The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 312
INTRODUCER: Senator Diaz
SUBJECT: Telehealth
DATE: October 13, 2021
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Smith Brown HP Favorable
2. BI
3. RC
I. Summary:
SB 312 removes a provision in the definition of “telehealth” that excludes audio-only telephone
calls.
The bill also amends a provision that, in practice, will allow a telehealth provider to issue a
renewal prescription for a controlled substance listed in Schedule III, IV, or V of s. 893.03, F.S.,
through telehealth, within the scope of his or her practice, and in accordance with other state and
federal laws. Currently, telehealth providers are prohibited from prescribing controlled
substances through telehealth unless the prescription is for: the treatment of a psychiatric
disorder, inpatient treatment at a hospital, the treatment of a patient receiving hospice services, or
the treatment of a resident in a nursing home facility.
1
The bill narrows this prohibition to
prohibit the prescribing of only Schedule II controlled substances through telehealth except
under those specific circumstances.
The bill provides an effective date of July 1, 2022.
II. Present Situation:
Telehealth
Relevant Terminology
Section 456.47, F.S., defines the term “telehealth” as the use of synchronous or asynchronous
telecommunications technology by a telehealth provider to provide health care 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
1
Section 456.47(2)(c), F.S.
REVISED: BILL: SB 312 Page 2
services; and health administration. Section 456.47(1)(a), F.S., provides that the term does not
include audio-only telephone calls, e-mail messages, or facsimile transmissions.
“Synchronous” telehealth refers to the live, real-time, or interactive transmission of information
between a patient and a health care provider during the same time period. The use of live video
to evaluate and diagnosis a patient would be considered synchronous telehealth.
“Asynchronous” telehealth refers to the transfer of data between a patient and a health care
provider over a period of time and typically in separate time frames. This is commonly referred
to as “store-and-forward.”
Florida Telehealth Providers
In 2019, the Legislature passed and the Governor approved CS/CS/HB 23, which created s.
456.47, F.S. The bill became effective on July 1, 2019.
2
It authorized Florida-licensed health care
providers
3
to use telehealth to deliver health care services within their respective scopes of
practice.
The bill also authorized out-of-state health care providers to use telehealth to deliver health care
services to Florida patients if they register with the Department of Health (DOH) or the
applicable board
4
and meet certain eligibility requirements.
5
A registered out-of-state telehealth
provider may use telehealth, within the relevant scope of practice established by Florida law and
rule, to provide health care services to Florida patients but is prohibited from opening an office
in Florida and from providing in-person health care services to patients located in Florida.
Telehealth providers who treat patients located in Florida must be one of the licensed health care
practitioners listed below
6
and be either Florida-licensed, licensed under a multi-state health care
licensure compact of which Florida is a member state, or registered as an out-of-state telehealth
provider:
Behavioral Analyst
Acupuncturist
Allopathic physician
Osteopathic physician
Chiropractor
Podiatrist
Optometrist
Nurse
Pharmacist
2
Chapter 2019-137, s. 6, Laws of Fla.
3
Section 456.47(1)(b), F.S.
4
Under s. 456.001(1), F.S., the term “board” is defined as any board, commission, or other statutorily created entity, to the
extent such entity is authorized to exercise regulatory or rulemaking functions within the DOH or, in some cases, within the
DOH’s Division of Medical Quality Assurance.
5
Section 456.47(4), F.S.
6
Section 456.47(1)(b), F.S. These are professionals licensed under s. 393.17; part III, ch. 401; ch. 457; ch. 458; ch. 459; ch.
460; ch. 461; ch. 463; ch. 464; ch. 465; ch. 466; ch. 467; part I, part III, part IV, part V, part X, part XIII, and part XIV, ch.
468; ch. 478; ch. 480; part II and part III, ch. 483; ch. 484; ch. 486; ch. 490; or ch. 491. BILL: SB 312 Page 3
Dentist
Dental Hygienist
Midwife
Speech Therapist
Occupational Therapist
Radiology Technician
Electrologist
Orthotist
Pedorthist
Prosthetist
Medical Physicist
Emergency Medical Technician
Paramedic
Massage Therapist
Optician
Hearing Aid Specialist
Clinical Laboratory Personnel
Respiratory Therapist
Psychologist
Psychotherapist
Dietician/Nutritionist
Athletic Trainer
Clinical Social Worker
Marriage and Family Therapist
Mental Health Counselor
The Legislature also passed HB 7067 in 2019 that would have required an out-of-state telehealth
provider to pay an initial registration fee of $150 and a biennial registration renewal fee of $150,
but the bill was vetoed by the Governor and did not become law.
