On June 25, Florida Governor Ron DeSantis signed into law HB 23, which sets up guidelines for telehealth services in Florida. The legislation took effect July 1.
Among other things, the law creates new practice standards for how telehealth can be used and by whom, registration of out-of-state telehealth providers, where telehealth services can be provided, and provisions relating to reimbursement.
The key provisions are as follows:
Definition of Telehealth: The use of synchronous (real time) or asynchronous (store and forward) telecommunications technology by a telehealth provider to provide healthcare services, including, but not limited to: assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term telehealth does not refer to audio only phone calls, e-mail messages or FAX transmissions.
Definition of Telehealth Provider: Any individual who provides healthcare and related services using telehealth including, but not limited to: a licensed physician, optometrist, nurse or nurse practitioner, optometrist, dentist, chiropractor, pharmacist, midwife, speech pathologist, audiologist, occupational therapist, acupuncturist, radiologist, dietician, respiratory therapist, orthotist, optician, hearing aid specialist, physical therapist, psychologist, clinical social worker, mental health counselor, psychotherapist, marriage and family therapist, behavior analyst, pedorthist, prosthetist, electrologist, massage therapist, medical physicist, basic or advanced life support service, or air ambulance service. A telehealth provider also includes an individual licensed under a multistate healthcare licensure compact of which Florida is a member state, or someone who obtains an out-of-state telehealth registration.
The law also establishes the following practice standards:
Scope of Practice: A telehealth provider has the duty to practice in a manner consistent with his or her scope of practice and the prevailing professional standard of practice for a healthcare professional who provides in-person healthcare services to patients in this state.
Exams: A telehealth provider may use telehealth to perform a patient evaluation. If a telehealth provider conducts a patient evaluation sufficient to diagnose and treat the patient, the telehealth provider is not required to research a patient’s medical history or conduct a physical examination of the patient before using telehealth to provide healthcare services.
Prescribing: A telehealth provider may not use telehealth to prescribe a controlled substance unless the controlled substance is prescribed for the the treatment of a psychiatric disorder; inpatient treatment at a hospital; the treatment of a patient receiving hospice services; the treatment of a resident of a nursing home facility.
Medical Records: A telehealth provider shall document in the patient’s medical record the healthcare services rendered using telehealth according to the same standard used for in-person services. Medical records, including video, audio, electronic, or other records generated as a result of providing such services are confidential.
Registration of out-of-state providers: A healthcare professional who is not licensed in Florida may provide healthcare services to a patient located in Florida using telehealth if the healthcare professional registers with the applicable board, or the department if there is no board, and provides healthcare services within the applicable scope of practice.
In order to obtain an out-of-state registration the healthcare professional must do the following:
- Complete an application;
- Have an active, unencumbered license issued by another state that is substantially similar to a license issued to a Florida-licensed provider;
- Has not been the subject of disciplinary action relating to his or her license during the 5-year period immediately prior to the submission of the application;
- A healthcare professional may not register if his or her license is subject to pending disciplinary investigation or action, or has been revoked;
- If a healthcare professional who is registered in Florida has restrictions placed on his or her license or has disciplinary action taken or pending, they must provide notification within five business days after the restriction or disciplinary action is initiated;
- Designate a duly appointed registered agent for service of process in Florida;
- Maintain professional liability coverage or financial responsibility that includes coverage or financial responsibility for telehealth services provided to patients not located in the provider’s home state in in amounts equal to, or greater than, what are required for a Florida-licensed practitioner;
- May not open an office in Florida and may not provide in-person healthcare services to patients in Florida;
- Pharmacists providing telehealth services must use a Florida-licensed pharmacy or a registered non-Florida pharmacy or outsourcing facility to dispense drugs to patients located in Florida.
Exemptions: A healthcare professional who is not licensed to provide healthcare services in Florida, but who holds an active license to provide healthcare services in another state or jurisdiction, and who provides healthcare services using telehealth to a patient located in this state, is not subject to the registration requirement if the services are provided:
- In response to an emergency medical condition;
- In consultation with a healthcare professional licensed in Florida who has ultimate authority over the diagnosis and care of the patient.
Reimbursement: The bill allows payers and providers to negotiate their own rates, but it does not require health plans to cover telehealth services. The bill reads as follows:
“A contract between a health maintenance organization issuing major medical individual or group coverage and a telehealth provider … must be voluntary between the health maintenance organization and the provider must establish mutually acceptable payment rates or payment methodologies for services provided through telehealth. Any contract provision that distinguishes between payment rates or payment methodologies for services provided through telehealth and the same services provided without the use of telehealth must be initialed by the telehealth provider.”
According to the American Hospital Association, nearly every state Medicaid program has some form of coverage for telehealth services, but private insurers haven’t been as quick to provide coverage, though more are embracing it.
Once the exception, telemedicine is being embraced by providers and patients as a way to deliver and access quality and cost-effective care.
The Health Law Offices of Anthony C. Vitale assists providers with a variety of matters relating to the provision of telemedicine including contracts and compliance. Give us a call at 305-358-4500, or send an email to email@example.com and let’s discuss how we might be able to assist you.