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 298
INTRODUCER: Senator Boyd
SUBJECT: Telehealth Practice Standards
DATE: February 17, 2023
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Van
Winkle
Brown
HP
Pre-meeting
2. BI
3. RC
I. Summary:
SB 298 amends s. 456.47(1)(a), F.S., to revise the definition of “telehealth.” Under the bill, the
use of audio-only telephone calls is no longer excluded from the definition.
The bill provides an effective date of July 1, 2023.
II. Present Situation:
Telehealth
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
services; and health administration. The term does not include audio-only telephone calls, e-mail
messages, or facsimile transmissions.
In a general sense, “synchronous” telehealth happens in live, real-time settings where the patient
interacts with a provider, usually via phone or video. Providers and patients communicate
directly, often resulting in a diagnosis, treatment plan, or prescription. Synchronous
telehealth can include additional at-home devices such as a blood pressure or heart rate monitors,
thermometers, oximeters, cameras, or scales to help the provider more accurately assess the
patient’s health status.
1
1
TELEHEALTH.HHS.GOV, “Synchronous direct-to-consumer telehealth,” available at
https://telehealth.hhs.gov/providers/direct-to-consumer/synchronous-direct-to-consumer-telehealth/ (last visited Jan. 20,
2023).
REVISED: BILL: SB 298 Page 2
“Asynchronous” telehealth, also known as “store-and-forward,” is often used for patient intake
or follow-up care. For example, a patient sends a photo of a skin condition that is later reviewed
by a dermatologist who recommends treatment.
2
Section 456.47, F.S., authorizes Florida-licensed health care providers
3
to use telehealth to
deliver health care services within their respective scopes of practice. The statute also authorizes
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 regulatory 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 without first
becoming licensed by the state of Florida.
A telehealth provider is an individual who provides health care and related services to patients
located in Florida and must be one of the licensed health care practitioners listed below. He or
she may 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:
Acupuncturist;
6
Allopathic physicians or physician assistants;
7
Osteopathic physicians or physician assistants;
8
Chiropractic physicians, or chiropractic physician assistant;
9
Podiatric physicians;
10
Optometrists;
11
Autonomous advance practice registered nurses ,advanced practice registered nurses,
registered nurses, licensed practical nurses and certified nursing assistant;
12
Pharmacists;
13
Dentists, dental hygienist and dental laboratories;
14
Midwives;
15
2
TELEHEALTH.HHS.GOV, “Asynchronous direct-to-consumer telehealth,” available at
https://telehealth.hhs.gov/providers/direct-to-consumer/asynchronous-direct-to-consumer-telehealth/ (last visited Jan. 20,
2023).
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 DOH or, in some cases, within DOH’s
Division of Medical Quality Assurance (MQA).
5
Section 456.47(4), F.S.
6
Chapter 457, F.S.
7
Chapter 458, F.S.
8
Chapter 459, F.S.
9
Chapter 460, F.S.
10
Chapter 461, F.S.
11
Chapter 463, F.S.
12
Chapter 464, F.S.
13
Chapter 465, F.S.
14
Chapter 466, F.S.
15
Chapter 467, F.S. BILL: SB 298 Page 3
Speech and language pathologists;
16
Audiologists;
17
Occupational therapists;
18
Radiological Personnel;
19
Respiratory therapists;
20
Dieticians and nutritionists;
21
Athletic trainers;
22
Orthotists, prosthetists, and pedorthists;
23
Electrologists;
24
Massage therapists;
25
Clinical laboratory personnel;
26
Medical physicists;
27
Opticians;
28
Hearing aid specialists;
29
Physical therapists;
30
Psychologists and school psychologists;
31
and
Clinical social workers, mental health counselors and marriage and family therapists.