7
On March 16, 2020, Surgeon General Scott Rivkees executed DOH Emergency Order 20-002
authorizing certain out-of-state physicians, osteopathic physicians, physician assistants, and
advanced practice registered nurses to provide telehealth in Florida without the need to register
as a telehealth provider under s. 456.47(4), F.S.
8
Five days later, the Surgeon General executed
DOH Emergency Order 20-003
9
to also authorize certain out-of-state clinical social workers,
marriage and family therapists, mental health counselors, and psychologists to provide telehealth
in Florida without the need to register as a telehealth provider under s. 456.47(4), F.S. These
7
Transmittal Letter from Governor Ron DeSantis to Secretary of State Laurel Lee (June 27, 2019) available at
https://www.flgov.com/wp-content/uploads/2019/06/06.27.2019-Transmittal-Letter-3.pdf (last visited Oct 21, 2021).
8
Department of Health, State of Florida, Emergency Order DOH No. 20-002 (Mar. 16, 2020) available at
http://floridahealthcovid19.gov/wp-content/uploads/2020/03/filed-eo-doh-no.-20-002-medical-professionals-03.16.2020.pdf
(last visited Oct. 21, 2021).
9
Department of Health, State of Florida, Emergency Order DOH No. 20-003 (Mar. 21, 2020) available at
https://s33330.pcdn.co/wp-content/uploads/2020/03/DOH-EO-20-003-3.21.2020.pdf (last visited Oct. 21, 2021). BILL: SB 312 Page 4
emergency orders were extended and expired on June 26, 2021.
10
Out-of-state health care
practitioners are no longer authorized to perform telehealth services for patients in Florida unless
they become licensed or registered in Florida.
Florida Medicaid Program
The Medicaid program is a joint federal-state program that finances health coverage for
individuals, including eligible low-income adults, children, pregnant women, elderly adults and
persons with disabilities.
11
The Centers for Medicare & Medicaid Services (CMS) within the
U.S. Department of Health and Human Services (HHS) is responsible for administering the
federal Medicaid program. Florida Medicaid is the health care safety net for low-income
Floridians. Florida’s program is administered by the AHCA and financed through state and
federal funds.
12
Medicaid enrollees generally receive benefits through one of two service-delivery systems: fee-
for-service (FFS) or managed care. Under FFS, health care providers are paid by the state
Medicaid program for each service provided to a Medicaid enrollee. Under managed care, the
AHCA contracts with private managed care plans for the coordination and payment of services
for Medicaid enrollees. The state pays the managed care plans a capitation payment, or fixed
monthly payment, per recipient enrolled in the managed care plan. In Florida, the majority of
Medicaid recipients receive their services through a managed care plan contracted with the
AHCA under the Statewide Medicaid Managed Care (SMMC) program.
13
Telemedicine Coverage under the Florida Medicaid Program
Florida Medicaid covers telemedicine in both the managed care and fee-for-service delivery
systems.
Medicaid health plans have broad flexibility in covering telemedicine services.
14
Beginning on
April 3, 2020, and throughout the COVID-19 state of emergency, the AHCA provided for the
reimbursement of audio-only telehealth services in the managed care and fee-for-service delivery
systems when rendered by licensed physicians (including psychiatrists), advanced practice
10
Florida Board of Medicine, Important Updates for Health Care Providers Regarding Expiration of Emergency Orders
(July 1, 2021) available at https://r.bulkmail.flhealthsource.gov/mk/mr/JV-U0AMitwBXlP7zcFx3Djqu1KfE1B57JaGN-
nnNySmOjEY5xGSsIyII28XjOGeZ4yKv9rWQUryqAibmdrixNZdgE9Q61dmUoHRF1Rnyijg -ewyAl_rZBT8c (last visited
Oct. 18, 2021).
11
Medicaid.gov, Medicaid, available at https://www.medicaid.gov/medicaid/index.html (last visited Oct. 21, 2021).
12
Section 20.42, F.S.
13
Id.
14
Agency for Health Care Administration, Florida Medicaid Health Care Alert, Medicaid Telemedicine Guidance for
Medical and Behavioral Health Providers (Mar. 18, 2020) available at
https://ahca.myflorida.com/Medicaid/pdffiles/provider_alerts/2020_03/Medicaid_Telemedicine_Guidance_20200318.pdf
(last visited Nov. 1, 2021). BILL: SB 312 Page 5
registered nurses, and physician assistants.
