Florida Senate - 2019                                    SB 1526
       
       
        
       By Senator Harrell
       
       
       
       
       
       25-01317B-19                                          20191526__
    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         deleting obsolete language; creating s. 456.4501,
    7         F.S.; defining the terms “telehealth” and “telehealth
    8         provider”; establishing certain practice standards for
    9         telehealth providers; prohibiting a telehealth
   10         provider from using telehealth to prescribe a
   11         controlled substance; providing exceptions; clarifying
   12         that prescribing medications based solely on answers
   13         to an electronic medical questionnaire constitutes a
   14         certain failure to practice medicine; specifying
   15         equipment and technology requirements for telehealth
   16         providers; providing recordkeeping requirements;
   17         providing applicability; defining the terms “emergency
   18         medical services” and “emergency medical condition”;
   19         authorizing the applicable board or the Department of
   20         Health to adopt rules; creating s. 627.42393, F.S.;
   21         providing reimbursement requirements for health
   22         insurers relating to telehealth services; amending s.
   23         641.31, F.S.; prohibiting a health maintenance
   24         organization from requiring a subscriber to receive
   25         services via telehealth; creating s. 641.31093, F.S.;
   26         providing reimbursement requirements for health
   27         maintenance organizations relating to telehealth
   28         services; providing an effective date.
   29          
   30  Be It Enacted by the Legislature of the State of Florida:
   31  
   32         Section 1. Paragraph (c) of subsection (2) of section
   33  409.967, Florida Statutes, is amended to read:
   34         409.967 Managed care plan accountability.—
   35         (2) The agency shall establish such contract requirements
   36  as are necessary for the operation of the statewide managed care
   37  program. In addition to any other provisions the agency may deem
   38  necessary, the contract must require:
   39         (c) Access.—
   40         1. The agency shall establish specific standards for the
   41  number, type, and regional distribution of providers in managed
   42  care plan networks to ensure access to care for both adults and
   43  children. Each plan must maintain a regionwide network of
   44  providers in sufficient numbers to meet the access standards for
   45  specific medical services for all recipients enrolled in the
   46  plan. A plan may not use providers who exclusively provide
   47  services through telehealth, as defined in s. 456.4501, to meet
   48  this requirement. The exclusive use of mail-order pharmacies may
   49  not be sufficient to meet network access standards. Consistent
   50  with the standards established by the agency, provider networks
   51  may include providers located outside the region. A plan may
   52  contract with a new hospital facility before the date the
   53  hospital becomes operational if the hospital has commenced
   54  construction, will be licensed and operational by January 1,
   55  2013, and a final order has issued in any civil or
   56  administrative challenge. Each plan shall establish and maintain
   57  an accurate and complete electronic database of contracted
   58  providers, including information about licensure or
   59  registration, locations and hours of operation, specialty
   60  credentials and other certifications, specific performance
   61  indicators, and such other information as the agency deems
   62  necessary. The database must be available online to both the
   63  agency and the public and have the capability to compare the
   64  availability of providers to network adequacy standards and to
   65  accept and display feedback from each provider’s patients. Each
   66  plan shall submit quarterly reports to the agency identifying
   67  the number of enrollees assigned to each primary care provider.
   68         2. Each managed care plan must publish any prescribed drug
   69  formulary or preferred drug list on the plan’s website in a
   70  manner that is accessible to and searchable by enrollees and
   71  providers. The plan must update the list within 24 hours after
   72  making a change. Each plan must ensure that the prior
   73  authorization process for prescribed drugs is readily accessible
   74  to health care providers, including posting appropriate contact
   75  information on its website and providing timely responses to
   76  providers. For Medicaid recipients diagnosed with hemophilia who
   77  have been prescribed anti-hemophilic-factor replacement
   78  products, the agency shall provide for those products and
   79  hemophilia overlay services through the agency’s hemophilia
   80  disease management program.
   81         3. Managed care plans, and their fiscal agents or
   82  intermediaries, must accept prior authorization requests for any
   83  service electronically.
   84         4. Managed care plans serving children in the care and
   85  custody of the Department of Children and Families must maintain
   86  complete medical, dental, and behavioral health encounter
   87  information and participate in making such information available
   88  to the department or the applicable contracted community-based
   89  care lead agency for use in providing comprehensive and
   90  coordinated case management. The agency and the department shall
   91  establish an interagency agreement to provide guidance for the
   92  format, confidentiality, recipient, scope, and method of
   93  information to be made available and the deadlines for
   94  submission of the data. The scope of information available to
   95  the department shall be the data that managed care plans are
