Of the two telemedicine bills moving through the Florida Legislature this year, only one seems poised to have a chance to become law: Senate Bill (SB) 1686, which authorizes healthcare practitioners to use telehealth and also creates a Telehealth Task Force under Agency for Health Care Administration (AHCA) to analyze and provide recommendations concerning telehealth operations.
"At least it would give us something substantial to build on," said Lloyd Sirmons, director of the Southeastern Telehealth Resource Center (SETRC), who has been leading a Florida Telehealth Workforce Group for the last two years to advance telehealth policy.
A companion bill, House Bill (HB) 7087, allows access to telehealth services by licensed healthcare professionals in Florida. If out-of-state healthcare professionals register with the Department of Health or an applicable board, meet requirements, and pay a fee, they may also provide telehealth services to Floridians. However, they would be prohibited from opening a physical location and offering in-person services in the state. Otherwise, they would be able to practice within the relevant scope of practice established by Florida law and rule.
Both bills - SB 1686 and HB 7087 - passed committees the second week of February. However, bill-watchers are concerned that neither version will lead to telehealth policy law.
"In the 2015 Florida Legislative Session, the legislature avoided controversial telehealth coverage mandates and consensus-breaking details of more than 40 potential policy issues," said Tamara Y. Demko, JD, MPH, author of Moving Telehealth Forward: The High Costs of Paying Later, a report recently produced by Florida TaxWatch. "Instead, both the Florida House of Representatives and the Florida Senate focused on a set of narrow telehealth policy issues that nearly led to consensus and bill passage."
Even though both bills advance telehealth in Florida to some degree, neither provides a provision addressing reimbursement of telehealth services. What is addressed are the fundamentals: definitions of telehealth, a broad list of eligible telehealth providers, standards of care, recordkeeping, and most aspects of prescription drugs.
Telehealth reimbursement struggles with many barriers, Demko pointed out, the first of which is lack of telehealth provider knowledge regarding billing and payment options.
"Florida providers need telehealth education, as some remain under the incorrect impression that Florida Medicaid provides no telehealth reimbursement," she said. "Across six clinical delivery models and nine business models for telehealth, standards of care and fraud and abuse concerns need to be addressed to provide assurances of comparative value for payers and quality of patient care for state actors. With a growing number of telehealth companies, certain companies have found ways to provide such assurance."
While California, Texas, and New York have telehealth-friendly statutes and regulations, Florida does not, pointed out Dominic M. Calabro, president and CEO of Florida TaxWatch.
"In a healthcare environment where federal changes create uncertain funding streams, telehealth provides a way for states to increase self-sufficiency, contain costs, and improve access," he said.
"While Florida currently has no telehealth mandates, Florida Medicaid does reimburse physicians for certain telemedicine services," said Demko, "and an unspecified number of providers have successfully negotiated private payer reimbursement arrangements."
State prioritization of telehealth, regardless of federal funding discussions, is essential for one, little-discussed reason: statewide telehealth expansion can ultimately reduce reliance on non-secured federal healthcare funding and increase state self-sufficiency, said Demko.
"Telehealth would allow Florida to reach its 19 million residents across 67 counties, regardless of location, age, infirmity, or transportation ability," she said.
Speed of the advancement of telehealth in Florida would bode well in addressing a troubling healthcare trend. By 2030, the 65 and older sector of Floridians is projected to reach 25 percent of the population.
"Before the silver tsunami strikes, and there's a state of emergency, Florida can prepare for a healthcare crisis by having in place an established infrastructure," said Demko. "Time wasted is money lost and, for Florida, the cost of waiting to act on telehealth is too high to ignore."
Agency for Health Care Administration