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Health Advocates Respond to DHCS Telehealth Proposal, Upcoming Telehealth Informational Hearing, and Support for AB 32

CALIFORNIA – After rescheduling the original hearing date from last week, today the Assembly Health Committee will hold an Informational Hearing on “Telehealth Policy Post-Pandemic.” Health care providers and advocacy groups co-sponsoring AB 32(Aguiar-Curry) applaud the California Assembly for holding such a critical informational session, and call on the Legislature and Governor to support and invest in telehealth delivery, including audio visits.

The hearing takes place less than three weeks after the Department of Health Care Services (DHCS) released a set of broad-based telehealth policy recommendations. While making certain COVID-19 flexibilities permanent following the end of the public health emergency, the recommendations fall short in supporting equitable access to telehealth services. 

Specifically, DHCS’ proposal, which is focused on the Medi-Cal population, would modify, or expand the use of telehealth in various formats, including video, phone, and remote patient monitoring, but does not extend them equally beyond the pandemic. The proposal suggests creating a separate, lower fee schedule for telephone visits, which would create access barriers for many elderly, underserved, and rural patients. In addition, although the proposed policy includes the expansion of video visits for federally qualified health centers (FQHCs) and the removal of barriers limiting the use of video, FQHC audio visits would not be eligible for reimbursement. Other non-FQHC providers in hospitals and clinics could be reimbursed for audio visits, but only at a lower rate than in-person visits.

Audio visits are critical for vulnerable patients. Homeless populations, essential workers, those who need privacy, and others may lack access to the internet, home computers, or may have limited data plans. Varying levels of digital literacy and comfort with technology may also play a role in patients’ ability to use video.

Health care advocates and providers call on the Legislature and Governor to support a comprehensive telehealth policy that builds off lessons learned during the pandemic, meets the demand for virtual remote care, and ensures access for all populations, as addressed in AB 32 authored by Asm. Aguiar-Curry:

“The pandemic has made abundantly clear what many of us have known for years:  Healthy lives start with dependable access to our health professionals,” said Assemblymember Cecilia Aguiar-Curry (D-Winters).  “We need AB 32 to make the full range of telehealth tools a permanent part of our health care system for working families, people with mobility concerns, and people with limited access to health care in their communities.”

“We acknowledge DHCS’ efforts in releasing their telehealth recommendation proposal but are concerned that it will weaken California’s efforts in addressing health equity,” said Carmela Castellano Garcia, President and CEO of California Health+ Advocates. “If enacted in its current form, this proposal will widen the gap in care propelling some communities forward while leaving behind others. COVID-19 has exposed the disparity in our health care delivery system, and this proposal exacerbates that disparity. This proposal specifically signals to the 7.4 million patients served by health center providers that receiving care at health centers means that their access, their care, their health matters less. Medi-Cal at its core must commit to equitable access meaning ubiquitous access across all California communities. I look forward to working with the Newsom Administration on advancing AB 32 and reaching a solution that works for all Californians.”

“California’s public health care systems serve a large proportion of Medi-Cal patients and other at-risk populations, including individuals without housing,” said Erica Murray, President and CEO, California Association of Public Hospitals and Health Systems (CAPH). “These patients face unique barriers to care, and phone visits have proven to be a way to ensure more equitable and accessible care. While the permanent expansion of video visits for FQHCs is an important advancement, the majority of telehealth visits occurring across California’s public health care systems are by phone, and the State’s proposal limits our ability to continue to offer this important modality to those who need it most.”

“If California’s leadership is going to commit to an equity-centered approach, the need to support and invest in the health care modalities and the providers Californians’ turn to is essential,” said Jodi Hicks, President and CEO of Planned Parenthood Affiliates of California. “As such, we have grave concerns the DHCS proposal will deepen–rather than work to close–the inequities in California’s public health care system. Because of telehealth, safety-net providers like Planned Parenthood, have been able to use technology and innovation to provide Californians with critical sexual and reproductive health care services by phone or video conferencing. Refusing to fully fund audio visits when we know it makes up a significant percentage of all patient visits, including a quarter of all Planned Parenthood services statewide, is a disastrously dangerous step backward in the fight for health equity, and one which will disproportionately impact Black, Latino/a, and Indigenous communities in California who are already forced to navigate a history of discriminatory systems. We look forward to working with both Assemblymember Aguiar-Curry and the Governor’s administration to help bridge the divide between Californians insured by Medi-Cal and those with commercial insurance to ensure people have equitable access to care—no matter what.”

“Telehealth has emerged as a critical pathway for patients across the state to get time-sensitive sexual and reproductive health care remotely during the pandemic,” said Amy Moy, Chief External Affairs Officer at Essential Access Health. “Although COVID-19 created an urgent need for telehealth adoption, barriers to in-person services like transportation, child care, and time away from work are not new. Our state leaders must take action to advance health and equity for all Californians by ensuring that comprehensive telehealth modalities – including video and audio-only visits – continue to be viable and affordable access points during the public health emergency and beyond.”

“As we continue to wrestle with the pandemic and to work towards a more equitable health care landscape, providing and sustaining access to care through telehealth must remain a priority,” said Peter N. Bretan, Jr., M.D., California Medical Association President. “Telehealth has become an essential tool for physicians’ practices during this time because it allows them to provide safe and effective care to their patients. Additionally, telehealth bridges access barriers by utilizing technology to better harness physician time and expertise, and connecting patients to their care providers more quickly, efficiently and conveniently. Protecting the telehealth expansions, especially those that relate to telephonic visits which play a crucial role in bridging access barriers, is essential to both meeting our health care demands in this moment, and to ensuring that all Californians – regardless of their geography, income, or background – can receive access to quality care in the future.”

This coalition of safety net providers and other advocates urge the Legislature to pass AB 32, which offers California a telehealth solution that is inclusive, fair and equitable. If passed, AB 32 will be a key solution to ensure equal access to care for all Californians.