Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 1526
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: FAV            .                                
                  04/18/2019           .                                

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