Florida Senate - 2019 SENATOR AMENDMENT Bill No. CS for CS for HB 23 Ì8457808Î845780 LEGISLATIVE ACTION Senate . House . . . Floor: AE/2R . 04/26/2019 02:09 PM . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Senator Harrell moved 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) A telehealth provider may use telehealth to perform a 35 patient evaluation. If a telehealth provider conducts a patient 36 evaluation sufficient to diagnose and treat the patient, the 37 telehealth provider is not required to research a patient’s 38 medical history or conduct a physical examination of the patient 39 before using telehealth to provide health care services to the 40 patient. 41 (c) A telehealth provider may not use telehealth to 42 prescribe a controlled substance unless the controlled substance 43 is prescribed for the following: 44 1. The treatment of a psychiatric disorder; 45 2. Inpatient treatment at a hospital licensed under chapter 46 395; 47 3. The treatment of a patient receiving hospice services as 48 defined in s. 400.601; or 49 4. The treatment of a resident of a nursing home facility 50 as defined in s. 400.021. 51 (d) A telehealth provider and a patient may be in separate 52 locations when telehealth is used to provide health care 53 services to a patient. 54 (e) A nonphysician telehealth provider using telehealth and 55 acting within his or her relevant scope of practice, as 56 established by Florida law or rule, is not in violation of s. 57 458.327(1)(a) or s. 459.013(1)(a). 58 (3) RECORDS.—A telehealth provider shall document in the 59 patient’s medical record the health care services rendered using 60 telehealth according to the same standard as used for in-person 61 services. Medical records, including video, audio, electronic, 62 or other records generated as a result of providing such 63 services, are confidential pursuant to ss. 395.3025(4) and 64 456.057. 65 (4) REGISTRATION OF OUT-OF-STATE TELEHEALTH PROVIDERS.— 66 (a) A health care professional not licensed in this state 67 may provide health care services to a patient located in this 68 state using telehealth if the health care professional registers 69 with the applicable board, or the department if there is no 70 board, and provides health care services within the applicable 71 scope of practice established by Florida law or rule. 72 (b) The board, or the department if there is no board, 73 shall register a health care professional not licensed in this 74 state as a telehealth provider if the health care professional: 75 1. Completes an application in the format prescribed by the 76 department; 77 2. Is licensed with an active, unencumbered license that is 78 issued by another state, the District of Columbia, or a 79 possession or territory of the United States and that is 80 substantially similar to a license issued to a Florida-licensed 81 provider specified in paragraph (1)(b); 82 3. Has not been the subject of disciplinary action relating 83 to his or her license during the 5-year period immediately prior 84 to the submission of the application; 85 4. Designates a duly appointed registered agent for service 86 of process in this state on a form prescribed by the department; 87 and 88 5. Demonstrates to the board, or the department if there is 89 no board, that he or she is in compliance with paragraph (e). 90 91 The department shall use the National Practitioner Data Bank to 92 verify the information submitted under this paragraph, as 93 applicable. 94 (c) The website of a telehealth provider registered under 95 paragraph (b) must prominently display a hyperlink to the 96 department’s website containing information required under 97 paragraph (h). 98 (d) A health care professional may not register under this 99 subsection if his or her license to provide health care services 100 is subject to a pending disciplinary investigation or action, or 101 has been revoked in any state or jurisdiction. A health care 102 professional registered under this subsection must notify the 103 appropriate board, or the department if there is no board, of 104 restrictions placed on his or her license to practice, or any 105 disciplinary action taken or pending against him or her, in any 106 state or jurisdiction. The notification must be provided within 107 5 business days after the restriction is placed or disciplinary 108 action is initiated or taken. 109 (e) A provider registered under this subsection shall 110 maintain professional liability coverage or financial 111 responsibility, that includes coverage or financial 112 responsibility for telehealth services provided to patients not 113 located in the provider’s home state, in an amount equal to or 114 greater than the requirements for a licensed practitioner under 115 s. 456.048, s. 458.320, or s. 459.0085, as applicable. 116 (f) A health care professional registered under this 117 subsection may not open an office in this state and may not 118 provide in-person health care services to patients located in 119 this state. 120 (g) A pharmacist registered under this subsection may only 121 use a pharmacy permitted under chapter 465, a nonresident 122 pharmacy registered under s. 465.0156, or a nonresident pharmacy 123 or outsourcing facility holding an active permit pursuant to s. 124 465.0158 to dispense medicinal drugs to patients located in this 125 state. 126 (h) The department shall publish on its website a list of 127 all registrants and include, to the extent applicable, each 128 registrant’s: 129 1. Name. 130 2. Health care occupation. 131 3. Completed health care training and education, including 132 completion dates and any certificates or degrees obtained. 133 4. Out-of-state health care license with the license 134 number. 135 5. Florida telehealth provider registration number. 136 6. Specialty. 137 7. Board certification. 138 8. Five-year disciplinary history, including sanctions and 139 board actions. 140 9. Medical malpractice insurance provider and policy 141 limits, including whether the policy covers claims that arise in 142 this state. 143 10. The name and address of the registered agent designated 144 for service of process in this state. 145 (i) The board, or the department if there is no board, may 146 take disciplinary action against an out-of-state telehealth 147 provider registered under this subsection if the registrant: 148 1. Fails to notify the applicable board, or the department 149 if there is no board, of any adverse actions taken against his 150 or her license as required under paragraph (d). 151 2. Has restrictions placed on or disciplinary action taken 152 against his or her license in any state or jurisdiction. 153 3. Violates any of the requirements of this section. 