Florida Senate - 2018 SB 280 By Senator Bean 4-00393B-18 2018280__ 1 A bill to be entitled 2 An act relating to telehealth; amending s. 110.123, 3 F.S.; encouraging the state group health insurance 4 program to offer health insurance plans that include 5 telehealth coverage for state employees; amending s. 6 409.906, F.S.; authorizing the Agency for Health Care 7 Administration to pay for certain telehealth services 8 as optional Medicaid services; creating s. 456.4501, 9 F.S.; defining terms; establishing the standard of 10 care for telehealth providers; authorizing telehealth 11 providers to use telehealth to perform patient 12 evaluations; providing that telehealth providers, 13 under certain circumstances, are not required to 14 research a patient’s history or conduct physical 15 examinations before providing services through 16 telehealth; providing that a nonphysician telehealth 17 provider using telehealth acting within her or her 18 relevant scope of practice is not deemed to be 19 practicing medicine without a license; authorizing 20 certain telehealth providers to use telehealth to 21 prescribe specified controlled substances; providing 22 for construction; requiring the Department of Health 23 to develop and disseminate certain educational 24 materials to specified licensees by a specified date; 25 providing requirements for recordkeeping by telehealth 26 providers; providing requirements for patient consent 27 for telehealth treatment; amending s. 627.0915, F.S.; 28 encouraging insurers offering certain rating plans for 29 workers’ compensation and employer’s liability 30 insurance, which are approved by the Office of 31 Insurance Regulation, to include in the plans services 32 provided through telehealth; providing an effective 33 date. 34 35 Be It Enacted by the Legislature of the State of Florida: 36 37 Section 1. Paragraph (b) of subsection (3) of section 38 110.123, Florida Statutes, is amended to read: 39 110.123 State group insurance program.— 40 (3) STATE GROUP INSURANCE PROGRAM.— 41 (b) It is the intent of the Legislature to offer a 42 comprehensive package of health insurance and retirement 43 benefits and a personnel system for state employees which are 44 provided in a cost-efficient and prudent manner, and to allow 45 state employees the option to choose benefit plans that
which46 best suit their individual needs. The state group insurance 47 program may include the state group health insurance plan or 48 plans, health maintenance organization plans, group life 49 insurance plans, TRICARE supplemental insurance plans, group 50 accidental death and dismemberment plans, group disability 51 insurance plans, other group insurance plans or coverage 52 choices, and other benefits authorized by law. While not 53 mandated to do so, the state group health insurance program is 54 encouraged to offer a selection of plans that include coverage 55 of services provided through telehealth. 56 Section 2. Subsection (28) is added to section 409.906, 57 Florida Statutes, to read: 58 409.906 Optional Medicaid services.—Subject to specific 59 appropriations, the agency may make payments for services which 60 are optional to the state under Title XIX of the Social Security 61 Act and are furnished by Medicaid providers to recipients who 62 are determined to be eligible on the dates on which the services 63 were provided. Any optional service that is provided shall be 64 provided only when medically necessary and in accordance with 65 state and federal law. Optional services rendered by providers 66 in mobile units to Medicaid recipients may be restricted or 67 prohibited by the agency. Nothing in this section shall be 68 construed to prevent or limit the agency from adjusting fees, 69 reimbursement rates, lengths of stay, number of visits, or 70 number of services, or making any other adjustments necessary to 71 comply with the availability of moneys and any limitations or 72 directions provided for in the General Appropriations Act or 73 chapter 216. If necessary to safeguard the state’s systems of 74 providing services to elderly and disabled persons and subject 75 to the notice and review provisions of s. 216.177, the Governor 76 may direct the Agency for Health Care Administration to amend 77 the Medicaid state plan to delete the optional Medicaid service 78 known as “Intermediate Care Facilities for the Developmentally 79 Disabled.” Optional services may include: 80 (28) TELEHEALTH.—The agency may pay for live video 81 conferencing, store and forward, as defined in s. 456.4501(1), 82 and remote patient monitoring of a covered service delivered by 83 or under the direction of a licensed health care practitioner. 84 Section 3. Section 456.4501, Florida Statutes, is created 85 to read: 86 456.4501 Use of telehealth to provide services.— 87 (1) DEFINITIONS.—As used in this section, the term: 88 (a) “Information and telecommunications technologies” means 89 those secure electronic applications used by health care 90 practitioners and health care providers to provide health care 91 services, evaluate health care information or data, provide 92 remote patient monitoring, or promote healthy behavior through 93 interactions that include, but are not limited to, live video 94 interactions, text messages, or store and forward transmissions. 95 (b) “Store and forward” means the type of telehealth 96 encounter which uses still images of patient data for rendering 97 a medical opinion or patient diagnosis. The term includes the 98 asynchronous transmission of clinical data from one site to 99 another site. 100 (c) “Synchronous” means live or two-way interactions using 101 a telecommunications system between a provider and a person who 102 is a patient, caregiver, or provider. 