Florida Senate - 2021                        COMMITTEE AMENDMENT
       Bill No. CS for SB 700
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       Appropriations Subcommittee on Health and Human Services
       (Rodriguez) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Present paragraph (e) of subsection (14) of
    6  section 409.908, Florida Statutes, is redesignated as paragraph
    7  (f), present subsections (22) through (26) of that section are
    8  redesignated as subsections (23) through (27), respectively, a
    9  new paragraph (e) is added to subsection (14) of that section,
   10  and a new subsection (22) is added to that section, to read:
   11         409.908 Reimbursement of Medicaid providers.—Subject to
   12  specific appropriations, the agency shall reimburse Medicaid
   13  providers, in accordance with state and federal law, according
   14  to methodologies set forth in the rules of the agency and in
   15  policy manuals and handbooks incorporated by reference therein.
   16  These methodologies may include fee schedules, reimbursement
   17  methods based on cost reporting, negotiated fees, competitive
   18  bidding pursuant to s. 287.057, and other mechanisms the agency
   19  considers efficient and effective for purchasing services or
   20  goods on behalf of recipients. If a provider is reimbursed based
   21  on cost reporting and submits a cost report late and that cost
   22  report would have been used to set a lower reimbursement rate
   23  for a rate semester, then the provider’s rate for that semester
   24  shall be retroactively calculated using the new cost report, and
   25  full payment at the recalculated rate shall be effected
   26  retroactively. Medicare-granted extensions for filing cost
   27  reports, if applicable, shall also apply to Medicaid cost
   28  reports. Payment for Medicaid compensable services made on
   29  behalf of Medicaid eligible persons is subject to the
   30  availability of moneys and any limitations or directions
   31  provided for in the General Appropriations Act or chapter 216.
   32  Further, nothing in this section shall be construed to prevent
   33  or limit the agency from adjusting fees, reimbursement rates,
   34  lengths of stay, number of visits, or number of services, or
   35  making any other adjustments necessary to comply with the
   36  availability of moneys and any limitations or directions
   37  provided for in the General Appropriations Act, provided the
   38  adjustment is consistent with legislative intent.
   39         (14) A provider of prescribed drugs shall be reimbursed the
   40  least of the amount billed by the provider, the provider’s usual
   41  and customary charge, or the Medicaid maximum allowable fee
   42  established by the agency, plus a dispensing fee. The Medicaid
   43  maximum allowable fee for ingredient cost must be based on the
   44  lowest of: the average wholesale price (AWP) minus 16.4 percent,
   45  the wholesaler acquisition cost (WAC) plus 1.5 percent, the
   46  federal upper limit (FUL), the state maximum allowable cost
   47  (SMAC), or the usual and customary (UAC) charge billed by the
   48  provider.
   49         (e) A pharmacist providing health care services through
   50  telehealth as defined in s. 456.47 shall be reimbursed for such
   51  services in accordance with this subsection.
   52         (22) Subject to any limitations or directions provided in
   53  the General Appropriations Act, the agency shall reimburse the
   54  use of telehealth as defined by s. 456.47, including services
   55  provided in real time, services provided using store-and-forward
   56  technologies, and remote patient monitoring services to the
   57  extent that these technologies are available.
   58         (a)Providers using any modality described in this
   59  subsection must ensure that treatment services are medically
   60  necessary and performed within a provider’s scope of practice
   61  and any applicable supervision requirements.
   62         (b)Providers must include documentation regarding the use
   63  of telehealth in the medical record or progress notes for each
   64  encounter with a recipient.
   65         (c)Out-of-state providers who are registered under s.
   66  456.47(4) and enrolled in Florida Medicaid as an out-of-state
   67  provider may be reimbursed for telehealth services provided to
   68  recipients in this state.
   69         (d)Reimbursement under this subsection does not cover the
   70  purchase of any general telecommunications equipment that is not
   71  specific to or used solely for the provision of telehealth,
   72  including, but not limited to, computers, tablets, cell phones,
   73  smartphones, or any other similar equipment or device.
   74         Section 2. Paragraph (a) of subsection (1) and paragraph
   75  (c) of subsection (2) of section 456.47, Florida Statutes, are
   76  amended to read:
   77         456.47 Use of telehealth to provide services.—
   78         (1) DEFINITIONS.—As used in this section, the term:
   79         (a) “Telehealth” means the use of synchronous or
   80  asynchronous telecommunications technology by a telehealth
   81  provider to provide or supervise the provision of health care
   82  services, including, but not limited to, assessment, diagnosis,
   83  consultation, treatment, and monitoring of a patient; transfer
   84  of medical data; patient and professional health-related
   85  education; public health services; and health administration.
   86  The term includes does not include audio-only telephone calls,
   87  personal e-mail messages, or facsimile transmissions, and any
   88  other nonpublic-facing telecommunications technology.
   89         (2) PRACTICE STANDARDS.—
   90         (c) A telehealth provider, acting within the scope of his
   91  or her practice and in accordance with chapter 893, may not use
   92  telehealth to prescribe a controlled substance listed in
   93  Schedule III, Schedule IV, or Schedule V of s. 893.03 and may
   94  use telehealth to prescribe a controlled substance listed in
   95  Schedule II of s. 893.03 if unless the controlled substance is
   96  prescribed for the following:
   97         1. The treatment of a psychiatric disorder;
   98         2. Inpatient treatment at a hospital licensed under chapter
   99  395;
  100         3. The treatment of a patient receiving hospice services as
  101  defined in s. 400.601; or
  102         4. The treatment of a resident of a nursing home facility
  103  as defined in s. 400.021.
