Senate Bill 726 (2022) — Telehealth
SB 726
Florida Bills
Florida Senate - 2022 SB 726 By Senator Ausley 3-00937-22 2022726__ Page 1 of 9 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1
An act relating to telehealth; amending s. 409.967, 2 F.S.; prohibiting Medicaid managed care plans from 3 using providers who exclusively provide services 4 through telehealth to achieve network adequacy; 5 amending s. 627.42396, F.S.; prohibiting certain 6 health insurance policies from denying coverage for 7 covered services provided through telehealth under 8 certain circumstances; prohibiting health insurers 9 from excluding covered services provided through 10 telehealth from coverage; providing reimbursement 11 requirements and cost-sharing limitations for health 12 insurers relating to telehealth services; prohibiting 13 health insurers from requiring an insured person to 14 receive services through telehealth; authorizing 15 health insurers to conduct utilization reviews under 16 certain circumstances; authorizing health insurers to 17 limit telehealth services to certain providers; 18 deleting requirements for contracts between certain 19 health insurers and telehealth providers; amending s. 20 627.6699, F.S.; requiring certain small employer 21 benefit plans to comply with certain requirements for 22 reimbursement of telehealth services; amending s. 23 641.31, F.S.; prohibiting a health maintenance 24 organization from requiring a subscriber to receive 25 certain services through telehealth; deleting 26 requirements for contracts between certain health 27 insurers and telehealth providers; creating s. 28 641.31093, F.S.; prohibiting certain health 29
Florida Senate - 2022 SB 726 3-00937-22 2022726__ Page 2 of 9 CODING: Words stricken are deletions; words underlined are additions. maintenance organizations from denying coverage for 30 covered services provided through telehealth under 31 certain circumstances; prohibiting health maintenance 32 organizations from excluding covered services provided 33 through telehealth from coverage; providing 34 reimbursement requirements and cost-sharing 35 limitations for health maintenance organizations 36 relating to telehealth services; prohibiting a health 37 maintenance organization from requiring a subscriber 38 to receive services through telehealth; authorizing 39 health maintenance organizations to conduct 40 utilization reviews under certain circumstances; 41 authorizing health maintenance organizations to limit 42 telehealth services to certain providers; providing an 43 effective date. 44 45 WHEREAS, it is the intent of the Legislature to mitigate 46 geographic discrimination in the delivery of health care by 47 recognizing the provision of and payment for covered medical 48 care by means of telehealth services, provided that such 49 services are provided by a physician or by another health care 50 practitioner or professional acting within the scope of practice 51 of a health care practitioner or professional and in accordance 52 with s. 456.47, Florida Statutes, NOW, THEREFORE, 53 54 Be It Enacted by the Legislature of the State of Florida: 55 56
Section 1. Paragraph (
c) of subsection (2) of
section 57 409.967, Florida Statutes, is amended to read: 58
Florida Senate - 2022 SB 726 3-00937-22 2022726__ Page 3 of 9 CODING: Words stricken are deletions; words underlined are additions. 409.967 Managed care plan accountability.— 59
(2) The agency shall establish such contract requirements 60 as are necessary for the operation of the statewide managed care 61 program. In addition to any other provisions the agency may deem 62 necessary, the contract must require: 63 (
c) Access.— 64 1. The agency shall establish specific standards for the 65 number, type, and regional distribution of providers in managed 66 care plan networks to ensure access to care for both adults and 67 children. Each plan must maintain a regionwide network of 68 providers in sufficient numbers to meet the access standards for 69 specific medical services for all recipients enrolled in the 70 plan. A plan may not use providers who exclusively provide 71 services through telehealth as defined in s. 456.47 to meet this 72 requirement.
The exclusive use of mail-order pharmacies may not 73 be sufficient to meet network access standards. Consistent with 74 the standards established by the agency, provider networks may 75 include providers located outside the region. A plan may 76 contract with a new hospital facility before the date the 77 hospital becomes operational if the hospital has commenced 78 construction, will be licensed and operational by January 1, 79 2013, and a final order has issued in any civil or 80 administrative challenge.
Each plan shall establish and maintain 81 an accurate and complete electronic database of contracted 82 providers, including information about licensure or 83 registration, locations and hours of operation, specialty 84 credentials and other certifications, specific performance 85 indicators, and such other information as the agency deems 86 necessary. The database must be available online to both the 87
Florida Senate - 2022 SB 726 3-00937-22 2022726__ Page 4 of 9 CODING: Words stricken are deletions; words underlined are additions. agency and the public and have the capability to compare the 88 availability of providers to network adequacy standards and to 89 accept and display feedback from each provider’s patients.
