Florida Senate - 2021 SB 1250
By Senator Ausley
3-01061-21 20211250__
1 A bill to be entitled
2 An act relating to telehealth; amending s. 409.967,
3 F.S.; prohibiting Medicaid managed care plans from
4 using providers who exclusively provide services
5 through telehealth to achieve network adequacy;
6 amending s. 627.42396, F.S.; prohibiting certain
7 health insurance policies from denying coverage for
8 covered services provided through telehealth under
9 certain circumstances; prohibiting health insurers
10 from excluding covered services provided through
11 telehealth from coverage; providing reimbursement
12 requirements and cost-sharing limitations for health
13 insurers relating to telehealth services; prohibiting
14 health insurers from requiring an insured to receive
15 services through telehealth services; authorizing
16 health insurers to conduct utilization reviews under
17 certain circumstances; authorizing health insurers to
18 limit telehealth services to certain providers;
19 deleting requirements for contracts between certain
20 health insurers and telehealth providers; amending s.
21 627.6699, F.S.; requiring certain small employer
22 benefit plans to comply with certain requirements for
23 reimbursement of telehealth services; amending s.
24 641.31, F.S.; prohibiting a health maintenance
25 organization from requiring a subscriber to receive
26 certain services through telehealth; deleting
27 requirements for contracts between certain health
28 insurers and telehealth providers; creating s.
29 641.31093, F.S.; prohibiting certain health
30 maintenance organizations from denying coverage for
31 covered services provided through telehealth under
32 certain circumstances; prohibiting health maintenance
33 organizations from excluding covered services provided
34 through telehealth from coverage; providing
35 reimbursement requirements and cost-sharing
36 limitations for health maintenance organizations
37 relating to telehealth services; prohibiting a health
38 maintenance organization from requiring a subscriber
39 to receive services through telehealth; authorizing
40 health maintenance organizations to conduct
41 utilization reviews under certain circumstances;
42 authorizing health maintenance organizations to limit
43 telehealth services to certain providers; providing an
44 effective date.
45
46 WHEREAS, it is the intent of the Legislature to mitigate
47 geographic discrimination in the delivery of health care by
48 recognizing the provision of and payment for covered medical
49 care by means of telehealth services, provided that such
50 services are provided by a physician or by another health care
51 practitioner or professional acting within the scope of practice
52 of such health care practitioner or professional and in
53 accordance with section 456.47, Florida Statutes, NOW,
54 THEREFORE,
55
56 Be It Enacted by the Legislature of the State of Florida:
57
58 Section 1. Paragraph (c) of subsection (2) of section
59 409.967, Florida Statutes, is amended to read:
60 409.967 Managed care plan accountability.—
61 (2) The agency shall establish such contract requirements
62 as are necessary for the operation of the statewide managed care
63 program. In addition to any other provisions the agency may deem
64 necessary, the contract must require:
65 (c) Access.—
66 1. The agency shall establish specific standards for the
67 number, type, and regional distribution of providers in managed
68 care plan networks to ensure access to care for both adults and
69 children. Each plan must maintain a regionwide network of
70 providers in sufficient numbers to meet the access standards for
71 specific medical services for all recipients enrolled in the
72 plan. A plan may not use providers who exclusively provide
73 services through telehealth, as defined in s. 456.47, to meet
74 this requirement. The exclusive use of mail-order pharmacies may
75 not be sufficient to meet network access standards. Consistent
76 with the standards established by the agency, provider networks
77 may include providers located outside the region. A plan may
78 contract with a new hospital facility before the date the
79 hospital becomes operational if the hospital has commenced
80 construction, will be licensed and operational by January 1,
81 2013, and a final order has issued in any civil or
82 administrative challenge. Each plan shall establish and maintain
83 an accurate and complete electronic database of contracted
84 providers, including information about licensure or
85 registration, locations and hours of operation, specialty
86 credentials and other certifications, specific performance
87 indicators, and such other information as the agency deems
88 necessary. The database must be available online to both the
89 agency and the public and have the capability to compare the
90 availability of providers to network adequacy standards and to
91 accept and display feedback from each provider’s patients. Each
92 plan shall submit quarterly reports to the agency identifying
93 the number of enrollees assigned to each primary care provider.
