Florida Senate - 2014                        COMMITTEE AMENDMENT
       Bill No. SB 1646
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/01/2014           .                                

       (Garcia) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete lines 99 - 246
    4  and insert:
    5         (12) “Telemedicine provider” means a physician or physician
    6  assistant licensed under chapter 458 or chapter 459, an advanced
    7  registered nurse practitioner licensed under chapter 464, or a
    8  pharmacist licensed under chapter 465 who provides telemedicine
    9  services.
   10         Section 3. Section 456.4503, Florida Statutes, is created
   11  to read:
   12         456.4503 Telemedicine requirements.—
   13         (1) An out-of-state physician, physician assistant,
   14  advanced registered nurse practitioner, or pharmacist who
   15  provides telemedicine across state lines to a patient physically
   16  located in this state must have a Florida license to practice as
   17  provided under chapter 458, chapter 459, chapter 464, or chapter
   18  465.
   19         (2) An out-of-state physician, physician assistant,
   20  advanced registered nurse practitioner, or pharmacist is exempt
   21  from subsection (1) if:
   22         (a) The out-of-state physician, physician assistant,
   23  advanced registered nurse practitioner, or pharmacist is
   24  consulting with a telemedicine provider licensed to practice in
   25  this state; and
   26         (b) The telemedicine provider licensed in this state
   27  retains ultimate authority and responsibility for the diagnosis,
   28  treatment, and care of the patient located within this state.
   29         (3)Consultations that occur on an emergency basis and that
   30  are conducted via telemedicine are exempt from subsection (1).
   31  The terms “emergency services and care and emergency medical
   32  condition have the same meanings as provided in s. 395.002.
   33         (4)A health care provider or patient presenter acting
   34  under the direction and supervision of a telemedicine provider
   35  through the use of telemedicine may not be interpreted as
   36  practicing without a license. However, the health care provider
   37  must be trained in, educated on, and knowledgeable about the
   38  procedure and technology and may not perform duties for which he
   39  or she does not have sufficient training, education, and
   40  knowledge. Failure to have adequate training, education, and
   41  knowledge is grounds for disciplinary action by the appropriate
   42  board, or the department if there is no board, or the affiliated
   43  regulatory entity for affiliated providers.
   44         (5) Upon license renewal, a physician, physician assistant,
   45  advanced registered nurse practitioner, or pharmacist practicing
   46  telemedicine shall:
   47         (a)Designate himself or herself as a telemedicine provider
   48  on the practitioner profile; and
   49         (b) Submit proof of successful completion of a course and
   50  subsequent examination, approved by the board, on the standards
   51  of practice in telemedicine. The course must consist of 2 web
   52  based contact hours. The first course and examination must be
   53  offered by July 1, 2014, and shall be conducted at least
   54  annually thereafter. The course and examination shall be
   55  developed and offered by a statewide professional association
   56  accredited to provide educational activities as designated by
   57  the board. The board shall review and approve the content of the
   58  initial course and examination if the board determines that the
   59  course and examination adequately and reliably satisfy the
   60  criteria set forth in this section. Annually thereafter, the
   61  board shall review the course and examination and, if the board
   62  determines that the content continues to adequately and reliably
   63  satisfy the criteria set forth in this section, approve them.
   64  Successful completion of the board-approved course and
   65  examination may be used to satisfy 2 hours of continuing
   66  education requirements for the biennial period during which the
   67  board-approved course and examination are taken. A physician,
   68  physician assistant, advanced registered nurse practitioner, or
   69  pharmacist who does not complete a board-approved course and
   70  examination under this section may not provide telemedicine
   71  services.
   72         (6) Venue for a civil or administrative action initiated by
   73  the telemedicine recipient, the department, or the appropriate
   74  board shall be based on the location of the patient or shall be
   75  in Leon County.
   76         (7)The boards may adopt rules to administer the
   77  requirements of this act and must repeal rules that are
   78  inconsistent with this act, including rules that prohibit the
   79  use of telemedicine in this state. The appropriate board may
   80  also develop standards and adopt rules relating to requirements
   81  for patient presenters. Such rules may not require the use of
   82  patient presenters in telemedicine services if special skills or
   83  training is not needed for a patient to participate in the
   84  encounter.
   85         Section 4. Section 456.4504, Florida Statutes, is created
   86  to read:
   87         456.4504 Telemedicine standards.—
   88         (1) The standard of care as provided in s. 766.102 is the
   89  same regardless of whether the physician, physician assistant,
   90  advanced registered nurse practitioner, or pharmacist provides
   91  health care services in person or by telemedicine. The
   92  applicable board may adopt rules specifically related to the
   93  standard of care for telemedicine.
   94         (2) A telemedicine provider providing telemedicine services
   95  under this act is responsible for the quality of the equipment
   96  and technology employed and for its safe use. Telemedicine
   97  equipment and advanced communications technology must, at a
   98  minimum, be able to provide the same information to the
   99  telemedicine provider as the information that would be obtained
  100  in an in-person encounter with a health care provider and must
  101  enable the telemedicine provider to meet or exceed the
  102  prevailing standard of care for the practice of the profession.
  103         (3) The telemedicine provider is not required to conduct a
  104  patient history or physical examination of the patient before
  105  engaging in a telemedicine encounter if the telemedicine
  106  provider conducts a patient evaluation sufficient to meet the
  107  prevailing standard of care for the services provided.
  108         (4) Before each telemedicine encounter, the identification
  109  and location of the telemedicine provider and all other
  110  individuals present via advanced communications technology who
  111  will view the patient or the patient’s information must be
  112  identified to the patient.
  113         (5) For the purposes of this act, the nonemergency
  114  prescribing of a legend drug based solely on an electronic
  115  questionnaire without a visual examination is considered a
  116  failure to practice with the level of care, skill, and treatment
  117  which is recognized by a reasonably prudent physician, physician
  118  assistant, advanced registered nurse practitioner, or pharmacist
  119  and is not authorized under this act.
  121  ================= T I T L E  A M E N D M E N T ================
  122  And the title is amended as follows:
  123         Delete lines 5 - 12
  124  and insert:
  125         s. 456.4503, F.S.; requiring specified practitioners
  126         providing telemedicine services to patients in this
  127         state to be licensed in this state; requiring
  128         pertinent records to be made available upon request;
  129         providing certain exceptions for emergency services
  130         and consultations; requiring other health care
  131         providers to be supervised by a telemedicine provider;
  132         providing continuing education requirements