Florida Senate - 2019 COMMITTEE AMENDMENT Bill No. SB 1526 Ì763358FÎ763358 LEGISLATIVE ACTION Senate . House . . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Appropriations Subcommittee on Health and Human Services (Harrell) recommended the following: 1 Senate Amendment (with title amendment) 2 3 Delete everything after the enacting clause 4 and insert: 5 Section 1. Section 456.47, Florida Statutes, is created to 6 read: 7 456.47 Use of telehealth to provide services.— 8 (1) DEFINITIONS.—As used in this section, the term: 9 (a) “Telehealth” means the use of synchronous or 10 asynchronous telecommunications technology by a telehealth 11 provider to provide health care services, including, but not 12 limited to, assessment, diagnosis, consultation, treatment, and 13 monitoring of a patient; transfer of medical data; patient and 14 professional health-related education; public health services; 15 and health administration. The term does not include audio-only 16 telephone calls, e-mail messages, or facsimile transmissions. 17 (b) “Telehealth provider” means any individual who provides 18 health care and related services using telehealth and who is 19 licensed or certified under s. 393.17; part III of chapter 401; 20 chapter 457; chapter 458; chapter 459; chapter 460; chapter 461; 21 chapter 463; chapter 464; chapter 465; chapter 466; chapter 467; 22 part I, part III, part IV, part V, part X, part XIII, or part 23 XIV of chapter 468; chapter 478; chapter 480; part II or part 24 III of chapter 483; chapter 484; chapter 486; chapter 490; or 25 chapter 491; who is licensed under a multi-state health care 26 licensure compact of which Florida is a member state; or who is 27 registered under and complies with subsection (4). 28 (2) PRACTICE STANDARDS.— 29 (a) A telehealth provider has the duty to practice in a 30 manner consistent with his or her scope of practice and the 31 prevailing professional standard of practice for a health care 32 professional who provides in-person health care services to 33 patients in this state. 34 (b) If the applicable standard of practice does not require 35 an in-person physical examination: 36 1. A telehealth provider may use telehealth to perform a 37 patient evaluation. 38 2. If a patient evaluation performed by telehealth under 39 subparagraph 1. is sufficient to diagnose and treat the patient, 40 the telehealth provider is not required to research a patient’s 41 medical history or to conduct a physical examination of the 42 patient before using telehealth to provide health care services 43 to the patient. 44 (c) A telehealth provider may not use telehealth to 45 prescribe a controlled substance unless the controlled substance 46 is prescribed for the following: 47 1. The treatment of a psychiatric disorder; 48 2. Inpatient treatment at a hospital licensed under chapter 49 395; 50 3. The treatment of a patient receiving hospice services as 51 defined in s. 400.601; or 52 4. The treatment of a resident of a nursing home facility 53 as defined in s. 400.021. 54 (d) A telehealth provider and a patient may be in separate 55 locations when telehealth is used to provide health care 56 services to a patient. 57 (e) A nonphysician telehealth provider using telehealth and 58 acting within his or her relevant scope of practice, as 59 established by Florida law or rule, is not in violation of s. 60 458.327(1)(a) or s. 459.013(1)(a). 61 (3) RECORDS.—A telehealth provider shall document in the 62 patient’s medical record the health care services rendered using 63 telehealth according to the same standard as used for in-person 64 services. Medical records, including video, audio, electronic, 65 or other records generated as a result of providing such 66 services, are confidential pursuant to ss. 395.3025(4) and 67 456.057. 68 (4) REGISTRATION OF OUT-OF-STATE TELEHEALTH PROVIDERS.— 69 (a) A health care professional not licensed in this state 70 may provide health care services to a patient located in this 71 state using telehealth if the health care professional registers 72 with the applicable board, or the department if there is no 73 board, and provides health care services within the applicable 74 scope of practice established by Florida law or rule. 75 (b) The board, or the department if there is no board, 76 shall register a health care professional not licensed in this 77 state as a telehealth provider if the health care professional: 78 1. Completes an application in the format prescribed by the 79 department; 80 2. Is licensed with an active, unencumbered license that is 81 issued by another state, the District of Columbia, or a 82 possession or territory of the United States and that is 83 substantially similar to a license issued to a Florida-licensed 84 provider specified in paragraph (1)(b); 85 3. Has not been the subject of disciplinary action relating 86 to his or her license during the 5-year period immediately prior 87 to the submission of the application; 88 4. Designates a duly appointed registered agent for service 89 of process in this state on a form prescribed by the department; 90 and 91 5. Demonstrates to the department that he or she is in 92 compliance with paragraph (e). 93 94 The department shall use the National Practitioner Data Bank to 95 verify the information submitted under this paragraph, as 96 applicable. 97 (c) The website of a telehealth provider registered under 98 paragraph (b) must prominently display a hyperlink to the 99 department’s website containing information required under 100 paragraph (g). 101 (d) A health care professional may not register under this 102 subsection if his or her license to provide health care services 103 is subject to a pending disciplinary investigation or action, or 104 has been revoked in any state or jurisdiction. A health care 105 professional registered under this subsection must notify the 106 appropriate board, or the department if there is no board, of 107 restrictions placed on his or her license to practice, or any 108 disciplinary action taken or pending against him or her, in any 109 state or jurisdiction. The notification must be provided within 110 5 business days after the restriction is placed or disciplinary 111 action is initiated or taken. 