After several years of developing telehealth legislation in a state that pioneered the practice at the University of Miami circa 1970, Florida lawmakers almost unanimously passed a basic telehealth bill in March, paving the way for comprehensive telehealth reimbursement to be considered in the 2018 legislative session.
"The good news is that we've finally gotten legislation passed, and it's the beginning of telehealth initiatives in the Florida Legislature," said Mike Smith MA, MPA, program director of the Center for Strategic Public Health Preparedness and principal investigator for the Center for Universal Research to Eradicate Disease (FLCURED.org) at Florida State University.
House Bill 7087 is a hybrid of House and Senate versions that excludes a special registration process allowing out-of-state healthcare providers to offer telehealth services to Floridians without the requirement of full Florida licensure (House) and language regarding telehealth practice standards and remote prescribing of controlled substances (Senate).
"The House version charged out-of-state doctors $150 to practice telehealth on a very restrictive basis," explained Smith. "They couldn't establish an office in Florida, among other requirements. Wish that part had passed."
At the core of the bill is the creation of a formal Telehealth Advisory Council within Florida's Agency for Health Care Administration (AHCA); that key language was included in both chamber versions. Florida's Department of Health, Office of Insurance Regulation and AHCA are required to survey providers, professionals, facilities and health plans to determine the extent that commercial health plans are already covering telehealth services, and also the corresponding reimbursement rates. Providers and insurers who fail to report the data could face fines and penalties.
The 15-member Telehealth Advisory Council, to be chaired by the AHCA secretary or designee, is mandated to gather research data by Dec. 31, 2016, and to turn their findings into an objective assessment of the state's telehealth landscape, with a special focus on commercial insurance coverage, by Oct. 31, 2017.
"Even though it'll take longer to introduce and pass meaningful legislation concerning telehealth reimbursement, the task force isn't a bad thing," said Smith. "The formal process will allow the state to study telehealth trends and hopefully move forward quickly."
Legislative talk about telehealth began several years ago, with State Rep. Mia Jones (D-Jacksonville) and State Sen. Arthenia Joyner (D-Tampa) putting forth complementary bills in both chambers. Bipartisan support came via State Sen. Aaron Bean (R-Jacksonville) and State Rep. Chris Sprowls (R-Clearwater), who paved the way for HB 7087 passage.
"Last year, we wouldn't have wanted the proposed telehealth legislation to pass because it would've undone progress we've already made, especially concerning behavioral health patients," said Smith, pointing out the telehealth bill effective July 1 coincides with the Board of Medicine's new telehealth policy of allowing remote prescribing of controlled substances for the treatment of psychiatric disorders.
The 2016 legislative session placed telehealth legislation as a priority item, with the Florida Medical Association (FMA), Florida Hospital Association (FHA), and insurers coming to the legislature with varying definitions of telehealth providers.
The Florida Chamber of Commerce and the Associated Industries of Florida lobbied hard for good telehealth legislation.
"Suppose you're at work when you get a call from the school to pick up a sick child," said Smith. "Normally, that person would leave work, pick up their child, call for an appointment with their pediatrician or take their child to an urgent care clinic or emergency room to deal with their illness. If we had telehealth in schools, the child could be treated for minor, noncontagious illnesses. The child will be fine, the parent's work might not be disrupted, and the cost and time savings will be substantial."
Florida's telehealth legislation mimics efforts by Congress to analyze Medicare coverage of telehealth services. In last April's Doc Fix Bill, Congress called on the Government Accountability Office to produce two reports - due in April 2017 - that analyze national telehealth programs and their coverage by Medicare.
For now, Florida joins 29 states and the District of Columbia with telehealth laws requiring commercial health insurers to cover some services provided via telehealth. The National Conference of State Legislatures estimates 32 states will have laws on the books by 2017.
"We're extremely pleased the legislature has decided to take action on expanding telehealth," said Florida TaxWatch CEO Dominic Calabro. "Telehealth is critical in providing more high-quality, affordable healthcare to all Floridians."
Telehealth's origins trace back to the 1960s, when NASA wanted to know how a zero-gravity environment in space travel impacted astronauts' vital signs. Monitoring their health from afar led to an essay in the Bulletin of the Medical Library Association, "Earth-bound Physicians Trying to Diagnose or Treat a Patient in a Remote Location."