Florida Senate - 2013                                     SB 898
       By Senator Joyner
       19-01298-13                                            2013898__
    1                        A bill to be entitled                      
    2         An act relating to health care coverage; requiring
    3         health insurers, corporations, and health maintenance
    4         organizations issuing certain health policies to
    5         provide coverage for telemedicine services; providing
    6         definitions; prohibiting the exclusion of telemedicine
    7         cost coverage solely because the services were not
    8         provided face to face; specifying conditions under
    9         which an insurer, corporation, or health maintenance
   10         organization must reimburse a telemedicine provider
   11         for certain fees and costs; authorizing provisions
   12         requiring a deductible, copayment, or coinsurance
   13         requirement for telemedicine services under certain
   14         circumstances; prohibiting the imposition of certain
   15         dollar and durational coverage limitations or
   16         copayments, coinsurance, or deductibles on
   17         telemedicine services unless imposed equally on all
   18         terms and services; providing for applicability and
   19         construction; requiring a utilization review under
   20         certain circumstances; providing coverage under the
   21         state plan or a waiver for health home services
   22         provided to eligible individuals with chronic
   23         conditions; requiring the Department of Health to
   24         conduct an interagency study relating to telemedicine
   25         services and coverage; requiring a report to the
   26         Legislature; authorizing the department to adopt rules
   27         in consultation with certain boards; providing an
   28         effective date.
   30         WHEREAS, today, more and more people take advantage of
   31  telemedicine and e-health opportunities, including participating
   32  in consultations with doctors and joining monitoring programs
   33  for patients with chronic disease, and
   34         WHEREAS, by connecting residents of the state with
   35  geographically distant specialists, telemedicine can improve the
   36  quality of care that residents may expect to receive and reduce
   37  costs by providing services that might otherwise require long
   38  distance travel or admission to a health care facility, NOW,
   41  Be It Enacted by the Legislature of the State of Florida:
   43         Section 1. Coverage for telemedicine services.—
   44         (1) An insurer, corporation, or health maintenance
   45  organization must provide coverage for the cost of health care
   46  services provided through telemedicine services under the
   47  following policies, contracts, and plans:
   48         (a) An individual or group accident and sickness insurance
   49  policy issued by an insurer to provide hospital, medical and
   50  surgical, or major medical coverage on an expense-incurred
   51  basis.
   52         (b) An individual or group accident and sickness
   53  subscription contract entered into by a corporation.
   54         (c) A health care plan for health care services provided by
   55  a health maintenance organization.
   56         (2) As used in this section, the term:
   57         (a) “Adverse decision” means a determination that the use
   58  of telemedicine services rendered or proposed to be rendered is
   59  not covered under the policy, contract, or plan.
   60         (b) “Telemedicine services,” as it pertains to the delivery
   61  of health care services, means synchronous video conferencing,
   62  remote patient monitoring, asynchronous health images, or other
   63  health transmissions supported by mobile devices (mHealth) or
   64  other telecommunications technology used for the purpose of
   65  diagnosis, consultation, or treatment at a site other than the
   66  site where the provider is located. The term does not include an
   67  audio-only telephone, e-mail messages, or facsimile
   68  transmission.
   69         (c) “Utilization review” means a review to determine the
   70  appropriateness of telemedicine services, or whether coverage of
   71  the delivery of telemedicine services rendered or proposed to be
   72  rendered by a health care provider is required, if the
   73  determination is made in the same manner as those determinations
   74  are made for the treatment of any other illness, condition, or
   75  disorder covered under the policy, contract, or plan.
   76         (3) An insurer, corporation, or health maintenance
   77  organization may not exclude a service from coverage solely
   78  because the service is provided through telemedicine services
   79  rather than face-to-face consultation or contact between a
   80  health care provider and a patient.
   81         (4) An insurer, corporation, or health maintenance
   82  organization is not required to reimburse the telemedicine
   83  provider or the consulting provider for technology fees or costs
   84  related to the provision of telemedicine services; however, an
   85  insurer, corporation, or health maintenance organization must
   86  reimburse the telemedicine provider or the consulting provider
   87  for the diagnosis, consultation, or treatment of the insured
   88  delivered through telemedicine services on the same basis that
   89  the insurer, corporation, or health maintenance organization is
   90  responsible for coverage of the same services through face-to
   91  face diagnosis, consultation, or treatment.
