Florida Senate - 2021                                     SB 700
       By Senator Rodriguez
       39-00936A-21                                           2021700__
    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 the use of telehealth
    5         services under certain circumstances and subject to
    6         certain limitations; requiring providers to include
    7         certain documentation in patient records and notes;
    8         authorizing certain out-of-state providers to receive
    9         reimbursement for telehealth services; providing an
   10         exception; amending s. 456.47, F.S.; revising the
   11         definition of the term “telehealth”; authorizing
   12         telehealth providers to prescribe specified controlled
   13         substances through telehealth under certain
   14         circumstances; authorizing nonphysician health care
   15         practitioners to satisfy a certain supervision
   16         requirement through telehealth; authorizing out-of
   17         state physician telehealth providers to engage in
   18         formal supervisory relationships with certain
   19         nonphysician health care practitioners in this state;
   20         providing an exception; amending ss. 458.347 and
   21         459.022, F.S.; revising the definition of the term
   22         “supervision”; amending s. 465.003, F.S.; revising the
   23         definition of the term “pharmacy”; revising
   24         construction of the term “not present and on duty”;
   25         amending s. 465.014, F.S.; authorizing registered
   26         pharmacy technicians to compound and dispense
   27         medicinal drugs under certain circumstances; providing
   28         an exception to certain supervision limitations;
   29         amending s. 465.015, F.S.; providing applicability;
   30         exempting certain registered pharmacy technicians from
   31         specified prohibitions; creating s. 465.0198, F.S.;
   32         defining the term “supervising pharmacy”; providing
   33         for the permitting of remote-site pharmacies;
   34         requiring a licensed or consultant pharmacist to serve
   35         as the prescription department manager of a remote
   36         site; requiring remote-site pharmacies to notify the
   37         Department of Health of a change in the pharmacy’s
   38         prescription department manager within a specified
   39         timeframe; providing requirements for remote-site
   40         pharmacies; providing that remote-site pharmacies are
   41         not considered pharmacy locations for purposes of
   42         network access in managed care programs; authorizing
   43         remote-site pharmacies to store, hold, and dispense
   44         medicinal drugs; prohibiting remote-site pharmacies
   45         from performing centralized prescription filling;
   46         requiring prescription department managers to visit
   47         remote sites, based on a certain schedule, to perform
   48         specified tasks; authorizing registered pharmacists to
   49         serve as prescription department managers for up to
   50         three remote-site pharmacies under certain
   51         circumstances; amending s. 465.022, F.S.; exempting
   52         registered pharmacists serving as prescription
   53         department managers for remote-site pharmacies from
   54         certain practice limitations; amending s. 465.0265,
   55         F.S.; providing applicability; amending s. 893.05,
   56         F.S.; prohibiting telehealth providers from
   57         prescribing specified controlled substances through
   58         telehealth; providing an effective date.
   60  Be It Enacted by the Legislature of the State of Florida:
   62         Section 1. Present subsections (22) through (26) of section
   63  409.908, Florida Statutes, are redesignated as subsections (23)
   64  through (27), respectively, and a new subsection (22) is added
   65  to that section, to read:
   66         409.908 Reimbursement of Medicaid providers.—Subject to
   67  specific appropriations, the agency shall reimburse Medicaid
   68  providers, in accordance with state and federal law, according
   69  to methodologies set forth in the rules of the agency and in
   70  policy manuals and handbooks incorporated by reference therein.
   71  These methodologies may include fee schedules, reimbursement
   72  methods based on cost reporting, negotiated fees, competitive
   73  bidding pursuant to s. 287.057, and other mechanisms the agency
   74  considers efficient and effective for purchasing services or
   75  goods on behalf of recipients. If a provider is reimbursed based
   76  on cost reporting and submits a cost report late and that cost
   77  report would have been used to set a lower reimbursement rate
   78  for a rate semester, then the provider’s rate for that semester
   79  shall be retroactively calculated using the new cost report, and
   80  full payment at the recalculated rate shall be effected
   81  retroactively. Medicare-granted extensions for filing cost
   82  reports, if applicable, shall also apply to Medicaid cost
   83  reports. Payment for Medicaid compensable services made on
   84  behalf of Medicaid eligible persons is subject to the
   85  availability of moneys and any limitations or directions
   86  provided for in the General Appropriations Act or chapter 216.
