(a) If a health care service plan offers a service via telehealth to an enrollee through a third-party corporate telehealth provider, all of the following conditions shall be met: (1) The health care service plan shall disclose to the enrollee in any promotion or coordination of the service both of the following: (A) The availability of receiving the service on an in-person basis or via telehealth, if available, from the enrolleeâs primary care provider, treating specialist, or from another contracting individual health professional, contracting clinic, or contracting health facility consistent with the service and existing timeliness and geographic access standards in Sections 1367 and 1367.03 and regulations promulgated thereunder. (B) If the enrollee has coverage for out-of-network benefits, a reminder of the availability of receiving the service either via telehealth or on an in-person basis using the enrolleeâs out-of-network benefits, and the cost sharing obligation for out-of-network benefits compared to in-network benefits and balance billing protections for services received from contracted providers. (2) After being notified pursuant to paragraph (1), the enrollee chooses to receive the service via telehealth through a third-party corporate telehealth provider. (3) The enrollee consents to the service consistent with Section 2290.5 of the Business and Professions Code. (4) If the enrollee is currently receiving specialty telehealth services for a mental or behavioral health condition, the enrollee is given the option of continuing to receive that service with the contracting individual health professional, a contracting clinic, or a contracting health facility. (b) For purposes of this section, the following definitions apply: (1) âContracting individual health professionalâ means a physician and surgeon or other professional who is licensed by the state to deliver or furnish health care services, including mental and behavioral health services, and who is contracted with or employed by the enrolleeâs health care service plan as a network provider. A âcontracting individual health professionalâ shall not include a dentist licensed pursuant to the Dental Practice Act (Chapter 4 (commencing with Section 1600) of Division 2 of the Business and Professions Code). Application of this definition is not precluded by a contracting individual health professionalâs affiliation with a group. (2) âContracting clinicâ means a clinic, as defined in Section 1200, that is contracted with or owned by the enrolleeâs health care service plan and as a network provider. (3) âContracting health facilityâ means a health facility, as defined in Section 1250 and paragraph (1) of subdivision (f) of Section 1371.9, that is contracted with or operated by the enrolleeâs health care service plan and serves as a network provider. (4) âThird-party corporate telehealth providerâ means a corporation directly contracted with a health care service plan that provides health care services exclusively through a telehealth technology platform and has no physical location at which a patient can receive services. (c) If services are provided to an enrollee through a third-party corporate telehealth provider, a health care service plan shall comply with all of the following: (1) Notify the enrollee of their right to access their medical records pursuant to, and consistent with, Chapter 1 (commencing with Section 123100) of Part 1 of Division 106. (2) Notify the enrollee that the record of any services provided to the enrollee through a third-party corporate telehealth provider shall be shared with their primary care provider, unless the enrollee objects. (3) Ensure that the records are entered into a patient record system shared with the enrolleeâs primary care provider or are otherwise provided to the enrolleeâs primary care provider, unless the enrollee objects, in a manner consistent with state and federal law. (4) Notif
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