32
A telehealth provider has the duty to practice in a manner consistent with his or her scope of
practice and the prevailing professional standard of practice for a health care professional who
provides in-person health care services to patients in Florida. A telehealth provider may use
telehealth to perform a patient evaluation. If a telehealth provider conducts a patient evaluation
sufficient to diagnose and treat the patient, the telehealth provider is not required to research a
patient’s medical history or conduct a physical examination of the patient before using telehealth
to provide health care services to the patient.
33
A telehealth provider may not use telehealth to prescribe a controlled substance listed in
Schedule II
34
or s. 893.03, F.S., unless the controlled substance is prescribed for the following:
16
Part I, ch. 468, F.S.
17
Id.
18
Part III, ch. 468, F.S.
19
Part IV, ch. 468, F.S.
20
Part V, ch. 468, F.S.
21
Part X, ch. 468, F.S.
22
Part XIII, ch. 468, F.S.
23
Part XIV, ch. 468, F.S.
24
Chapter 478, F.S.
25
Chapter 480, F.S.
26
Part I, ch. 483, F.S.
27
Part II, ch. 483, F.S.
28
Part I, ch. 484, F.S.
29
Part II, ch. 484, F.S.
30
Chapter 486, F.S.
31
Chapter 490, F.S.
32
Chapter 491, F.S.
33
Section 456.47(2)(a) and (b), F.S.
34
Schedule II drugs are combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin),
cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), BILL: SB 298 Page 4
The treatment of a psychiatric disorder;
Inpatient treatment at a hospital licensed under ch. 395, F.S.
The treatment of a patient receiving hospice services as defined in s. 400.601, F.S.; or
The treatment of a resident of a nursing home facility as defined in s. 400.021, F.S.
35
A telehealth provider must document in the patient’s medical record the health care services
rendered using telehealth according to the same standard as used for in-person services. Medical
records, including video, audio, electronic, or other records generated as a result of providing
such services, are confidential pursuant to ss. 395.3025(4) and 456.057, F.S.
36
The board, or the DOH if there is no board, must register a health care professional not licensed
in this state as a telehealth provider if the health care professional:
Completes a DOH application form;
Has an active, unencumbered license that is issued by another state, the District of Columbia,
or a U.S. possession or territory that is substantially similar to a license issued to a similar
Florida-licensed provider;
Has not been the subject of disciplinary action relating to his or her license during the five-
year period immediately prior to the application submission;
Designates a duly appointed registered agent for service of process in this state on a DOH
prescribed form; and
Demonstrates to the board, or the DOH if there is no board, that he or she maintains
professional liability insurance coverage or financial responsibility, that includes coverage or
financial responsibility for telehealth services provided to patients not located in the
provider’s home state, in an amount equal to, or greater than, the requirements for a licensed
practitioner under ss. 456.048, 458.320, or 459.0085, F.S., as applicable.
37
The website of an out-of-state telehealth provider registered under s. 456.47, F.S., must
prominently display a hyperlink to the DOH website, and the DOH website must publish a list of
all out-of-state registrants and include the following information for each:
Name;
Health care occupation;
Health care training and education, including completion dates and any certificates or
degrees obtained;
Out-of-state health care licenses, including license numbers;
Florida telehealth provider registration number;
Specialty, if any;
Board certification, if any;
Five-years of disciplinary history, including sanctions imposed and board actions;
Medical malpractice insurance provider and policy limits, including whether the policy
covers claims that arise in Florida; and
fentanyl, Dexedrine, Adderall, and Ritalin. See: United States Drug Enforcement Administration, Drug Scheduling, Schedule
II, available at: https://www.dea.gov/drug-information/drug-scheduling (last visited Feb. 16, 2023).
35
Section 456.47(2)(c), F.S.
36
Section 456.47(3), F.S.
37
Section 456.47(4)(b) and (e), F.S. BILL: SB 298 Page 5
The name and address of the registered agent designated for service of process in this state.