   87  Further, nothing in this section shall be construed to prevent
   88  or limit the agency from adjusting fees, reimbursement rates,
   89  lengths of stay, number of visits, or number of services, or
   90  making any other adjustments necessary to comply with the
   91  availability of moneys and any limitations or directions
   92  provided for in the General Appropriations Act, provided the
   93  adjustment is consistent with legislative intent.
   94         (22) Subject to any limitations or directions provided in
   95  the General Appropriations Act, the agency shall reimburse the
   96  use of telehealth as defined by s. 456.47, to include services
   97  provided in real time, services provided using store-and-forward
   98  technologies, and remote patient monitoring services to the
   99  extent that these technologies are available.
  100         (a)Providers using any modality described in this
  101  subsection must ensure that treatment services are medically
  102  necessary and performed within a provider’s scope of practice
  103  and any applicable supervision requirements.
  104         (b)Providers must include documentation regarding the use
  105  of telehealth in the medical record or progress notes for each
  106  encounter with a recipient.
  107         (c)Out-of-state providers who are registered under s.
  108  456.47(4) and enrolled in Florida Medicaid as an out-of-state
  109  provider may be reimbursed for telehealth services provided to
  110  recipients in this state.
  111         (d)Reimbursement under this subsection does not cover the
  112  purchase of any general telecommunications equipment that is not
  113  specific to or used solely for the provision of telehealth,
  114  including, but not limited to, computers, tablets, cell phones,
  115  smartphones, or any other similar equipment or device.
  116         Section 2. Present paragraphs (h) and (i) of subsection (4)
  117  of section 456.47, Florida Statutes, are redesignated as
  118  paragraphs (i) and (j), respectively, a new paragraph (h) is
  119  added to that subsection, paragraph (f) is added to subsection
  120  (2) of that section, and paragraph (a) of subsection (1),
  121  paragraph (c) of subsection (2), and paragraph (c) of subsection
  122  (4) of that section are amended, to read:
  123         456.47 Use of telehealth to provide services.—
  124         (1) DEFINITIONS.—As used in this section, the term:
  125         (a) “Telehealth” means the use of synchronous or
  126  asynchronous telecommunications technology by a telehealth
  127  provider to provide or supervise the provision of health care
  128  services, including, but not limited to, assessment, diagnosis,
  129  consultation, treatment, and monitoring of a patient; transfer
  130  of medical data; patient and professional health-related
  131  education; public health services; and health administration.
  132  The term includes does not include audio-only telephone calls,
  133  personal e-mail messages, or facsimile transmissions, and any
  134  other nonpublic-facing telecommunications technology.
  135         (2) PRACTICE STANDARDS.—
  136         (c) A telehealth provider, acting within the scope of his
  137  or her practice and in accordance with chapter 893, may not use
  138  telehealth to prescribe a controlled substance listed in
  139  Schedule III, Schedule IV, or Schedule V of s. 893.03 unless the
  140  controlled substance is prescribed for the following:
  141         1. The treatment of a psychiatric disorder;
  142         2. Inpatient treatment at a hospital licensed under chapter
  143  395;
  144         3. The treatment of a patient receiving hospice services as
  145  defined in s. 400.601; or
  146         4. The treatment of a resident of a nursing home facility
  147  as defined in s. 400.021.
  148         (f)A nonphysician health care practitioner, including, but
  149  not limited to, an advanced practice registered nurse, a
  150  certified registered nurse anesthetist, or a physician
  151  assistant, who is required to maintain a formal supervisory
  152  relationship with a physician may satisfy such requirement
  153  through telehealth.
  155         (c) The website of a telehealth provider registered under
  156  paragraph (b) must prominently display a hyperlink to the
  157  department’s website containing information required under
  158  paragraph (i)(h).
