Florida Senate - 2021              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. CS for SB 700
       Proposed Committee Substitute by the Committee on Appropriations
       (Appropriations Subcommittee on Health and Human Services)
    1                        A bill to be entitled                      
    2         An act relating to telehealth; amending s. 409.908,
    3         F.S.; requiring the Agency for Health Care
    4         Administration to reimburse pharmacists for health
    5         care services provided through telehealth; requiring
    6         the agency to reimburse the use of telehealth services
    7         under certain circumstances and subject to certain
    8         limitations; requiring providers to include certain
    9         documentation in patient records and notes;
   10         authorizing certain out-of-state providers to receive
   11         reimbursement for telehealth services; providing an
   12         exception; amending s. 456.47, F.S.; revising the
   13         definition of the term “telehealth”; authorizing
   14         telehealth providers to prescribe specified controlled
   15         substances through telehealth under certain
   16         circumstances; revising an exemption from telehealth
   17         registration requirements; amending ss. 458.347 and
   18         459.022, F.S.; revising the definition of the term
   19         “supervision”; amending s. 465.003, F.S.; revising the
   20         definition of the term “pharmacy”; creating s.
   21         465.0198, F.S.; defining the term “supervising
   22         pharmacy”; providing for the permitting of remote-site
   23         pharmacies; requiring a licensed or consultant
   24         pharmacist to serve as the prescription department
   25         manager of a remote site; requiring remote-site
   26         pharmacies to notify the Department of Health of a
   27         change in the pharmacy’s prescription department
   28         manager within a specified timeframe; providing
   29         requirements for remote-site pharmacies; providing
   30         that remote-site pharmacies are not considered
   31         pharmacy locations for purposes of network access in
   32         managed care programs; authorizing remote-site
   33         pharmacies to store, hold, and dispense medicinal
   34         drugs; prohibiting remote-site pharmacies from
   35         performing centralized prescription filling; requiring
   36         prescription department managers to visit remote
   37         sites, based on a certain schedule, to perform
   38         specified tasks; authorizing registered pharmacists to
   39         serve as prescription department managers for up to
   40         three remote-site pharmacies under certain
   41         circumstances; amending s. 465.1893, F.S.; providing
   42         additional long-acting medications pharmacists may
   43         administer under certain circumstances; revising
   44         requirements for a continuing education course such
   45         pharmacists must complete; providing an effective
   46         date.
   48  Be It Enacted by the Legislature of the State of Florida:
   50         Section 1. Present paragraph (e) of subsection (14) of
   51  section 409.908, Florida Statutes, is redesignated as paragraph
   52  (f), present subsections (22) through (26) of that section are
   53  redesignated as subsections (23) through (27), respectively, a
   54  new paragraph (e) is added to subsection (14) of that section,
   55  and a new subsection (22) is added to that section, to read:
   56         409.908 Reimbursement of Medicaid providers.—Subject to
   57  specific appropriations, the agency shall reimburse Medicaid
   58  providers, in accordance with state and federal law, according
   59  to methodologies set forth in the rules of the agency and in
   60  policy manuals and handbooks incorporated by reference therein.
   61  These methodologies may include fee schedules, reimbursement
   62  methods based on cost reporting, negotiated fees, competitive
   63  bidding pursuant to s. 287.057, and other mechanisms the agency
   64  considers efficient and effective for purchasing services or
   65  goods on behalf of recipients. If a provider is reimbursed based
   66  on cost reporting and submits a cost report late and that cost
   67  report would have been used to set a lower reimbursement rate
   68  for a rate semester, then the provider’s rate for that semester
   69  shall be retroactively calculated using the new cost report, and
   70  full payment at the recalculated rate shall be effected
   71  retroactively. Medicare-granted extensions for filing cost
   72  reports, if applicable, shall also apply to Medicaid cost
   73  reports. Payment for Medicaid compensable services made on
   74  behalf of Medicaid eligible persons is subject to the
   75  availability of moneys and any limitations or directions
   76  provided for in the General Appropriations Act or chapter 216.
   77  Further, nothing in this section shall be construed to prevent
   78  or limit the agency from adjusting fees, reimbursement rates,
   79  lengths of stay, number of visits, or number of services, or
   80  making any other adjustments necessary to comply with the
   81  availability of moneys and any limitations or directions
   82  provided for in the General Appropriations Act, provided the
   83  adjustment is consistent with legislative intent.
