Florida Senate - 2019 COMMITTEE AMENDMENT Bill No. SB 1526 Ì147794TÎ147794 LEGISLATIVE ACTION Senate . House . . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— The Committee on Appropriations (Harrell) recommended the following: 1 Senate Substitute for Amendment (763358) (with title 2 amendment) 3 4 Delete everything after the enacting clause 5 and insert: 6 Section 1. Section 456.47, Florida Statutes, is created to 7 read: 8 456.47 Use of telehealth to provide services.— 9 (1) DEFINITIONS.—As used in this section, the term: 10 (a) “Telehealth” means the use of synchronous or 11 asynchronous telecommunications technology by a telehealth 12 provider to provide health care services, including, but not 13 limited to, assessment, diagnosis, consultation, treatment, and 14 monitoring of a patient; transfer of medical data; patient and 15 professional health-related education; public health services; 16 and health administration. The term does not include audio-only 17 telephone calls, e-mail messages, or facsimile transmissions. 18 (b) “Telehealth provider” means any individual who provides 19 health care and related services using telehealth and who is 20 licensed or certified under s. 393.17; part III of chapter 401; 21 chapter 457; chapter 458; chapter 459; chapter 460; chapter 461; 22 chapter 463; chapter 464; chapter 465; chapter 466; chapter 467; 23 part I, part III, part IV, part V, part X, part XIII, or part 24 XIV of chapter 468; chapter 478; chapter 480; part II or part 25 III of chapter 483; chapter 484; chapter 486; chapter 490; or 26 chapter 491; who is licensed under a multi-state health care 27 licensure compact of which Florida is a member state; or who is 28 registered under and complies with subsection (4). 29 (2) PRACTICE STANDARDS.— 30 (a) A telehealth provider has the duty to practice in a 31 manner consistent with his or her scope of practice and the 32 prevailing professional standard of practice for a health care 33 professional who provides in-person health care services to 34 patients in this state. 35 (b) A telehealth provider may use telehealth to perform a 36 patient evaluation. If a telehealth provider conducts a patient 37 evaluation sufficient to diagnose and treat the patient, the 38 telehealth provider is not required to research a patient’s 39 medical history or conduct a physical examination of the patient 40 before using telehealth to provide health care services to the 41 patient. 42 (c) A telehealth provider may not use telehealth to 43 prescribe a controlled substance unless the controlled substance 44 is prescribed for the following: 45 1. The treatment of a psychiatric disorder; 46 2. Inpatient treatment at a hospital licensed under chapter 47 395; 48 3. The treatment of a patient receiving hospice services as 49 defined in s. 400.601; or 50 4. The treatment of a resident of a nursing home facility 51 as defined in s. 400.021. 52 (d) A telehealth provider and a patient may be in separate 53 locations when telehealth is used to provide health care 54 services to a patient. 55 (e) A nonphysician telehealth provider using telehealth and 56 acting within his or her relevant scope of practice, as 57 established by Florida law or rule, is not in violation of s. 58 458.327(1)(a) or s. 459.013(1)(a). 59 (3) RECORDS.—A telehealth provider shall document in the 60 patient’s medical record the health care services rendered using 61 telehealth according to the same standard as used for in-person 62 services. Medical records, including video, audio, electronic, 63 or other records generated as a result of providing such 64 services, are confidential pursuant to ss. 395.3025(4) and 65 456.057. 66 (4) REGISTRATION OF OUT-OF-STATE TELEHEALTH PROVIDERS.— 67 (a) A health care professional not licensed in this state 68 may provide health care services to a patient located in this 69 state using telehealth if the health care professional registers 70 with the applicable board, or the department if there is no 71 board, and provides health care services within the applicable 72 scope of practice established by Florida law or rule. 73 (b) The board, or the department if there is no board, 74 shall register a health care professional not licensed in this 75 state as a telehealth provider if the health care professional: 76 1. Completes an application in the format prescribed by the 77 department; 78 2. Is licensed with an active, unencumbered license that is 79 issued by another state, the District of Columbia, or a 80 possession or territory of the United States and that is 81 substantially similar to a license issued to a Florida-licensed 82 provider specified in paragraph (1)(b); 83 3. Has not been the subject of disciplinary action relating 84 to his or her license during the 5-year period immediately prior 85 to the submission of the application; 86 4. Designates a duly appointed registered agent for service 87 of process in this state on a form prescribed by the department; 88 and 89 5. Demonstrates to the board, or the department if there is 90 no board, that he or she is in compliance with paragraph (e). 