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.
   35  Be It Enacted by the Legislature of the State of Florida:
   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.—
   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 which
   46  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.