Florida Senate - 2021 COMMITTEE AMENDMENT
Bill No. CS for SB 700
Ì645592?Î645592
LEGISLATIVE ACTION
Senate . House
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Appropriations Subcommittee on Health and Human Services
(Rodriguez) recommended the following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Present paragraph (e) of subsection (14) of
6 section 409.908, Florida Statutes, is redesignated as paragraph
7 (f), present subsections (22) through (26) of that section are
8 redesignated as subsections (23) through (27), respectively, a
9 new paragraph (e) is added to subsection (14) of that section,
10 and a new subsection (22) is added to that section, to read:
11 409.908 Reimbursement of Medicaid providers.—Subject to
12 specific appropriations, the agency shall reimburse Medicaid
13 providers, in accordance with state and federal law, according
14 to methodologies set forth in the rules of the agency and in
15 policy manuals and handbooks incorporated by reference therein.
16 These methodologies may include fee schedules, reimbursement
17 methods based on cost reporting, negotiated fees, competitive
18 bidding pursuant to s. 287.057, and other mechanisms the agency
19 considers efficient and effective for purchasing services or
20 goods on behalf of recipients. If a provider is reimbursed based
21 on cost reporting and submits a cost report late and that cost
22 report would have been used to set a lower reimbursement rate
23 for a rate semester, then the provider’s rate for that semester
24 shall be retroactively calculated using the new cost report, and
25 full payment at the recalculated rate shall be effected
26 retroactively. Medicare-granted extensions for filing cost
27 reports, if applicable, shall also apply to Medicaid cost
28 reports. Payment for Medicaid compensable services made on
29 behalf of Medicaid eligible persons is subject to the
30 availability of moneys and any limitations or directions
31 provided for in the General Appropriations Act or chapter 216.
32 Further, nothing in this section shall be construed to prevent
33 or limit the agency from adjusting fees, reimbursement rates,
34 lengths of stay, number of visits, or number of services, or
35 making any other adjustments necessary to comply with the
36 availability of moneys and any limitations or directions
37 provided for in the General Appropriations Act, provided the
38 adjustment is consistent with legislative intent.
39 (14) A provider of prescribed drugs shall be reimbursed the
40 least of the amount billed by the provider, the provider’s usual
41 and customary charge, or the Medicaid maximum allowable fee
42 established by the agency, plus a dispensing fee. The Medicaid
43 maximum allowable fee for ingredient cost must be based on the
44 lowest of: the average wholesale price (AWP) minus 16.4 percent,
45 the wholesaler acquisition cost (WAC) plus 1.5 percent, the
46 federal upper limit (FUL), the state maximum allowable cost
47 (SMAC), or the usual and customary (UAC) charge billed by the
48 provider.
49 (e) A pharmacist providing health care services through
50 telehealth as defined in s. 456.47 shall be reimbursed for such
51 services in accordance with this subsection.
52 (22) Subject to any limitations or directions provided in
53 the General Appropriations Act, the agency shall reimburse the
54 use of telehealth as defined by s. 456.47, including services
55 provided in real time, services provided using store-and-forward
56 technologies, and remote patient monitoring services to the
57 extent that these technologies are available.
58 (a) Providers using any modality described in this
59 subsection must ensure that treatment services are medically
60 necessary and performed within a provider’s scope of practice
61 and any applicable supervision requirements.
62 (b) Providers must include documentation regarding the use
63 of telehealth in the medical record or progress notes for each
64 encounter with a recipient.
65 (c) Out-of-state providers who are registered under s.
66 456.47(4) and enrolled in Florida Medicaid as an out-of-state
67 provider may be reimbursed for telehealth services provided to
68 recipients in this state.
69 (d) Reimbursement under this subsection does not cover the
70 purchase of any general telecommunications equipment that is not
71 specific to or used solely for the provision of telehealth,
72 including, but not limited to, computers, tablets, cell phones,
73 smartphones, or any other similar equipment or device.
74 Section 2. Paragraph (a) of subsection (1) and paragraph
75 (c) of subsection (2) of section 456.47, Florida Statutes, are
76 amended to read:
77 456.47 Use of telehealth to provide services.—
78 (1) DEFINITIONS.—As used in this section, the term:
79 (a) “Telehealth” means the use of synchronous or
80 asynchronous telecommunications technology by a telehealth
81 provider to provide or supervise the provision of health care
82 services, including, but not limited to, assessment, diagnosis,
83 consultation, treatment, and monitoring of a patient; transfer
84 of medical data; patient and professional health-related
85 education; public health services; and health administration.
86 The term includes does not include audio-only telephone calls,
87 personal e-mail messages, or facsimile transmissions, and any
88 other nonpublic-facing telecommunications technology.
89 (2) PRACTICE STANDARDS.—
90 (c) A telehealth provider, acting within the scope of his
91 or her practice and in accordance with chapter 893, may not use
92 telehealth to prescribe a controlled substance listed in
93 Schedule III, Schedule IV, or Schedule V of s. 893.03 and may
94 use telehealth to prescribe a controlled substance listed in
95 Schedule II of s. 893.03 if unless the controlled substance is
96 prescribed for the following:
97 1. The treatment of a psychiatric disorder;
98 2. Inpatient treatment at a hospital licensed under chapter
99 395;
100 3. The treatment of a patient receiving hospice services as
101 defined in s. 400.601; or
102 4. The treatment of a resident of a nursing home facility
103 as defined in s. 400.021.