91 92 The department shall use the National Practitioner Data Bank to 93 verify the information submitted under this paragraph, as 94 applicable. 95 (c) The website of a telehealth provider registered under 96 paragraph (b) must prominently display a hyperlink to the 97 department’s website containing information required under 98 paragraph (h). 99 (d) A health care professional may not register under this 100 subsection if his or her license to provide health care services 101 is subject to a pending disciplinary investigation or action, or 102 has been revoked in any state or jurisdiction. A health care 103 professional registered under this subsection must notify the 104 appropriate board, or the department if there is no board, of 105 restrictions placed on his or her license to practice, or any 106 disciplinary action taken or pending against him or her, in any 107 state or jurisdiction. The notification must be provided within 108 5 business days after the restriction is placed or disciplinary 109 action is initiated or taken. 110 (e) A provider registered under this subsection shall 111 maintain professional liability coverage or financial 112 responsibility, that includes coverage or financial 113 responsibility for telehealth services provided to patients not 114 located in the provider’s home state, in an amount equal to or 115 greater than the requirements for a licensed practitioner under 116 s. 456.048, s. 458.320, or s. 459.0085, as applicable. 117 (f) A health care professional registered under this 118 subsection may not open an office in this state and may not 119 provide in-person health care services to patients located in 120 this state. 121 (g) A pharmacist registered under this subsection may only 122 use a pharmacy permitted under chapter 465, a nonresident 123 pharmacy registered under s. 465.0156, or a nonresident pharmacy 124 or outsourcing facility holding an active permit pursuant to s. 125 465.0158 to dispense medicinal drugs to patients located in this 126 state. 127 (h) The department shall publish on its website a list of 128 all registrants and include, to the extent applicable, each 129 registrant’s: 130 1. Name. 131 2. Health care occupation. 132 3. Completed health care training and education, including 133 completion dates and any certificates or degrees obtained. 134 4. Out-of-state health care license with the license 135 number. 136 5. Florida telehealth provider registration number. 137 6. Specialty. 138 7. Board certification. 139 8. Five-year disciplinary history, including sanctions and 140 board actions. 141 9. Medical malpractice insurance provider and policy 142 limits, including whether the policy covers claims that arise in 143 this state. 144 10. The name and address of the registered agent designated 145 for service of process in this state. 146 (i) The board, or the department if there is no board, may 147 take disciplinary action against an out-of-state telehealth 148 provider registered under this subsection if the registrant: 149 1. Fails to notify the applicable board, or the department 150 if there is no board, of any adverse actions taken against his 151 or her license as required under paragraph (d). 152 2. Has restrictions placed on or disciplinary action taken 153 against his or her license in any state or jurisdiction. 154 3. Violates any of the requirements of this section. 155 4. Commits any act that constitutes grounds for 156 disciplinary action under s. 456.072(1) or the applicable 157 practice act for Florida-licensed providers. 158 159 Disciplinary action taken by a board, or the department if there 160 is no board, under this paragraph may include suspension or 161 revocation of the provider’s registration or the issuance of a 162 reprimand or letter of concern. A suspension may be accompanied 163 by a corrective action plan as determined by the board, or the 164 department if there is no board, the completion of which may 165 lead to the suspended registration being reinstated according to 166 rules adopted by the board, or the department if there is no 167 board. 168 (5) VENUE.—For the purposes of this section, any act that 169 constitutes the delivery of health care services is deemed to 170 occur at the place where the patient is located at the time the 171 act is performed or in the patient’s county of residence. Venue 172 for a civil or administrative action initiated by the 173 department, the appropriate board, or a patient who receives 174 telehealth services from an out-of-state telehealth provider may 175 be located in the patient’s county of residence or in Leon 176 County. 177 (6) EXEMPTIONS.—A health care professional who is not 178 licensed to provide health care services in this state but who 179 holds an active license to provide health care services in 180 another state or jurisdiction, and who provides health care 181 services using telehealth to a patient located in this state, is 182 not subject to the registration requirement under this section 183 if the services are provided: 184 (a) In response to an emergency medical condition as 185 defined in s. 395.002; or 186 (b) In consultation with a health care professional 187 licensed in this state who has ultimate authority over the 188 diagnosis and care of the patient. 