Each 90 plan shall submit quarterly reports to the agency identifying 91 the number of enrollees assigned to each primary care provider. 92 The agency shall conduct, or contract for, systematic and 93 continuous testing of the provider network databases maintained 94 by each plan to confirm accuracy, confirm that behavioral health 95 providers are accepting enrollees, and confirm that enrollees 96 have access to behavioral health services. 97 2.
Each managed care plan must publish any prescribed drug 98 formulary or preferred drug list on the plan’s website in a 99 manner that is accessible to and searchable by enrollees and 100 providers. The plan must update the list within 24 hours after 101 making a change. Each plan must ensure that the prior 102 authorization process for prescribed drugs is readily accessible 103 to health care providers, including posting appropriate contact 104 information on its website and providing timely responses to 105 providers.
For Medicaid recipients diagnosed with hemophilia who 106 have been prescribed anti-hemophilic-factor replacement 107 products, the agency shall provide for those products and 108 hemophilia overlay services through the agency’s hemophilia 109 disease management program. 110 3. Managed care plans, and their fiscal agents or 111 intermediaries, must accept prior authorization requests for any 112 service electronically. 113 4. Managed care plans serving children in the care and 114 custody of the Department of Children and Families must maintain 115 complete medical, dental, and behavioral health encounter 116
Florida Senate - 2022 SB 726 3-00937-22 2022726__ Page 5 of 9 CODING: Words stricken are deletions; words underlined are additions. information and participate in making such information available 117 to the department or the applicable contracted community-based 118 care lead agency for use in providing comprehensive and 119 coordinated case management. The agency and the department shall 120 establish an interagency agreement to provide guidance for the 121 format, confidentiality, recipient, scope, and method of 122 information to be made available and the deadlines for 123 submission of the data.
The scope of information available to 124 the department shall be the data that managed care plans are 125 required to submit to the agency. The agency shall determine the 126 plan’s compliance with standards for access to medical, dental, 127 and behavioral health services; the use of medications; and 128 follow up followup on all medically necessary services 129 recommended as a result of early and periodic screening, 130 diagnosis, and treatment. 131
Section
Section 627.42396, Florida Statutes, is amended 132 to read: 133 627.42396 Requirements for reimbursement by health insurers 134 for telehealth services.— 135
(1) An individual, group, blanket, or franchise health 136 insurance policy delivered or issued for delivery to any insured 137 person in this state on or after January 1, 2023, may not deny 138 coverage for a covered service on the basis of the service being 139 provided through telehealth if the same service would be covered 140 if provided through an in-person encounter. 141
(2) A health insurer may not exclude an otherwise covered 142 service from coverage solely because the service is provided 143 through telehealth rather than through an in-person encounter. 144
(3) A health insurer shall reimburse a telehealth provider 145
Florida Senate - 2022 SB 726 3-00937-22 2022726__ Page 6 of 9 CODING: Words stricken are deletions; words underlined are additions. for the diagnosis, consultation, or treatment of any insured 146 person provided through telehealth on the same basis and at 147 least at the same rate that the health insurer would reimburse 148 the provider if the covered service were delivered through an 149 in-person encounter. However, a health insurer may not require a 150 health care provider or telehealth provider to accept a 151 reimbursement amount greater than the amount the provider is 152 willing to charge. 153
(4) A health insurer shall reimburse a telehealth provider 154 for reasonable originating site fees or costs for the provision 155 of telehealth services. 156
(5) A covered service provided through telehealth may not 157 be subject to a greater deductible, copayment, or coinsurance 158 amount than would apply if the same service were provided 159 through an in-person encounter. 160
(6) A health insurer may not impose upon any insured person 161 receiving benefits under this
section any copayment, 162 coinsurance, or deductible amount or any policy-year, calendar-163 year, lifetime, or other durational benefit limitation or 164 maximum for benefits or services provided through telehealth 165 which is not equally imposed upon all terms and services covered 166 under the policy. 167
(7) A health insurer may not require an insured person to 168 obtain a covered service through telehealth instead of an in-169 person encounter. 170
(8) This
section does not preclude a health insurer from 171 conducting a utilization review to determine the appropriateness 172 of telehealth as a means of delivering a covered service if such 173 determination is made in the same manner as would be made for 174
