Florida Senate - 2014 COMMITTEE AMENDMENT Bill No. SPB 7028 Ì401616ÈÎ401616 LEGISLATIVE ACTION Senate . House Comm: FAV . 03/05/2014 . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— following: 1 Senate Substitute for Amendment (484228) (with title 2 amendment) 3 4 Delete everything after the enacting clause 5 and insert: 6 Section 1. Section 456.4501, Florida Statutes, is created 7 to read: 8 456.4501 Short title.—Sections 465.4501-465.4507 may be 9 cited as the “Florida Telemedicine Act.” 10 Section 2. Section 456.4502, Florida Statutes, is created 11 to read: 12 456.4502 Definitions.—As used in this act, the term: 13 (1) “Act” means the Florida Telemedicine Act. 14 (2) “Advanced communications technology” means: 15 (a) Compressed digital interactive video, audio, or data 16 transmissions; 17 (b) Real-time synchronous video- or web-conferencing 18 communications; 19 (c) Secure web-based communications; 20 (d) Still-image capture or asynchronous store and forward; 21 (e) Health care service transmissions supported by mobile 22 devices (mHealth); or 23 (f) Other technology that facilitates access to health care 24 services or medical specialty expertise. 25 (3) “Distant site” means the location at which the 26 telemedicine provider delivering the health care service is 27 located at the time the service is provided via telemedicine. 28 (4) “Encounter” means an examination, consultation, 29 monitoring, or other health care service. 30 (5) “Health care provider” means a health care practitioner 31 or out-of-state licensed individual who provides health care 32 services within the scope of his or her professional license. 33 (6) “In person” means that a patient is in the physical 34 presence of the health care provider without regard to whether 35 portions of the encounter are conducted by other providers. 36 (7) “Originating site” means the location of the patient 37 receiving telemedicine services, which site meets the standards 38 of this act as verified by the telemedicine provider. 39 (8) “Patient presenter” means an individual who has 40 clinical background training in the use of advanced 41 communications technology equipment and who is available at the 42 originating site to present the patient, manage the cameras or 43 equipment, and perform any hands-on activity necessary to 44 successfully complete the telemedicine encounter under the 45 direction and supervision of a telemedicine provider. 46 (9) “Store and forward” means the type of telemedicine 47 encounter that uses still images of patient data for rendering a 48 medical opinion or diagnosis. The term includes the asynchronous 49 transmission of clinical data from one site to another. 50 (10) “Telehealth” means the use of advanced communications 51 technology to provide access to health assessment, diagnosis, 52 intervention, consultation, supervision, and information across 53 distances. The term includes the use of remote patient 54 monitoring devices that are used to collect and transmit data 55 for telemonitoring and interpretation. 56 (11) “Telemedicine” means the practice of medicine through 57 the use of advanced communications technology by a telemedicine 58 provider at a distant site in compliance with federal and state 59 privacy and confidentiality requirements and encryption 60 standards. Services provided through telemedicine may include 61 patient assessment, diagnosis, consultation, treatment, 62 prescription of medicine, transfer of medical data, or other 63 medical-related services. The term does not include audio-only 64 calls, e-mail messages, or facsimile transmissions. Telemedicine 65 includes telehealth and telemonitoring. 66 (12) “Telemedicine provider” means a physician licensed 67 under chapter 458 or chapter 459 who provides telemedicine 68 services. 69 Section 3. Section 456.4503, Florida Statutes, is created 70 to read: 71 456.4503 Telemedicine requirements.— 72 (1) An out-of-state physician who provides telemedicine 73 across state lines to a patient physically located in this state 74 must: 75 (a) Have a Florida license to practice medicine as provided 76 under chapter 458 or chapter 459, except as provided under 77 subsection (2); or 78 (b) If not licensed in this state: 79 1. Hold an unrestricted active license to practice 80 allopathic or osteopathic medicine in the state of the distant 81 site and that state’s licensure requirements must meet or exceed 82 those of this state under chapter 458 or chapter 459, as 83 determined by the appropriate board; 84 2. Maintain professional liability coverage that includes 85 coverage for telemedicine services, in an amount and manner 86 consistent with s. 458.320 and appropriate to the physician’s 87 scope of practice and location; 88 3. Have one of the following: 89 a. Privileges at or be on the medical staff of an out-of 90 state hospital affiliated with a Florida hospital licensed under 91 chapter 395; or 92 b. Affiliation with an out-of-state health insurer or 93 health plan that is also authorized to conduct business in this 94 state pursuant to chapter 627 or chapter 641; and 95 4. Practice in a state that authorizes Florida-licensed 96 physicians to provide telemedicine services to patients located 97 in that state without having to be licensed to practice medicine 98 in that state. 