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