15,16
During the state of emergency, Medicaid health
plans are required to cover telemedicine services in “parity” with face-to-face services, meaning
the health plan must cover services via telemedicine in a manner no more restrictive than the
health plan would cover the service face-to-face.
17
Under the fee-for service delivery system and in times of non-emergency, Florida Medicaid
generally reimburses only for synchronous telemedicine services provided through the use of
audio-visual equipment.
18
Beginning on April 16, 2020, and throughout the state of emergency,
the AHCA provided for the reimbursement of audio-only behavioral health services for Medicaid
reimbursement under the fee-for service and managed care delivery systems when video
capability was not available.
19
To be reimbursed, a behavioral health provider must have
documented that the enrollee did not have access to audio and video technology necessary for the
service to be fully provided via telemedicine.
20
The Federal Health Insurance Portability and Accountability Act (HIPAA)
21
HIPAA Privacy Rule
22
The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects
personal health information. The HIPAA Privacy Rule sets national standards for when protected
health information (PHI) may be used and disclosed.
Only certain entities and their business associates are subject to HIPAA’s provisions. These
“covered entities” include: health plans, health care providers; and health care clearinghouses.
The Privacy Rule gives individuals privacy and confidentiality rights with respect to their
protected PHI, including rights to examine and obtain a copy of their health records in the form
and manner they request, and to ask for corrections to their information. Also, the Privacy Rule
permits the use and disclosure of health information needed for patient care and other important
purposes.
15
Agency for Health Care Administration, Statewide Medicaid Managed Care (SMMC) Policy Transmittal: 2020-20 (Apr. 3,
2020) available at
https://ahca.myflorida.com/Medicaid/statewide_mc/pdf/2018-23_plan_comm/PT_2020-20_COVID-19_State-of-
Emergency_Telemedicine_Services.pdf (last visited Nov. 1, 2021).
16
2021 Senate Bill 700 also amended the definition of telehealth in s. 456.47, F.S., to include audio-only telephone calls.
Agency for Health Care Administration, Senate Bill 700 Fiscal Analysis (Feb. 15, 2021) (on file with the Senate Committee
on Health Policy).
17
Id.
18
Agency for Health Care Administration, Senate Bill 852 Analysis (Feb. 1, 2021) (on file with the Senate Committee on
health Policy).
19
Agency for Health Care Administration, Florida Medicaid Health Care Alert, Medicaid Telemedicine Flexibilities for
Behavioral Health Providers During the COVID-19 State of Emergency (Apr. 16, 2020) available at
https://ahca.myflorida.com/Medicaid/pdffiles/provider_alerts/2020_03/Medicaid_Telemedicine_Guidance_20200318.pdf
(last visited Nov. 1, 2021).
20
Id.
21
Centers for Medicare & Medicaid Services, Medicare Learning Network Booklet, HIPAA Basics for Providers: Privacy,
Security, and Breach Notification Rules (May. 2021) available at https://www.cms.gov/Outreach-and-Education/Medicare-
Learning-Network-MLN/MLNProducts/Downloads/HIPAAPrivacyandSecurity.pdf (last visited Oct. 29, 2021).
22
45 C.F.R. Part 160 and Subparts A and E of Part 164. BILL: SB 312 Page 6
The Privacy Rule protects PHI held or transmitted by a covered entity or its business associate,
in any form, whether electronic, paper, or verbal. PHI includes information that relates to any of
the following:
The individual’s past, present, or future physical or mental health or condition;
The provision of health care to the individual; or
The past, present, or future payment for the provision of health care to the individual.
HIPAA Security Rule
23
The HIPAA Security Rule specifies safeguards that covered entities and their business associates
must implement to protect electronic PHI (ePHI) confidentiality, integrity, and availability.
Covered entities and business associates must develop and implement reasonable and appropriate
security measures through policies and procedures to protect the security of ePHI they create,
receive, maintain, or transmit. Each entity must analyze the risks to ePHI in its environment and
create solutions appropriate for its own situation. What is reasonable and appropriate depends on
the nature of the entity’s business as well as its size, complexity, and resources.
Under the Security Rule, covered entities must:
Ensure the confidentiality, integrity, and availability of all ePHI they create, receive,
maintain, or transmit;
Identify and protect against reasonably anticipated threats to the security or integrity of the
ePHI;
Protect against reasonably anticipated, impermissible uses or disclosures; and
Ensure compliance by their workforce.