   92         (5) An insurer, corporation, or health maintenance
   93  organization may offer a health care plan containing a
   94  deductible, copayment, or coinsurance requirement for a health
   95  care service provided through telemedicine services if the
   96  deductible, copayment, or coinsurance does not exceed the
   97  deductible, copayment, or coinsurance that would be applicable
   98  if the same services were provided through face-to-face
   99  diagnosis, consultation, or treatment.
  100         (6) An insurer, corporation, or health maintenance
  101  organization may not impose any annual or lifetime dollar
  102  maximum on coverage for telemedicine services other than an
  103  annual or lifetime dollar maximum that applies in the aggregate
  104  to all items and services covered under the policy, contract, or
  105  plan and may not impose upon any person receiving benefits under
  106  this section any copayment, coinsurance, or deductible amount,
  107  or any policy year, calendar year, lifetime, or other durational
  108  benefit limitation or maximum for benefits or services, that is
  109  not equally imposed upon all terms and services covered under
  110  the policy, contract, or plan.
  111         (7) This section applies to:
  112         (a) An insurance policy, contract, or plan that is
  113  delivered, issued for delivery, reissued, or extended in this
  114  state on or after July 1, 2013; a policy, contract, or plan for
  115  which any term of the policy, contract, or plan is changed or
  116  any premium adjustment is made on or after July 1, 2013; and,
  117  effective July 1, 2014, any other policy, contract, or plan. For
  118  purposes of this paragraph, a policy, contract, or plan is
  119  deemed to be renewed no later than the next annual anniversary
  120  date of the contract, policy, or plan.
  121         (b) Medicaid plans, if the health care service would be
  122  covered were it provided through in-person consultation between
  123  the recipient and a health care provider, including statewide
  124  coverage, services originating from a recipient’s home or any
  125  other place where the recipient is located, and the provision of
  126  any telemedicine services, including, but not limited to,
  127  asynchronous health images or other health transmissions
  128  supported by mobile devices provided by authorized health care
  129  professions if such health care services would otherwise be
  130  covered under the state Medicaid plan.
  131         (8) This section does not apply to short-term travel,
  132  accident-only, limited or specified disease, or individual
  133  conversion policies or contracts; policies or contracts designed
  134  for issuance to persons eligible for Medicare coverage under
  135  Title XVIII of the federal Social Security Act; or any other
  136  similar coverage under state or federal governmental plans.
  137         (9) This section does not preclude an insurer, corporation,
  138  or health maintenance organization providing coverage for
  139  telemedicine services under an insurance policy, contract, or
  140  plan from conducting a utilization review. After making an
  141  adverse decision, an insurer, corporation, or health maintenance
  142  organization must notify the covered individual and the
  143  individual’s health care provider and must conduct a utilization
  144  review after receiving a written request to conduct such a
  145  review from a covered individual or the individual’s health care
  146  provider.
  147         Section 2. Under the state plan or a waiver of the state
  148  plan, eligible individuals with chronic conditions as defined in
  149  42 U.S.C. s. 1396w-4 are eligible for medical assistance that
  150  provides health home services in compliance with 42 U.S.C. s.
  151  1396w-4.
  152         Section 3. Interagency telemedicine study by Department of
  153  Health.—The Department of Health shall lead and conduct an
  154  interagency study on options for inclusion in a comprehensive
  155  state plan to implement telemedicine services and coverage that
  156  includes multipayer coverage and reimbursement for stroke
  157  diagnosis, high-risk pregnancies, premature births, and
  158  emergency services. By July 1, 2014, the Department of Health
  159  shall submit a final report of its findings and recommendations
  160  concerning the study to the President of the Senate and the
  161  Speaker of the House of Representatives.
  162         Section 4. The Department of Health may adopt rules in
  163  consultation with those boards that exercise regulatory or
  164  rulemaking functions within the department relating to health
  165  care practitioners as defined in s. 456.001(4), Florida
  166  Statutes, to implement the requirements of this act relating to
  167  the provision of telemedicine services and coverage by such
  168  health care practitioners.
  169         Section 5. This act shall take effect July 1, 2013.