Providers

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Who can use telehealth to provide health care services?

The health care provider rendering Medi-Cal covered benefits or services provided via a telehealth modality must meet the requirements of Business and Professions Code (B&P Code), Section 2290.5(a)(3), or equivalent requirements under California law in which the provider is considered to be licensed, for example, providers who are certified by the Behavior Analyst Certification Board, which is accredited by the National Commission for Certifying Agencies, may provide services via telehealth.

Providers who do not have a path to enroll in Fee-for-Service (FFS) Medi-Cal do not need to enroll with DHCS in order to provide services via telehealth in FFS or managed care. For example, behavioral analysts do not have an enrollment pathway, but may provide services via telehealth to managed care beneficiaries with appropriate approval from the managed care plan.

Does Medi-Cal allow out-of-state providers to render services via telehealth?

The health care provider rendering Medi-Cal covered benefits or services via a telehealth modality must be licensed in California, enrolled as a Medi-Cal rendering provider or non-physician medical practitioner (NMP), and affiliated with an enrolled Medi-Cal provider group. The enrolled Medi-Cal provider group for which the health care provider renders services via telehealth must meet all Medi-Cal program enrollment requirements and must be located in California or a border community.

A person who is licensed as a health care practitioner in another state and is employed by a tribal health program does not need to be licensed in California to perform services for the tribal health program (Business and Professions Code section 719).

If I have privileges and credentials at my hospital, do I need privileges and credentials at the originating hospital to care for a patient at that hospital?

Issues of privileges and credentialing for distant physicians to care for patients via telehealth are determined by the policies of the originating hospital. However, state law – see Business and Professions Code section 2290.5 (h) -  and federal regulations – see Title 42 of the Code of Federal Regulations, Part 482.12, 482.22 and 485.616 - allow hospitals to accept the privileges and credentials for providers at distant hospitals. 
 
Last modified date: 3/23/2021 8:57 AM