Florida Senate - 2022 SB 726 3-00937-22 2022726__ Page 7 of 9 CODING: Words stricken are deletions; words underlined are additions. the same service provided through an in-person encounter. 175
(9) A health insurer may limit the covered services 176 provided through telehealth to providers who are in a network 177 approved by the insurer A contract between a health insurer 178 issuing major medical comprehensive coverage through an 179 individual or group policy and a telehealth provider, as defined 180 in s. 456.47, must be voluntary between the insurer and the 181 provider and must establish mutually acceptable payment rates or 182 payment methodologies for services provided through telehealth. 183 Any contract provision that distinguishes between payment rates 184 or payment methodologies for services provided through 185 telehealth and the same services provided without the use of 186 telehealth must be initialed by the telehealth provider. 187
Section 3. Paragraph (
h) is added to subsection (5) of 188
section 627.6699, Florida Statutes, to read: 189 627.6699 Employee Health Care Access Act.— 190
(5) AVAILABILITY OF COVERAGE.— 191 (
h) A health benefit plan covering small employers which is 192 delivered, issued, or renewed in this state on or after January 193 1, 2023, must comply with s. 627.42396. 194
Section 4. Subsection (45) of
section 641.31, Florida 195 Statutes, is amended to read: 196 641.31 Health maintenance contracts.— 197
(45) A contract between a health maintenance organization 198 issuing major medical individual or group coverage may not 199 require a subscriber to consult with, seek approval from, or 200 obtain any type of referral or authorization by way of 201 telehealth from and a telehealth provider, as defined in s. 202 456.47, must be voluntary between the health maintenance 203
Florida Senate - 2022 SB 726 3-00937-22 2022726__ Page 8 of 9 CODING: Words stricken are deletions; words underlined are additions. organization and the provider and must establish mutually 204 acceptable payment rates or payment methodologies for services 205 provided through telehealth. Any contract provision that 206 distinguishes between payment rates or payment methodologies for 207 services provided through telehealth and the same services 208 provided without the use of telehealth must be initialed by the 209 telehealth provider. 210
Section
Section 641.31093, Florida Statutes, is created 211 to read: 212 641.31093 Requirements for reimbursement by health 213 maintenance organizations for telehealth services.— 214
(1) A health maintenance organization that offers, issues, 215 or renews a major medical or similar comprehensive contract in 216 this state on or after January 1, 2023, may not deny coverage 217 for a covered service on the basis of the covered service being 218 provided through telehealth if the same service would be covered 219 if provided through an in-person encounter. 220
(2) A health maintenance organization may not exclude an 221 otherwise covered service from coverage solely because the 222 service is provided through telehealth rather than through an 223 in-person encounter. 224
(3) A health maintenance organization shall reimburse a 225 telehealth provider for the diagnosis, consultation, or 226 treatment of any subscriber provided through telehealth on the 227 same basis and at least the same rate that the health 228 maintenance organization would reimburse the provider if the 229 service were provided through an in-person encounter. However, a 230 health maintenance organization may not require a health care 231 provider or telehealth provider to accept a reimbursement amount 232
Florida Senate - 2022 SB 726 3-00937-22 2022726__ Page 9 of 9 CODING: Words stricken are deletions; words underlined are additions. greater than the amount the provider is willing to charge. 233
(4) A health maintenance organization shall reimburse a 234 telehealth provider for reasonable originating site fees or 235 costs for the provision of telehealth services. 236
(5) A covered service provided through telehealth may not 237 be subject to a greater deductible, copayment, or coinsurance 238 amount than would apply if the same service were provided 239 through an in-person encounter. 240
(6) A health maintenance organization may not impose upon 241 any subscriber receiving benefits under this
section any 242 copayment, coinsurance, or deductible amount or any contract-243 year, calendar-year, lifetime, or other durational benefit 244 limitation or maximum for benefits or services provided through 245 telehealth which is not equally imposed upon all services 246 covered under the contract. 247
(7) A health maintenance organization may not require an 248 insured person to obtain a covered service through telehealth 249 instead of an in-person encounter. 250
(8) This
section does not preclude a health maintenance 251 organization from conducting a utilization review to determine 252 the appropriateness of telehealth as a means of delivering a 253 covered service if such determination is made in the same manner 254 as would be made for the same service provided through an in-255 person encounter. 256
(9) A health maintenance organization may limit covered 257 services provided through telehealth to providers who are in a 258 network approved by the health maintenance organization. 259