When developing and implementing Security Rule compliant safeguards, covered entities and
their business associates may consider all of the following:
Size, complexity, and capabilities;
Technical, hardware, and software infrastructure;
The costs of security measures; and
The likelihood and possible impact of risks to ePHI.
Covered entities must review and modify security measures to continue protecting ePHI in a
changing environment.
HIPAA Breach Notification Rule
24
The HIPAA Breach Notification Rule requires covered entities to notify affected individuals; the
federal HHS; and, in some cases, the media of a breach of unsecured PHI. Generally, a breach is
an impermissible use or disclosure under the Privacy Rule that compromises the security or
privacy of PHI.
23
45 C.F.R. Part 160 and Subparts A and C of Part 164.
24
45 C.F.R. Subpart D. BILL: SB 312 Page 7
The impermissible use or disclosure of PHI is presumed to be a breach unless the covered entity
demonstrates a low probability that the PHI has been compromised based on a risk assessment
of, at a minimum, the following factors:
The nature and extent of the PHI involved, including the types of identifiers and the
likelihood of re-identification;
The unauthorized person who used the PHI or to whom the disclosure was made;
Whether the PHI was actually acquired or viewed; and
The extent to which the risk to the PHI has been mitigated.
Most notifications must be provided without unreasonable delay and no later than 60 days
following the breach discovery. Notifications of smaller breaches affecting fewer than 500
individuals may be submitted to HHS annually. The Breach Notification Rule also requires
business associates of covered entities to notify the covered entity of breaches at or by the
business associate.
Notification of Enforcement Discretion during Public Health Emergency
Covered health care providers acting in good faith will not be subject to penalties for violations
of the HIPAA Privacy Rule, the HIPAA Security Rule, or the HIPAA Breach Notification Rule
that occur in the good faith provision of telehealth during the public health emergency.
25
On March 17, 2020, the federal Department of Health & Human Services (HHS) Office for Civil
Rights (OCR) issued a Notification of Enforcement of Discretion, meaning that the OCR may
exercise its enforcement discretion and not pursue penalties for HIPPA violations against health
care providers that serve patients through everyday communication technologies during the
public health emergency.
26
If a provider follows the terms of the Notification and any applicable
OCR guidance, it will not face HIPAA penalties if it experiences a hack that exposes protected
health information from a telehealth session.
27
Jurisdiction and Venue for Telehealth-related Actions
28
For purposes of s. 456.47, F.S., any act that constitutes the delivery of health care services is
deemed to occur at the place where the patient is located at the time the act is performed or in the
patient’s county of residence. Venue for a civil or administrative action initiated by the DOH, the
appropriate board, or a patient who receives telehealth services from an out-of-state telehealth
provider, may be located in the patient’s county of residence or in Leon County.
25
U.S. Department for Health and Human Services Office for Civil Rights, FAQs on Telehealth and HIPAA during the
COVID-10 nationwide public health emergency (Mar. 2020) available at https://www.hhs.gov/sites/default/files/telehealth-
faqs-508.pdf (last visited Nov. 1, 2021).
26
Press Release, U.S. Department of Health and Human Services, OCR Announces Notification of Enforcement Discretion
for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency (Mar. 17, 2021)
available at https://www.hhs.gov/about/news/2020/03/17/ocr-announces-notification-of-enforcement-discretion-for-
telehealth-remote-communications-during-the-covid-19.html (last visited Oct. 31, 2021).
27
Supra note 25.
28
Section 456.47(5), F.S. BILL: SB 312 Page 8
Controlled Substance Prescribing through Telehealth
Controlled Substances Generally
Chapter 893, F.S., sets forth the Florida Comprehensive Drug Abuse Prevention and Control Act.
This chapter classifies controlled substances into five schedules in order to regulate the
manufacture, distribution, preparation, and dispensing of the substances. The scheduling of
substances in Florida law is generally consistent with the federal scheduling of substances under
21 U.S.C. s. 812:
A Schedule I substance has a high potential for abuse and no currently accepted medical use
in treatment in the United States and its use under medical supervision does not meet
accepted safety standards. Examples include heroin and lysergic acid diethylamide (LSD).
A Schedule II substance has a high potential for abuse, a currently accepted but severely
restricted medical use in treatment in the United States, and abuse may lead to severe
psychological or physical dependence. Examples include cocaine and morphine.
A Schedule III substance has a potential for abuse less than the substances contained in
Schedules I and II, a currently accepted medical use in treatment in the United States, and
abuse may lead to moderate or low physical dependence or high psychological dependence
or, in the case of anabolic steroids, may lead to physical damage. Examples include lysergic
acid; ketamine; and some anabolic steroids.
