Telehealth in Florida — Everything You Need to Know to Start Practicing Online Patient Care in Florida

Posted by Michael Hsu on 5/28/20 6:07 AM
Michael Hsu

Florida got proper telehealth legislation only recently, in 2019. The state legislature had been working on the law for several years before it was passed. What hindered its enactment was a debate over payment parity, which payer organizations won in the end.

The first real attempt at getting a telehealth law in Florida happened in 2017 when a state-assigned council issued a report that proposed the definition of telehealth and its adoption. A bill was charted based on the report, but it failed to pass the committee.

The legal guidelines on telehealth and telemedicine in Florida were unsatisfactory, to say the least. Once the state lawmakers passed House Bill 23, Florida telehealth providers finally got instructions on how to use technology for patient care.

We’ll take a closer look at how Florida telemedicine law developed and what healthcare providers can and can’t do as of July 1, 2019.

Telehealth in Florida before House Bill 23

Telemedicine was practiced in Florida, but providers didn’t have clear guidelines on how to do so while staying within the law. The state tried to change that in 2016 by appointing a body, the Telehealth Advisory Council, to survey healthcare providers and health insurers about the state of telehealth in Florida and submit a detailed report. 

The purpose of this report was to provide insight into the established practices, further needs, and potential issues to be solved. The state legislation from 2016 that created the council also included a rough set of definitions and regulations regarding telehealth to hold the fort until a new bill arrives. The new bill was supposed to be based on the council’s findings.

In 2017, the state-appointed council came up with a report that contained a number of recommendations for improving and clarifying telehealth regulations. Among these were the following:

  • The definition of “telehealth”
  • Coverage and payment condition for payers
  • Encouragement of asynchronous (store-and-forward) telehealth

Soon after the report was published, Senate Bill 280 was proposed by State Senator Aaron Bean. The bill was mostly based on the council’s report. The following year, the state legislature failed to pass it, leaving both providers and insurers in the dark. The bill fell apart due to the lawmakers’ and payment organizations’ disagreement over whether payment parity for telehealth should be mandated.

Current Florida telehealth law breakdown

The year 2019 was vital for those who practice or wish to start practicing telehealth in Florida. It’s when the state got its first comprehensive law on telemedicine. Governor DeSantis signed House Bill 23 into law in April 2019, and it came into effect in July the same year.

The bill is largely based on the 2017 Telehealth Advisory Council report. It covers five key points:

  1. Key definitions
  2. Practice standards
  3. Out-of-state providers registration
  4. Licensure exceptions
  5. Insurance coverage

House Bill 23 is now part of the Florida Statutes as Section 456.47. We will talk about its provisions and what they mean in practice in great detail.

What is telehealth in Florida?

Telehealth is described in simple terms as the use of both synchronous and asynchronous technology by a telehealth provider to provide healthcare services. The difference between these two types of technology is in the time of information sharing. The former relays information in real-time, while the latter transmits data intermittently, i.e., with a lag.

The healthcare services that a telehealth provider can offer include:

  • Assessment
  • Diagnosis
  • Consultation
  • Treatment
  • Patient monitoring
  • Medical data transfer
  • Patient and professional health-related education
  • Public health services
  • Health administration

What type of communication does telehealth entail?

Telehealth mostly refers to video meetings as well as other means of remote communication, excluding voice-only calls, email correspondence, and data transfer through faxing services. These activities are not prohibited, but they are not considered telehealth by the law. Why would you want to engage in them anyway when you can use a secure and practical video telehealth solution, such as our Curogram.

What is the difference between telemedicine and telehealth in Florida?

Before House Bill 23, the term “telemedicine” was defined in a similar way that “telehealth” is defined now. Here’s a definition by the Florida Board of Medicine:

“‘Telemedicine’ means the practice of medicine by a licensed Florida physician or physician assistant where patient care, treatment, or services are provided through the use of medical information exchanged from one site to another via electronic communications.”

As you can see, “telemedicine” was used to denote practices that now fall under the definition of telehealth. The difference is that the latter is described in greater detail as its definition specifies which healthcare services you can provide and which technologies you can use. 

As you’ll see later, the Florida telehealth law gives a much broader definition of who can provide healthcare services, and this goes way beyond licensed Florida physicians and physician assistants. 

Given the above information, we can say that the practice of telemedicine falls under the scope of telehealth. The truth is that the term “telemedicine” isn’t even used in the law anymore as the rule defining it was repealed when the current law was enacted.

Who can provide telehealth services in Florida?