   84         (14) A provider of prescribed drugs shall be reimbursed the
   85  least of the amount billed by the provider, the provider’s usual
   86  and customary charge, or the Medicaid maximum allowable fee
   87  established by the agency, plus a dispensing fee. The Medicaid
   88  maximum allowable fee for ingredient cost must be based on the
   89  lowest of: the average wholesale price (AWP) minus 16.4 percent,
   90  the wholesaler acquisition cost (WAC) plus 1.5 percent, the
   91  federal upper limit (FUL), the state maximum allowable cost
   92  (SMAC), or the usual and customary (UAC) charge billed by the
   93  provider.
   94         (e) A pharmacist providing health care services through
   95  telehealth as defined in s. 456.47 shall be reimbursed for such
   96  services in accordance with this subsection.
   97         (22) Subject to any limitations or directions provided in
   98  the General Appropriations Act, the agency shall reimburse the
   99  use of telehealth as defined by s. 456.47, including services
  100  provided in real time, services provided using store-and-forward
  101  technologies, and remote patient monitoring services to the
  102  extent that these technologies are available.
  103         (a)Providers using any modality described in this
  104  subsection must ensure that treatment services are medically
  105  necessary and performed within a provider’s scope of practice
  106  and any applicable supervision requirements.
  107         (b)Providers must include documentation regarding the use
  108  of telehealth in the medical record or progress notes for each
  109  encounter with a recipient.
  110         (c)Out-of-state providers who are registered under s.
  111  456.47(4) and enrolled in Florida Medicaid as an out-of-state
  112  provider may be reimbursed for telehealth services provided to
  113  recipients in this state.
  114         (d)Reimbursement under this subsection does not cover the
  115  purchase of any general telecommunications equipment that is not
  116  specific to or used solely for the provision of telehealth,
  117  including, but not limited to, computers, tablets, cell phones,
  118  smartphones, or any other similar equipment or device.
  119         Section 2. Paragraph (a) of subsection (1), paragraph (c)
  120  of subsection (2), and subsection (6) of section 456.47, Florida
  121  Statutes, are amended to read:
  122         456.47 Use of telehealth to provide services.—
  123         (1) DEFINITIONS.—As used in this section, the term:
  124         (a) “Telehealth” means the use of synchronous or
  125  asynchronous telecommunications technology by a telehealth
  126  provider to provide or supervise the provision of health care
  127  services, including, but not limited to, assessment, diagnosis,
  128  consultation, treatment, and monitoring of a patient; transfer
  129  of medical data; patient and professional health-related
  130  education; public health services; and health administration.
  131  The term includes does not include audio-only telephone calls,
  132  personal e-mail messages, or facsimile transmissions, and any
  133  other nonpublic-facing telecommunications technology.
  134         (2) PRACTICE STANDARDS.—
  135         (c) A telehealth provider, acting within the scope of his
  136  or her practice and in accordance with chapter 893, may not use
  137  telehealth to prescribe a controlled substance listed in
  138  Schedule III, Schedule IV, or Schedule V of s. 893.03 and may
  139  use telehealth to prescribe a controlled substance listed in
  140  Schedule II of s. 893.03 if unless the controlled substance is
  141  prescribed for the following:
  142         1. The treatment of a psychiatric disorder;
  143         2. Inpatient treatment at a hospital licensed under chapter
  144  395;
  145         3. The treatment of a patient receiving hospice services as
  146  defined in s. 400.601; or
  147         4. The treatment of a resident of a nursing home facility
  148  as defined in s. 400.021.
  150  A telehealth provider may not use telehealth to prescribe a
  151  controlled substance listed in Schedule I of s. 893.03 or to
  152  issue a physician certification for marijuana for medical use
  153  under s. 381.986.
  154         (6) EXEMPTIONS.—A health care professional who is not
  155  licensed to provide health care services in this state but who
  156  holds an active license to provide health care services in
  157  another state or jurisdiction, and who provides health care
  158  services using telehealth to a patient located in this state, is
  159  not subject to the registration requirement under this section
  160  if the services are provided:
  161         (a) In response to an emergency medical condition as
  162  defined in s. 395.002; or
  163         (b) In consultation with a health care professional
  164  licensed in this state who has ultimate authority over the
  165  diagnosis and care of the patient.