99 (2) An out-of-state physician authorized under paragraph 100 (1)(b) to provide telemedicine services to patients in this 101 state is subject to appropriate disciplinary action by a 102 regulatory entity in this state which has regulatory 103 jurisdiction over the hospital, insurer, or health plan 104 affiliated with the physician as described in subparagraph 105 (1)(b)3. Such affiliated hospital, insurer, or health plan shall 106 be held responsible by the appropriate state regulatory entities 107 and other legal and regulatory authorities in this state, as 108 applicable, for the actions of its affiliated physicians 109 providing telemedicine services to patients in this state. 110 (3) A telemedicine provider and a hospital, insurer, or 111 health plan operating in this state which is affiliated with an 112 out-of-state provider as described in subparagraph (1)(b)2. 113 shall make any pertinent records available upon request of the 114 board, the department, or other regulatory authority as 115 applicable. Failure to comply with such request may result in 116 the revocation of the provider’s license or imposition of a fine 117 by the applicable board; or, in the case of an affiliated 118 hospital, insurer, or health plan, a fine, license restriction, 119 or revocation of an affiliated entity’s authorization to conduct 120 business in this state. 121 (4) An out-of-state physician is not required to meet the 122 requirements of subsection (1) if: 123 (a) The out-of-state physician is consulting with a 124 physician licensed to practice medicine in this state; and 125 (b) The physician licensed in this state retains ultimate 126 authority and responsibility for the diagnosis, treatment, and 127 care of the patient located within this state. 128 (5) Physician consultations that occur on an emergency 129 basis and that are conducted via telemedicine are exempt from 130 subsection (1). Emergency services and care provided to relieve 131 an emergency medical condition have the same meaning as provided 132 in s. 395.002. 133 (6) A health care provider or patient presenter acting 134 under the direction and supervision of a physician through the 135 use of telemedicine may not be interpreted as practicing 136 medicine without a license. However, the health care provider 137 must be trained in, educated on, and knowledgeable about the 138 procedure and technology and may not perform duties for which 139 the provider does not have sufficient training, education, and 140 knowledge. Failure to have adequate training, education, and 141 knowledge is grounds for disciplinary action by the appropriate 142 board, or the department if there is no board, or the affiliated 143 regulatory entity for affiliated providers. 144 (7) Upon license renewal, a physician practicing 145 telemedicine shall: 146 (a) Designate himself or herself as a telemedicine provider 147 on the physician’s practitioner profile; and 148 (b) Submit proof of successful completion of a course and 149 subsequent examination, approved by the board, on the standards 150 of practice in telemedicine. The course must consist of 2 web 151 based contact hours. The first course and examination must be 152 offered by July 1, 2014, and shall be conducted at least 153 annually thereafter. The course and examination shall be 154 developed and offered by a statewide professional association of 155 physicians in this state accredited to provide educational 156 activities designated for an American Medical Association 157 Physician’s Recognition Award (AMA PRA) Category 1 credit. The 158 board shall review and approve the content of the initial course 159 and examination if the board determines that the course and 160 examination adequately and reliably satisfy the criteria set 161 forth in this section. The board shall annually thereafter 162 review and approve the course and examination if the board 163 determines that the content continues to adequately and reliably 164 satisfy the criteria set forth in this section. Successful 165 completion of the board-approved course and examination may be 166 used by a certified physician to satisfy 2 hours of continuing 167 education requirements for the biennial period during which the 168 board-approved course and examination are taken. A physician who 169 does not complete a board-approved course and examination under 170 this section may not provide telemedicine services. 171 (8) Venue for a civil or administrative action initiated by 172 the telemedicine recipient, the department, or the appropriate 173 board shall be based on the location of the patient or shall be 174 in Leon County. 