154 4. Commits any act that constitutes grounds for 155 disciplinary action under s. 456.072(1) or the applicable 156 practice act for Florida-licensed providers. 157 158 Disciplinary action taken by a board, or the department if there 159 is no board, under this paragraph may include suspension or 160 revocation of the provider’s registration or the issuance of a 161 reprimand or letter of concern. A suspension may be accompanied 162 by a corrective action plan as determined by the board, or the 163 department if there is no board, the completion of which may 164 lead to the suspended registration being reinstated according to 165 rules adopted by the board, or the department if there is no 166 board. 167 (5) VENUE.—For the purposes of this section, any act that 168 constitutes the delivery of health care services is deemed to 169 occur at the place where the patient is located at the time the 170 act is performed or in the patient’s county of residence. Venue 171 for a civil or administrative action initiated by the 172 department, the appropriate board, or a patient who receives 173 telehealth services from an out-of-state telehealth provider may 174 be located in the patient’s county of residence or in Leon 175 County. 176 (6) EXEMPTIONS.—A health care professional who is not 177 licensed to provide health care services in this state but who 178 holds an active license to provide health care services in 179 another state or jurisdiction, and who provides health care 180 services using telehealth to a patient located in this state, is 181 not subject to the registration requirement under this section 182 if the services are provided: 183 (a) In response to an emergency medical condition as 184 defined in s. 395.002; or 185 (b) In consultation with a health care professional 186 licensed in this state who has ultimate authority over the 187 diagnosis and care of the patient. 188 (7) RULEMAKING.—The applicable board, or the department if 189 there is no board, may adopt rules to administer this section. 190 Section 2. Effective January 1, 2020, section 627.42396, 191 Florida Statutes, is created to read: 192 627.42396 Reimbursement for telehealth services.—A contract 193 between a health insurer issuing major medical comprehensive 194 coverage through an individual or group policy and a telehealth 195 provider, as defined in s. 456.47, must be voluntary between the 196 insurer and the provider and must establish mutually acceptable 197 payment rates or payment methodologies for services provided 198 through telehealth. Any contract provision that distinguishes 199 between payment rates or payment methodologies for services 200 provided through telehealth and the same services provided 201 without the use of telehealth must be initialed by the 202 telehealth provider. 203 Section 3. Effective January 1, 2020, subsection (45) is 204 added to section 641.31, Florida Statutes, to read: 205 641.31 Health maintenance contracts.— 206 (45) A contract between a health maintenance organization 207 issuing major medical individual or group coverage and a 208 telehealth provider, as defined in s. 456.47, must be voluntary 209 between the health maintenance organization and the provider 210 must establish mutually acceptable payment rates or payment 211 methodologies for services provided through telehealth. Any 212 contract provision that distinguishes between payment rates or 213 payment methodologies for services provided through telehealth 214 and the same services provided without the use of telehealth 215 must be initialed by the telehealth provider. 216 Section 4. Effective July 1, 2020, the Department of Health 217 shall annually review the amount of any fees collected under 218 section 456.47, Florida Statutes, in the prior fiscal year and 219 shall determine whether such fees are sufficient to enable the 220 department and the boards, as defined in section 456.001, 221 Florida Statutes, to fully implement section 456.47, Florida 222 Statutes. If the department determines that the fees collected 223 are insufficient, the department shall so indicate to the 224 Legislature in its annual legislative budget request and shall 225 recommend appropriate adjustments to the applicable fees. 226 Section 5. For fiscal year 2019-2020, the sums of $261,389 227 in recurring funds and $15,020 in nonrecurring funds from the 228 Medical Quality Assurance Trust Fund are appropriated to the 229 Department of Health, and four full-time equivalent positions 230 with associated salary rate of 145,870 are authorized for the 231 purpose of implementing s. 456.47, Florida Statutes, as created 232 by this act. 233 Section 6. Except as otherwise provided, this act shall 234 take effect July 1, 2019. 235 236 ================= T I T L E A M E N D M E N T ================ 237 And the title is amended as follows: 238 Delete everything before the enacting clause 239 and insert: 240 A bill to be entitled 241 An act relating to telehealth; creating s. 456.47, 242 F.S.; defining terms; establishing standards of 243 practice for telehealth providers; authorizing 244 telehealth providers to use telehealth to perform 245 patient evaluations; authorizing certain telehealth 246 providers to use telehealth to prescribe certain 247 controlled substances under specified circumstances; 248 providing that a nonphysician telehealth provider 249 using telehealth and acting within his or her relevant 250 scope of practice is not deemed to be practicing 251 medicine without a license; providing recordkeeping 252 requirements for telehealth providers; providing 253 registration requirements for out-of-state telehealth 254 providers; requiring the Department of Health to 255 publish certain information on its website; 256 authorizing a board, or the department if there is no 257 board, to take disciplinary action against a 258 telehealth provider under certain circumstances; 259 providing venue; providing exemptions from telehealth 260 registration requirements; authorizing the applicable 261 board, or the department if there is no board, to 262 adopt rules; creating s. 627.42396, F.S.; providing 263 requirements for a contract between a certain health 264 insurer and a telehealth provider; amending s. 641.31, 265 F.S.; providing requirements for a contract between a 266 certain health maintenance organization and a 267 telehealth provider; requiring the department to 268 annually review the amount of certain collected fees 269 and make a determination relating to the sufficiency 270 of funding to implement specified telehealth 271 provisions; upon making a certain determination, 272 requiring the department to indicate insufficient 273 funding and recommend fee adjustments in its annual 274 legislative budget request; providing an 275 appropriation; authorizing positions; providing 276 effective dates.