104
105 A telehealth provider may not use telehealth to prescribe a
106 controlled substance listed in Schedule I of s. 893.03 or to
107 issue a physician certification for marijuana for medical use
108 under s. 381.986.
109 Section 3. Paragraph (f) of subsection (2) of section
110 458.347, Florida Statutes, is amended to read:
111 458.347 Physician assistants.—
112 (2) DEFINITIONS.—As used in this section:
113 (f) “Supervision” means responsible supervision and
114 control. Except in cases of emergency, supervision requires the
115 easy availability or physical presence of the licensed physician
116 for consultation and direction of the actions of the physician
117 assistant. For the purposes of this definition, the term “easy
118 availability” includes the ability to communicate by way of
119 telehealth as defined in s. 456.47 telecommunication. The boards
120 shall establish rules as to what constitutes responsible
121 supervision of the physician assistant.
122 Section 4. Paragraph (f) of subsection (2) of section
123 459.022, Florida Statutes, is amended to read:
124 459.022 Physician assistants.—
125 (2) DEFINITIONS.—As used in this section:
126 (f) “Supervision” means responsible supervision and
127 control. Except in cases of emergency, supervision requires the
128 easy availability or physical presence of the licensed physician
129 for consultation and direction of the actions of the physician
130 assistant. For the purposes of this definition, the term “easy
131 availability” includes the ability to communicate by way of
132 telehealth as defined in s. 456.47 telecommunication. The boards
133 shall establish rules as to what constitutes responsible
134 supervision of the physician assistant.
135 Section 5. Section 465.1893, Florida Statutes, is amended
136 to read
137 465.1893 Administration of long-acting antipsychotic
138 medication by injection.—
139 (1)(a) A pharmacist, at the direction of a physician
140 licensed under chapter 458 or chapter 459, may administer a
141 long-acting antipsychotic medication or an extended-release
142 medication indicated to treat opioid use disorder, alcohol use
143 disorder, or other substance use disorder or dependency,
144 including, but not limited to, buprenorphine, naltrexone, or
145 other medications that have been approved by the United States
146 Food and Drug Administration by injection to a patient if the
147 pharmacist:
148 1. Is authorized by and acting within the framework of an
149 established protocol with the prescribing physician.
150 2. Practices at a facility that accommodates privacy for
151 nondeltoid injections and conforms with state rules and
152 regulations regarding the appropriate and safe disposal of
153 medication and medical waste.
154 3. Has completed the course required under subsection (2).
155 (b) A separate prescription from a physician is required
156 for each injection administered by a pharmacist under this
157 subsection.
158 (2)(a) A pharmacist seeking to administer a long-acting
159 antipsychotic medication described in paragraph (1)(a) by
160 injection must complete an 8-hour continuing education course
161 offered by:
162 1. A statewide professional association of physicians in
163 this state accredited to provide educational activities
164 designated for the American Medical Association Physician’s
165 Recognition Award (AMA PRA) Category 1 Credit or the American
166 Osteopathic Association (AOA) Category 1-A continuing medical
167 education (CME) credit; and
168 2. A statewide association of pharmacists.
169 (b) The course may be offered in a distance learning format
170 and must be included in the 30 hours of continuing professional
171 pharmaceutical education required under s. 465.009(1). The
172 course shall have a curriculum of instruction that concerns the
173 safe and effective administration of behavioral health,
174 addiction, and antipsychotic medications by injection,
175 including, but not limited to, potential allergic reactions to
176 such medications.
177 Section 6. Paragraph (e) is added to subsection (1) of
178 section 893.05, Florida Statutes, to read:
179 893.05 Practitioners and persons administering controlled
180 substances in their absence.—
181 (1)
182 (e) A telehealth provider as defined in s. 456.47 may not
183 prescribe through telehealth a controlled substance listed in
184 Schedule I or Schedule II of s. 893.03.
185 Section 7. This act shall take effect July 1, 2021.
186
187 ================= T I T L E A M E N D M E N T ================
188 And the title is amended as follows:
189 Delete everything before the enacting clause
190 and insert:
191 A bill to be entitled
192 An act relating to telehealth; amending s. 409.908,
193 F.S.; requiring the Agency for Health Care
194 Administration to reimburse pharmacists for health
195 care services provided through telehealth; requiring
196 the agency to reimburse the use of telehealth services
197 under certain circumstances and subject to certain
198 limitations; requiring providers to include certain
199 documentation in patient records and notes;
200 authorizing certain out-of-state providers to receive
201 reimbursement for telehealth services; providing an
202 exception; amending s. 456.47, F.S.; revising the
203 definition of the term “telehealth”; authorizing
204 telehealth providers to prescribe specified controlled
205 substances through telehealth under certain
206 circumstances; amending ss. 458.347 and 459.022, F.S.;
207 revising the definition of the term “supervision”;
208 amending s. 465.1893, F.S.; providing additional long
209 acting medications pharmacists may administer under
210 certain circumstances; revising requirements for a
211 continuing education course such pharmacists must
212 complete; amending s. 893.05, F.S.; prohibiting
213 telehealth providers from prescribing specified
214 controlled substances through telehealth; providing an
215 effective date.