This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0267b.HCA
DATE: 4/11/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 267 Telehealth Practice Standards
SPONSOR(S): Fabricio and others
TIED BILLS: IDEN./SIM. BILLS: HB 79, SB 298
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 16 Y, 0 N Osborne McElroy
2) Health Care Appropriations Subcommittee Aderibigbe Clark
3) Health & Human Services Committee
SUMMARY ANALYSIS
Telehealth is not a type of health care service, but rather is a mechanism for the delivery of health care
services. Health care professionals use telehealth as a platform to provide traditional health care services in a
non-traditional manner. These services include, among others, preventive medicine and the treatment of
chronic conditions. Section 456.47, F.S., enacted in 2019, authorizes the use of telehealth for all practitioners,
within the applicable scope of practice, and regulates the use of telehealth by out-of-state healthcare providers.
Current health care practitioner licensure law broadly defines 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 services; and
Health administration.
Under current law, audio-only telephone calls are not included in the licensure definition of telehealth; however,
this does not prohibit health care practitioners from calling patients on the telephone. Current law does not
address insurance coverage for services provided via telehealth or for services provided via telephone calls.
HB 267 revises the definition of telehealth to include telephone calls in the telehealth technology authorization
statute. This change does not affect whether health insurers will reimburse health care practitioners for
services provided through telephone calls.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2023.
STORAGE NAME: h0267b.HCA PAGE: 2
DATE: 4/11/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Telehealth
Telehealth is not a type of health care service, but rather is a mechanism for the delivery of health care
services. Health care professionals use telehealth as a platform to provide traditional health care
services in a non-traditional manner. These services include, among others, preventive medicine and
the treatment of chronic conditions.
1
Section 456.47, F.S., enacted in 2019, authorizes the use of
telehealth for all practitioners, within the applicable scope of practice, and regulates the use of
telehealth by out-of-state healthcare providers.
Current health care practitioner licensure law broadly defines telehealth as the use of synchronous or
asynchronous telecommunications technology by a telehealth provider to provide health care services,
including, but not limited to:
2
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.
Under current law, audio-only telephone calls are not included in the licensure definition of telehealth;
however, this does not prohibit health care practitioners from calling patients on the telephone. Current
law does not address insurance coverage for services provided via telehealth or for services provided
via telephone calls.
Current law sets the standard of care for telehealth providers at the same level as the standard of care
for health care practitioners or health care providers providing in-person health care services to patients
in this state. This ensures that a patient receives the same standard of care irrespective of the modality
used by the health care professional to deliver the services. A patient receiving telehealth services may
be in any location at the time services are rendered and a telehealth provider may be in any location
when providing telehealth services to a patient.
3
Telehealth Providers
Health care services may be provided via telehealth by a Florida-licensed health care practitioner, a
practitioner licensed under a multistate health care licensure compact of which Florida is a member,
4
or
a registered out-of-state-health care provider.
5
Out-of-state health care providers may provide services
to patients in Florida using telehealth upon registering with the Department of Health (DOH) as an out-
of-state telehealth provider.
6
Out-of-state providers must provide services within their applicable scope
of practice as established by Florida law or rule.
7
The out of-state telehealth provider registration does
not expire; however, registered providers must comply with all registration requirements until they
request to nullify their registration.
8
1
U.S. Department of Health and Human Services, Report to Congress: E-Health and Telemedicine (August 12, 2016), available at
https://aspe.hhs.gov/system/files/pdf/206751/TelemedicineE-HealthReport.pdf (last viewed January 23, 2023).
2
S. 456.47(1)(a), F.S.
3
S. 456.47(2), F.S.
4
Florida is a member of the Nurse Licensure Compact. See s. 464.0095, F.S.
5
S. 456.47(4), F.S.
6
Id.
7
Id.
8
Florida Department of Health, Division of Medical Quality Assurance, Florida Telehealth: Frequently Asked Questions, available at
https://flhealthsource.gov/telehealth/faqs/ (last visited February 7, 2023). STORAGE NAME: h0267b.HCA PAGE: 3
DATE: 4/11/2023
In order to register as an out-of-state telehealth provider, one must:
9
Submit a completed application in the format prescribed by DOH;
Maintain an active and unencumbered license, which is substantially similar to a license issued
to a Florida practitioner in the same profession, in a U.S. state or jurisdiction;
Not have been the subject of disciplinary action relating to his or her license during the five-year
period preceding the submission of the application;
10
Designate a duly appointed registered agent for the service of process in Florida; and
Maintain professional liability coverage or financial responsibility for telehealth services provided
to patients in Florida in an amount equal to or greater than that required for Florida-licensed
practitioners.
