2015 Florida
Legislative
Session
Wrap-Up
May 2015
Telehealth Summary
Dear Fellow Taxpayer,
Each spring, the elected members of the Florida Legislature return to Tallahassee
to perform their roles as the representatives of the people of the Sunshine State.
Surrounded by interest groups both large and small, regular citizens and high-powered
lobbyists, our senators and representatives propose and debate new laws and attempt to
meet the needs of their constituents.
The 2015 Regular Session will be remembered as a unique one, with an unusual
ending that has not been seen in Florida in decades. On top of the progress of many
bills coming to an abrupt end, the Legislature failed to pass its only required piece of
legislation: a budget.
During Session, Florida TaxWatch provides on our website the public a weekly recap of
bills related to the issues that we are following, including economic development, health
care, criminal and juvenile justice, and education policies and programs.
This publication is a final look at legislation related to telehealth, one of the top issues
covered by TaxWatch.
For more information on TaxWatch research on this issue, please visit
http://www.floridataxwatch.org/telehealth
Sincerely,
Dominic M. Calabro
President & CEO
1
Note: Florida TaxWatch has recommended expanding the use of telehealth in Florida
by creating a legislative framework in its March 2014 report, “Critical Connections to
Care,” and advancing public policy to remain nationally competitive in its November
2014 report, “Time for Telehealth.” In addition, Florida TaxWatch hosted the Telehealth
Cornerstone Conference in November 2014 and will be hosting the Second Annual
Telehealth Conference in September 2015. This 2015 Florida Legislative Session Wrap-
Up Summary was prepared for its members and telehealth partners. If you would like to
be included on future telehealth mailings and conference calls, please contact Stephani
Meyers at smeyers@floridataxwatch.org.
Telehealth Research Background
The Sunshine State prides itself on being an ideal location to live, work, and play. While Florida,
now the nation’s third most populous state, remains competitive across areas such as economic
development, business opportunities, cutting-edge research, and arguably leads the nation in
tourism, Florida lags behind a majority of states when it comes to addressing the health access needs
of its large, rapidly growing, diversely-aged population. In the Sunshine State, where more than 24
percent of the population is estimated to be ages 65 years and older by 2030, geographic and status
disparities in health as noted by America’s Health Rankings place Florida in the bottom quintile of
all states. Projected health workforce needs further suggest that long-term health planning solutions
are needed to ensure a healthy Florida going forward. In the midst of health financing uncertainties,
research suggests that telehealth could play a major role in health care delivery. Telehealth can reduce
certain health care expenses, with a mere one percent reduction to annual Florida hospital-related
charges through less-costly, timely, and appropriate health care via telehealth saving approximately $1
billion or more.
In the time that Florida considered telehealth legislation this session, other states were continuing to
advance policy, putting Florida even further behind in comparison. For example, in May 2015, the
American Telemedicine Association reported that 35 states and Washington D.C. received higher
composite scores than Florida in coverage and reimbursement for telehealth, up from 28 states and
Washington D.C. in September 2014.
Telehealth Legislative Background in Florida
After several years of attempted legislation, the business and health industries pushed telehealth as a
top priority issue heading into the 2014 Legislative Session, when four telemedicine bills: SB 70, HB
167, HB 751, and SB 1646 were introduced. Although the issue ultimately failed to pass as part of
a surviving omnibus health bill package (PCS for CS/HB 7113), it was championed heavily prior to
2
the start of the 2015 Legislative Session, and did stand a significant chance of being enacted into law,
prior to legislative impasse primarily centered on issues that included Medicaid expansion and Low
Income Pool (LIP) funding. The bills introduced this session show a movement toward Senate and
House consensus for a foundational telehealth law.
