Florida Senate - 2014 COMMITTEE AMENDMENT
Bill No. CS for SB 1646
Ì449942@Î449942
LEGISLATIVE ACTION
Senate . House
Comm: UNFAV .
04/11/2014 .
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recommended the following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 456.4501, Florida Statutes, is created
6 to read:
7 456.4501 Short title.—Sections 456.4501-456.4506 may be
8 cited as the “Florida Telemedicine Act.”
9 Section 2. Section 456.4502, Florida Statutes, is created
10 to read:
11 456.4502 Definitions.—As used in this act, the term:
12 (1) “Act” means the Florida Telemedicine Act.
13 (2) “Advanced communications technology” means:
14 (a) Compressed digital interactive video, audio, or data
15 transmissions;
16 (b) Real-time synchronous video- or web-conferencing
17 communications;
18 (c) Secure web-based communications;
19 (d) Still-image capture or asynchronous store and forward;
20 (e) Health care service transmissions supported by mobile
21 devices (mHealth); or
22 (f) Other technology that facilitates access to health care
23 services or medical specialty expertise.
24 (3) “Distant site” means the location at which the
25 telemedicine provider delivering the health care service is
26 located at the time the service is provided via telemedicine.
27 (4) “Encounter” means an examination, consultation,
28 monitoring, or other health care service.
29 (5) “Health care provider” means a health care practitioner
30 or out-of-state licensed individual who provides health care
31 services within the scope of his or her professional license.
32 (6) “In person” means that a patient is in the physical
33 presence of the health care provider without regard to whether
34 portions of the encounter are conducted by other providers.
35 (7) “Originating site” means the location of the patient
36 receiving telemedicine services, which site meets the standards
37 of this act as verified by the telemedicine provider.
38 (8) “Patient presenter” means an individual who has
39 clinical background training in the use of advanced
40 communications technology equipment and who is available at the
41 originating site to present the patient, manage the cameras or
42 equipment, and perform any hands-on activity necessary to
43 successfully complete the telemedicine encounter under the
44 direction and supervision of a telemedicine provider.
45 (9) “Store and forward” means the type of telemedicine
46 encounter that uses still images of patient data for rendering a
47 medical opinion or diagnosis. The term includes the asynchronous
48 transmission of clinical data from one site to another.
49 (10) “Telehealth” means the use of advanced communications
50 technology to provide access to health assessment, diagnosis,
51 intervention, consultation, supervision, and information across
52 distances. The term includes the use of remote patient
53 monitoring devices that are used to collect and transmit data
54 for telemonitoring and interpretation.
55 (11) “Telemedicine” means the use of advanced
56 communications technology by a telemedicine provider at a
57 distant or originating site in compliance with federal and state
58 privacy and confidentiality requirements and encryption
59 standards. Services provided through telemedicine may include
60 patient assessment, diagnosis, consultation, treatment,
61 prescription of medicine, transfer of medical data, or other
62 medical-related services. The term does not include audio-only
63 calls, e-mail messages, or facsimile transmissions. Telemedicine
64 includes telehealth and telemonitoring.
65 (12) “Telemedicine provider” means a health care
66 practitioner licensed or certified in this state who provides
67 telemedicine services.
68 Section 3. Section 456.4503, Florida Statutes, is created
69 to read:
70 456.4503 Telemedicine requirements.—
71 (1) A health care provider who provides telemedicine across
72 state lines to a patient physically located in this state must
73 be licensed or certified in this state.
74 (2) An out-of-state health care provider is exempt from
75 subsection (1) if:
76 (a) The out-of-state health care provider is consulting
77 with a telemedicine provider licensed to practice in this state;
78 (b) The telemedicine provider licensed in this state
79 retains ultimate authority and responsibility for the diagnosis,
80 treatment, and care of the patient located within this state;
81 and
82 (c) The out-of-state health care provider has privileges at
83 or is on the medical staff of an out-of-state hospital
84 affiliated with a Florida hospital licensed under chapter 395,
85 or has an affiliation with an out-of-state health insurer or
86 health plan that is also authorized to conduct business in this
87 state pursuant to chapter 627 or chapter 641.