175 (9) The boards may adopt rules to administer the 176 requirements of this act and must repeal rules that are 177 inconsistent with this act, including rules that prohibit the 178 use of telemedicine in this state. The appropriate board may 179 also develop standards and adopt rules relating to requirements 180 for patient presenters. Such rules may not require the use of 181 patient presenters in telemedicine services if special skills or 182 training is not needed for a patient to participate in the 183 encounter. 184 Section 4. Section 456.4504, Florida Statutes, is created 185 to read: 186 456.4504 Telemedicine standards.— 187 (1) The standard of care as provided in s. 766.102 is the 188 same regardless of whether the physician provides health care 189 services in person or by telemedicine. The applicable board may 190 adopt rules specifically related to the standard of care for 191 telemedicine. 192 (2) A telemedicine provider providing telemedicine services 193 under this act is responsible for the quality of the equipment 194 and technology employed and for its safe use. Telemedicine 195 equipment and advanced communications technology must, at a 196 minimum, be able to provide the same information to the 197 telemedicine provider as the information that would be obtained 198 in an in-person encounter with a health care provider and must 199 enable the telemedicine provider to meet or exceed the 200 prevailing standard of care for the practice of the profession. 201 (3) The telemedicine provider is not required to conduct a 202 patient history or physical examination of the patient before 203 engaging in a telemedicine encounter if the telemedicine 204 provider conducts a patient evaluation sufficient to meet the 205 prevailing standard of care for the services provided. 206 (4) Before each telemedicine encounter, the identification 207 and location of the telemedicine provider and all other 208 individuals present via advanced communications technology who 209 will view the patient or the patient’s information must be 210 identified to the patient. 211 (5) For the purposes of this act, the nonemergency 212 prescribing of a legend drug based solely on an electronic 213 questionnaire without a visual examination is considered a 214 failure to practice medicine with the level of care, skill, and 215 treatment which is recognized by a reasonably prudent physician 216 or other authorized practitioner and is not authorized under 217 this act. 218 (6) A controlled substance may not be prescribed through 219 the use of telemedicine for chronic, nonmalignant pain. 220 (7) Medical records must be kept by each telemedicine 221 provider that participates in a patient telemedicine encounter 222 to the same extent as required for an in-person encounter under 223 state and federal law. Telemedicine providers are encouraged to 224 create electronic health records to document the encounter and 225 to transmit information in the most efficient manner possible. 226 (8) Any medical records generated, including records 227 maintained via video, audio, electronic, or other means, due to 228 a telemedicine encounter must conform to the confidentiality and 229 recordkeeping requirements of federal law and nationally 230 recognized health care accreditation organizations and the laws 231 and rules of this state, regardless of where the medical records 232 of a patient in this state are maintained. 233 (9) Telemedicine technology used by a telemedicine provider 234 must be encrypted and must use a recordkeeping program to verify 235 each interaction. 236 (10) In those situations in which a telemedicine provider 237 uses telemedicine technology provided by a third-party vendor, 238 the telemedicine provider must: 239 (a) Require a business associate agreement with the third 240 party vendor; and 241 (b) Ensure that the third-party vendor complies with the 242 administrative, physical, and technical safeguards and standards 243 set forth by the Health Information Technology for Economic and 244 Clinical Health (HITECH) Act and by federal regulations 245 implemented pursuant to HITECH. 246 Section 5. Section 456.4505, Florida Statutes, is created 247 to read: 248 456.4505 Telemedicine services to diagnose or treat the 249 human eye.