94 The agency shall conduct, or contract for, systematic and
95 continuous testing of the provider network databases maintained
96 by each plan to confirm accuracy, confirm that behavioral health
97 providers are accepting enrollees, and confirm that enrollees
98 have access to behavioral health services.
99 2. Each managed care plan must publish any prescribed drug
100 formulary or preferred drug list on the plan’s website in a
101 manner that is accessible to and searchable by enrollees and
102 providers. The plan must update the list within 24 hours after
103 making a change. Each plan must ensure that the prior
104 authorization process for prescribed drugs is readily accessible
105 to health care providers, including posting appropriate contact
106 information on its website and providing timely responses to
107 providers. For Medicaid recipients diagnosed with hemophilia who
108 have been prescribed anti-hemophilic-factor replacement
109 products, the agency shall provide for those products and
110 hemophilia overlay services through the agency’s hemophilia
111 disease management program.
112 3. Managed care plans, and their fiscal agents or
113 intermediaries, must accept prior authorization requests for any
114 service electronically.
115 4. Managed care plans serving children in the care and
116 custody of the Department of Children and Families must maintain
117 complete medical, dental, and behavioral health encounter
118 information and participate in making such information available
119 to the department or the applicable contracted community-based
120 care lead agency for use in providing comprehensive and
121 coordinated case management. The agency and the department shall
122 establish an interagency agreement to provide guidance for the
123 format, confidentiality, recipient, scope, and method of
124 information to be made available and the deadlines for
125 submission of the data. The scope of information available to
126 the department shall be the data that managed care plans are
127 required to submit to the agency. The agency shall determine the
128 plan’s compliance with standards for access to medical, dental,
129 and behavioral health services; the use of medications; and
130 followup on all medically necessary services recommended as a
131 result of early and periodic screening, diagnosis, and
132 treatment.
133 Section 2. Section 627.42396, Florida Statutes, is amended
134 to read:
135 627.42396 Requirements for reimbursement by health insurers
136 for telehealth services.—
137 (1) An individual, group, blanket, or franchise health
138 insurance policy delivered or issued for delivery to any insured
139 person in this state on or after January 1, 2022, may not deny
140 coverage for a covered service on the basis of the service being
141 provided through telehealth if the same service would be covered
142 if provided through an in-person encounter.
143 (2) A health insurer may not exclude an otherwise covered
144 service from coverage solely because the service is provided
145 through telehealth rather than through an in-person encounter.
146 (3) A health insurer shall reimburse a telehealth provider
147 for the diagnosis, consultation, or treatment of any insured
148 person provided through telehealth on the same basis and at
149 least at the same rate that the health insurer would reimburse
150 the provider if the covered service were delivered through an
151 in-person encounter. However, a health insurer may not require a
152 health care provider or telehealth provider to accept a
153 reimbursement amount greater than the amount the provider is
154 willing to charge.
155 (4) A health insurer shall reimburse a telehealth provider
156 for reasonable originating site fees or costs for the provision
157 of telehealth services.
158 (5) A covered service provided through telehealth may not
159 be subject to a greater deductible, copayment, or coinsurance
160 amount than would apply if the same service were provided
161 through an in-person encounter.
162 (6) A health insurer may not impose upon any insured person
163 receiving benefits under this section any copayment,
164 coinsurance, or deductible amount or any policy-year, calendar
165 year, lifetime, or other durational benefit limitation or
166 maximum for benefits or services provided through telehealth
167 which is not equally imposed upon all terms and services covered
168 under the policy.
169 (7) A health insurer may not require an insured person to
170 obtain a covered service through telehealth instead of an in
171 person encounter.
172 (8) This section does not preclude a health insurer from
173 conducting a utilization review to determine the appropriateness
174 of telehealth as a means of delivering a covered service if such
175 determination is made in the same manner as would be made for
176 the same service provided through an in-person encounter.
