California Health and Safety Code

§ 1374.14

HSC § 1374.14 Effective Jan 1, 2022Div. 2 · Ch. 2.2 · Art. 5

Statute text

(a)(1) A contract between a health care service plan and a health care provider for the provision of health care services to an enrollee or subscriber shall specify that the health care service plan shall reimburse the treating or consulting health care provider for the diagnosis, consultation, or treatment of an enrollee or subscriber appropriately delivered through telehealth services on the same basis and to the same extent that the health care service plan is responsible for reimbursement for the same service through in-person diagnosis, consultation, or treatment.

(2)This section does not limit the ability of a health care service plan and a health care provider to negotiate the rate of reimbursement for a health care service provided pursuant to a contract subject to this section. Services that are the same, as determined by the provider’s description of the service on the claim, shall be reimbursed at the same rate whether provided in person or through telehealth. When negotiating a rate of reimbursement for telehealth services for which no in-person equivalent exists, a health care service plan and the provider shall ensure the rate is consistent with subdivision (h) of Section 1367.

(3)This section does not require telehealth reimbursement to be unbundled from other capitated or bundled, risk-based payments.

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Legislative history

Amended by Stats. 2021, Ch. 439, Sec. 4. (AB 457) Effective January 1, 2022.