Florida 2022 Regular Session

Florida House Bill H1087 Compare Versions

Only one version of the bill is available at this time.

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3	3	HB 1087 2022
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7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb1087-00
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10	10	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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14	14	A bill to be entitled 1
15	15	An act relating to insurance coverage for telehealth 2
16	16	services; amending s. 409.967, F.S.; prohibiting 3
17	17	Medicaid managed care plans from using providers who 4
18	18	provide services exclusively through telehealth to 5
19	19	achieve network adequacy; amending s. 627.42396, F .S.; 6
20	20	prohibiting certain health insurance policies from 7
21	21	denying coverage for covered services provided through 8
22	22	telehealth under certain circumstances; prohibiting 9
23	23	health insurers from excluding covered services 10
24	24	provided through telehealth from coverage; pr oviding 11
25	25	reimbursement requirements and cost -sharing 12
26	26	limitations for health insurers relating to telehealth 13
27	27	services; prohibiting health insurers from requiring 14
28	28	insured persons to receive services through 15
29	29	telehealth; authorizing health insurers to conduct 16
30	30	utilization reviews under certain circumstances; 17
31	31	authorizing health insurers to limit telehealth 18
32	32	services to certain providers; deleting requirements 19
33	33	for contracts between certain health insurers and 20
34	34	telehealth providers; amending s. 627.6699, F.S.; 21
35	35	requiring certain small employer benefit plans to 22
36	36	comply with certain requirements for reimbursement of 23
37	37	telehealth services; amending s. 641.31, F.S.; 24
38	38	prohibiting a health maintenance organization from 25
39	39
40	40	HB 1087 2022
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45	45	hb1087-00
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47	47	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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49	49
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51	51	requiring a subscriber to receive certain services 26
52	52	through telehealth; deleting requirements for 27
53	53	contracts between certain maintenance organizations 28
54	54	and telehealth providers; creating s. 641.31093, F.S.; 29
55	55	prohibiting certain health maintenance organizations 30
56	56	from denying coverage for covered services provided 31
57	57	through telehealth under certain circumstances; 32
58	58	prohibiting health maintenance organizations from 33
59	59	excluding covered services provided through telehealth 34
60	60	from coverage; providing reimbursement requirements 35
61	61	and cost-sharing limitations for health maintenance 36
62	62	organizations relating to telehealth services; 37
63	63	prohibiting health maintenance organizations from 38
64	64	requiring subscribers to receive services through 39
65	65	telehealth; authorizing health maintenance 40
66	66	organizations to conduct utilization reviews under 41
67	67	certain circumstances; authorizing health maintenance 42
68	68	organizations to limit telehealth services to certain 43
69	69	providers; providing an effective date. 44
70	70	45
71	71	WHEREAS, it is the intent of the Legislature to mitigate 46
72	72	geographic discrimination in the delivery of health care by 47
73	73	recognizing the provision of and payment for covered medical 48
74	74	care by means of telehealth services, provided that such 49
75	75	services are provided by a physician or by another health care 50
76	76
77	77	HB 1087 2022
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84	84	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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88	88	practitioner or professional acting within the scope of practice 51
89	89	of a health care practitioner or professional and in accordance 52
90	90	with s. 456.47, Florida Statutes, NOW, THEREFORE, 53
91	91	54
92	92	Be It Enacted by the Legislature of the State of Florida: 55
93	93	56
94	94	Section 1. Paragraph (c) of subsection (2) of section 57
95	95	409.967, Florida Statutes, is amended t o read: 58
96	96	409.967 Managed care plan accountability. — 59
97	97	(2) The agency shall establish such contract requirements 60
98	98	as are necessary for the operation of the statewide managed care 61
99	99	program. In addition to any other provisions the agency may deem 62
100	100	necessary, the contract must require: 63
101	101	(c) Access.— 64
102	102	1. The agency shall establish specific standards for the 65
103	103	number, type, and regional distribution of providers in managed 66
104	104	care plan networks to ensure access to care for both adults and 67
105	105	children. Each plan must main tain a regionwide network of 68
106	106	providers in sufficient numbers to meet the access standards for 69
107	107	specific medical services for all recipients enrolled in the 70
108	108	plan. A plan may not use providers who provide services 71
109	109	exclusively through telehealth as defined in s. 456.47(1) to 72
110	110	meet this requirement. The exclusive use of mail -order 73
111	111	pharmacies may not be sufficient to meet network access 74
112	112	standards. Consistent with the standards established by the 75
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114	114	HB 1087 2022
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121	121	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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123	123
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125	125	agency, provider networks may include providers located outside 76
126	126	the region. A plan may contract with a new hospital facility 77
127	127	before the date the hospital becomes operational if the hospital 78
128	128	has commenced construction, will be licensed and operational by 79
129	129	January 1, 2013, and a final order has issued in any civil or 80
130	130	administrative challenge. Each plan shall establish and maintain 81
131	131	an accurate and complete electronic database of contracted 82
132	132	providers, including information about licensure or 83
133	133	registration, locations and hours of operation, specialty 84
134	134	credentials and other certifica tions, specific performance 85
135	135	indicators, and such other information as the agency deems 86
136	136	necessary. The database must be available online to both the 87
137	137	agency and the public and have the capability to compare the 88
138	138	availability of providers to network adequacy s tandards and to 89
139	139	accept and display feedback from each provider's patients. Each 90
140	140	plan shall submit quarterly reports to the agency identifying 91
141	141	the number of enrollees assigned to each primary care provider. 92
142	142	The agency shall conduct, or contract for, systema tic and 93
143	143	continuous testing of the provider network databases maintained 94
144	144	by each plan to confirm accuracy, confirm that behavioral health 95
145	145	providers are accepting enrollees, and confirm that enrollees 96
146	146	have access to behavioral health services. 97
147	147	2. Each managed care plan must publish any prescribed drug 98
148	148	formulary or preferred drug list on the plan's website in a 99
149	149	manner that is accessible to and searchable by enrollees and 100
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155	155	CODING: Words stricken are deletions; words underlined are additions.