  166         Section 3. Paragraph (f) of subsection (2) of section
  167  458.347, Florida Statutes, is amended to read:
  168         458.347 Physician assistants.—
  169         (2) DEFINITIONS.—As used in this section:
  170         (f) “Supervision” means responsible supervision and
  171  control. Except in cases of emergency, supervision requires the
  172  easy availability or physical presence of the licensed physician
  173  for consultation and direction of the actions of the physician
  174  assistant. For the purposes of this definition, the term “easy
  175  availability” includes the ability to communicate by way of
  176  telehealth as defined in s. 456.47 telecommunication. The boards
  177  shall establish rules as to what constitutes responsible
  178  supervision of the physician assistant.
  179         Section 4. Paragraph (f) of subsection (2) of section
  180  459.022, Florida Statutes, is amended to read:
  181         459.022 Physician assistants.—
  182         (2) DEFINITIONS.—As used in this section:
  183         (f) “Supervision” means responsible supervision and
  184  control. Except in cases of emergency, supervision requires the
  185  easy availability or physical presence of the licensed physician
  186  for consultation and direction of the actions of the physician
  187  assistant. For the purposes of this definition, the term “easy
  188  availability” includes the ability to communicate by way of
  189  telehealth as defined in s. 456.47 telecommunication. The boards
  190  shall establish rules as to what constitutes responsible
  191  supervision of the physician assistant.
  192         Section 5. Paragraph (a) of subsection (11) of section
  193  465.003, Florida Statutes, is amended to read
  194         465.003 Definitions.—As used in this chapter, the term:
  195         (11)(a) “Pharmacy” includes a community pharmacy, an
  196  institutional pharmacy, a nuclear pharmacy, a special pharmacy,
  197  and an Internet pharmacy, and a remote-site pharmacy.
  198         1. The term “community pharmacy” includes every location
  199  where medicinal drugs are compounded, dispensed, stored, or sold
  200  or where prescriptions are filled or dispensed on an outpatient
  201  basis.
  202         2. The term “institutional pharmacy” includes every
  203  location in a hospital, clinic, nursing home, dispensary,
  204  sanitarium, extended care facility, or other facility,
  205  hereinafter referred to as “health care institutions,” where
  206  medicinal drugs are compounded, dispensed, stored, or sold.
  207         3. The term “nuclear pharmacy” includes every location
  208  where radioactive drugs and chemicals within the classification
  209  of medicinal drugs are compounded, dispensed, stored, or sold.
  210  The term “nuclear pharmacy” does not include hospitals licensed
  211  under chapter 395 or the nuclear medicine facilities of such
  212  hospitals.
  213         4. The term “special pharmacy” includes every location
  214  where medicinal drugs are compounded, dispensed, stored, or sold
  215  if such locations are not otherwise defined in this subsection.
  216         5. The term “Internet pharmacy” includes locations not
  217  otherwise licensed or issued a permit under this chapter, within
  218  or outside this state, which use the Internet to communicate
  219  with or obtain information from consumers in this state and use
  220  such communication or information to fill or refill
  221  prescriptions or to dispense, distribute, or otherwise engage in
  222  the practice of pharmacy in this state. Any act described in
  223  this definition constitutes the practice of pharmacy as defined
  224  in subsection (13).
  225         6.The term “remote-site pharmacy” or “remote site”
  226  includes every location within a community mental health center
  227  or clinic as defined in s. 394.455 in which medicinal drugs are
  228  compounded or dispensed by a registered pharmacy technician who
  229  is remotely supervised by an off-site pharmacist acting in the
  230  capacity of a prescription department manager.
  231         Section 6. Section 465.0198, Florida Statutes, is created
  232  to read:
  233         465.0198 Remote-site pharmacy permits.—
  234         (1)As used in this section, the term “supervising
  235  pharmacy” means a pharmacy licensed in this state which employs
  236  a licensed pharmacist who remotely supervises a registered
  237  pharmacy technician at a remote-site pharmacy.
  238         (2)Any person desiring a permit to operate a remote-site
  239  pharmacy must apply to the department. If the board certifies
  240  that the application complies with the laws and rules of the
  241  board, the department must issue the permit. A permit may not be
  242  issued unless a licensed pharmacist or consultant pharmacist is
  243  designated as the prescription department manager responsible
  244  for the oversight of the remote site. The permittee must notify
  245  the department within 10 days after any change of the
  246  prescription department manager.