  159         (h)A physician registered under this subsection may use
  160  telehealth to engage in a formal supervisory relationship with a
  161  nonphysician health care practitioner in this state, including
  162  but not limited to, an advanced practice registered nurse, a
  163  certified registered nurse anesthetist, or a physician
  164  assistant. However, such supervision may not be for the
  165  provision of any health care service that requires direct
  166  supervision under the applicable laws and rules in this state.
  167         Section 3. Paragraph (f) of subsection (2) of section
  168  458.347, Florida Statutes, is amended to read:
  169         458.347 Physician assistants.—
  170         (2) DEFINITIONS.—As used in this section:
  171         (f) “Supervision” means responsible supervision and
  172  control. Except in cases of emergency, supervision requires the
  173  easy availability or physical presence of the licensed physician
  174  for consultation and direction of the actions of the physician
  175  assistant. For the purposes of this definition, the term “easy
  176  availability” includes the ability to communicate by way of
  177  telehealth as defined in s. 456.47(1) telecommunication. The
  178  boards shall establish rules as to what constitutes responsible
  179  supervision of the physician assistant.
  180         Section 4. Paragraph (f) of subsection (2) of section
  181  459.022, Florida Statutes, is amended to read:
  182         459.022 Physician assistants.—
  183         (2) DEFINITIONS.—As used in this section:
  184         (f) “Supervision” means responsible supervision and
  185  control. Except in cases of emergency, supervision requires the
  186  easy availability or physical presence of the licensed physician
  187  for consultation and direction of the actions of the physician
  188  assistant. For the purposes of this definition, the term “easy
  189  availability” includes the ability to communicate by way of
  190  telehealth as defined in s. 456.47(1) telecommunication. The
  191  boards shall establish rules as to what constitutes responsible
  192  supervision of the physician assistant.
  193         Section 5. Subsection (11) of section 465.003, Florida
  194  Statutes, is amended to read:
  195         465.003 Definitions.—As used in this chapter, the term:
  196         (11)(a) “Pharmacy” includes a community pharmacy, an
  197  institutional pharmacy, a nuclear pharmacy, a special pharmacy,
  198  and an Internet pharmacy, and a remote-site pharmacy.
  199         1. The term “community pharmacy” includes every location
  200  where medicinal drugs are compounded, dispensed, stored, or sold
  201  or where prescriptions are filled or dispensed on an outpatient
  202  basis.
  203         2. The term “institutional pharmacy” includes every
  204  location in a hospital, clinic, nursing home, dispensary,
  205  sanitarium, extended care facility, or other facility,
  206  hereinafter referred to as “health care institutions,” where
  207  medicinal drugs are compounded, dispensed, stored, or sold.
  208         3. The term “nuclear pharmacy” includes every location
  209  where radioactive drugs and chemicals within the classification
  210  of medicinal drugs are compounded, dispensed, stored, or sold.
  211  The term “nuclear pharmacy” does not include hospitals licensed
  212  under chapter 395 or the nuclear medicine facilities of such
  213  hospitals.
  214         4. The term “special pharmacy” includes every location
  215  where medicinal drugs are compounded, dispensed, stored, or sold
  216  if such locations are not otherwise defined in this subsection.
  217         5. The term “Internet pharmacy” includes locations not
  218  otherwise licensed or issued a permit under this chapter, within
  219  or outside this state, which use the Internet to communicate
  220  with or obtain information from consumers in this state and use
  221  such communication or information to fill or refill
  222  prescriptions or to dispense, distribute, or otherwise engage in
  223  the practice of pharmacy in this state. Any act described in
  224  this definition constitutes the practice of pharmacy as defined
  225  in subsection (13).
  226         6.The term “remote-site pharmacy” or “remote site”
  227  includes every location where medicinal drugs are compounded or
  228  dispensed by a registered pharmacy technician who is remotely
  229  supervised by an off-site pharmacist acting in the capacity of a
  230  prescription department manager.