A Schedule IV substance has a low potential for abuse relative to the substances in Schedule
III, a currently accepted medical use in treatment in the United States, and abuse may lead to
limited physical or psychological dependence relative to the substances in Schedule III.
Examples include alprazolam, diazepam, and phenobarbital.
A Schedule V substance has a low potential for abuse relative to the substances in Schedule
IV, a currently accepted medical use in treatment in the United States, and abuse may lead to
limited physical or psychological dependence relative to the substances in Schedule IV.
Examples include low dosage levels of codeine, certain stimulants, and certain narcotic
compounds.
Federal Law
29
The Ryan Haight Online Pharmacy Consumer Protection Act of 2008
30
amended the federal
Controlled Substances Act, to prohibit a practitioner from issuing a “valid prescription” for a
controlled substance through the Internet without having first conducted at least one in-person
medical evaluation, except in certain circumstances. Thereafter, the prescriber may prescribe
controlled substances to that patient via Internet or a phone call. The Act offers seven exceptions
to the in-person exam. One such exception occurs when the Secretary of the federal Department
of Health and Human Services (HHS) has declared a public health emergency.
29
21 U.S.C. s. 829.
30
Public Law No. 110-425 (2008). BILL: SB 312 Page 9
Federal Guidance During the COVID-19 Public Health Emergency
On January 31, 2020, the Secretary of HHS issued a public health emergency.
31
On March 16,
2020, the federal Drug Enforcement Agency (DEA) published a COVID-19 Information page on
the Diversion Control Division website, authorizing DEA-registered practitioners, authorized
designated DEA-registered practitioners to issue prescriptions for all Schedule II-V controlled
substances to patients without first conducting an in-person medical evaluation during the public
health emergency, provided all of the following conditions are met:
The prescription is issued for a legitimate medical purpose by a practitioner acting in the
usual course of his/her professional practice.
The evaluation is conducted using an audio-visual, real-time, two-way interactive
communication system.
The practitioner is acting in accordance with applicable federal and state law.
32
Florida Law
Under Florida law, controlled substance providers are required to conduct an in-person physical
examination prior to issuing a prescription for a controlled substance.
33
Section 456.44, F.S., as amended during the 2018 legislative session by CS/CS/HB 21,
34
authorizes prescribers to prescribe a three-day supply of a Schedule II opioid
35
or up to a seven-
day supply if medically necessary. The prescribing limits on Schedule II opioids do not apply to
prescriptions for acute pains related to: cancer, a terminal condition, pain treated with palliative
care, or a traumatic injury with an Injury Severity Score of 9 or higher.
36
That section also requires a prescriber and dispenser to report to and review the Prescription
Drug Monitoring Program database known as E-FORCSE (Electronic-Florida Online Reporting
Controlled Substance Evaluation) to review a patient’s controlled substance dispensing history
prior to prescribing or dispensing a Schedule II-IV controlled substance for patients 16 years
older.
37
These limitations and requirements apply to practitioners providing services in-person
and through telehealth.
31
Determination that a Public Health Emergency Exists, Alex M. Azar II, Secretary of U.S. Department of Health and
Human Services (January 31, 2020) available at https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-
nCoV.aspx (last visited Oct. 31, 2021).
32
Diversion Control Division, U.S. Department of Justice Drug Enforcement Administration, COVID-19 Information Page,
available at https://www.deadiversion.usdoj.gov/coronavirus.html (last visited Nov. 1, 2021). Letter from Thomas Prevoznik,
Deputy Assistant Administrator, Diversion Control Division, U.S. Department of Justice Drug Enforcement Administration,
to DEA Qualifying Practitioners and Other Practitioners, (Mar. 31, 2020) available at
https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-
022)(DEA068)%20DEA%20SAMHSA%20buprenorphine%20telemedicine%20%20(Final)%20+Esign.pdf last visited Nov.
1, 2021).
33
Section 456.44, F.S.
34
Chapter 2018-13, Laws of Fla.
35
All opioids are controlled substances. Opioids range in classification between Schedule I and Schedule V.
36
Section 456.44(1)(a), F.S.
37
Section 893.055, F.S. BILL: SB 312 Page 10
Section 456.47(2)(c), F.S., as created by 2019 CS/CS/HB 23,
38
prohibits telehealth providers
from prescribing any controlled substance unless the controlled substance is prescribed for:
The treatment of a psychiatric disorder;
Inpatient treatment at a licensed hospital;
The treatment of a patient receiving hospice services; or
The treatment of a resident of a nursing home facility.