  247         (3)A remote-site pharmacy must comply with all of the
  248  following:
  249         (a)Be jointly owned by or operated under a contract with a
  250  supervising pharmacy.
  251         (b)Maintain a video surveillance system that records
  252  continuously 24 hours per day and retain video surveillance
  253  recordings for at least 45 days.
  254         (c)Display a sign visible to the public indicating that
  255  the location is a remote-site pharmacy and that the facility is
  256  under 24-hour video surveillance.
  257         (d)Maintain a policies and procedures manual, which must
  258  be made available to the board or its agent upon request, and
  259  must include, but need not be limited to, all of the following:
  260         1.A description of how the pharmacy will comply with
  261  federal and state laws and rules.
  262         2.The procedures for supervising the remote site and
  263  counseling its patients.
  264         3.The procedures for reviewing the prescription drug
  265  inventory and drug records maintained by the remote site.
  266         4.The policies and procedures for providing security
  267  adequate to protect the confidentiality and integrity of patient
  268  information.
  269         5.The written plan for recovery from an event that
  270  interrupts or prevents the prescription department manager from
  271  supervising the remote site’s operation.
  272         6.The procedures for use of the state prescription drug
  273  monitoring program by the prescription department manager before
  274  he or she may authorize the dispensing of any controlled
  275  substance.
  276         7.The procedures for maintaining a perpetual inventory of
  277  the controlled substances listed in s. 893.03(2).
  278         8.The specific duties, tasks, and functions that
  279  registered pharmacy technicians are authorized to perform at the
  280  remote site.
  281         (4)A remote-site pharmacy is not considered a pharmacy
  282  location for purposes of network access in managed care
  283  programs.
  284         (5)A remote-site pharmacy may store, hold, or dispense any
  285  medicinal drug.
  286         (6)A remote-site pharmacy may not perform centralized
  287  prescription filling as defined in s. 465.003(16).
  288         (7)The prescription department manager must visit the
  289  remote site, based on a schedule determined by the board, to
  290  inspect the pharmacy, address personnel matters, and provide
  291  clinical services for patients.
  292         (8)A registered pharmacist may serve as the prescription
  293  department manager for up to three remote-site pharmacies that
  294  are under common control of the same supervising pharmacy.
  295         Section 7. Section 465.1893, Florida Statutes, is amended
  296  to read
  297         465.1893 Administration of long-acting antipsychotic
  298  medication by injection.—
  299         (1)(a) A pharmacist, at the direction of a physician
  300  licensed under chapter 458 or chapter 459, may administer a
  301  long-acting antipsychotic medication or an extended-release
  302  medication indicated to treat opioid use disorder, alcohol use
  303  disorder, or other substance use disorder or dependency,
  304  including, but not limited to, buprenorphine, naltrexone, or
  305  other medications that have been approved by the United States
  306  Food and Drug Administration by injection to a patient if the
  307  pharmacist:
  308         1. Is authorized by and acting within the framework of an
  309  established protocol with the prescribing physician.
  310         2. Practices at a facility that accommodates privacy for
  311  nondeltoid injections and conforms with state rules and
  312  regulations regarding the appropriate and safe disposal of
  313  medication and medical waste.
  314         3. Has completed the course required under subsection (2).
  315         (b) A separate prescription from a physician is required
  316  for each injection administered by a pharmacist under this
  317  subsection.
  318         (2)(a) A pharmacist seeking to administer a long-acting
  319  antipsychotic medication described in paragraph (1)(a) by
  320  injection must complete an 8-hour continuing education course
  321  offered by:
  322         1. A statewide professional association of physicians in
  323  this state accredited to provide educational activities
  324  designated for the American Medical Association Physician’s
  325  Recognition Award (AMA PRA) Category 1 Credit or the American
  326  Osteopathic Association (AOA) Category 1-A continuing medical
  327  education (CME) credit; and
  328         2. A statewide association of pharmacists.
  329         (b) The course may be offered in a distance learning format
  330  and must be included in the 30 hours of continuing professional
  331  pharmaceutical education required under s. 465.009(1). The
  332  course shall have a curriculum of instruction that concerns the
  333  safe and effective administration of behavioral health,
  334  addiction, and antipsychotic medications by injection,
  335  including, but not limited to, potential allergic reactions to
  336  such medications.
  337         Section 8. This act shall take effect July 1, 2021.