1348.8
. (a) A health care service plan that provides, operates, or
contracts for telephone medical advice services to its enrollees and
subscribers shall do all of the following:
(1) Ensure that the in-state or out-of-state telephone medical
advice service is registered pursuant to Chapter 15 (commencing with
Section 4999) of Division 2 of the Business and Professions Code.
(2) Ensure that the staff providing telephone medical advice
services for the in-state or out-of-state telephone medical advice
service are licensed as follows:
(A) For full service health care service plans, the staff hold a
valid California license as a registered nurse or a valid license in
the state within which they provide telephone medical advice services
as a physician and surgeon or physician assistant, and are operating
in compliance with the laws governing their respective scopes of
practice.
(B) (i) For specialized health care service plans providing,
operating, or contracting with a telephone medical advice service in
California, the staff shall be appropriately licensed, registered, or
certified as a dentist pursuant to Chapter 4 (commencing with
Section 1600) of Division 2 of the Business and Professions Code, as
a dental hygienist pursuant to Article 7 (commencing with Section
1740) of Chapter 4 of Division 2 of the Business and Professions
Code, as a physician and surgeon pursuant to Chapter 5 (commencing
with Section 2000) of Division 2 of the Business and Professions Code
or the Osteopathic Initiative Act, as a registered nurse pursuant to
Chapter 6 (commencing with Section 2700) of Division 2 of the
Business and Professions Code, as a psychologist pursuant to Chapter
6.6 (commencing with Section 2900) of Division 2 of the Business and
Professions Code, as an optometrist pursuant to Chapter 7 (commencing
with Section 3000) of Division 2 of the Business and Professions
Code, as a marriage and family therapist pursuant to Chapter 13
(commencing with Section 4980) of Division 2 of the Business and
Professions Code, as a licensed clinical social worker pursuant to
Chapter 14 (commencing with Section 4991) of Division 2 of the
Business and Professions Code, as a professional clinical counselor
pursuant to Chapter 16 (commencing with Section 4999.10) of Division
2 of the Business and Professions Code, or as a chiropractor pursuant
to the Chiropractic Initiative Act, and operating in compliance with
the laws governing their respective scopes of practice.
(ii) For specialized health care service plans providing,
operating, or contracting with an out-of-state telephone medical
advice service, the staff shall be health care professionals, as
identified in clause (i), who are licensed, registered, or certified
in the state within which they are providing the telephone medical
advice services and are operating in compliance with the laws
governing their respective scopes of practice. All registered nurses
providing telephone medical advice services to both in-state and
out-of-state business entities registered pursuant to this chapter
shall be licensed pursuant to Chapter 6 (commencing with Section
2700) of Division 2 of the Business and Professions Code.
(3) Ensure that every full service health care service plan
provides for a physician and surgeon who is available on an on-call
basis at all times the service is advertised to be available to
enrollees and subscribers.
(4) Ensure that staff members handling enrollee or subscriber
calls, who are not licensed, certified, or registered as required by
paragraph (2), do not provide telephone medical advice. Those staff
members may ask questions on behalf of a staff member who is
licensed, certified, or registered as required by paragraph (2), in
order to help ascertain the condition of an enrollee or subscriber so
that the enrollee or subscriber can be referred to licensed staff.
However, under no circumstances shall those staff members use the
answers to those questions in an attempt to assess, evaluate, advise,
or make any decision regarding the condition of an enrollee or
subscriber or determine when an enrollee or subscriber needs to be
seen by a licensed medical professional.
(5) Ensure that no staff member uses a title or designation when
speaking to an enrollee or subscriber that may cause a reasonable
person to believe that the staff member is a licensed, certified, or
registered professional described in Section 4999.2 of the Business
and Professions Code unless the staff member is a licensed,
certified, or registered professional.
(6) Ensure that the in-state or out-of-state telephone medical
advice service designates an agent for service of process in
California and files this designation with the director.
(7) Requires that the in-state or out-of-state telephone medical
advice service makes and maintains records for a period of five years
after the telephone medical advice services are provided, including,
but not limited to, oral or written transcripts of all medical
advice conversations with the health care service plan's enrollees or
subscribers in California and copies of all complaints. If the
records of telephone medical advice services are kept out of state,
the health care service plan shall, upon the request of the director,
provide the records to the director within 10 days of the request.
(8) Ensure that the telephone medical advice services are provided
consistent with good professional practice.
(b) The director shall forward to the Department of Consumer
Affairs, within 30 days of the end of each calendar quarter, data
regarding complaints filed with the department concerning telephone
medical advice services.
(c) For purposes of this section, "telephone medical advice" means
a telephonic communication between a patient and a health care
professional in which the health care professional's primary function
is to provide to the patient a telephonic response to the patient's
questions regarding his or her or a family member's medical care or
treatment. "Telephone medical advice" includes assessment,
evaluation, or advice provided to patients or their family members.