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158	158	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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160	160
161	161
162	162	providers. The plan must update the list within 24 hours after 101
163	163	making a change. Each pla n must ensure that the prior 102
164	164	authorization process for prescribed drugs is readily accessible 103
165	165	to health care providers, including posting appropriate contact 104
166	166	information on its website and providing timely responses to 105
167	167	providers. For Medicaid recipients di agnosed with hemophilia who 106
168	168	have been prescribed anti -hemophilic-factor replacement 107
169	169	products, the agency shall provide for those products and 108
170	170	hemophilia overlay services through the agency's hemophilia 109
171	171	disease management program. 110
172	172	3. Managed care plans, a nd their fiscal agents or 111
173	173	intermediaries, must accept prior authorization requests for any 112
174	174	service electronically. 113
175	175	4. Managed care plans serving children in the care and 114
176	176	custody of the Department of Children and Families must maintain 115
177	177	complete medical, dental, and behavioral health encounter 116
178	178	information and participate in making such information available 117
179	179	to the department or the applicable contracted community -based 118
180	180	care lead agency for use in providing comprehensive and 119
181	181	coordinated case management. The agency and the department shall 120
182	182	establish an interagency agreement to provide guidance for the 121
183	183	format, confidentiality, recipient, scope, and method of 122
184	184	information to be made available and the deadlines for 123
185	185	submission of the data. The scope of information available to 124
186	186	the department shall be the data that managed care plans are 125
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188	188	HB 1087 2022
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195	195	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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197	197
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199	199	required to submit to the agency. The agency shall determine the 126
200	200	plan's compliance with standards for access to medical, dental, 127
201	201	and behavioral health services; the use of medication s; and 128
202	202	follow up followup on all medically necessary services 129
203	203	recommended as a result of early and periodic screening, 130
204	204	diagnosis, and treatment. 131
205	205	Section 2. Section 627.42396, Florida Statutes, is amended 132
206	206	to read: 133
207	207	627.42396 Requirements for reimbursement by health 134
208	208	insurers for telehealth services. — 135
209	209	(1) An individual, group, blanket, or franchise health 136
210	210	insurance policy delivered or issued for delivery to any insured 137
211	211	person in this state on or after January 1, 2023, may not deny 138
212	212	coverage for a covered service on the basis of the service being 139
213	213	provided through telehealth if the same service would be covered 140
214	214	if provided through an in -person encounter. 141
215	215	(2) A health insurer may not exclude an otherwise covered 142
216	216	service from coverage solely because the ser vice is provided 143
217	217	through telehealth rather than through an in -person encounter. 144
218	218	(3) A health insurer shall reimburse a telehealth provider 145
219	219	for the diagnosis, consultation, or treatment of any insured 146
220	220	person provided through telehealth on the same basis a nd at 147
221	221	least at the same rate that the health insurer would reimburse 148
222	222	the provider if the covered service were delivered through an 149
223	223	in-person encounter. However, a health insurer may not require a 150
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232	232	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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236	236	health care provider or telehealth provider to accept a 151
237	237	reimbursement amount greater than the amount the provider is 152
238	238	willing to charge. 153
239	239	(4) A health insurer shall reimburse a telehealth provider 154
240	240	for reasonable originating site fees or costs for the provision 155
241	241	of telehealth services. 156
242	242	(5) A covered service provide d through telehealth may not 157
243	243	be subject to a greater deductible, copayment, or coinsurance 158
244	244	amount than would apply if the same service were provided 159
245	245	through an in-person encounter. 160
246	246	(6) A health insurer may not impose upon any insured 161
247	247	person receiving ben efits under this section any copayment, 162
248	248	coinsurance, or deductible amount or any policy -year, calendar-163
249	249	year, lifetime, or other durational benefit limitation or 164
250	250	maximum for benefits or services provided through telehealth 165
251	251	which is not equally imposed upon all terms and services covered 166
252	252	under the policy. 167
253	253	(7) A health insurer may not require an insured person to 168
254	254	obtain a covered service through telehealth instead of an in -169
255	255	person encounter. 170
256	256	(8) This section does not preclude a health insurer from 171
257	257	conducting a utilization review to determine the appropriateness 172
258	258	of telehealth as a means of delivering a covered service if such 173
259	259	determination is made in the same manner as would be made for 174
260	260	the same service provided through an in -person encounter. 175
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269	269	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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273	273	(9) A health insurer may limit the covered services 176
274	274	provided through telehealth to providers who are in a network 177