  231         (b) The pharmacy department of any permittee shall be
  232  considered closed whenever a Florida licensed pharmacist is not
  233  present and on duty. The term “not present and on duty” may
  234  shall not be construed to prevent any of the following:
  235         1. A pharmacist from exiting the prescription department
  236  for the purposes of consulting or responding to inquiries or
  237  providing assistance to patients or customers.
  238         2.A pharmacist from, attending to personal hygiene needs.
  239         3.A pharmacist from, or performing any other function for
  240  which the pharmacist is responsible, provided that such
  241  activities are conducted in a manner consistent with the
  242  pharmacist’s responsibility to provide pharmacy services.
  243         4.An off-site pharmacist, acting in the capacity of a
  244  prescription department manager, from remotely supervising a
  245  registered pharmacy technician at a remote-site pharmacy.
  246         Section 6. Subsection (1) of section 465.014, Florida
  247  Statutes, is amended to read:
  248         465.014 Pharmacy technician.—
  249         (1) A person other than a licensed pharmacist or pharmacy
  250  intern may not engage in the practice of the profession of
  251  pharmacy, except that a licensed pharmacist may delegate to
  252  pharmacy technicians who are registered pursuant to this section
  253  those duties, tasks, and functions that do not fall within the
  254  purview of s. 465.003(13), and a registered pharmacy technician
  255  operating under remote supervision of an off-site pharmacist
  256  under s. 465.0198 may compound and dispense medicinal drugs
  257  under such supervision. All such delegated acts must be
  258  performed under the direct supervision of a licensed pharmacist
  259  who is responsible for all such acts performed by persons under
  260  his or her supervision. A registered pharmacy technician, under
  261  the supervision of a pharmacist, may initiate or receive
  262  communications with a practitioner or his or her agent, on
  263  behalf of a patient, regarding refill authorization requests. A
  264  licensed pharmacist may not supervise more than one registered
  265  pharmacy technician, except as provided in s. 465.0198 or unless
  266  otherwise permitted by the guidelines adopted by the board. The
  267  board shall establish guidelines to be followed by licensees or
  268  permittees in determining the circumstances under which a
  269  licensed pharmacist may supervise more than one pharmacy
  270  technician.
  271         Section 7. Paragraph (b) of subsection (1) and paragraph
  272  (b) of subsection (2) of section 465.015, Florida Statutes, are
  273  amended to read:
  274         465.015 Violations and penalties.—
  275         (1) It is unlawful for any person to own, operate,
  276  maintain, open, establish, conduct, or have charge of, either
  277  alone or with another person or persons, a pharmacy:
  278         (b) In which a person not licensed as a pharmacist in this
  279  state or not registered as an intern in this state or in which
  280  an intern who is not acting under the direct and immediate
  281  personal supervision of a licensed pharmacist fills, compounds,
  282  or dispenses any prescription or dispenses medicinal drugs. This
  283  paragraph does not apply to any person who owns, operates,
  284  maintains, opens, establishes, conducts, or has charge of a
  285  remote site pursuant to s. 465.0198.
  286         (2) It is unlawful for any person:
  287         (b) To fill, compound, or dispense prescriptions or to
  288  dispense medicinal drugs if such person does not hold an active
  289  license as a pharmacist in this state, is not registered as an
  290  intern in this state, or is an intern not acting under the
  291  direct and immediate personal supervision of a licensed
  292  pharmacist, or is not a registered pharmacy technician at a
  293  remote-site pharmacy acting under remote supervision of a
  294  licensed pharmacist pursuant to s. 465.0198.
  295         Section 8. Section 465.0198, Florida Statutes, is created
  296  to read:
  297         465.0198 Remote-site pharmacy permits.—
  298         (1)As used in this section, the term “supervising
  299  pharmacy” means a pharmacy licensed in this state which employs
  300  a licensed pharmacist who remotely supervises a registered
  301  pharmacy technician at a remote-site pharmacy.
