Florida Senate - 2022                                     SB 726
       
       
        
       By Senator Ausley
       
       
       
       
       
       3-00937-22                                             2022726__
    1                        A bill to be entitled                      
    2         An act relating to telehealth; amending s. 409.967,
    3         F.S.; prohibiting Medicaid managed care plans from
    4         using providers who exclusively provide services
    5         through telehealth to achieve network adequacy;
    6         amending s. 627.42396, F.S.; prohibiting certain
    7         health insurance policies from denying coverage for
    8         covered services provided through telehealth under
    9         certain circumstances; prohibiting health insurers
   10         from excluding covered services provided through
   11         telehealth from coverage; providing reimbursement
   12         requirements and cost-sharing limitations for health
   13         insurers relating to telehealth services; prohibiting
   14         health insurers from requiring an insured person to
   15         receive services through telehealth; authorizing
   16         health insurers to conduct utilization reviews under
   17         certain circumstances; authorizing health insurers to
   18         limit telehealth services to certain providers;
   19         deleting requirements for contracts between certain
   20         health insurers and telehealth providers; amending s.
   21         627.6699, F.S.; requiring certain small employer
   22         benefit plans to comply with certain requirements for
   23         reimbursement of telehealth services; amending s.
   24         641.31, F.S.; prohibiting a health maintenance
   25         organization from requiring a subscriber to receive
   26         certain services through telehealth; deleting
   27         requirements for contracts between certain health
   28         insurers and telehealth providers; creating s.
   29         641.31093, F.S.; prohibiting certain health
   30         maintenance organizations from denying coverage for
   31         covered services provided through telehealth under
   32         certain circumstances; prohibiting health maintenance
   33         organizations from excluding covered services provided
   34         through telehealth from coverage; providing
   35         reimbursement requirements and cost-sharing
   36         limitations for health maintenance organizations
   37         relating to telehealth services; prohibiting a health
   38         maintenance organization from requiring a subscriber
   39         to receive services through telehealth; authorizing
   40         health maintenance organizations to conduct
   41         utilization reviews under certain circumstances;
   42         authorizing health maintenance organizations to limit
   43         telehealth services to certain providers; providing an
   44         effective date.
   45  
   46         WHEREAS, it is the intent of the Legislature to mitigate
   47  geographic discrimination in the delivery of health care by
   48  recognizing the provision of and payment for covered medical
   49  care by means of telehealth services, provided that such
   50  services are provided by a physician or by another health care
   51  practitioner or professional acting within the scope of practice
   52  of a health care practitioner or professional and in accordance
   53  with s. 456.47, Florida Statutes, NOW, THEREFORE,
   54  
   55  Be It Enacted by the Legislature of the State of Florida:
   56  
   57         Section 1. Paragraph (c) of subsection (2) of section
   58  409.967, Florida Statutes, is amended to read:
   59         409.967 Managed care plan accountability.—
   60         (2) The agency shall establish such contract requirements
   61  as are necessary for the operation of the statewide managed care
   62  program. In addition to any other provisions the agency may deem
   63  necessary, the contract must require:
   64         (c) Access.—
   65         1. The agency shall establish specific standards for the
   66  number, type, and regional distribution of providers in managed
   67  care plan networks to ensure access to care for both adults and
   68  children. Each plan must maintain a regionwide network of
   69  providers in sufficient numbers to meet the access standards for
   70  specific medical services for all recipients enrolled in the
   71  plan. A plan may not use providers who exclusively provide
   72  services through telehealth as defined in s. 456.47 to meet this
   73  requirement. The exclusive use of mail-order pharmacies may not
   74  be sufficient to meet network access standards. Consistent with
   75  the standards established by the agency, provider networks may
   76  include providers located outside the region. A plan may
   77  contract with a new hospital facility before the date the
   78  hospital becomes operational if the hospital has commenced
   79  construction, will be licensed and operational by January 1,
   80  2013, and a final order has issued in any civil or
   81  administrative challenge. Each plan shall establish and maintain
   82  an accurate and complete electronic database of contracted
   83  providers, including information about licensure or
   84  registration, locations and hours of operation, specialty
   85  credentials and other certifications, specific performance