— 250 (1) The use of automated equipment, including computer 251 controlled devices, in the provision of telemedicine services to 252 diagnose or treat the human eye and its appendages, is 253 permissible if the following requirements are met at the time 254 the automated equipment is used: 255 (a) The automated equipment is approved by the United 256 States Food and Drug Administration for the intended use; 257 (b) The automated equipment is designed and operated in a 258 manner that provides any accommodation required by the federal 259 ADA Amendments Act of 2008; 260 (c) The automated equipment and accompanying technology 261 used for the collection and transmission of information and 262 data, including photographs and scans, gathers and transmits 263 protected health information in compliance with the federal 264 Health Insurance Portability and Accountability Act; 265 (d) The procedure for which the automated equipment is used 266 has a recognized Current Procedural Terminology (CPT) code 267 approved by the Centers for Medicare and Medicaid Services; 268 (e) The physical location of the automated equipment 269 prominently displays the name and Florida license number of the 270 individual who will read and interpret the diagnostic 271 information and data, including photographs and scans; 272 (f) Diagnostic information and data, including photographs 273 and scans, gathered by the automated equipment is read and 274 interpreted by an optometrist licensed under chapter 463 or a 275 physician skilled in diseases of the human eye and licensed 276 under chapter 458 or chapter 459; and 277 (g) The owner or lessee of the automated equipment 278 maintains liability insurance in an amount adequate to cover 279 claims made by individuals diagnosed or treated based on 280 information and data, including photographs and scans, generated 281 by the automated equipment. 282 (2) A prescription for spectacles or contact lens may not 283 be made based on telemedicine services or based solely on the 284 refractive error of the human eye generated by a computer 285 controlled device such as an autorefractor. 286 Section 6. Section 456.4506, Florida Statutes, is created 287 to read: 288 456.4506 Telemedicine services under Medicaid.— 289 (1) The Agency for Health Care Administration shall 290 reimburse for Medicaid services provided through telemedicine in 291 the same manner and equivalent to Medicaid services provided in 292 person under parts III and IV of chapter 409, except as provided 293 in subsection (7). 294 (2) Telemedicine services reimbursed under Medicaid must 295 meet the standards and requirements of this act. 296 (3) Except as provided in subsection (7), the agency may 297 not require in-person contact between a telemedicine provider 298 and Medicaid recipient as a prerequisite for payment for 299 services appropriately provided through telemedicine in 300 accordance with generally accepted health care practices and 301 standards prevailing in the applicable health care community at 302 the time the services are provided. 303 (4) Before receipt of telemedicine services, a Medicaid 304 recipient or the legal representative of a Medicaid recipient 305 must provide informed consent for telemedicine services. A 306 Medicaid recipient shall also be provided the opportunity to 307 receive the same service through an in-person encounter. 308 (5) A Medicaid service that is provided through a fee-for 309 service or managed care program may not be denied as a 310 creditable Medicaid service solely because that service is 311 provided through telemedicine. 312 (6) Reimbursement of telemedicine services under Medicaid 313 shall be the amount negotiated between the parties involved to 314 the extent permitted under state and federal law. Regardless of 315 the reimbursement methodology or amount, telemedicine providers 316 located at the originating site and the distant site should both 317 receive reimbursement based on the services rendered, if any, 318 during the telemedicine encounter. 319 (7) If, after implementation, the agency determines that 320 the delivery of a particular service through telemedicine is not 321 cost-effective or does not adequately meet the clinical needs of 322 recipients and the determination has been documented, the agency 323 may discontinue Medicaid reimbursement for that telemedicine 324 service. 325 (8) The agency shall submit a report on the usage and 326 costs, including savings, if any, associated with the provision 327 of health care services through telemedicine under the Medicaid 328 program by January 1, 2017, to the President of the Senate, the 329 Speaker of the House of Representatives, and the minority 330 leaders of the Senate and the House of Representatives. 331 (9) This section is repealed June 30, 2017. 332 Section 7. Section 456.4507, Florida Statutes, is created 333 to read: 334 456.4507 Requirements for private insurer reimbursement.— 335 (1) Each health carrier or health benefit plan that offers 336 or issues health benefit plans that are delivered, issued for 337 delivery, continued, or renewed in this state on or after 338 January 1, 2014, may not deny coverage for a health care service 339 on the basis that the health care service is provided through 340 telemedicine if the same service would be covered if provided 341 through an in-person encounter. 