Florida Senate - 2019                          SENATOR AMENDMENT
       Bill No. CS for CS for HB 23
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                Floor: 1/RE/2R         .                                
             04/26/2019 02:09 PM       .                                

       Senator Harrell moved the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 456.47, Florida Statutes, is created to
    6  read:
    7         456.47Use 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.
   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).
   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.
  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 a voluntary contract
  196  between the insurer and the provider, must establish mutually
  197  acceptable payment rates or payment methodologies for services
  198  provided through telehealth, and must give the provider the
  199  option to accept a reimbursement for a covered service provided
  200  through telehealth in an amount less than the reimbursement the
  201  insurer would pay if the service were delivered through an in
  202  person encounter.
  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 a
  209  voluntary contract between the health maintenance organization
  210  and the provider, must establish mutually acceptable payment
  211  rates or payment methodologies for services provided through
  212  telehealth, and must give the provider the option to accept a
  213  reimbursement for a covered service provided through telehealth
  214  in an amount less than the reimbursement the health maintenance
  215  organization would pay if the service were delivered through an
  216  in-person encounter.
  217         Section 4. Effective July 1, 2020, the Department of Health
  218  shall annually review the amount of any fees collected under
  219  section 456.47, Florida Statutes, in the prior fiscal year and
  220  shall determine whether such fees are sufficient to enable the
  221  department and the boards, as defined in section 456.001,
  222  Florida Statutes, to fully implement section 456.47, Florida
  223  Statutes. If the department determines that the fees collected
  224  are insufficient, the department shall so indicate to the
  225  Legislature in its annual legislative budget request and shall
  226  recommend appropriate adjustments to the applicable fees.
  227         Section 5. For fiscal year 2019-2020, the sums of $261,389
  228  in recurring funds and $15,020 in nonrecurring funds from the
  229  Medical Quality Assurance Trust Fund are appropriated to the
  230  Department of Health, and four full-time equivalent positions
  231  with associated salary rate of 145,870 are authorized for the
  232  purpose of implementing s. 456.47, Florida Statutes, as created
  233  by this act.
  234         Section 6. Except as otherwise provided, this act shall
  235  take effect July 1, 2019.
  237  ================= T I T L E  A M E N D M E N T ================
  238  And the title is amended as follows:
  239         Delete everything before the enacting clause
  240  and insert:
  241                        A bill to be entitled                      
  242         An act relating to telehealth; creating s. 456.47,
  243         F.S.; defining terms; establishing standards of
  244         practice for telehealth providers; authorizing
  245         telehealth providers to use telehealth to perform
  246         patient evaluations; authorizing certain telehealth
  247         providers to use telehealth to prescribe certain
  248         controlled substances under specified circumstances;
  249         providing that a nonphysician telehealth provider
  250         using telehealth and acting within his or her relevant
  251         scope of practice is not deemed to be practicing
  252         medicine without a license; providing recordkeeping
  253         requirements for telehealth providers; providing
  254         registration requirements for out-of-state telehealth
  255         providers; requiring the Department of Health to
  256         publish certain information on its website;
  257         authorizing a board, or the department if there is no
  258         board, to take disciplinary action against a
  259         telehealth provider under certain circumstances;
  260         providing venue; providing exemptions from telehealth
  261         registration requirements; authorizing the applicable
  262         board, or the department if there is no board, to
  263         adopt rules; creating s. 627.42396, F.S.; providing
  264         requirements for a contract between a certain health
  265         insurer and a telehealth provider; amending s. 641.31,
  266         F.S.; providing requirements for a contract between a
  267         certain health maintenance organization and a
  268         telehealth provider; requiring the department to
  269         annually review the amount of certain collected fees
  270         and make a determination relating to the sufficiency
  271         of funding to implement specified telehealth
  272         provisions; upon making a certain determination,
  273         requiring the department to indicate insufficient
  274         funding and recommend fee adjustments in its annual
  275         legislative budget request; providing an
  276         appropriation; authorizing positions; providing
  277         effective dates.