HB 505

1	A bill to be entitled
2	An act relating to health care coverage; requiring health
3	insurers, corporations, and health maintenance
4	organizations issuing certain health policies to provide
5	coverage for telemedicine services; providing definitions;
6	prohibiting the exclusion of telemedicine cost coverage
7	solely because the services were not provided face to
8	face; specifying conditions under which an insurer,
9	corporation, or health maintenance organization must
10	reimburse a telemedicine provider for certain fees and
11	costs; authorizing provisions requiring a deductible,
12	copayment, or coinsurance requirement for telemedicine
13	services under certain circumstances; prohibiting the
14	imposition of certain dollar and durational coverage
15	limitations or copayments, coinsurance, or deductibles on
16	telemedicine services unless imposed equally on all terms
17	and services; providing application; providing
18	construction; requiring a utilization review under certain
19	circumstances; providing coverage under the state plan or
20	a waiver for health home services provided to eligible
21	individuals with chronic conditions; creating ss. 458.355
22	and 459.029, F.S.; authorizing physicians and osteopathic
23	physicians to provide diagnostic services through
24	electronic means directly to a patient under specified
25	circumstances; providing nonapplicability; providing
26	effective dates.
27
28	WHEREAS, today, more and more people take advantage of
29	telemedicine and e-health opportunities, including participating
30	in consultations with doctors and joining monitoring programs
31	for patients with chronic disease, and
32	WHEREAS, by connecting residents of this state with
33	geographically distant specialists, telemedicine can improve the
34	quality of care residents can expect to receive and reduce costs
35	by providing services that might otherwise require long-distance
36	travel or admission to a health care facility, NOW, THEREFORE,
37
38	Be It Enacted by the Legislature of the State of Florida:
39
40	Section 1.  Coverage for telemedicine services.-Each
41	insurer proposing to issue individual or group accident and
42	sickness insurance policies providing hospital, medical and
43	surgical, or major medical coverage on an expense-incurred
44	basis; each corporation providing individual or group accident
45	and sickness subscription contracts; and each health maintenance
46	organization providing a health care plan for health care
47	services must provide coverage for the cost of such health care
48	services provided through telemedicine services, as provided in
49	this section.
50	(1)  As used in this section, the term:
51	(a)  "Adverse decision" means a determination that the use
52	of telemedicine services rendered or proposed to be rendered is
53	not covered under the policy, contract, or plan.
54	(b)  "Telemedicine services," as it pertains to the
55	delivery of health care services, means interactive audio,
56	video, or other electronic media used for the purpose of
57	diagnosis, consultation, or treatment, including home health
58	video conferencing and remote patient monitoring. "Telemedicine
59	services" does not include an audio-only telephone, electronic
60	mail message, or facsimile transmission.
61	(c)  "Utilization review" means a review to determine the
62	appropriateness of telemedicine services or whether coverage of
63	the delivery of telemedicine services rendered or proposed to be
64	rendered by a health care provider is required, provided the
65	determination is made in the same manner as those determinations
66	are made for the treatment of any other illness, condition, or
67	disorder covered under the policy, contract, or plan.
68	(2)  An insurer, corporation, or health maintenance
69	organization may not exclude a service from coverage solely
70	because the service is provided through telemedicine services
71	rather than face-to-face consultation or contact between a
72	health care provider and a patient.
73	(3)  An insurer, corporation, or health maintenance
74	organization is not required to reimburse the telemedicine
75	provider or the consulting provider for technological fees or
76	costs for the provision of telemedicine services; however, an
77	insurer, corporation, or health maintenance organization must
78	reimburse the telemedicine provider or the consulting provider
79	for the diagnosis, consultation, or treatment of the insured
80	delivered through telemedicine services on the same basis that
81	the insurer, corporation, or health maintenance organization is
82	responsible for coverage for the provision of the same services
83	through face-to-face diagnosis, consultation, or treatment.