  105  A telehealth provider may not use telehealth to prescribe a
  106  controlled substance listed in Schedule I of s. 893.03 or to
  107  issue a physician certification for marijuana for medical use
  108  under s. 381.986.
  109         Section 3. Paragraph (f) of subsection (2) of section
  110  458.347, Florida Statutes, is amended to read:
  111         458.347 Physician assistants.—
  112         (2) DEFINITIONS.—As used in this section:
  113         (f) “Supervision” means responsible supervision and
  114  control. Except in cases of emergency, supervision requires the
  115  easy availability or physical presence of the licensed physician
  116  for consultation and direction of the actions of the physician
  117  assistant. For the purposes of this definition, the term “easy
  118  availability” includes the ability to communicate by way of
  119  telehealth as defined in s. 456.47 telecommunication. The boards
  120  shall establish rules as to what constitutes responsible
  121  supervision of the physician assistant.
  122         Section 4. Paragraph (f) of subsection (2) of section
  123  459.022, Florida Statutes, is amended to read:
  124         459.022 Physician assistants.—
  125         (2) DEFINITIONS.—As used in this section:
  126         (f) “Supervision” means responsible supervision and
  127  control. Except in cases of emergency, supervision requires the
  128  easy availability or physical presence of the licensed physician
  129  for consultation and direction of the actions of the physician
  130  assistant. For the purposes of this definition, the term “easy
  131  availability” includes the ability to communicate by way of
  132  telehealth as defined in s. 456.47 telecommunication. The boards
  133  shall establish rules as to what constitutes responsible
  134  supervision of the physician assistant.
  135         Section 5. Section 465.1893, Florida Statutes, is amended
  136  to read
  137         465.1893 Administration of long-acting antipsychotic
  138  medication by injection.—
  139         (1)(a) A pharmacist, at the direction of a physician
  140  licensed under chapter 458 or chapter 459, may administer a
  141  long-acting antipsychotic medication or an extended-release
  142  medication indicated to treat opioid use disorder, alcohol use
  143  disorder, or other substance use disorder or dependency,
  144  including, but not limited to, buprenorphine, naltrexone, or
  145  other medications that have been approved by the United States
  146  Food and Drug Administration by injection to a patient if the
  147  pharmacist:
  148         1. Is authorized by and acting within the framework of an
  149  established protocol with the prescribing physician.
  150         2. Practices at a facility that accommodates privacy for
  151  nondeltoid injections and conforms with state rules and
  152  regulations regarding the appropriate and safe disposal of
  153  medication and medical waste.
  154         3. Has completed the course required under subsection (2).
  155         (b) A separate prescription from a physician is required
  156  for each injection administered by a pharmacist under this
  157  subsection.
  158         (2)(a) A pharmacist seeking to administer a long-acting
  159  antipsychotic medication described in paragraph (1)(a) by
  160  injection must complete an 8-hour continuing education course
  161  offered by:
  162         1. A statewide professional association of physicians in
  163  this state accredited to provide educational activities
  164  designated for the American Medical Association Physician’s
  165  Recognition Award (AMA PRA) Category 1 Credit or the American
  166  Osteopathic Association (AOA) Category 1-A continuing medical
  167  education (CME) credit; and
  168         2. A statewide association of pharmacists.
  169         (b) The course may be offered in a distance learning format
  170  and must be included in the 30 hours of continuing professional
  171  pharmaceutical education required under s. 465.009(1). The
  172  course shall have a curriculum of instruction that concerns the
  173  safe and effective administration of behavioral health,
  174  addiction, and antipsychotic medications by injection,
  175  including, but not limited to, potential allergic reactions to
  176  such medications.
  177         Section 6. Paragraph (e) is added to subsection (1) of
  178  section 893.05, Florida Statutes, to read:
  179         893.05 Practitioners and persons administering controlled
  180  substances in their absence.—
  181         (1)
  182         (e) A telehealth provider as defined in s. 456.47 may not
  183  prescribe through telehealth a controlled substance listed in
  184  Schedule I or Schedule II of s. 893.03.
  185         Section 7. This act shall take effect July 1, 2021.
  187  ================= T I T L E  A M E N D M E N T ================
  188  And the title is amended as follows:
  189         Delete everything before the enacting clause
  190  and insert:
  191                        A bill to be entitled                      
  192         An act relating to telehealth; amending s. 409.908,
  193         F.S.; requiring the Agency for Health Care
  194         Administration to reimburse pharmacists for health
  195         care services provided through telehealth; requiring
  196         the agency to reimburse the use of telehealth services
  197         under certain circumstances and subject to certain
  198         limitations; requiring providers to include certain
  199         documentation in patient records and notes;
  200         authorizing certain out-of-state providers to receive
  201         reimbursement for telehealth services; providing an
  202         exception; amending s. 456.47, F.S.; revising the
  203         definition of the term “telehealth”; authorizing
  204         telehealth providers to prescribe specified controlled
  205         substances through telehealth under certain
  206         circumstances; amending ss. 458.347 and 459.022, F.S.;
  207         revising the definition of the term “supervision”;
  208         amending s. 465.1893, F.S.; providing additional long
  209         acting medications pharmacists may administer under
  210         certain circumstances; revising requirements for a
  211         continuing education course such pharmacists must
  212         complete; amending s. 893.05, F.S.; prohibiting
  213         telehealth providers from prescribing specified
  214         controlled substances through telehealth; providing an
  215         effective date.