275	275	approved by the insurer A contract between a health insurer 178
276	276	issuing major medical comprehensive coverage through an 179
277	277	individual or group policy and a telehe alth provider, as defined 180
278	278	in s. 456.47, must be voluntary between the insurer and the 181
279	279	provider and must establish mutually acceptable payment rates or 182
280	280	payment methodologies for services provided through telehealth. 183
281	281	Any contract provision that distinguishes between payment rates 184
282	282	or payment methodologies for services provided through 185
283	283	telehealth and the same services provided without the use of 186
284	284	telehealth must be initialed by the telehealth provider . 187
285	285	Section 3. Paragraph (h) is added to subsection (5) of 188
286	286	section 627.6699, Florida Statutes, to read: 189
287	287	627.6699 Employee Health Care Access Act. — 190
288	288	(5) AVAILABILITY OF COVERAGE. — 191
289	289	(h) A health benefit plan covering small employers which 192
290	290	is delivered, issued, or renewed in this state on or after 193
291	291	January 1, 2023, must comply with s. 627.42396. 194
292	292	Section 4. Subsection (45) of section 641.31, Florida 195
293	293	Statutes, is amended to read: 196
294	294	641.31 Health maintenance contracts. — 197
295	295	(45) A contract between a health maintenance organization 198
296	296	issuing major medical individual or group coverage may not 199
297	297	require a subscriber to consult with, seek approval from, or 200
298	298
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306	306	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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310	310	obtain any type of referral or authorization by way of 201
311	311	telehealth from and a telehealth provider, as defined in s. 202
312	312	456.47, must be voluntary between the health maintenance 203
313	313	organization and the provider and must establish mutually 204
314	314	acceptable payment rates or payment methodologies for services 205
315	315	provided through telehealth. Any contract provision that 206
316	316	distinguishes between payment rates or payment methodologies for 207
317	317	services provided through telehealth and the same services 208
318	318	provided without the use of telehealth must be initialed by the 209
319	319	telehealth provider. 210
320	320	Section 5. Section 641.31093, Florida Statutes, is created 211
321	321	to read: 212
322	322	641.31093 Requirements for reimbursement by health 213
323	323	maintenance organizations for telehealth services. — 214
324	324	(1) A health maintenance organization that offers, issues, 215
325	325	or renews a major medical or similar comprehensive contract in 216
326	326	this state on or after January 1, 2023, may not deny coverage 217
327	327	for a covered service on the basis of the covered service being 218
328	328	provided through telehealth if the same service would be covered 219
329	329	if provided through an in -person encounter. 220
330	330	(2) A health maintenance organization may not exclude an 221
331	331	otherwise covered service from coverage so lely because the 222
332	332	service is provided through telehealth rather than through an 223
333	333	in-person encounter. 224
334	334	(3) A health maintenance organization shall reimburse a 225
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343	343	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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347	347	telehealth provider for the diagnosis, consultation, or 226
348	348	treatment of any subscriber provided throu gh telehealth on the 227
349	349	same basis and at least the same rate that the health 228
350	350	maintenance organization would reimburse the provider if the 229
351	351	service were provided through an in -person encounter. However, a 230
352	352	health maintenance organization may not require a healt h care 231
353	353	provider or telehealth provider to accept a reimbursement amount 232
354	354	greater than the amount the provider is willing to charge. 233
355	355	(4) A health maintenance organization shall reimburse a 234
356	356	telehealth provider for reasonable originating site fees or 235
357	357	costs for the provision of telehealth services. 236
358	358	(5) A covered service provided through telehealth may not 237
359	359	be subject to a greater deductible, copayment, or coinsurance 238
360	360	amount than would apply if the same service were provided 239
361	361	through an in-person encounter. 240
362	362	(6) A health maintenance organization may not impose upon 241
363	363	any subscriber receiving benefits under this section any 242
364	364	copayment, coinsurance, or deductible amount or any contract -243
365	365	year, calendar-year, lifetime, or other durational benefit 244
366	366	limitation or maximum for benefits or services provided through 245
367	367	telehealth which is not equally imposed upon all services 246
368	368	covered under the contract. 247
369	369	(7) A health maintenance organization may not require a 248
370	370	subscriber to obtain a covered service through telehealth 249
371	371	instead of an in-person encounter. 250
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380	380	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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384	384	(8) This section does not preclude a health maintenance 251
385	385	organization from conducting a utilization review to determine 252
386	386	the appropriateness of telehealth as a means of delivering a 253
387	387	covered service if such determination is made in th e same manner 254
388	388	as would be made for the same service provided through an in -255
389	389	person encounter. 256
390	390	(9) A health maintenance organization may limit covered 257
391	391	services provided through telehealth to providers who are in a 258
392	392	network approved by the health maintenance organization. 259
393	393	Section 6. This act shall take effect July 1, 2022. 260