Florida Senate - 2019                             CS for SB 1526
       By the Committee on Appropriations; and Senator Harrell
       576-04600-19                                          20191526c1
    1                        A bill to be entitled                      
    2         An act relating to telehealth; creating s. 456.47,
    3         F.S.; defining terms; establishing standards of
    4         practice for telehealth providers; authorizing
    5         telehealth providers to use telehealth to perform
    6         patient evaluations; authorizing certain telehealth
    7         providers to use telehealth to prescribe certain
    8         controlled substances under specified circumstances;
    9         providing that a nonphysician telehealth provider
   10         using telehealth and acting within his or her relevant
   11         scope of practice is not deemed to be practicing
   12         medicine without a license; providing recordkeeping
   13         requirements for telehealth providers; providing
   14         registration requirements for out-of-state telehealth
   15         providers; requiring the Department of Health to
   16         publish certain information on its website;
   17         authorizing a board, or the department if there is no
   18         board, to take disciplinary action against a
   19         telehealth provider under certain circumstances;
   20         providing venue; providing exemptions from telehealth
   21         registration requirements; authorizing the applicable
   22         board, or the department if there is no board, to
   23         adopt rules; creating s. 627.42396, F.S.; prohibiting
   24         a contract between a certain health insurer and a
   25         telehealth provider from requiring the telehealth
   26         provider to be reimbursed at lesser amount than if the
   27         service were provided in person; amending s. 641.31,
   28         F.S.; prohibiting a contract between a certain health
   29         maintenance organization and a telehealth provider
   30         from requiring the telehealth provider to be
   31         reimbursed at lesser amount than if the service were
   32         provided in-person; requiring the department to
   33         annually review the amount of certain collected fees
   34         and make a determination relating to the sufficiency
   35         of funding to implement specified telehealth
   36         provisions; upon making a certain determination,
   37         requiring the department to indicate insufficient
   38         funding and recommend fee adjustments in its annual
   39         legislative budget request; providing an
   40         appropriation; authorizing positions; providing
   41         effective dates.
   43  Be It Enacted by the Legislature of the State of Florida:
   45         Section 1. Section 456.47, Florida Statutes, is created to
   46  read:
   47         456.47Use of telehealth to provide services.—
   48         (1)DEFINITIONS.—As used in this section, the term:
   49         (a)“Telehealth” means the use of synchronous or
   50  asynchronous telecommunications technology by a telehealth
   51  provider to provide health care services, including, but not
   52  limited to, assessment, diagnosis, consultation, treatment, and
   53  monitoring of a patient; transfer of medical data; patient and
   54  professional health-related education; public health services;
   55  and health administration. The term does not include audio-only
   56  telephone calls, e-mail messages, or facsimile transmissions.
   57         (b)“Telehealth provider” means any individual who provides
   58  health care and related services using telehealth and who is
   59  licensed or certified under s. 393.17; part III of chapter 401;
   60  chapter 457; chapter 458; chapter 459; chapter 460; chapter 461;
   61  chapter 463; chapter 464; chapter 465; chapter 466; chapter 467;
   62  part I, part III, part IV, part V, part X, part XIII, or part
   63  XIV of chapter 468; chapter 478; chapter 480; part II or part
   64  III of chapter 483; chapter 484; chapter 486; chapter 490; or
   65  chapter 491; who is licensed under a multi-state health care
   66  licensure compact of which Florida is a member state; or who is
   67  registered under and complies with subsection (4).
   68         (2)PRACTICE STANDARDS.—
   69         (a)A telehealth provider has the duty to practice in a
   70  manner consistent with his or her scope of practice and the
   71  prevailing professional standard of practice for a health care
   72  professional who provides in-person health care services to
   73  patients in this state.
   74         (b)A telehealth provider may use telehealth to perform a
   75  patient evaluation. If a telehealth provider conducts a patient
   76  evaluation sufficient to diagnose and treat the patient, the
   77  telehealth provider is not required to research a patient’s
   78  medical history or conduct a physical examination of the patient
   79  before using telehealth to provide health care services to the
   80  patient.
   81         (c)A telehealth provider may not use telehealth to
   82  prescribe a controlled substance unless the controlled substance
   83  is prescribed for the following:
   84         1. The treatment of a psychiatric disorder;
   85         2. Inpatient treatment at a hospital licensed under chapter
   86  395;
   87         3. The treatment of a patient receiving hospice services as
   88  defined in s. 400.601; or
   89         4. The treatment of a resident of a nursing home facility
   90  as defined in s. 400.021.