103 (d) “Telecommunications system” means the transfer of 104 health care data through advanced information technology using 105 compressed digital interactive video, audio, or other data 106 transmission; clinical data transmission using computer image 107 capture; and other technology that facilitates access to health 108 care services or medical specialty expertise. 109 (e) “Telehealth” means the mode of providing health care 110 services and public health services by a Florida licensed 111 practitioner, within the scope of his or her practice, through 112 synchronous and asynchronous information and telecommunications 113 technologies where the practitioner is located at a site other 114 than the site where the recipient, whether a patient or another 115 licensed practitioner, is located. 116 (f) “Telehealth provider” means a person who provides 117 health care services and related services through telehealth and 118 who is licensed under chapter 457; chapter 458; chapter 459; 119 chapter 460; chapter 461; chapter 462; chapter 463; chapter 464; 120 chapter 465; chapter 466; chapter 467; part I, part III, part 121 IV, part V, part X, part XIII, or part XIV of chapter 468; 122 chapter 478; chapter 480; parts III and IV of chapter 483; 123 chapter 484; chapter 486; chapter 490; or chapter 491; or who is 124 certified under s. 393.17 or part III of chapter 401. 125 (2) PRACTICE STANDARDS.— 126 (a) The standard of care for a telehealth provider 127 providing medical care to a patient is the same as the standard 128 of care generally accepted for a health care professional 129 providing in-person health care services to a patient. A 130 telehealth provider may use telehealth to perform a patient 131 evaluation. If a telehealth provider conducts a patient 132 evaluation sufficient to diagnose and treat the patient, the 133 telehealth provider is not required to research the patient’s 134 medical history or conduct a physical examination of the patient 135 before using telehealth to provide services to the patient. 136 (b) A telehealth provider and a patient may be in separate 137 locations when telehealth is used to provide health care 138 services to the patient. 139 (c) A nonphysician telehealth provider using telehealth and 140 acting within his or her relevant scope of practice is not 141 deemed to be practicing medicine without a license under any 142 provision of law listed in paragraph (1)(f). 143 (d) A telehealth provider who is authorized to prescribe a 144 controlled substance named or described in Schedules I through V 145 of s. 893.03 may use telehealth to prescribe a controlled 146 substance, except that telehealth may not be used to prescribe a 147 controlled substance to treat chronic nonmalignant pain as 148 defined in s. 458.3265(1)(a) or to issue a physician 149 certification for marijuana pursuant to s. 381.986. This 150 paragraph does not prohibit a physician from using telehealth to 151 order a controlled substance for an inpatient admitted to a 152 facility licensed under chapter 395 or a patient of a hospice 153 licensed under chapter 400. 154 (e) By January 1, 2019, the department, in coordination 155 with the applicable boards, shall develop and disseminate 156 educational materials for the licensees listed in paragraph 157 (1)(f) on the use of telehealth modalities to treat patients. 158 (3) RECORDS.—A telehealth provider shall document in the 159 patient’s medical record the health care services rendered using 160 telehealth according to the same standard used for in-person 161 health care services pursuant to ss. 395.3025(4) and 456.057. 162 (4) CONSENT.—Patients are not required to provide specific 163 authorization for treatment through telehealth, but must 164 authorize treatment that meets the requirements of the 165 applicable practice acts and s. 766.103, and must be allowed to 166 withhold consent for any specific procedure or treatment through 167 telehealth. 168 Section 4. Section 627.0915, Florida Statutes, is amended 169 to read: 170 627.0915 Rate filings; workers’ compensation, drug-free 171 workplace, and safe employers; consideration of telehealth.— 172 (1) The office shall approve rating plans for workers’ 173 compensation and employer’s liability insurance that give 174 specific identifiable consideration in the setting of rates to 175 employers that either implement a drug-free workplace program 176 pursuant to s. 440.102 and rules adopted under such section or 177 implement a safety program pursuant to provisions of the rating 178 plan or implement both a drug-free workplace program and a 179 safety program. The plans must be actuarially sound and must 180 state the savings anticipated to result from such drug-testing 181 and safety programs. 182 (2) An insurer offering a rate plan approved under this 183 section shall notify the employer at the time of the initial 184 quote for the policy and at the time of each renewal of the 185 policy of the availability of the premium discount where a drug 186 free workplace plan is used by the employer pursuant to s. 187 440.102 and rules adopted under such section. The Financial 188 Services Commission may adopt rules to implement the provisions 189 of this subsection. 190 (3) An insurer offering a rate plan approved under this 191 section is encouraged to include in the plan services provided 192 through telehealth. 193 Section 5. This act shall take effect July 1, 2018.