Following months of legislator and stakeholder discussions and media push in favor of telehealth
legislation, the 2015 Legislative Session saw two telehealth bills actively move through committees
of reference: CS/HB 545 and CS/SB 478. Unlike previous session bills, which contemplated a
broad spectrum of issues that included reimbursement, mandates, and licensure, the 2015 bills
were narrowly crafted to provide a foundational basis for telehealth. CS/HB 545 was not heard in
its last committee of reference prior to cessation of House committee meetings, and no additional
movement occurred after mid-March. CS/SB 478, while making to the full Senate Appropriations
Committee, its last committee of reference, remained unheard and was not revived in the
tumultuous last week of the 2015 Legislative Session. Below is a brief summary of where the final bill
versions are the same and where they differ, followed by a detailed review of each bill separately, both
final and prior versions.
CS/HB 545 & CS/SB 478 – HigHligHts of WHere Current Bill Versions are tHe same
“Telehealth” – Excludes audio-only, e-mail, and fax, but specifically includes public health and health
care administration.
• Health care provider chapters specifically included as “telehealth providers”: acupuncture,
allopathic and osteopathic medicine, chiropractic medicine, podiatric medicine, optometry,
nursing, dentistry, midwifery, speech-language pathology and audiology, occupational
therapy, radiology personnel, respiratory therapy, diet and nutrition, athletic trainers,
orthotics/prosthetics, electrolysis, massage, clinical laboratory personnel, medical physicists,
optical devices/hearing aids, physical therapy, psychology, clinical counseling and
psychotherapy, and medical transportation services (emergency medical technicians and
paramedics). Note: PCS to CS/SB 478 was made more expansive by including certified behavior
analysts.
• Standard of care for telehealth is the same as in-person
• Telehealth patient evaluation sufficient to diagnose and treat without in-person exam
or research of patient medical history (Note: who deems sufficient different)
• Non-physician telehealth provider acting within own scope of practice is not
practicing medicine (Note: reference to practice act varies)
3
• Authorized prescribers can prescribe Schedules II-V; no chronic non-malignant pain except
if a physician is treating a hospital inpatient (Note: CS/SB 478 more expansive by including
advanced registered nurse practitioners and treatment of hospice patients.)
• Record keeping same as in-person
• Excludes telehealth products from definition of “discount medical plan” under 636.202
CS/HB 545 & PCS to CS/SB 478 – HigHligHts of WHere final Bill Versions Differ
Final Version of CS/HB 545
Final Version (PCS) of CS/SB 478
Creates 456.47
Creates 456.4501
Provider and patient may be “in any
location”
Provider and patient may be “in separate
locations”
Excludes all consultations
Excludes consultations between FL telehealth
provider and licensed out-of-state providers
when the FL provider maintains responsibility
Standard of care determines evaluation
sufficiency
Provider determines evaluation sufficiency
Authorized prescribers can prescribe
Schedules II-V; no chronic non-malignant
pain except if a hospital
Authorized prescribers can prescribe Schedules
I-V; no chronic non-malignant pain except if
physician or ARNP prescribing for hospital
in-patient or hospice
No eye-specific prohibition.
Eye-specific prohibition: Cannot tele-prescribe
optical devices (e.g., contacts, glasses) based
only on refractive error shown by computer-
controlled device
4
SB 478
History of Cs/sB 478
CS/SB 478, sponsored by the Senate Health Policy Committee and introduced by Chairman
Aaron Bean and Senator Arthenia Joyner, covered an array of telehealth policy issues. It underwent
a series of language changes, including a Medicaid reference removal, a change of reference from
“telemedicine services” to “telehealth,” and additional defining of providers, practice standards,
prescribing, eye care, and record-keeping, before being voted favorably with a committee substitute
adopted. The final version was similar to the House position in the final CS/HB 545 with exceptions
to wording, consultations, breadth of teleprescribing restrictions (ARNPs), and eye care.
CS/SB 478 passed favorably out of Health Policy with committee substitute, underwent a first
reading, and then passed favorably Appropriations Subcommittee on Health and Human Services
with another committee substitute. At the end of session, it remained unheard in the Senate
Appropriations Committee. Senate staff analyses are available.