38
A health care professional may not register under s. 456.47, F.S., if his or her license to provide
health care services is subject to a pending disciplinary investigation or action, or has been
revoked in any state or jurisdiction. A health care professional registered under this subsection
must notify the appropriate board, or the DOH if there is no board, of any restrictions placed on
his or her license to practice, or any disciplinary action taken or pending against him or her, in
any state or jurisdiction. The notification must be provided within five business days after the
restriction is placed or disciplinary action is initiated or taken.
39
A health care professional registered under this subsection may not open an office in this state
and may not provide in-person health care services to patients located in this state.
40
A pharmacist registered under s. 456.47, F.S., may only dispense medicinal drugs to patients
located in this state using the following pharmacies:
A pharmacy permitted under ch. 465, F.S.;
A nonresident pharmacy registered under s. 465.0156, F.S.; or
A nonresident pharmacy or outsourcing facility holding an active permit pursuant to s.
465.0158, F.S.
41
The board, or the DOH if there is no board, may take disciplinary action against an out-of-state
telehealth provider registered under s. 456,47, F.S., if the registrant:
Fails to notify the applicable board, or the DOH if there is no board, of any adverse actions
taken against his or her license;
Has restrictions placed on or disciplinary action taken against his or her license in any state
or jurisdiction;
Violates any of the requirements of s. 456.47, F.S.; or
Commits any act that constitutes grounds for disciplinary action under s. 456.072, F.S, or the
Florida practice act that is applicable to the telehealth provider similar to Florida licensees.
42
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.
43
A health care professional who is not
licensed to provide health care services in Florida but who holds an active license to provide
health care services in another state or jurisdiction, and who provides such services using
telehealth to a patient located in this state, is not subject to the registration requirement under s.
456.47, F.S., if the services are provided:
In response to an emergency medical condition; or
38
Section 456.47(4)(h), F.S.
39
Section 456.47 (4)(d), F.S.
40
Section 456.47(4)(f), F.S.
41
Section 456.47(4)(g), F.S.
42
Section 456.47(4)(i), F.S.
43
Section 456.47(5), F.S. BILL: SB 298 Page 6
In consultation with a health care professional licensed in this state who has ultimate
authority over the diagnosis and care of the patient.
44
Audio-only Telephone Calls During the State of Emergency
On March 9, 2020, Governor Ron DeSantis issued Executive Order Number 20-52
45
declaring a
state of emergency related to the 2019 novel coronavirus (COVID-19). During the state of
emergency, numerous statutes were set aside in order to better enable the state to respond to the
emergency.
On April 3, 2020, the Agency for Health Care Administration (AHCA) issued a Statewide
Medicaid Managed Care Policy Transmittal
46
that addressed Medicaid coverage of telephonic
(audio-only) communications as a form of telehealth. Under the transmittal, Medicaid managed
care plans were required to expand coverage of telehealth services to include telephone-only
communications, only when rendered by licensed physicians (including physician extenders such
as advanced practice registered nurses and physician assistants) and licensed behavioral health
practitioners.
The state of emergency was extended several times before expiring on June 26, 2021.
III. Effect of Proposed Changes:
SB 298 amends s. 456.47(1)(a), F.S., to revise the definition of “telehealth.” Under the bill, the
use of audio-only telephone calls is no longer excluded from the definition.
The bill provides an effective date of July 1, 2023.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
44
Section 456.47(6), F.S.
45
Office of the Governor, Executive Order Number 20-52, March 9, 2020, available at: https://www.flgov.com/wp-
content/uploads/orders/2020/EO_20-52.pdf (last visited Feb. 16, 2023).
46
Agency for Health Care Administration, Statewide Medicaid Managed Care (SMMC) Policy Transmittal: 2020-20, April
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 Feb. 16, 2023). BILL: SB 298 Page 7
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:
The bill my allow patients without access to video-calling capabilities to have greater
access to health care services via telehealth and may reduce out-of-pocket costs by not
requiring them to travel to receive care.
C. Government Sector Impact:
None.
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.