23-1181m Providers Must Meet Medi-Cal In-Person Referral Requirement for Telehealth

Date: 11/03/23

AB 1241 provides clarification on requirements for referral and facilitation of in-person care when telehealth services are available

Effective January 1, 2024, all physicians and other providers offering covered services through video synchronous interaction or audio-only synchronous interaction must also:

• Offer the same services via in-person, face-to-face contact, or

• Arrange for a referral to and facilitation of in-person care.

Requirements for referral and facilitation

• In addition, Assembly Bill (AB) 1241 requires a provider to maintain protocols for patient referral to appropriate in-person care when the standard of care cannot be met by video synchronous interaction or audio-only synchronous interaction.

• AB 1241 also provide clarification that the referral and facilitation arrangement does not require a provider to schedule an appointment with a different provider on behalf of a patient. In other words, providers are required to make the referral and share clinical data so the patient does not need to locate a provider on their own. The patient can contact the provider to which they have been referred to schedule the appointment.

For more requirements related to telehealth in 2024

Access 23-974m, Updates to Medi-Cal Covered Services Offered Through Telehealth, posted online on September 5, 2023, for information related to changes for telehealth services, effective January 1, 2024, due to Department of Healthcare Services’ All Plan Letter 23-007.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center at 800-675-6110.

 

This information applies to Physicians and Participating Physician Groups (PPGs).

For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.