   96  required to submit to the agency. The agency shall determine the
   97  plan’s compliance with standards for access to medical, dental,
   98  and behavioral health services; the use of medications; and
   99  followup on all medically necessary services recommended as a
  100  result of early and periodic screening, diagnosis, and
  101  treatment.
  102         Section 2. Section 456.4501, Florida Statutes, is created
  103  to read:
  104         456.4501 Use of telehealth to provide services.—
  105         (1) DEFINITIONS.—As used in this section, the term:
  106         (a) “Telehealth” means the practice of a Florida-licensed
  107  telehealth provider’s profession in which patient care,
  108  treatment, or services are provided through the use of medical
  109  information exchanged between one physical location and another
  110  through electronic communications. The term does not include
  111  audio-only telephone calls, e-mail messages, text messages, U.S.
  112  mail or other parcel service, facsimile transmissions, or any
  113  combination thereof.
  114         (b) Telehealth provider” means an individual who provides
  115  health care and related services using telehealth and who holds
  116  a Florida license under chapter 458 or chapter 459, including
  117  providers who become Florida-licensed by way of the Interstate
  118  Medical Licensure Compact.
  119         (2) PRACTICE STANDARD.—
  120         (a) The standard of practice for telehealth providers who
  121  provide health care services is the same as the standard of
  122  practice for health care professionals who provide in-person
  123  health care services to patients in this state. If the standard
  124  of practice does not require an in-person physical examination,
  125  a telehealth provider may use telehealth to perform a patient
  126  evaluation and to provide services to the patient within the
  127  provider’s scope of practice.
  128         (b) A telehealth provider may not use telehealth to
  129  prescribe a controlled substance unless the controlled substance
  130  is prescribed for the following:
  131         1. The treatment of a psychiatric disorder;
  132         2. Inpatient treatment at a hospital licensed under chapter
  133  395;
  134         3. The treatment of a patient receiving hospice services as
  135  defined in s. 400.601; or
  136         4. The treatment of a resident of a nursing home facility
  137  as defined in s. 400.021.
  138         (c) A telehealth provider and a patient may be in separate
  139  locations when telehealth is used to provide health care
  140  services to a patient.
  141         (d) Prescribing medications solely based on answers to an
  142  electronic medical questionnaire constitutes a failure to
  143  practice medicine with the level of care, skill, and treatment
  144  that a reasonably prudent physician recognizes as being
  145  acceptable under similar conditions and circumstances.
  146         (e) Telehealth providers are responsible for the quality of
  147  the equipment and technology employed and for the safe use of
  148  such equipment and technology. Telehealth equipment and
  149  technology must be able to provide, at a minimum, the same
  150  information to the physician or physician assistant which will
  151  enable them to meet or exceed the standard of practice for the
  152  telehealth provider’s profession.
  153         (3) RECORDS.—A telehealth provider shall document in the
  154  patients medical record the health care services rendered using
  155  telehealth according to the same standards used for in-person
  156  services. Medical records, including video, audio, electronic,
  157  or other records generated as a result of providing telehealth
  158  services, are confidential under ss. 395.3025(4) and 456.057.
  159  Patient access to personal health information created by
  160  telehealth services is granted under ss. 395.3025 and 456.057.
  161         (4) APPLICABILITY.—
  162         (a) This section does not prohibit consultations between
  163  practitioners, to the extent that the practitioners are acting
  164  within their scope of practice, or the transmission and review
  165  of digital images, pathology specimens, test results, or other
  166  medical data related to the care of patients in this state.
  167         (b) This section does not apply to emergency medical
  168  services provided by emergency physicians, emergency medical
  169  technicians, paramedics, or emergency dispatchers. For the
  170  purposes of this section, the term emergency medical services”
  171  includes those activities or services designed to prevent or
  172  treat a sudden critical illness or injury and to provide
  173  emergency medical care and pre-hospital emergency medical
  174  transportation to sick, injured, or otherwise incapacitated
  175  persons in this state.
  176         (c) This section does not apply to a health care provider
  177  who is treating a patient with an emergency medical condition
  178  that requires immediate medical care. For the purposes of this
  179  section, the term emergency medical condition means a medical
  180  condition characterized by acute symptoms of sufficient severity
  181  that the absence of immediate medical attention will result in
  182  serious jeopardy to patient health, serious impairment to bodily
  183  functions, or serious dysfunction of a body organ or part.
  184         (d) To the extent that a health care provider is acting
  185  within his or her scope of practice, this section does not
  186  prohibit:
  187         1. A practitioner caring for a patient in consultation with
  188  another practitioner who has an ongoing relationship with the
  189  patient and who has agreed to supervise the patient’s treatment,
  190  including the use of any prescribed medications; or
  191         2. The health care provider from caring for a patient in
