Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 1526
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/19/2019           .                                

       The Committee on Appropriations (Harrell) recommended the
    1         Senate Substitute for Amendment (763358) (with title
    2  amendment)
    4         Delete everything after the enacting clause
    5  and insert:
    6         Section 1. Section 456.47, Florida Statutes, is created to
    7  read:
    8         456.47Use of telehealth to provide services.—
    9         (1)DEFINITIONS.—As used in this section, the term:
   10         (a)“Telehealth” means the use of synchronous or
   11  asynchronous telecommunications technology by a telehealth
   12  provider to provide health care services, including, but not
   13  limited to, assessment, diagnosis, consultation, treatment, and
   14  monitoring of a patient; transfer of medical data; patient and
   15  professional health-related education; public health services;
   16  and health administration. The term does not include audio-only
   17  telephone calls, e-mail messages, or facsimile transmissions.
   18         (b)“Telehealth provider” means any individual who provides
   19  health care and related services using telehealth and who is
   20  licensed or certified under s. 393.17; part III of chapter 401;
   21  chapter 457; chapter 458; chapter 459; chapter 460; chapter 461;
   22  chapter 463; chapter 464; chapter 465; chapter 466; chapter 467;
   23  part I, part III, part IV, part V, part X, part XIII, or part
   24  XIV of chapter 468; chapter 478; chapter 480; part II or part
   25  III of chapter 483; chapter 484; chapter 486; chapter 490; or
   26  chapter 491; who is licensed under a multi-state health care
   27  licensure compact of which Florida is a member state; or who is
   28  registered under and complies with subsection (4).
   29         (2)PRACTICE STANDARDS.—
   30         (a)A telehealth provider has the duty to practice in a
   31  manner consistent with his or her scope of practice and the
   32  prevailing professional standard of practice for a health care
   33  professional who provides in-person health care services to
   34  patients in this state.
   35         (b)A telehealth provider may use telehealth to perform a
   36  patient evaluation. If a telehealth provider conducts a patient
   37  evaluation sufficient to diagnose and treat the patient, the
   38  telehealth provider is not required to research a patient’s
   39  medical history or conduct a physical examination of the patient
   40  before using telehealth to provide health care services to the
   41  patient.
   42         (c)A telehealth provider may not use telehealth to
   43  prescribe a controlled substance unless the controlled substance
   44  is prescribed for the following:
   45         1. The treatment of a psychiatric disorder;
   46         2. Inpatient treatment at a hospital licensed under chapter
   47  395;
   48         3. The treatment of a patient receiving hospice services as
   49  defined in s. 400.601; or
   50         4. The treatment of a resident of a nursing home facility
   51  as defined in s. 400.021.
   52         (d)A telehealth provider and a patient may be in separate
   53  locations when telehealth is used to provide health care
   54  services to a patient.
   55         (e)A nonphysician telehealth provider using telehealth and
   56  acting within his or her relevant scope of practice, as
   57  established by Florida law or rule, is not in violation of s.
   58  458.327(1)(a) or s. 459.013(1)(a).
   59         (3)RECORDS.—A telehealth provider shall document in the
   60  patient’s medical record the health care services rendered using
   61  telehealth according to the same standard as used for in-person
   62  services. Medical records, including video, audio, electronic,
   63  or other records generated as a result of providing such
   64  services, are confidential pursuant to ss. 395.3025(4) and
   65  456.057.
   67         (a)A health care professional not licensed in this state
   68  may provide health care services to a patient located in this
   69  state using telehealth if the health care professional registers
   70  with the applicable board, or the department if there is no
   71  board, and provides health care services within the applicable
   72  scope of practice established by Florida law or rule.
   73         (b)The board, or the department if there is no board,
   74  shall register a health care professional not licensed in this
   75  state as a telehealth provider if the health care professional:
   76         1.Completes an application in the format prescribed by the
   77  department;
   78         2.Is licensed with an active, unencumbered license that is
   79  issued by another state, the District of Columbia, or a
   80  possession or territory of the United States and that is
   81  substantially similar to a license issued to a Florida-licensed
   82  provider specified in paragraph (1)(b);
   83         3. Has not been the subject of disciplinary action relating
   84  to his or her license during the 5-year period immediately prior
   85  to the submission of the application;
   86         4.Designates a duly appointed registered agent for service
   87  of process in this state on a form prescribed by the department;
   88  and
   89         5. Demonstrates to the board, or the department if there is
   90  no board, that he or she is in compliance with paragraph (e).