   86  indicators, and such other information as the agency deems
   87  necessary. The database must be available online to both the
   88  agency and the public and have the capability to compare the
   89  availability of providers to network adequacy standards and to
   90  accept and display feedback from each provider’s patients. Each
   91  plan shall submit quarterly reports to the agency identifying
   92  the number of enrollees assigned to each primary care provider.
   93  The agency shall conduct, or contract for, systematic and
   94  continuous testing of the provider network databases maintained
   95  by each plan to confirm accuracy, confirm that behavioral health
   96  providers are accepting enrollees, and confirm that enrollees
   97  have access to behavioral health services.
   98         2. Each managed care plan must publish any prescribed drug
   99  formulary or preferred drug list on the plan’s website in a
  100  manner that is accessible to and searchable by enrollees and
  101  providers. The plan must update the list within 24 hours after
  102  making a change. Each plan must ensure that the prior
  103  authorization process for prescribed drugs is readily accessible
  104  to health care providers, including posting appropriate contact
  105  information on its website and providing timely responses to
  106  providers. For Medicaid recipients diagnosed with hemophilia who
  107  have been prescribed anti-hemophilic-factor replacement
  108  products, the agency shall provide for those products and
  109  hemophilia overlay services through the agency’s hemophilia
  110  disease management program.
  111         3. Managed care plans, and their fiscal agents or
  112  intermediaries, must accept prior authorization requests for any
  113  service electronically.
  114         4. Managed care plans serving children in the care and
  115  custody of the Department of Children and Families must maintain
  116  complete medical, dental, and behavioral health encounter
  117  information and participate in making such information available
  118  to the department or the applicable contracted community-based
  119  care lead agency for use in providing comprehensive and
  120  coordinated case management. The agency and the department shall
  121  establish an interagency agreement to provide guidance for the
  122  format, confidentiality, recipient, scope, and method of
  123  information to be made available and the deadlines for
  124  submission of the data. The scope of information available to
  125  the department shall be the data that managed care plans are
  126  required to submit to the agency. The agency shall determine the
  127  plan’s compliance with standards for access to medical, dental,
  128  and behavioral health services; the use of medications; and
  129  follow up followup on all medically necessary services
  130  recommended as a result of early and periodic screening,
  131  diagnosis, and treatment.
  132         Section 2. Section 627.42396, Florida Statutes, is amended
  133  to read:
  134         627.42396 Requirements for reimbursement by health insurers
  135  for telehealth services.—
  136         (1)An individual, group, blanket, or franchise health
  137  insurance policy delivered or issued for delivery to any insured
  138  person in this state on or after January 1, 2023, may not deny
  139  coverage for a covered service on the basis of the service being
  140  provided through telehealth if the same service would be covered
  141  if provided through an in-person encounter.
  142         (2) A health insurer may not exclude an otherwise covered
  143  service from coverage solely because the service is provided
  144  through telehealth rather than through an in-person encounter.
  145         (3) A health insurer shall reimburse a telehealth provider
  146  for the diagnosis, consultation, or treatment of any insured
  147  person provided through telehealth on the same basis and at
  148  least at the same rate that the health insurer would reimburse
  149  the provider if the covered service were delivered through an
  150  in-person encounter. However, a health insurer may not require a
  151  health care provider or telehealth provider to accept a
  152  reimbursement amount greater than the amount the provider is
  153  willing to charge.
  154         (4)A health insurer shall reimburse a telehealth provider
  155  for reasonable originating site fees or costs for the provision
  156  of telehealth services.
  157         (5) A covered service provided through telehealth may not
  158  be subject to a greater deductible, copayment, or coinsurance
  159  amount than would apply if the same service were provided
  160  through an in-person encounter.
  161         (6) A health insurer may not impose upon any insured person
  162  receiving benefits under this section any copayment,
  163  coinsurance, or deductible amount or any policy-year, calendar
  164  year, lifetime, or other durational benefit limitation or
  165  maximum for benefits or services provided through telehealth
  166  which is not equally imposed upon all terms and services covered
  167  under the policy.
  168         (7)A health insurer may not require an insured person to
  169  obtain a covered service through telehealth instead of an in
  170  person encounter.
  171         (8) This section does not preclude a health insurer from
  172  conducting a utilization review to determine the appropriateness