84	(4)  An insurer, corporation, or health maintenance
85	organization may offer a health care plan containing a
86	deductible, copayment, or coinsurance requirement for a health
87	care service provided through telemedicine services if the
88	deductible, copayment, or coinsurance does not exceed the
89	deductible, copayment, or coinsurance applicable if the same
90	services were provided through face-to-face diagnosis,
91	consultation, or treatment.
92	(5)  An insurer, corporation, or health maintenance
93	organization may not impose any annual or lifetime dollar
94	maximum on coverage for telemedicine services other than an
95	annual or lifetime dollar maximum that applies in the aggregate
96	to all items and services covered under the policy, contract, or
97	plan and may not impose upon any person receiving benefits under
98	this section any copayment, coinsurance, or deductible amount,
99	or any policy year, calendar year, lifetime, or other durational
100	benefit limitation or maximum for benefits or services, that is
101	not equally imposed upon all terms and services covered under
102	the policy, contract, or plan.
103	(6)  This section applies to:
104	(a)  Insurance policies, contracts, and plans delivered,
105	issued for delivery, reissued, or extended in this state on and
106	after July 1, 2011, or at any time after July 1, 2011, when any
107	term of the policy, contract, or plan is changed or any premium
108	adjustment is made, but in no event later than July 1, 2012. For
109	purposes of this paragraph, all policies, contracts, and plans
110	are deemed to be renewed no later than the next yearly
111	anniversary date of the contract, policy, or plan.
112	(b)  Medicaid plans if the health care service would be
113	covered were it provided through in-person consultation between
114	the recipient and a health care provider.
115	(7)  This section does not apply to short-term travel,
116	accident-only, limited or specified disease, or individual
117	conversion policies or contracts or to policies or contracts
118	designed for issuance to persons eligible for Medicare coverage
119	under Title XVIII of the Social Security Act or any other
120	similar coverage under state or federal governmental plans.
121	(8)  This section may not be construed to preclude any
122	insurer, corporation, or health maintenance organization
123	providing coverage for telemedicine services under an insurance
124	policy, contract, or plan from undertaking a utilization review.
125	After making an adverse decision, an insurer, corporation, or
126	health maintenance organization must notify the covered
127	individual and the individual's health care provider and must
128	undertake a utilization review after receiving a written request
129	to undertake such review from a covered individual or the
130	individual's health care provider.
131	Section 2.  Effective January 1, 2012, under the state plan
132	or a waiver of the state plan, eligible individuals with chronic
133	conditions as defined in 42 U.S.C. s. 1396w-4 are eligible for
134	medical assistance that provides health home services in
135	compliance with 42 U.S.C. s. 1396w-4.
136	Section 3.  Section 458.355, Florida Statutes, is created
137	to read:
138	458.355  Provision of telemedicine services.-
139	(1)  A physician may provide diagnostic services through
140	electronic means directly to a patient if the patient is an
141	established patient of the physician's practice or group who has
142	had an in-person physical examination from the physician or a
143	member of the physician's practice or group.
144	(2)  This section does not apply to a physician practicing
145	in a pain-management clinic as defined in s. 458.3265 or s.
146	459.0137.
147	Section 4.  Section 459.029, Florida Statutes, is created
148	to read:
149	459.029  Provision of telemedicine services.-
150	(1)  An osteopathic physician may provide diagnostic
151	services through electronic means directly to a patient if the
152	patient is an established patient of the osteopathic physician's
153	practice or group who has had an in-person physical examination
154	from the osteopathic physician or a member of the osteopathic
155	physician's practice or group.
156	(2)  This section does not apply to an osteopathic
157	physician practicing in a pain-management clinic as defined in
158	s. 458.3265 or s. 459.0137.
159	Section 5.  Except as otherwise expressly provided in this
160	act, this act shall take effect July 1, 2011.

CODING: Words stricken are deletions; words underlined are additions.