   92  The department shall use the National Practitioner Data Bank to
   93  verify the information submitted under this paragraph, as
   94  applicable.
   95         (c)The website of a telehealth provider registered under
   96  paragraph (b) must prominently display a hyperlink to the
   97  department’s website containing information required under
   98  paragraph (h).
   99         (d)A health care professional may not register under this
  100  subsection if his or her license to provide health care services
  101  is subject to a pending disciplinary investigation or action, or
  102  has been revoked in any state or jurisdiction. A health care
  103  professional registered under this subsection must notify the
  104  appropriate board, or the department if there is no board, of
  105  restrictions placed on his or her license to practice, or any
  106  disciplinary action taken or pending against him or her, in any
  107  state or jurisdiction. The notification must be provided within
  108  5 business days after the restriction is placed or disciplinary
  109  action is initiated or taken.
  110         (e) A provider registered under this subsection shall
  111  maintain professional liability coverage or financial
  112  responsibility, that includes coverage or financial
  113  responsibility for telehealth services provided to patients not
  114  located in the provider’s home state, in an amount equal to or
  115  greater than the requirements for a licensed practitioner under
  116  s. 456.048, s. 458.320, or s. 459.0085, as applicable.
  117         (f)A health care professional registered under this
  118  subsection may not open an office in this state and may not
  119  provide in-person health care services to patients located in
  120  this state.
  121         (g)A pharmacist registered under this subsection may only
  122  use a pharmacy permitted under chapter 465, a nonresident
  123  pharmacy registered under s. 465.0156, or a nonresident pharmacy
  124  or outsourcing facility holding an active permit pursuant to s.
  125  465.0158 to dispense medicinal drugs to patients located in this
  126  state.
  127         (h)The department shall publish on its website a list of
  128  all registrants and include, to the extent applicable, each
  129  registrant’s:
  130         1.Name.
  131         2.Health care occupation.
  132         3.Completed health care training and education, including
  133  completion dates and any certificates or degrees obtained.
  134         4.Out-of-state health care license with the license
  135  number.
  136         5.Florida telehealth provider registration number.
  137         6.Specialty.
  138         7.Board certification.
  139         8.Five-year disciplinary history, including sanctions and
  140  board actions.
  141         9.Medical malpractice insurance provider and policy
  142  limits, including whether the policy covers claims that arise in
  143  this state.
  144         10.The name and address of the registered agent designated
  145  for service of process in this state.
  146         (i)The board, or the department if there is no board, may
  147  take disciplinary action against an out-of-state telehealth
  148  provider registered under this subsection if the registrant:
  149         1.Fails to notify the applicable board, or the department
  150  if there is no board, of any adverse actions taken against his
  151  or her license as required under paragraph (d).
  152         2.Has restrictions placed on or disciplinary action taken
  153  against his or her license in any state or jurisdiction.
  154         3.Violates any of the requirements of this section.
  155         4. Commits any act that constitutes grounds for
  156  disciplinary action under s. 456.072(1) or the applicable
  157  practice act for Florida-licensed providers.
  159  Disciplinary action taken by a board, or the department if there
  160  is no board, under this paragraph may include suspension or
  161  revocation of the provider’s registration or the issuance of a
  162  reprimand or letter of concern. A suspension may be accompanied
  163  by a corrective action plan as determined by the board, or the
  164  department if there is no board, the completion of which may
  165  lead to the suspended registration being reinstated according to
  166  rules adopted by the board, or the department if there is no
  167  board.
  168         (5)VENUE.—For the purposes of this section, any act that
  169  constitutes the delivery of health care services is deemed to
  170  occur at the place where the patient is located at the time the
  171  act is performed or in the patient’s county of residence. Venue
  172  for a civil or administrative action initiated by the
  173  department, the appropriate board, or a patient who receives
  174  telehealth services from an out-of-state telehealth provider may
  175  be located in the patient’s county of residence or in Leon
  176  County.
  177         (6)EXEMPTIONS.—A health care professional who is not
  178  licensed to provide health care services in this state but who
  179  holds an active license to provide health care services in
  180  another state or jurisdiction, and who provides health care
  181  services using telehealth to a patient located in this state, is
  182  not subject to the registration requirement under this section
  183  if the services are provided:
  184         (a)In response to an emergency medical condition as
  185  defined in s. 395.002; or
  186         (b)In consultation with a health care professional
  187  licensed in this state who has ultimate authority over the
  188  diagnosis and care of the patient.