   91         (d)A telehealth provider and a patient may be in separate
   92  locations when telehealth is used to provide health care
   93  services to a patient.
   94         (e)A nonphysician telehealth provider using telehealth and
   95  acting within his or her relevant scope of practice, as
   96  established by Florida law or rule, is not in violation of s.
   97  458.327(1)(a) or s. 459.013(1)(a).
   98         (3)RECORDS.—A telehealth provider shall document in the
   99  patient’s medical record the health care services rendered using
  100  telehealth according to the same standard as used for in-person
  101  services. Medical records, including video, audio, electronic,
  102  or other records generated as a result of providing such
  103  services, are confidential pursuant to ss. 395.3025(4) and
  104  456.057.
  106         (a)A health care professional not licensed in this state
  107  may provide health care services to a patient located in this
  108  state using telehealth if the health care professional registers
  109  with the applicable board, or the department if there is no
  110  board, and provides health care services within the applicable
  111  scope of practice established by Florida law or rule.
  112         (b)The board, or the department if there is no board,
  113  shall register a health care professional not licensed in this
  114  state as a telehealth provider if the health care professional:
  115         1.Completes an application in the format prescribed by the
  116  department;
  117         2.Is licensed with an active, unencumbered license that is
  118  issued by another state, the District of Columbia, or a
  119  possession or territory of the United States and that is
  120  substantially similar to a license issued to a Florida-licensed
  121  provider specified in paragraph (1)(b);
  122         3. Has not been the subject of disciplinary action relating
  123  to his or her license during the 5-year period immediately prior
  124  to the submission of the application;
  125         4.Designates a duly appointed registered agent for service
  126  of process in this state on a form prescribed by the department;
  127  and
  128         5. Demonstrates to the board, or the department if there is
  129  no board, that he or she is in compliance with paragraph (e).
  131  The department shall use the National Practitioner Data Bank to
  132  verify the information submitted under this paragraph, as
  133  applicable.
  134         (c)The website of a telehealth provider registered under
  135  paragraph (b) must prominently display a hyperlink to the
  136  department’s website containing information required under
  137  paragraph (h).
  138         (d)A health care professional may not register under this
  139  subsection if his or her license to provide health care services
  140  is subject to a pending disciplinary investigation or action, or
  141  has been revoked in any state or jurisdiction. A health care
  142  professional registered under this subsection must notify the
  143  appropriate board, or the department if there is no board, of
  144  restrictions placed on his or her license to practice, or any
  145  disciplinary action taken or pending against him or her, in any
  146  state or jurisdiction. The notification must be provided within
  147  5 business days after the restriction is placed or disciplinary
  148  action is initiated or taken.
  149         (e) A provider registered under this subsection shall
  150  maintain professional liability coverage or financial
  151  responsibility, that includes coverage or financial
  152  responsibility for telehealth services provided to patients not
  153  located in the provider’s home state, in an amount equal to or
  154  greater than the requirements for a licensed practitioner under
  155  s. 456.048, s. 458.320, or s. 459.0085, as applicable.
  156         (f)A health care professional registered under this
  157  subsection may not open an office in this state and may not
  158  provide in-person health care services to patients located in
  159  this state.
  160         (g)A pharmacist registered under this subsection may only
  161  use a pharmacy permitted under chapter 465, a nonresident
  162  pharmacy registered under s. 465.0156, or a nonresident pharmacy
  163  or outsourcing facility holding an active permit pursuant to s.
  164  465.0158 to dispense medicinal drugs to patients located in this
  165  state.
  166         (h)The department shall publish on its website a list of
  167  all registrants and include, to the extent applicable, each
  168  registrant’s:
  169         1.Name.
  170         2.Health care occupation.
  171         3.Completed health care training and education, including
  172  completion dates and any certificates or degrees obtained.
  173         4.Out-of-state health care license with the license
  174  number.
  175         5.Florida telehealth provider registration number.
  176         6.Specialty.
  177         7.Board certification.
  178         8.Five-year disciplinary history, including sanctions and
  179  board actions.
  180         9.Medical malpractice insurance provider and policy
  181  limits, including whether the policy covers claims that arise in
  182  this state.