  173  of telehealth as a means of delivering a covered service if such
  174  determination is made in the same manner as would be made for
  175  the same service provided through an in-person encounter.
  176         (9) A health insurer may limit the covered services
  177  provided through telehealth to providers who are in a network
  178  approved by the insurer A contract between a health insurer
  179  issuing major medical comprehensive coverage through an
  180  individual or group policy and a telehealth provider, as defined
  181  in s. 456.47, must be voluntary between the insurer and the
  182  provider and must establish mutually acceptable payment rates or
  183  payment methodologies for services provided through telehealth.
  184  Any contract provision that distinguishes between payment rates
  185  or payment methodologies for services provided through
  186  telehealth and the same services provided without the use of
  187  telehealth must be initialed by the telehealth provider.
  188         Section 3. Paragraph (h) is added to subsection (5) of
  189  section 627.6699, Florida Statutes, to read:
  190         627.6699 Employee Health Care Access Act.—
  191         (5) AVAILABILITY OF COVERAGE.—
  192         (h) A health benefit plan covering small employers which is
  193  delivered, issued, or renewed in this state on or after January
  194  1, 2023, must comply with s. 627.42396.
  195         Section 4. Subsection (45) of section 641.31, Florida
  196  Statutes, is amended to read:
  197         641.31 Health maintenance contracts.—
  198         (45) A contract between a health maintenance organization
  199  issuing major medical individual or group coverage may not
  200  require a subscriber to consult with, seek approval from, or
  201  obtain any type of referral or authorization by way of
  202  telehealth from and a telehealth provider, as defined in s.
  203  456.47, must be voluntary between the health maintenance
  204  organization and the provider and must establish mutually
  205  acceptable payment rates or payment methodologies for services
  206  provided through telehealth. Any contract provision that
  207  distinguishes between payment rates or payment methodologies for
  208  services provided through telehealth and the same services
  209  provided without the use of telehealth must be initialed by the
  210  telehealth provider.
  211         Section 5. Section 641.31093, Florida Statutes, is created
  212  to read:
  213         641.31093 Requirements for reimbursement by health
  214  maintenance organizations for telehealth services.—
  215         (1) A health maintenance organization that offers, issues,
  216  or renews a major medical or similar comprehensive contract in
  217  this state on or after January 1, 2023, may not deny coverage
  218  for a covered service on the basis of the covered service being
  219  provided through telehealth if the same service would be covered
  220  if provided through an in-person encounter.
  221         (2) A health maintenance organization may not exclude an
  222  otherwise covered service from coverage solely because the
  223  service is provided through telehealth rather than through an
  224  in-person encounter.
  225         (3) A health maintenance organization shall reimburse a
  226  telehealth provider for the diagnosis, consultation, or
  227  treatment of any subscriber provided through telehealth on the
  228  same basis and at least the same rate that the health
  229  maintenance organization would reimburse the provider if the
  230  service were provided through an in-person encounter. However, a
  231  health maintenance organization may not require a health care
  232  provider or telehealth provider to accept a reimbursement amount
  233  greater than the amount the provider is willing to charge.
  234         (4)A health maintenance organization shall reimburse a
  235  telehealth provider for reasonable originating site fees or
  236  costs for the provision of telehealth services.
  237         (5) A covered service provided through telehealth may not
  238  be subject to a greater deductible, copayment, or coinsurance
  239  amount than would apply if the same service were provided
  240  through an in-person encounter.
  241         (6) A health maintenance organization may not impose upon
  242  any subscriber receiving benefits under this section any
  243  copayment, coinsurance, or deductible amount or any contract
  244  year, calendar-year, lifetime, or other durational benefit
  245  limitation or maximum for benefits or services provided through
  246  telehealth which is not equally imposed upon all services
  247  covered under the contract.
  248         (7)A health maintenance organization may not require an
  249  insured person to obtain a covered service through telehealth
  250  instead of an in-person encounter.
  251         (8) This section does not preclude a health maintenance
  252  organization from conducting a utilization review to determine
  253  the appropriateness of telehealth as a means of delivering a
  254  covered service if such determination is made in the same manner
  255  as would be made for the same service provided through an in
  256  person encounter.
  257         (9) A health maintenance organization may limit covered
  258  services provided through telehealth to providers who are in a
  259  network approved by the health maintenance organization.
  260         Section 6. This act shall take effect July 1, 2022.