- One of the last states to formally establish a telehealth policy has been busy this month.
The Florida Telehealth Advisory Council, created by the state’s Legislature in March 2016, has put together a draft report that, among other things, defines “telehealth,” establishes payment and coverage conditions for payers and encourages asynchronous (store and forward) telehealth and remote patient monitoring under the state’s Medicaid program.
“It is imperative that the State of Florida moves forward in setting the framework for telehealth so that patients can begin utilizing this new technology,” Bean said in a press release issued on Sept. 20, one day after the advisory council’s meeting. “This bill is a good starting point and includes recommendations from the Telehealth Task Force that was established during the 2016 Legislative Session to review this important issue.”
The advisory council, which is due to issue recommendations to the state by Oct. 31, drafted its report after a series of 10 public meetings, presentations from some 30 state and national telehealth experts (including the American Telemedicine Association and Center for Connected Health Policy) and a statewide survey conducted late last year that showed strong support for telehealth and telemedicine.
The council’s recommendations include a formal definition for telehealth – the group notes there are several definitions for telemedicine in state regulations but nothing to define what’s consider a more encompassing term for the technology. The definition, the board said, would include six components:
- Telehealth can be used for providing health care and public health services.
- Telehealth includes synchronous and asynchronous modalities.
- Practitioners treating Florida patients must be appropriately licensed in Florida or appropriately supervised by a licensed Florida healthcare practitioner as prescribed by law or rule.
- Healthcare practitioners must treat within the scope of their practice.
- Telehealth can be healthcare practitioner to healthcare practitioner or healthcare practitioner to patient.
- There must be no limitations on geographic or site locations.
The council then went about defining telehealth as “the mode of providing health care and public health services through synchronous and asynchronous information and communication technology by a Florida licensed healthcare practitioner, within the scope of their practice, who is located at a site other than the site where a recipient (patient or licensed healthcare practitioner) is located.”
In other issues, the council recommends that all state-licensed health plans (excluding Medicare) provider coverage parity for telehealth, while those plans must also offer reimbursement for covered services provided via telehealth.
The legislation wouldn’t force insurers to adopt new service lines or specialties, mandate fee-for-service arrangements or hinder value-based payment programs, and it would allow those insurers to negotiate telehealth-friendly contracts with providers.
“The Council members have emphasized the importance of establishing a clear distinction between telehealth insurance coverage parity and reimbursement parity,” the council wrote in its draft report. “The Council recognizes telehealth coverage parity as a requirement of health plans to include benefits for services provided via telehealth, when possible and appropriate, to the same extent the plan covers the same services provided in-person. Coverage parity is silent regarding the amount of payment for telehealth services. The Council recognizes telehealth reimbursement parity as a requirement of health plans to pay healthcare facilities and practitioners for covered telehealth services at an equivalent rate as the in-person reimbursement for the same service.”
In terms of Medicare coverage, the council recommends that the state “support modifications to Medicare telehealth laws that would expand coverage to include remote patient monitoring as well as store and forward modalities; expand of the types of healthcare practitioners covered; and revise or eliminate the existing geographic and place of service requirements.”
With Medicaid, the council is asking the state to include coverage of store-and-forward and remote patient monitoring services, alongside current coverage for live video conferencing.
Among other issues, the council recommends:
- Maintaining the requirement that a provider treating patients in Florida must have a state license, and that the state participate in healthcare practitioner licensure compacts like the Interstate Medical Licensure Compact and Enhanced Nurse Licensure Compact.
- Adhering to the state’s current standards of care, while giving state healthcare regulatory boards and councils the authority to develop telehealth-specific standards if necessary.
- Enabling healthcare providers to establish a doctor-patient relationship through telehealth, rather than solely via an in-person meeting.
- Enabling providers to prescribe medications via telehealth as long as a doctor-patient relationship has been established, with limited exceptions made for the prescribing of controlled substances.
- State support for telehealth programs that increase access to technology and broadband networks and improve health information exchange and interoperability.
Bean’s bill, meanwhile, states the following:
- State health insurance programs would be encouraged, but not mandated, “to offer a selection of plans that include coverage of services provided through telehealth.”
- The state’s Medicaid program “may pay for” store-and-forward and RPM services in addition to live video conferencing.
- The standard of care for telehealth would be state same as the state’s standard of care for in-person services.
- Healthcare providers can prescribe medications via telehealth, including those authorized to prescribe controlled substances, with the exception of medications “to treat chronic nonmalignant pain” or marijuana.
- Patients are not required to give consent for telehealth treatment, but they can demand that telehealth not be used.