  189         (7)RULEMAKING.—The applicable board, or the department if
  190  there is no board, may adopt rules to administer this section.
  191         Section 2. Effective January 1, 2020, section 627.42396,
  192  Florida Statutes, is created to read:
  193         627.42396 Reimbursement for telehealth services.—A contract
  194  between a health insurer issuing major medical comprehensive
  195  coverage through an individual or group policy and a telehealth
  196  provider, as defined in s. 456.47, may not require the provider
  197  be reimbursed for a covered service provided through telehealth
  198  in an amount less than the reimbursement the insurer would pay
  199  if the service were delivered through an in-person encounter.
  200         Section 3. Effective January 1, 2020, subsection (45) is
  201  added to section 641.31, Florida Statutes, to read:
  202         641.31 Health maintenance contracts.—
  203         (45) A contract between a health maintenance organization
  204  issuing major medical individual or group coverage and a
  205  telehealth provider, as defined in s. 456.47, may not require
  206  the provider be reimbursed for a covered service provided
  207  through telehealth in an amount less than the reimbursement the
  208  health maintenance organization would pay if the service were
  209  delivered through an in-person encounter.
  210         Section 4. Effective July 1, 2020, the Department of Health
  211  shall annually review the amount of any fees collected under
  212  section 456.47, Florida Statutes, in the prior fiscal year and
  213  shall determine whether such fees are sufficient to enable the
  214  department and the boards, as defined in section 456.001,
  215  Florida Statutes, to fully implement section 456.47, Florida
  216  Statutes. If the department determines that the fees collected
  217  are insufficient, the department shall so indicate to the
  218  Legislature in its annual Legislative Budget Request and shall
  219  recommend appropriate adjustments to the applicable fees.
  220         Section 5. For fiscal year 2019-2020, the sums of $261,389
  221  in recurring funds and $15,020 in nonrecurring funds from the
  222  Medical Quality Assurance Trust Fund are appropriated to the
  223  Department of Health, and four full-time equivalent positions
  224  with associated salary rate of 145,870 are authorized for the
  225  purpose of implementing s. 456.47, Florida Statutes, as created
  226  by this act.
  227         Section 6. Except as otherwise provided, this act shall
  228  take effect July 1, 2019.
  230  ================= T I T L E  A M E N D M E N T ================
  231  And the title is amended as follows:
  232         Delete everything before the enacting clause
  233  and insert:
  234                        A bill to be entitled                      
  235         An act relating to telehealth; creating s. 456.47,
  236         F.S.; defining terms; establishing standards of
  237         practice for telehealth providers; authorizing
  238         telehealth providers to use telehealth to perform
  239         patient evaluations; authorizing certain telehealth
  240         providers to use telehealth to prescribe certain
  241         controlled substances under specified circumstances;
  242         providing that a nonphysician telehealth provider
  243         using telehealth and acting within his or her relevant
  244         scope of practice is not deemed to be practicing
  245         medicine without a license; providing recordkeeping
  246         requirements for telehealth providers; providing
  247         registration requirements for out-of-state telehealth
  248         providers; requiring the Department of Health to
  249         publish certain information on its website;
  250         authorizing a board, or the department if there is no
  251         board, to take disciplinary action against a
  252         telehealth provider under certain circumstances;
  253         providing venue; providing exemptions from telehealth
  254         registration requirements; authorizing the applicable
  255         board, or the department if there is no board, to
  256         adopt rules; amending s. 627.42396, F.S.; prohibiting
  257         a contract between a certain health insurer and a
  258         telehealth provider from requiring the telehealth
  259         provider to be reimbursed at lesser amount than if the
  260         service were provided in person; amending s. 641.31,
  261         F.S.; prohibiting a contract between a certain health
  262         maintenance organization and a telehealth provider
  263         from requiring the telehealth provider to be
  264         reimbursed at lesser amount than if the service were
  265         provided in-person; requiring the department to
  266         annually review the amount of certain collected fees
  267         and make a determination relating to the sufficiency
  268         of funding to implement specified telehealth
  269         provisions; upon making a certain determination,
  270         requiring the department to indicate insufficient
  271         funding and recommend fee adjustments in its annual
  272         Legislative Budget Request; providing an
  273         appropriation; authorizing positions; providing
  274         effective dates.