The following is a history of the bill from originally introduced text to where the bill text currently
stands. For a snapshot look at how the final (PCS) version of CS/SB 478 compares with the
previous versions of this bill, please see the table on pages 8-9.
summary of sB 478 as originally introDuCeD
sB 478 creates a new section of Chapter 456 (456.4501), defines “telemedicine services,” references
certain providers, prescribing, rulemaking, and emergency medical service provisions. The bill
defines “telemedicine services” to specifically exclude “audio-only transmissions, e-mail messages,”
and “facsimile transmissions.” The definition of “telemedicine services” specifically includes various
purposes and technologies, of note both “synchronous and asynchronous telecommunications…
consultation…monitoring…and patient and professional health-related education.”
Medical transportation services personnel (emergency medical technicians and paramedics) or a
“health care practitioner” may provide telemedicine services to Florida residents. The services “shall
be covered by Medicaid under parts III and IV of chapter 409 in the same manner” as in-person
services. Also, prescribers cannot use telehealth to prescribe controlled substances for chronic non-
malignant pain (as defined in general health professions laws) without exception or reference to
Schedules. In addition, the Department of Health and applicable regulatory boards are granted
rulemaking authority but any rules cannot prohibit telemedicine use. Furthermore, this new section
may not be read as restricting the delivery of emergency medical services.
The effective date is July 1, 2015.
5
Amendments to sB 478 as originally introDuCeD
On February 16, Chairman Bean offered a strike-all amendment to SB 478 as originally introduced,
Bar Code 813832. Senator Galvano successfully offered an amendment to the amendment, Bar
Code 539316, which prohibited telehealth use for prescribing corrective eyewear and other optical
devices or prescribe based “solely on the refractive error of the human eye generated by a computer-
controlled device such as an autorefractor.” These changes are collectively reflected in the summary
for the intermediate (first) version of CS/SB 478 below.
summary of tHe intermeDiate (first) Version of Cs/sB 478
Cs/sB 478 creates a new section of Chapter 456 (456.4501), defines: telehealth, telehealth provider,
prescription boundaries, practice standards, and record-keeping. The bill defines “telehealth”
to specifically exclude “audio-only transmissions, e-mail messages, facsimile transmissions, or
consultations between a telehealth provider in this state and a provider lawfully licensed in another
state when the provider licensed in this state maintains responsibility for the care of a patient in this
state.” The definition of “telehealth” specifically includes various purposes and technologies, of note
both “synchronous and asynchronous telecommunications…consultation…monitoring…patient
and professional health-related education, public health services, and health care administration.”
A “telehealth provider” is explicitly defined to include a broad spectrum of statutorily-recognized
professionals in health care areas: acupuncture, allopathic and osteopathic medicine, chiropractic
medicine, podiatric medicine, optometry, nursing, dentistry, midwifery, speech-language pathology
and audiology, occupational therapy, radiology personnel, respiratory therapy, diet and nutrition,
athletic trainers, orthotics/prosthetics, electrolysis, massage, clinical laboratory personnel, medical
physicists, optical devices/hearing aids, physical therapy, psychology, clinical counseling and
psychotherapy, and medical transportation services (emergency medical technicians and paramedics).
The standard of care for a telehealth provider is the same as that “generally accepted” for health care
professional providing in-person care. If the provider conducts a patient evaluation, which can be
performed via telehealth, “sufficient to diagnose and treat the patient,” there is no requirement of
either researching a patient’s medical history or conducting a physical exam before providing services
via telehealth. The provider and patient may be “in separate locations” when telehealth services
are provided. Also, a non-physician telehealth provider who is acting within his or her relevant,
previously noted, scope of practice is not deemed to be practicing medicine without a license.
In addition, prescribers can teleprescribe controlled substances in Schedules I through V, but cannot
use telehealth to prescribe controlled substances for chronic non-malignant pain (as statutorily-
defined in allopathic medicine laws) with an exception for the treatment of hospital inpatients and
6
hospice patients. Furthermore, providers may not use telehealth to prescribe optical devices such as
glasses or contact lenses based exclusively on the refractive error of the human eye generated by a
computer-controlled device.
Finally, record-keeping standards for telehealth services are the same as those used for in-person care.