  183         10.The name and address of the registered agent designated
  184  for service of process in this state.
  185         (i)The board, or the department if there is no board, may
  186  take disciplinary action against an out-of-state telehealth
  187  provider registered under this subsection if the registrant:
  188         1.Fails to notify the applicable board, or the department
  189  if there is no board, of any adverse actions taken against his
  190  or her license as required under paragraph (d).
  191         2.Has restrictions placed on or disciplinary action taken
  192  against his or her license in any state or jurisdiction.
  193         3.Violates any of the requirements of this section.
  194         4. Commits any act that constitutes grounds for
  195  disciplinary action under s. 456.072(1) or the applicable
  196  practice act for Florida-licensed providers.
  198  Disciplinary action taken by a board, or the department if there
  199  is no board, under this paragraph may include suspension or
  200  revocation of the provider’s registration or the issuance of a
  201  reprimand or letter of concern. A suspension may be accompanied
  202  by a corrective action plan as determined by the board, or the
  203  department if there is no board, the completion of which may
  204  lead to the suspended registration being reinstated according to
  205  rules adopted by the board, or the department if there is no
  206  board.
  207         (5)VENUE.—For the purposes of this section, any act that
  208  constitutes the delivery of health care services is deemed to
  209  occur at the place where the patient is located at the time the
  210  act is performed or in the patient’s county of residence. Venue
  211  for a civil or administrative action initiated by the
  212  department, the appropriate board, or a patient who receives
  213  telehealth services from an out-of-state telehealth provider may
  214  be located in the patient’s county of residence or in Leon
  215  County.
  216         (6)EXEMPTIONS.—A health care professional who is not
  217  licensed to provide health care services in this state but who
  218  holds an active license to provide health care services in
  219  another state or jurisdiction, and who provides health care
  220  services using telehealth to a patient located in this state, is
  221  not subject to the registration requirement under this section
  222  if the services are provided:
  223         (a)In response to an emergency medical condition as
  224  defined in s. 395.002; or
  225         (b)In consultation with a health care professional
  226  licensed in this state who has ultimate authority over the
  227  diagnosis and care of the patient.
  228         (7)RULEMAKING.—The applicable board, or the department if
  229  there is no board, may adopt rules to administer this section.
  230         Section 2. Effective January 1, 2020, section 627.42396,
  231  Florida Statutes, is created to read:
  232         627.42396 Reimbursement for telehealth services.—A contract
  233  between a health insurer issuing major medical comprehensive
  234  coverage through an individual or group policy and a telehealth
  235  provider, as defined in s. 456.47, may not require the provider
  236  be reimbursed for a covered service provided through telehealth
  237  in an amount less than the reimbursement the insurer would pay
  238  if the service were delivered through an in-person encounter.
  239         Section 3. Effective January 1, 2020, subsection (45) is
  240  added to section 641.31, Florida Statutes, to read:
  241         641.31 Health maintenance contracts.—
  242         (45) A contract between a health maintenance organization
  243  issuing major medical individual or group coverage and a
  244  telehealth provider, as defined in s. 456.47, may not require
  245  the provider be reimbursed for a covered service provided
  246  through telehealth in an amount less than the reimbursement the
  247  health maintenance organization would pay if the service were
  248  delivered through an in-person encounter.
  249         Section 4. Effective July 1, 2020, the Department of Health
  250  shall annually review the amount of any fees collected under
  251  section 456.47, Florida Statutes, in the prior fiscal year and
  252  shall determine whether such fees are sufficient to enable the
  253  department and the boards, as defined in section 456.001,
  254  Florida Statutes, to fully implement section 456.47, Florida
  255  Statutes. If the department determines that the fees collected
  256  are insufficient, the department shall so indicate to the
  257  Legislature in its annual legislative budget request and shall
  258  recommend appropriate adjustments to the applicable fees.
  259         Section 5. For fiscal year 2019-2020, the sums of $261,389
  260  in recurring funds and $15,020 in nonrecurring funds from the
  261  Medical Quality Assurance Trust Fund are appropriated to the
  262  Department of Health, and four full-time equivalent positions
  263  with associated salary rate of 145,870 are authorized for the
  264  purpose of implementing s. 456.47, Florida Statutes, as created
  265  by this act.
  266         Section 6. Except as otherwise provided, this act shall
  267  take effect July 1, 2019.