88 (3) An out-of-state health care provider authorized under
89 subsection (2) to provide telemedicine services to patients in
90 this state is subject to appropriate disciplinary action by the
91 appropriate board in this state or other regulatory entity in
92 this state which has regulatory jurisdiction over the hospital,
93 insurer, or health plan affiliated with the health care
94 practitioner as described in paragraph (2)(c).
95 (4) A telemedicine provider and a hospital, insurer, or
96 health plan operating in this state which is affiliated with an
97 out-of-state health care practitioner as described in paragraph
98 (2)(c) shall make any pertinent records available upon request
99 of the appropriate board, the department, or other regulatory
100 authority as applicable. Failure to comply with such request may
101 result in the revocation of the provider’s license or
102 certification or imposition of a fine by the applicable board
103 or, in the case of an affiliated hospital, insurer, or health
104 plan, a fine, license restriction, or revocation of an
105 affiliated entity’s authorization to conduct business in this
106 state.
107 (5) Consultations that occur on an emergency basis and that
108 are conducted via telemedicine are exempt from subsection (1).
109 As used in this subsection, the term “emergency basis” refers to
110 the provision of emergency services and care for an emergency
111 medical condition, as those terms are defined in s. 395.002.
112 (6) A health care practitioner or patient presenter acting
113 under the direction and supervision of a telemedicine provider
114 through the use of telemedicine may not be interpreted as
115 practicing without a license. However, the health care
116 practitioner must be trained in, educated on, and knowledgeable
117 about the procedure and technology and may not perform duties
118 for which he or she does not have sufficient training,
119 education, and knowledge. Failure to have adequate training,
120 education, and knowledge is grounds for disciplinary action by
121 the appropriate board, or department if there is no board, or
122 the affiliated regulatory entity for affiliated providers.
123 (7) Upon license or certification renewal, the health care
124 practitioner practicing telemedicine shall:
125 (a) Designate himself or herself as a telemedicine provider
126 on the practitioner’s profile, if applicable; and
127 (b) Submit proof of successful completion of a course and
128 subsequent examination, approved by the applicable regulatory
129 board, or the department if there is no board, on the standards
130 of practice in telemedicine. The course must consist of 2 web
131 based contact hours. The first course and examination must be
132 offered by October 1, 2014, and shall be conducted at least
133 annually thereafter. The course and examination shall be
134 developed and offered by a statewide professional association
135 accredited to provide educational activities as designated by
136 the board. The board shall review and approve the content of the
137 initial course and examination if the board determines that the
138 course and examination adequately and reliably satisfy the
139 criteria set forth in this section. Annually thereafter, the
140 applicable regulatory board shall review the course and
141 examination and, if the board determines that the content
142 continues to adequately and reliably satisfy the criteria set
143 forth in this section, approve them. Successful completion of an
144 approved course and examination may be used to satisfy 2 hours
145 of continuing education requirements for the biennial period
146 during which the approved course and examination are taken. A
147 health care practitioner who does not complete an approved
148 course and examination under this section may not provide
149 telemedicine services.
150 (8) Venue for a civil or administrative action initiated by
151 the telemedicine recipient, the department, or the appropriate
152 board shall be based on the location of the patient or shall be
153 in Leon County.
154 (9) The boards may adopt rules to administer the
155 requirements of this act and must repeal rules that are
156 inconsistent with this act, including rules that prohibit the
157 use of telemedicine in this state. The appropriate board may
158 also develop standards and adopt rules relating to requirements
159 for patient presenters. Such rules may not require the use of
160 patient presenters in telemedicine services if special skills or
161 training is not needed for a patient to participate in the
162 encounter.
163 Section 4. Section 456.4504, Florida Statutes, is created
164 to read:
165 456.4504 Telemedicine standards.—
166 (1) The standard of care as provided in s. 766.102 is the
167 same regardless of whether the health care practitioner provides
168 health care services in person or by telemedicine. The
169 applicable board may adopt rules specifically related to the
170 standard of care for telemedicine.
171 (2) A telemedicine provider providing telemedicine services
172 under this act is responsible for the quality of the equipment
173 and technology employed and for its safe use. Telemedicine
174 equipment and advanced communications technology must, at a
175 minimum, be able to provide the same information to the
176 telemedicine provider as the information that would be obtained
177 in an in-person encounter with a health care provider and must
178 enable the telemedicine provider to meet or exceed the
179 prevailing standard of care for the practice of the profession.