112 (e) A provider registered under this subsection shall 113 maintain professional liability coverage or financial 114 responsibility, that includes coverage or financial 115 responsibility for telehealth services provided to patients not 116 located in the provider’s home state, in an amount equal to or 117 greater than the requirements for a licensed practitioner under 118 s. 456.048, s. 458.320, or s. 459.0085, as applicable. 119 (f) A health care professional registered under this 120 subsection may not open an office in this state and may not 121 provide in-person health care services to patients located in 122 this state. 123 (g) A pharmacist registered under this subsection may only 124 use a pharmacy permitted under chapter 465, a nonresident 125 pharmacy registered under s. 465.0156, or a nonresident pharmacy 126 or outsourcing facility holding an active permit pursuant to s. 127 465.0158 to dispense medicinal drugs to patients located in this 128 state. 129 (h) The department shall publish on its website a list of 130 all registrants and include, to the extent applicable, each 131 registrant’s: 132 1. Name. 133 2. Health care occupation. 134 3. Completed health care training and education, including 135 completion dates and any certificates or degrees obtained. 136 4. Out-of-state health care license with the license 137 number. 138 5. Florida telehealth provider registration number. 139 6. Specialty. 140 7. Board certification. 141 8. Five-year disciplinary history, including sanctions and 142 board actions. 143 9. Medical malpractice insurance provider and policy 144 limits, including whether the policy covers claims that arise in 145 this state. 146 10. The name and address of the registered agent designated 147 for service of process in this state. 148 (i) The board, or the department if there is no board, may 149 revoke an out-of-state telehealth provider’s registration if the 150 registrant: 151 1. Fails to notify the applicable board, or the department 152 if there is no board, of any adverse actions taken against his 153 or her license as required under paragraph (d). 154 2. Has restrictions placed on or disciplinary action taken 155 against his or her license in any state or jurisdiction. 156 3. Violates any of the requirements of this section. 157 (5) VENUE.—For the purposes of this section, any act that 158 constitutes the delivery of health care services is deemed to 159 occur at the place where the patient is located at the time the 160 act is performed. Venue for a civil or administrative action 161 initiated by the department, the appropriate board, or a patient 162 who receives telehealth services from an out-of-state telehealth 163 provider may be located in the patient’s county of residence or 164 in Leon County. 165 (6) EXEMPTIONS.—A health care professional who is not 166 licensed to provide health care services in this state but who 167 holds an active license to provide health care services in 168 another state or jurisdiction, and who provides health care 169 services using telehealth to a patient located in this state, is 170 not subject to the registration requirement under this section 171 if the services are provided: 172 (a) In response to an emergency medical condition as 173 defined in s. 395.002; or 174 (b) In consultation with a health care professional 175 licensed in this state who has ultimate authority over the 176 diagnosis and care of the patient. 177 (7) RULEMAKING.—The applicable board, or the department if 178 there is no board, may adopt rules to administer this section. 179 Section 2. For fiscal year 2019-2020, the sums of $261,389 180 in recurring funds and $15,020 in nonrecurring funds from the 181 Medical Quality Assurance Trust Fund are appropriated to the 182 Department of Health, and four full-time equivalent positions 183 with associated salary rate of 145,870 are authorized for the 184 purpose of implementing s. 456.47, Florida Statutes, as created 185 by this act. 186 Section 3. This act shall take effect July 1, 2019. 187 188 ================= T I T L E A M E N D M E N T ================ 189 And the title is amended as follows: 190 Delete everything before the enacting clause 191 and insert: 192 A bill to be entitled 193 An act relating to telehealth; creating s. 456.47, 194 F.S.; defining terms; establishing standards of 195 practice for telehealth providers; authorizing 196 telehealth providers to use telehealth to perform 197 patient evaluations; providing that telehealth 198 providers, under certain circumstances, are not 199 required to research a patient’s history or to conduct 200 physical examinations before providing services 201 through telehealth; authorizing certain telehealth 202 providers to use telehealth to prescribe certain 203 controlled substances under specified circumstances; 204 providing that a nonphysician telehealth provider 205 using telehealth and acting within his or her relevant 206 scope of practice is not deemed to be practicing 207 medicine without a license; providing recordkeeping 208 requirements for telehealth providers; providing 209 registration requirements for out-of-state telehealth 210 providers; requiring the Department of Health to 211 publish certain information on its website; 212 authorizing a board, or the department if there is no 213 board, to revoke a telehealth provider’s registration 214 under certain circumstances; providing venue; 215 providing exemptions from telehealth registration 216 requirements; authorizing the applicable board, or the 217 department if there is no board, to adopt rules; 218 providing an appropriation; authorizing positions; 219 providing an effective date.