189 (7) RULEMAKING.—The applicable board, or the department if 190 there is no board, may adopt rules to administer this section. 191 Section 2. Effective January 1, 2020, section 627.42396, 192 Florida Statutes, is created to read: 193 627.42396 Reimbursement for telehealth services.—A contract 194 between a health insurer issuing major medical comprehensive 195 coverage through an individual or group policy and a telehealth 196 provider, as defined in s. 456.47, may not require the provider 197 be reimbursed for a covered service provided through telehealth 198 in an amount less than the reimbursement the insurer would pay 199 if the service were delivered through an in-person encounter. 200 Section 3. Effective January 1, 2020, subsection (45) is 201 added to section 641.31, Florida Statutes, to read: 202 641.31 Health maintenance contracts.— 203 (45) A contract between a health maintenance organization 204 issuing major medical individual or group coverage and a 205 telehealth provider, as defined in s. 456.47, may not require 206 the provider be reimbursed for a covered service provided 207 through telehealth in an amount less than the reimbursement the 208 health maintenance organization would pay if the service were 209 delivered through an in-person encounter. 210 Section 4. Effective July 1, 2020, the Department of Health 211 shall annually review the amount of any fees collected under 212 section 456.47, Florida Statutes, in the prior fiscal year and 213 shall determine whether such fees are sufficient to enable the 214 department and the boards, as defined in section 456.001, 215 Florida Statutes, to fully implement section 456.47, Florida 216 Statutes. If the department determines that the fees collected 217 are insufficient, the department shall so indicate to the 218 Legislature in its annual Legislative Budget Request and shall 219 recommend appropriate adjustments to the applicable fees. 220 Section 5. For fiscal year 2019-2020, the sums of $261,389 221 in recurring funds and $15,020 in nonrecurring funds from the 222 Medical Quality Assurance Trust Fund are appropriated to the 223 Department of Health, and four full-time equivalent positions 224 with associated salary rate of 145,870 are authorized for the 225 purpose of implementing s. 456.47, Florida Statutes, as created 226 by this act. 227 Section 6. Except as otherwise provided, this act shall 228 take effect July 1, 2019. 229 230 ================= T I T L E A M E N D M E N T ================ 231 And the title is amended as follows: 232 Delete everything before the enacting clause 233 and insert: 234 A bill to be entitled 235 An act relating to telehealth; creating s. 456.47, 236 F.S.; defining terms; establishing standards of 237 practice for telehealth providers; authorizing 238 telehealth providers to use telehealth to perform 239 patient evaluations; authorizing certain telehealth 240 providers to use telehealth to prescribe certain 241 controlled substances under specified circumstances; 242 providing that a nonphysician telehealth provider 243 using telehealth and acting within his or her relevant 244 scope of practice is not deemed to be practicing 245 medicine without a license; providing recordkeeping 246 requirements for telehealth providers; providing 247 registration requirements for out-of-state telehealth 248 providers; requiring the Department of Health to 249 publish certain information on its website; 250 authorizing a board, or the department if there is no 251 board, to take disciplinary action against a 252 telehealth provider under certain circumstances; 253 providing venue; providing exemptions from telehealth 254 registration requirements; authorizing the applicable 255 board, or the department if there is no board, to 256 adopt rules; amending s. 627.42396, F.S.; prohibiting 257 a contract between a certain health insurer and a 258 telehealth provider from requiring the telehealth 259 provider to be reimbursed at lesser amount than if the 260 service were provided in person; amending s. 641.31, 261 F.S.; prohibiting a contract between a certain health 262 maintenance organization and a telehealth provider 263 from requiring the telehealth provider to be 264 reimbursed at lesser amount than if the service were 265 provided in-person; requiring the department to 266 annually review the amount of certain collected fees 267 and make a determination relating to the sufficiency 268 of funding to implement specified telehealth 269 provisions; upon making a certain determination, 270 requiring the department to indicate insufficient 271 funding and recommend fee adjustments in its annual 272 Legislative Budget Request; providing an 273 appropriation; authorizing positions; providing 274 effective dates.