180 (3) The telemedicine provider is not required to conduct a
181 patient history or physical examination of the patient before
182 engaging in a telemedicine encounter if the telemedicine
183 provider conducts a patient evaluation sufficient to meet the
184 prevailing standard of care for the services provided.
185 (4) Before each telemedicine encounter, the identification
186 and location of the telemedicine provider and all other
187 individuals present via advanced communications technology who
188 will view the patient or the patient’s information must be
189 identified to the patient.
190 (5) For the purposes of this act, the nonemergency
191 prescribing of a legend drug based solely on an electronic
192 questionnaire without a visual examination is considered a
193 failure to practice with the level of care, skill, and treatment
194 which is recognized by a reasonably prudent health care
195 practitioner and is not authorized under this act.
196 (6) A controlled substance may not be prescribed through
197 the use of telemedicine for chronic, nonmalignant pain.
198 (7) Medical records must be kept by each telemedicine
199 provider that participates in a patient telemedicine encounter
200 to the same extent as required for an in-person encounter under
201 state and federal law. Telemedicine providers are encouraged to
202 create electronic health records to document the encounter and
203 to transmit information in the most efficient manner possible.
204 (8) Any medical records generated, including records
205 maintained via video, audio, electronic, or other means, due to
206 a telemedicine encounter must conform to the confidentiality and
207 recordkeeping requirements of federal law and nationally
208 recognized health care accreditation organizations and the laws
209 and rules of this state, regardless of where the medical records
210 of a patient in this state are maintained.
211 (9) Telemedicine technology used by a telemedicine provider
212 must be encrypted and must use a recordkeeping program to verify
213 each interaction.
214 (10) In those situations in which a telemedicine provider
215 uses telemedicine technology provided by a third-party vendor,
216 the telemedicine provider must:
217 (a) Require a business associate agreement with the third
218 party vendor; and
219 (b) Ensure that the third-party vendor complies with the
220 administrative, physical, and technical safeguards and standards
221 set forth by the Health Information Technology for Economic and
222 Clinical Health (HITECH) Act and by federal regulations
223 implemented pursuant to HITECH.
224 Section 5. Section 456.4505, Florida Statutes, is created
225 to read:
226 456.4505 Telemedicine services to diagnose or treat the
227 human eye.—
228 (1) The use of automated equipment, including computer
229 controlled devices, in the provision of telemedicine services to
230 diagnose or treat the human eye and its appendages, is
231 permissible if the following requirements are met at the time
232 the automated equipment is used:
233 (a) The automated equipment is approved by the United
234 States Food and Drug Administration for the intended use;
235 (b) The automated equipment is designed and operated in a
236 manner that provides any accommodation required by the federal
237 ADA Amendments Act of 2008;
238 (c) The automated equipment and accompanying technology
239 used for the collection and transmission of information and
240 data, including photographs and scans, gathers and transmits
241 protected health information in compliance with the federal
242 Health Insurance Portability and Accountability Act;
243 (d) The procedure for which the automated equipment is used
244 has a recognized Current Procedural Terminology (CPT) code
245 approved by the Centers for Medicare and Medicaid Services;
246 (e) The physical location of the automated equipment
247 prominently displays the name and Florida license number of the
248 individual who will read and interpret the diagnostic
249 information and data, including photographs and scans;
250 (f) Diagnostic information and data, including photographs
251 and scans, gathered by the automated equipment is read and
252 interpreted by an optometrist licensed under chapter 463 or a
253 physician skilled in diseases of the human eye and licensed
254 under chapter 458 or chapter 459; and
255 (g) The owner or lessee of the automated equipment
256 maintains liability insurance in an amount adequate to cover
257 claims made by individuals diagnosed or treated based on
258 information and data, including photographs and scans, generated
259 by the automated equipment.
260 (2) A prescription for spectacles or contact lens may not
261 be made based on telemedicine services or based solely on the
262 refractive error of the human eye generated by a computer
263 controlled device such as an autorefractor.