342 (2) A health carrier may not exclude an otherwise covered 343 health care service from coverage solely because the service is 344 provided through telemedicine rather than through an in-person 345 encounter between a health care provider and a patient. 346 (3) A health carrier is not required to reimburse a 347 telemedicine provider or a consulting provider for originating 348 site fees or costs for the provision of telemedicine services; 349 however, subject to correct coding, a health carrier shall 350 reimburse a health care provider for the diagnosis, 351 consultation, or treatment of an insured or enrollee if the 352 health care service is delivered through telemedicine on the 353 same basis that the health carrier reimburses the service when 354 it is delivered in person. 355 (4) A health care service provided through telemedicine may 356 not be subject to a greater deductible, copayment, or 357 coinsurance amount than would be applicable if the same service 358 was provided through an in-person diagnosis, consultation, or 359 treatment. 360 (5) A health carrier may not impose upon any person 361 receiving benefits under this section any copayment, 362 coinsurance, or deductible amount or any policy year, calendar 363 year, lifetime, or other durational benefit limitation or 364 maximum for benefits or services which is not equally imposed 365 upon all terms and services covered under the policy, contract, 366 or health benefit plan. 367 (6) This section does not preclude a health carrier from 368 conducting a utilization review to determine the appropriateness 369 of telemedicine as a means of delivering a health care service 370 if such determination is made in the same manner as would be 371 made for the same service delivered in person. 372 (7) A health carrier or health benefit plan may limit 373 coverage for health care services that are provided through 374 telemedicine to health care providers that are in a network 375 approved by the plan or the health carrier. 376 (8) This section does not require a health care provider to 377 be physically present with a patient unless the health care 378 provider who is providing health care services by means of 379 telemedicine determines that the presence of a health care 380 provider is necessary. 381 (9) This section does not apply to a supplemental insurance 382 policy, including a life care contract, accident-only policy, 383 specified-disease policy, hospital policy providing a fixed 384 daily benefit only, Medicare supplement policy, long-term care 385 policy, or short-term major medical policy of a duration of 6 386 months or less or any other supplemental policy as determined by 387 the Office of Insurance Regulation. 388 Section 8. This act shall take effect October 1, 2014. 389 390 ================= T I T L E A M E N D M E N T ================ 391 And the title is amended as follows: 392 Delete everything before the enacting clause 393 and insert: 394 A bill to be entitled 395 An act relating to telemedicine; creating s. 456.4501, 396 F.S.; providing a short title; creating s. 456.4502, 397 F.S.; defining terms applicable to the act; creating 398 s. 456.4503, F.S.; requiring physicians providing 399 telemedicine services to patients in this state to be 400 licensed in this state or to meet alternative 401 requirements; providing for disciplining out-of-state 402 physicians through affiliated entities operating in 403 this state; requiring pertinent records to be made 404 available upon request; providing certain exceptions 405 for emergency services and consultations; requiring 406 other health care providers to be supervised by a 407 physician; providing continuing education requirements 408 for telemedicine providers; establishing venue; 409 providing applicability; authorizing the licensing 410 boards to adopt rules; creating s. 456.4504, F.S.; 411 providing standards and prohibitions for the provision 412 of telemedicine services; prohibiting nonemergency 413 prescribing of a legend drug without a physical 414 examination; prohibiting the prescription of a 415 controlled substance using telemedicine; creating s. 416 456.4505, F.S.; authorizing the use of telemedicine 417 services in the diagnosis and treatment of the human 418 eye; providing requirements for the use of automated 419 equipment; requiring the owner or lessee of the 420 automated equipment to maintain specified liability 421 insurance under certain circumstances; prohibiting 422 prescriptions for spectacles or contact lens based 423 solely on the use of an autorefractor; creating s. 424 456.4506, F.S.; providing requirements for 425 reimbursement of telemedicine services under the 426 Medicaid program; requiring a report to the 427 Legislature on the usage and costs of telemedicine in 428 Medicaid by a certain date; creating s. 456.4507, 429 F.S.; providing the requirements for the reimbursement 430 of telemedicine services by private health insurers; 431 providing applicability; providing an effective date.