177 (9) A health insurer may limit the covered services that
178 are provided through telehealth to providers who are in a
179 network approved by the insurer A contract between a health
180 insurer issuing major medical comprehensive coverage through an
181 individual or group policy and a telehealth provider, as defined
182 in s. 456.47, must be voluntary between the insurer and the
183 provider and must establish mutually acceptable payment rates or
184 payment methodologies for services provided through telehealth.
185 Any contract provision that distinguishes between payment rates
186 or payment methodologies for services provided through
187 telehealth and the same services provided without the use of
188 telehealth must be initialed by the telehealth provider.
189 Section 3. Paragraph (h) is added to subsection (5) of
190 section 627.6699, Florida Statutes, to read:
191 627.6699 Employee Health Care Access Act.—
192 (5) AVAILABILITY OF COVERAGE.—
193 (h) A health benefit plan covering small employers which is
194 delivered, issued, or renewed in this state on or after January
195 1, 2022, must comply with s. 627.42396.
196 Section 4. Subsection (45) of section 641.31, Florida
197 Statutes, is amended to read:
198 641.31 Health maintenance contracts.—
199 (45) A contract between a health maintenance organization
200 issuing major medical individual or group coverage may not
201 require a subscriber to consult with, seek approval from, or
202 obtain any type of referral or authorization by way of
203 telehealth from and a telehealth provider, as defined in s.
204 456.47, must be voluntary between the health maintenance
205 organization and the provider and must establish mutually
206 acceptable payment rates or payment methodologies for services
207 provided through telehealth. Any contract provision that
208 distinguishes between payment rates or payment methodologies for
209 services provided through telehealth and the same services
210 provided without the use of telehealth must be initialed by the
211 telehealth provider.
212 Section 5. Section 641.31093, Florida Statutes, is created
213 to read:
214 641.31093 Requirements for reimbursement by health
215 maintenance organizations for telehealth services.—
216 (1) A health maintenance organization that offers, issues,
217 or renews a major medical or similar comprehensive contract in
218 this state on or after January 1, 2022, may not deny coverage
219 for a covered service on the basis of the covered service being
220 provided through telehealth if the same service would be covered
221 if provided through an in-person encounter.
222 (2) A health maintenance organization may not exclude an
223 otherwise covered service from coverage solely because the
224 service is provided through telehealth rather than through an
225 in-person encounter.
226 (3) A health maintenance organization shall reimburse a
227 telehealth provider for the diagnosis, consultation, or
228 treatment of any subscriber provided through telehealth on the
229 same basis and at least the same rate that the health
230 maintenance organization would reimburse the provider if the
231 service were provided through an in-person encounter. However, a
232 health maintenance organization may not require a health care
233 provider or telehealth provider to accept a reimbursement amount
234 greater than the amount the provider is willing to charge.
235 (4) A health maintenance organization shall reimburse a
236 telehealth provider for reasonable originating site fees or
237 costs for the provision of telehealth services.
238 (5) A covered service provided through telehealth may not
239 be subject to a greater deductible, copayment, or coinsurance
240 amount than would apply if the same service were provided
241 through an in-person encounter.
242 (6) A health maintenance organization may not impose upon
243 any subscriber receiving benefits under this section any
244 copayment, coinsurance, or deductible amount or any contract
245 year, calendar-year, lifetime, or other durational benefit
246 limitation or maximum for benefits or services provided through
247 telehealth which is not equally imposed upon all services
248 covered under the contract.
249 (7) A health maintenance organization may not require an
250 insured person to obtain a covered service through telehealth
251 instead of an in-person encounter.
252 (8) This section does not preclude a health maintenance
253 organization from conducting a utilization review to determine
254 the appropriateness of telehealth as a means of delivering a
255 covered service if such determination is made in the same manner
256 as would be made for the same service provided through an in
257 person encounter.
258 (9) A health maintenance organization may limit covered
259 services that are provided through telehealth to providers who
260 are in a network approved by the health maintenance
261 organization.
262 Section 6. This act shall take effect July 1, 2021.