11
Current law authorizes the following licensed health care practitioners to provide services through
telehealth:
12
Coverage for Telephone Calls under Florida Medicaid
In response to the COVID-19 pandemic, on April 3, 2020, the Agency for Health Care Administration
(AHCA) issued a Statewide Medicaid Managed Care Policy Transmittal that addressed Medicaid
coverage of telephonic (audio-only) communications as a form of telehealth.
13
Under the transmittal,
Medicaid managed care plans were required to expand coverage of telehealth services to include
telephone-only communications when rendered by licensed physicians, physician assistants, advanced
9
S. 456.47(4), F.S.
10
Current law requires DOH to consult the National Practitioner Data Bank to verify whether adverse information is available for the
registrant.
11
Florida law requires physicians, acupuncturists, chiropractic physicians, dentists, anesthesiologist assistants, advanced practice
registered nurses, and licensed midwives to demonstrate $100,000 per claim and an annual aggregate of $300,000 of professional
responsibility (see ss. 458.320 and 459.0085, F.S.; r. 64B1-12.001. F.A.C; r. 64B2-17.009, F.A.C.; 64B5-17.0105, F.A.C.; rr. 64B8-
31.006 and 64B15-7.006, F.A.C.; r. 64B9-4.002, F.A.C.; and r. 64B24-7.013, F.A.C.; respectively). Podiatric physicians must
demonstrate professional responsibility in the amount of $100,000 (see r. 64B18-14.0072, F.A.C.).
12
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.
13
Agency for Health Care Administration, Statewide Medicaid Managed Care Policy Transmittal 2020-20 (April 3, 2020), available at
https://ahca.myflorida.com/content/download/8001/file/PT_2020-20_COVID-19_State-of-Emergency_Telemedicine_Services.pdf (last
viewed Apr. 10, 2023).
Behavioral analyst Nurse
Acupuncturist Pharmacist
Allopathic physician Dentist
Osteopathic physician Dental hygienist
Chiropractor Midwife
Podiatrist Speech therapist
Occupational therapist Medical physicist
Radiology technician Emergency Medical Technician
Electrologist Paramedic
Orthotist Massage therapist
Pedorthist Optician
Prosthetist Hearing aid specialist
Clinical laboratory personnel Dietician/Nutritionist
Respiratory therapist Athletic trainer
Psychologist Clinical social worker
Psychotherapist Marriage and family therapist
Optometrist Mental health counselor STORAGE NAME: h0267b.HCA PAGE: 4
DATE: 4/11/2023
practice nurse practitioners, and behavioral health practitioners until the end of the state of emergency
as declared in Executive Order Number 20-52.
14
A later Statewide Medicaid Managed Care Policy Transmittal published on April 20, 2020, specified that
audio-only telephone calls should only be used as a modality for behavioral health services as a last
resort and when a patient does not have access to audio/video technology.
15
The state of emergency was extended several times before expiring on June 26, 2021.
Effect of the Bill
HB 267 revises the definition of telehealth to include telephone calls in the telehealth technology
authorization statute. This change does not affect whether health insurers will reimburse health care
practitioners for services provided through telephone calls.
The bill provides an effective date of July 1, 2023.
B. SECTION DIRECTORY:
Section 1: Amends s. 456.47, F.S., relating to definitions.
Section 2: Provides an effective date of July 1, 2023.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
14
Executive Office of the Governor, Executive Order 20-25, Emergency Management - COVID-19 Public Health Emergency, March 9,
2020, available at https://www.flgov.com/wp-content/uploads/orders/2020/EO_20-52.pdf (last viewed Apr. 10, 2023).
15
Agency for Health Care Administration, Statewide Medicaid Managed Care Policy Transmittal 2020-25 (April 20, 2020), available at
https://ahca.myflorida.com/content/download/8009/file/PT_2020-25_COVID-19_BehavHealthTelemedRequire_04-21-2020.pdf (last
viewed Apr. 10, 2023). STORAGE NAME: h0267b.HCA PAGE: 5
DATE: 4/11/2023
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
DOH has sufficient rulemaking authority to implement the bill’s provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
None.