Florida DOH Emergency Order No. 20-002
The same day that the HHS Secretary authorized qualified prescribers to prescribe Schedule II-V
controlled substances, Surgeon General Rivkees issued DOH Emergency Order No. 20-002,
39
which suspended s. 456.47(2)(c), F.S., and authorized specified Florida-licensed prescribers
40
to
issue a renewal prescription for a Schedule II-IV controlled substance only for an existing patient
for the purpose of treating chronic nonmalignant pain without conducting another physical
examination of the patient. This emergency order was extended
41
and expired on June 26,
2021.
42
III. Effect of Proposed Changes:
Section 1 of the bill amends s. 456.47(1)(a), F.S., to remove a provision in the definition of
“telehealth” that excludes audio-only telephone calls. This change does not post a direct impact
on Florida Medicaid but would allow Medicaid to elect to reimburse for audio-only telephone
calls.
Section 1 of the bill also amends s. 456.47(2)(c), F.S. Currently, telehealth providers are
prohibited from prescribing controlled substances through telehealth unless the prescription is
for: the treatment of a psychiatric disorder, inpatient treatment at a hospital, the treatment of a
patient receiving hospice services, or the treatment of a resident in a nursing home facility. The
bill narrows this prohibition to prohibit the prescribing of only Schedule II controlled substances
through telehealth except under those specific circumstances. In practice, this change will
authorize a telehealth provider to issue a renewal prescription for a controlled substance listed in
Schedule III, IV, or V of s. 893.03, F.S., through telehealth, within the scope of his or her
practice, and in accordance with other state and federal laws.
38
Chapter 2019-137, Laws of Fla.
39
Department of Health, State of Florida, Emergency Order DOH No. 20-002 (Mar. 16, 2020) available at
http://floridahealthcovid19.gov/wp-content/uploads/2020/03/filed-eo-doh-no.-20-002-medical-professionals-03.16.2020.pdf
(last visited Nov. 1, 2021).
40
Physicians, osteopathic physicians, physician assistants, or advanced practice registered nurses that have designated
themselves as a controlled substance prescribing practitioner on their practitioner profiles pursuant to s. 456.44, F.S.
41
Department of Health, State of Florida, Emergency Order DOH No. 20-011 (June 30, 2020) available at
https://floridahealthcovid19.gov/wp-content/uploads/2020/06/DOH-Emergency-Order-DOH-No.-20-011.pdf (last visited
Nov. 1, 2021).
42
Florida Board of Medicine, Important Updates for Health Care Providers Regarding Expiration of Emergency Orders
(July 1, 2021) available at https://r.bulkmail.flhealthsource.gov/mk/mr/JV-U0AMitwBXlP7zcFx3Djqu1KfE1B57JaGN-
nnNySmOjEY5xGSsIyII28XjOGeZ4yKv9rWQUryqAibmdrixNZdgE9Q61dmUoHRF1Rnyijg -ewyAl_rZBT8c (last visited
Oct. 18, 2021). BILL: SB 312 Page 11
Under current law, no provider may prescribe a Schedule I drug under any circumstances.
Florida law requires a prescriber to perform an in-person physical examination prior to
prescribing a controlled substance for the treatment of chronic nonmalignant pain. All
prescribers and dispensers of controlled substances must comply with ch. 893, F.S., by
consulting and reporting to the Prescription Drug Monitoring Program database.
The applicable board, or the DOH if there is no board, may adopt rules to administer this section
of statute.
43
Section 2 of the bill provides an effective date of July 1, 2022.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
The bill does not pose a direct impact on Florida Medicaid but would allow the AHCA to
elect to reimburse for audio-only telephone calls. If the AHCA decides to authorize the
43
Section 456.47(7), F.S. BILL: SB 312 Page 12
reimbursement of audio-only telemedicine services, it will need to update Rule 59G-
1.057, F.A.C., and communicate the changes to enrolled providers and health plans, both
of which are part of the AHCA’s routine business practices.
44
The vast majority of
Medicaid recipients are already covered for audio-only telehealth services through the
Medicaid health plans, so the bill is unlikely to increase overall costs to the Florida
Medicaid program.
45
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends section 456.47 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.
44
Agency for Health Care Administration, Senate Bill 864 Bill Analysis & Economic Impact Statement (Mar. 11, 2021) (on
file with the Senate Committee on Health Policy).
45
Supra note 16.