than 30 medical conditions, which include the following:
Even if they have already provided you with expert medical advice, they still encourage their users to have follow-up check-ups or inform their primary care physicians about the current treatment they are undergoing from TembiHealth.
Aside from providing prescriptions and refills, which they can directly send to your local pharmacy, they also issue laboratory and radiology orders. It is to be noted that the refill they issue is limited to a single refill only and must be approved by your designated provider. You may request a doctor’s note if your school or office requires you to present one.
Telemedicine Resources in California
Need to know more about telemedicine in California? Check out the following sources for your reference:
- California Legislative Information: All enacted laws, passed bills, statuses, and the most recent amendments are organized in their database. One can easily use the Advanced Search feature to find any legislation based on various keywords like the author, date, status, committee, and the likes.
- California Health Care Foundation (CHCF): This organization works to expand and widen access to telehealth services, especially for low-income Californians. They have funded demonstration projects and invested in private telehealth providers in collaboration with other agencies.
- California Telehealth Resource Center (CTRC): This is an education and training telehealth resource for providers, Californian patients, and the community. With the knowledge they provide at CTRC, you can utilize telehealth services to its maximum advantage. They also enlighten readers and participants with the latest reimbursement policies.
- Center for Connected Health Policy (CCHP) – California: This site provides an overview and summary of all current laws and reimbursement policies in the state. It also provides links to various credible and up-to-date sources.
- California Telehealth Policy Coalition: This site’s contents and corresponding newsletter come from discussions among its over sixty statewide members about policies, issues, and advances in telehealth.
- California Healthline: This is somewhat an online newspaper that publishes articles about California’s health industry, public health, insurance such as Medi-Cal, Medicare, and Covered California, the health law, mental health, and any other topics closely associated with health.
- Department of Health Care Services (DHCS): Their website gives a detailed and point-by-point discussion about Telehealth in California, what services, and up to what extent they are covered under Medi-Cal.