264 Section 6. Section 456.4506, Florida Statutes, is created
265 to read:
266 456.4506 Telemedicine services under Medicaid.—
267 (1) The Agency for Health Care Administration may reimburse
268 for Medicaid services provided through telemedicine in the same
269 manner and equivalent to Medicaid services provided in-person
270 under parts III and IV of chapter 409, except as provided in
271 subsection (7).
272 (2) Telemedicine services reimbursed under Medicaid must
273 meet the standards and requirements of this act.
274 (3) Except as provided in subsection (7), the agency may
275 not require in-person contact between a telemedicine provider
276 and Medicaid recipient as a prerequisite for payment for
277 services appropriately provided through telemedicine in
278 accordance with generally accepted health care practices and
279 standards prevailing in the applicable health care community at
280 the time the services are provided.
281 (4) Before receipt of telemedicine services, a Medicaid
282 recipient or the legal representative of a Medicaid recipient
283 must provide informed consent for telemedicine services. A
284 Medicaid recipient shall also be provided the opportunity to
285 receive the same service through an in-person encounter.
286 (5) A Medicaid service that is provided through a fee-for
287 service or managed care program may not be denied as a
288 creditable Medicaid service solely because that service is
289 provided through telemedicine.
290 (6) Reimbursement of telemedicine services under Medicaid
291 shall be the amount negotiated between the parties involved to
292 the extent permitted under state and federal law. Regardless of
293 the reimbursement methodology or amount, telemedicine providers
294 located at the originating site and the distant site should both
295 receive reimbursement based on the services rendered, if any,
296 during the telemedicine encounter.
297 (7) If, after implementation, the agency determines that
298 the delivery of a particular service through telemedicine is not
299 cost-effective or does not adequately meet the clinical needs of
300 recipients and the determination has been documented, the agency
301 may discontinue Medicaid reimbursement for that telemedicine
302 service.
303 (8) The agency shall submit a report on the usage and
304 costs, including savings, if any, associated with the provision
305 of health care services through telemedicine under the Medicaid
306 program by January 1, 2017, to the President of the Senate, the
307 Speaker of the House of Representatives, and the minority
308 leaders of the Senate and the House of Representatives.
309 (9) This section is repealed June 30, 2017.
310 Section 7. This act shall take effect October 1, 2014.
311
312 ================= T I T L E A M E N D M E N T ================
313 And the title is amended as follows:
314 Delete everything before the enacting clause
315 and insert:
316 A bill to be entitled
317 An act relating to telemedicine; creating s. 456.4501,
318 F.S.; providing a short title; creating s. 456.4502,
319 F.S.; defining terms applicable to the act; creating
320 s. 456.4503, F.S.; requiring specified practitioners
321 providing telemedicine services to patients in this
322 state to be licensed in this state; providing certain
323 exceptions for emergency services and consultations;
324 requiring pertinent records to be made available upon
325 request; requiring other health care providers to be
326 supervised by a telemedicine provider; providing
327 continuing education requirements for telemedicine
328 providers; establishing venue; authorizing the
329 licensing boards to adopt rules; creating s. 456.4504,
330 F.S.; providing standards and prohibitions for the
331 provision of telemedicine services; prohibiting
332 nonemergency prescribing of a legend drug without a
333 physical examination; prohibiting the prescription of
334 a controlled substance for chronic, nonmalignant pain
335 using telemedicine; establishing a method for
336 disciplinary action of out-of-state health providers;
337 requiring a telemedicine provider to keep medical
338 records of a patient; requiring the records to conform
339 to certain requirements; providing duties for a
340 telemedicine provider that uses telemedicine
341 technology provided by a third-party vendor; creating
342 s. 456.4505, F.S.; authorizing the use of telemedicine
343 services in the diagnosis and treatment of the human
344 eye; providing requirements for the use of automated
345 equipment; requiring the owner or lessee of the
346 automated equipment to maintain specified liability
347 insurance under certain circumstances; prohibiting
348 prescriptions for spectacles or contact lens based
349 solely on the use of an autorefractor; creating s.
350 456.4506, F.S.; providing requirements for
351 reimbursement of telemedicine services under the
352 Medicaid program; requiring a report to the
353 Legislature on the usage and costs of telemedicine
354 services under the Medicaid program by a certain date;
355 providing for future repeal; providing an effective
356 date.