  192  on-call or cross-coverage situations in which another
  193  practitioner has access to patient records.
  194         (5) RULEMAKING.—The applicable board, or the department if
  195  there is no board, may adopt rules to administer this section.
  196         Section 3. Section 627.42393, Florida Statutes, is created
  197  to read:
  198         627.42393Requirements for insurer reimbursement of
  199  telehealth services.—
  200         (1) An individual, group, blanket, or franchise health
  201  insurance policy delivered or issued for delivery to any insured
  202  person in this state on or after January 1, 2020, may not deny
  203  coverage for a covered service on the basis of the service being
  204  provided through telehealth if the same service would be covered
  205  if provided through an in-person encounter.
  206         (2) A health insurer may not exclude an otherwise covered
  207  service from coverage solely because the service is provided
  208  through telehealth rather than through an in-person encounter
  209  between a health care provider and a patient.
  210         (3) A health insurer is not required to reimburse a
  211  telehealth provider for originating site fees or costs for the
  212  provision of telehealth services. However, a health insurer
  213  shall reimburse a telehealth provider for the diagnosis,
  214  consultation, or treatment of any insured individual provided
  215  through telehealth on the same basis that the health insurer
  216  would reimburse the provider if the covered service were
  217  delivered through an in-person encounter.
  218         (4) A covered service provided through telehealth may not
  219  be subject to a greater deductible, copayment, or coinsurance
  220  amount than would apply if the same service were provided
  221  through an in-person encounter.
  222         (5) A health insurer may not impose upon any insured
  223  receiving benefits under this section any copayment,
  224  coinsurance, or deductible amount or any policy-year, calendar
  225  year, lifetime, or other durational benefit limitation or
  226  maximum for benefits or services provided via telehealth which
  227  is not equally imposed upon all terms and services covered under
  228  the policy.
  229         (6) This section does not preclude a health insurer from
  230  conducting a utilization review to determine the appropriateness
  231  of telehealth as a means of delivering a covered service if such
  232  determination is made in the same manner as would be made for
  233  the same service provided through an in-person encounter.
  234         (7) A health insurer may limit the covered services that
  235  are provided via telehealth to providers who are in a network
  236  approved by the insurer.
  237         Section 4. Subsection (45) is added to section 641.31,
  238  Florida Statutes, to read:
  239         641.31 Health maintenance contracts.—
  240         (45) A health maintenance organization may not require a
  241  subscriber to consult with, seek approval from, or obtain any
  242  type of referral or authorization by way of telehealth from a
  243  telehealth provider, as defined in s. 456.4501.
  244         Section 5. Section 641.31093, Florida Statutes, is created
  245  to read:
  246         641.31093 Requirements for reimbursement by health
  247  maintenance organization for telehealth services.—
  248         (1) Each health maintenance organization that offers,
  249  issues, or renews a major medical or similar comprehensive
  250  contract in this state on or after January 1, 2020, may not deny
  251  coverage for a covered service on the basis of the covered
  252  service being provided through telehealth if the same covered
  253  service would be covered if provided through an in-person
  254  encounter.
  255         (2) A health maintenance organization may not exclude an
  256  otherwise covered service from coverage solely because the
  257  service is provided through telehealth rather than through an
  258  in-person encounter between a health care provider and a
  259  subscriber.
  260         (3) A health maintenance organization is not required to
  261  reimburse a telehealth provider for originating site fees or
  262  costs for the provision of telehealth services. However, a
  263  health maintenance organization shall reimburse a telehealth
  264  provider for the diagnosis, consultation, or treatment of any
  265  subscriber provided through telehealth on the same basis that
  266  the health maintenance organization would reimburse the provider
  267  if the service were provided through an in-person encounter.
  268         (4) A covered service provided through telehealth may not
  269  be subject to a greater deductible, copayment, or coinsurance
  270  amount than would apply if the same service were provided
  271  through an in-person encounter.
  272         (5) A health maintenance organization may not impose upon
  273  any subscriber receiving benefits under this section any
  274  copayment, coinsurance, or deductible amount or any contract
  275  year, calendar-year, lifetime, or other durational benefit
  276  limitation or maximum for benefits or services provided via
  277  telehealth which is not equally imposed upon all services
  278  covered under the contract.
  279         (6) This section does not preclude a health maintenance
  280  organization from conducting a utilization review to determine
  281  the appropriateness of telehealth as a means of delivering a
  282  covered service if such determination is made in the same manner
  283  as would be made for the same service provided through an in
  284  person encounter.
  285         (7) A health maintenance organization may limit covered
  286  services that are provided via telehealth to providers who are
  287  in a network approved by the health maintenance organization.
  288         Section 6. This act shall take effect July 1, 2019.