The effective date is July 1, 2015.
Amendments to tHe intermeDiate (first) Version of Cs/sB 478
On April 13, Senator Bean offered an amendment to the intermediate (first) version of CS/SB
478 at line 63, Bar Code 620994. This amendment mirrored House bill language (CS/HB 545)
excluding telehealth products from the statutory definition of “discount medical plan.” In addition,
the amendment expanded statutory references to the definition of “chronic nonmalignant pain”
to include a definition under osteopathic medicine. The newly-referenced definition is identical
to that under allopathic medicine, which was already included in prior bill versions. (“Chronic
nonmalignant pain” means pain unrelated to cancer which persists beyond the usual course of
disease or the injury that is the cause of the pain or more than 90 days after surgery). Finally, the
amendment did not preclude “a physician” from using telehealth to order controlled substance for a
hospital inpatient or hospice patient.
On April 14, Senator Bean offered a substitute amendment, Bar Code 596394, to that just described
in the previous paragraph above. The substitute amendment was identical with one notable
exception: the amendment did not preclude “a practitioner licensed under chapter 458 or chapter
459 or an advanced registered nurse practitioner certified under s. 464.012” from using telehealth to
order controlled substance for a hospital inpatient or hospice patient.
Senator Bean offered another amendment at line 39 on April 14th, Bar Code 707614. This
amendment expanded the definition of “telehealth provider” to include certified behavior analysts.
summary of final Version (PCs) of Cs/sB 478
The Final Version/Proposed Committee Substitute (PCS) to CS/SB 478 filed on April 16, creates
a new section of Chapter 456 (456.4501), defines telehealth, telehealth provider, prescription
boundaries, practice standards, and record-keeping. The bill defines “telehealth” to specifically
exclude “audio-only transmissions, e-mail messages, facsimile transmissions,” and “consultations”
without exception. The definition of “telehealth” specifically includes various purposes and
technologies, of note both “synchronous and asynchronous telecommunications… monitoring…
patient and professional health-related education, public health services, and health care
administration.”
7
A “telehealth provider” is explicitly defined to include a broad spectrum of statutorily-recognized
professionals in health care areas: acupuncture, allopathic and osteopathic medicine, chiropractic
medicine, podiatric medicine, optometry, nursing, dentistry, midwifery, speech-language pathology
and audiology, occupational therapy, radiology personnel, respiratory therapy, diet and nutrition,
athletic trainers, orthotics/prosthetics, electrolysis, massage, clinical laboratory personnel, medical
physicists, optical devices/hearing aids, physical therapy, psychology, clinical counseling and
psychotherapy, medical transportation services (emergency medical technicians and paramedics), and
certified behavior analysts.
The standard of care for a telehealth provider is the same as that for a health care professional
providing in-person care. If the provider conducts a patient evaluation, which can be performed
via telehealth, “in a manner consistent with the applicable standard of care sufficient to diagnose
and treat the patient,” there is no requirement of either researching a patient’s medical history or
conducting a physical exam before providing services via telehealth. The provider and patient may
be “in any location” when telehealth services are provided. Also, a non-physician telehealth provider
who is acting within his or her applicable scope of practice is not deemed to be practicing medicine
without a license.
In addition, prescribers can teleprescribe controlled substances in Schedules I through V, but cannot
use telehealth to prescribe controlled substances for chronic non-malignant pain (as statutorily-
defined in either allopathic or osteopathic medicine laws) with an exception for the treatment of
hospital inpatients and hospice patients by “a practitioner licensed under chapter 458 or chapter 459
or an advanced registered nurse practitioner certified under s. 464.012.” Furthermore, providers may
not use telehealth to prescribe optical devices such as glasses or contact lenses based exclusively on
the refractive error of the human eye generated by a computer-controlled device.
Furthermore, record-keeping standards for telehealth services are the same as those used for in-
person care.
Finally, “any telehealth product regulated under s. 456.47” is explicitly excluded from the term
“discount medical plan” as defined in s. 636.202, Florida Statutes.
The effective date is July 1, 2015.
8
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