  302         (2)Any person desiring a permit to operate a remote-site
  303  pharmacy must apply to the department. If the board certifies
  304  that the application complies with the laws and rules of the
  305  board, the department must issue the permit. A permit may not be
  306  issued unless a licensed pharmacist or consultant pharmacist is
  307  designated as the prescription department manager responsible
  308  for the oversight of the remote site. The permittee must notify
  309  the department within 10 days after any change of the
  310  prescription department manager.
  311         (3)A remote-site pharmacy must comply with all of the
  312  following:
  313         (a)Be jointly owned by or operated under a contract with a
  314  supervising pharmacy.
  315         (b)Maintain a video surveillance system that records
  316  continuously 24 hours per day and retain video surveillance
  317  recordings for at least 45 days.
  318         (c)Display a sign visible to the public indicating that
  319  the location is a remote-site pharmacy and that the facility is
  320  under 24-hour video surveillance.
  321         (d)Maintain a policies and procedures manual, which must
  322  be made available to the board or its agent upon request, and
  323  must include, but need not be limited to, all of the following:
  324         1.A description of how the pharmacy will comply with
  325  federal and state laws and rules.
  326         2.The procedures for supervising the remote site and
  327  counseling its patients.
  328         3.The procedures for reviewing the prescription drug
  329  inventory and drug records maintained by the remote site.
  330         4.The policies and procedures for providing security
  331  adequate to protect the confidentiality and integrity of patient
  332  information.
  333         5.The written plan for recovery from an event that
  334  interrupts or prevents the prescription department manager from
  335  supervising the remote site’s operation.
  336         6.The procedures for use of the state prescription drug
  337  monitoring program by the prescription department manager before
  338  he or she may authorize the dispensing of any controlled
  339  substance.
  340         7.The procedures for maintaining a perpetual inventory of
  341  the controlled substances listed in s. 893.03(2).
  342         8.The specific duties, tasks, and functions that
  343  registered pharmacy technicians are authorized to perform at the
  344  remote site.
  345         (4)A remote-site pharmacy is not considered a pharmacy
  346  location for purposes of network access in managed care
  347  programs.
  348         (5)A remote-site pharmacy may store, hold, or dispense any
  349  medicinal drug.
  350         (6)A remote-site pharmacy may not perform centralized
  351  prescription filling as defined in s. 465.003(16).
  352         (7)The prescription department manager must visit the
  353  remote site, based on a schedule determined by the board, to
  354  inspect the pharmacy, address personnel matters, and provide
  355  clinical services for patients.
  356         (8)A registered pharmacist may serve as the prescription
  357  department manager for up to three remote-site pharmacies that
  358  are under common control of the same supervising pharmacy.
  359         Section 9. Paragraph (c) of subsection (11) of section
  360  465.022, Florida Statutes, is amended to read:
  361         465.022 Pharmacies; general requirements; fees.—
  362         (11) A permittee must notify the department of the identity
  363  of the prescription department manager within 10 days after
  364  employment. The prescription department manager must comply with
  365  the following requirements:
  366         (c) A registered pharmacist may not serve as the
  367  prescription department manager in more than one location,
  368  except as authorized under s. 465.0198, unless approved by the
  369  board.
  370         Section 10. Subsection (1) of section 465.0265, Florida
  371  Statutes, is amended to read:
  372         465.0265 Centralized prescription filling.—
  373         (1) A pharmacy licensed under this chapter may perform
  374  centralized prescription filling for another pharmacy, provided
  375  that the pharmacies have the same owner or have a written
  376  contract specifying the services to be provided by each
  377  pharmacy, the responsibilities of each pharmacy, and the manner
  378  in which the pharmacies will comply with federal and state laws,
  379  rules, and regulations. This subsection does not apply to a
  380  remote-site pharmacy.
  381         Section 11. Paragraph (e) is added to subsection (1) of
  382  section 893.05, Florida Statutes, to read:
  383         893.05 Practitioners and persons administering controlled
  384  substances in their absence.—
  385         (1)
  386         (e) A telehealth provider as defined in s. 456.47 may not
  387  prescribe through telehealth a controlled substance listed in
  388  Schedule I or Schedule II of s. 893.03.
  389         Section 12. This act shall take effect July 1, 2021.