Florida law allows a variety of state-licensed healthcare professionals to provide services using telehealth, and these include but are not limited to:

  • Physician
  • Podiatrist
  • Massage therapist
  • Chiropractor
  • Dietician
  • Physical therapist
  • Occupational therapist
  • Radiological personnel
  • Marriage and family therapist
  • Pedorthist
  • Optometrist
  • Midwife
  • Athletic trainer
  • Behavior analyst
  • Optician
  • Medical physicist
  • Acupuncturist
  • Pharmacist
  • Audiologist
  • Electrologist
  • Psychologist
  • Mental health counselor
  • Nurse
  • Hearing aid specialist
  • Clinical social worker
  • Psychotherapist
  • Nurse practitioner
  • Respiratory therapist
  • Dentist
  • Prosthesis
  • Orthotist
  • Air ambulance service
  • Basic or advanced life support service
  • Speech-language pathologist

Individuals who are not medical professionals licensed in Florida can also practice telehealth in two possible ways:

  1. If they are multi-state healthcare license holders (provided that Florida is part of the compact)
  2. If they obtain an out-of-state telehealth registration (to be discussed in more detail later)

Practice standards for telehealth providers in Florida

There are several practice standards mandated by the telehealth law that practitioners need to adhere to. These are the following:

  1. Standard of care
  2. Establishing a doctor-patient relationship
  3. Prescription requirements
  4. Handling patient medical records

Standard of care

The standard of care is straightforward—a healthcare professional using telehealth only has to provide services that are within their scope of practice and, in doing so, comply with the professional standard of practice for medical professionals who see patients in person in Florida. 

To put it simply—continue being a professional even when providing services remotely.

Establishing a doctor-patient relationship

Some states have complicated requirements when it comes to establishing a provider-patient relationship. Their telehealth and telemedicine laws obligate providers to establish in-person contact with a patient before conducting a telemedicine appointment with them. This often means that doctors can treat only their existing patients.

Florida law allows doctors to evaluate patients via telehealth directly. If that evaluation is sufficient for the provider to diagnose and treat a patient, they can proceed to do so without accessing any of the patient’s medical history or examining them in person first.

This is great news for telehealth providers as their services are not limited by complicated procedures, and neither is their potential patient base.

Prescription requirements

Florida legislation limits the use of telehealth in prescribing controlled substances, which is only reasonable. There are instances in which telehealth providers can prescribe this type of medication, and these include:

  • Treating a psychiatric disorder
  • Treating hospital patients
  • Treating nursing home facility residents
  • Treating a patient receiving hospice care

Before this law was introduced, providers could only prescribe controlled substances in the first two instances described above. This is a welcome change, but you should always be careful when dealing with these kinds of drugs.

Handling patient medical records

All telehealth services need to be documented in the patient’s medical record just like they would be after an in-person appointment. All medical records, including the video of the appointment and any electronic files resulting from it, are confidential.

If you opt for Curogram as your telehealth platform, you’ll have a much easier time documenting everything as it syncs with your EHR. Our app also complies with all the Florida state laws as well as federal laws, so you don’t have to worry about the confidentiality and security of your patient information.

Curogram EHR integrations

eClinicalWorks

Athena

Epic

Cerner

DrChrono

NextGen

Practice Fusion

CareCloud

Kareo

OfficeAlly

See More Integrations Here

Out-of-state providers registration in Florida

Out-of-state providers can apply for registration with the state of Florida that would permit them to practice telehealth in Florida, i.e., to provide healthcare services to Florida patients. These practitioners would have to apply for a registration number with the Florida Department of Health.

Here are the prerequisites for obtaining out-of-state telehealth registration:

  • The provider needs to fill out and submit the application form
  • The provider needs to have a valid license in another state that is similar to Florida-issued licenses
  • The provider mustn’t have a record of any disciplinary measures tied to their license in the five-year period preceding the application
  • The provider needs to choose a designated registered agent (from the list of these agents by the Division of Corporations)
  • The provider needs to maintain professional liability coverage, that includes coverage for telehealth services to Florida patients, in equal or greater amounts to those required for a Florida-licensed provider
  • The provider mustn’t set a physical office or provide in-person healthcare services to Florida patients

The current telehealth law has caused some worry in the Florida healthcare community as it has a loophole that out-of-state practitioners can take advantage of to avoid paying any fees to the state.

The bill initially called for a $150 fee, but Florida Statutes necessitate the existence of a separate bill that would set fees. Such a bill was introduced, but the Governor vetoed it. This left Florida without any fee rules applicable to those registering outside of the state.

Licensure exceptions for practicing telehealth in Florida

As a non-Florida-based medical professional, you can provide telehealth services in some cases without registering with the Department of Health. These cases include the following:

  1. If there is an emergency medical situation
  2. If you’re collaborating with a Florida-based practitioner who has the authority over the patient care

Insurance coverage for telehealth services in Florida

While Florida-based telehealth providers got many benefits from the current law, insurance coverage is not one of them. The law doesn’t require healthcare plans to cover services rendered online.

The payer and the telehealth provider need to reach a mutually satisfactory agreement on the payment rates and methods. The payer organization enters into an agreement voluntarily, and reimbursement can differ greatly from that for the same services rendered in person.

This law leaves Florida without payment and coverage parity laws, which makes it the minority among the states. More than 36 states mandate coverage parity for telehealth, while more than ten require payment parity.

Florida law is favorable for insurers, who have argued that they should be the ones to set payment rates for virtual care, not lawmakers. Their argument is that these rates should be lower for telehealth as online care reduces many expenses and shouldn’t cost more than in-person care.

Telehealth advocates are of the opposite opinion—reimbursement rates should be the same as those for in-person services as these are essentially the same services. They argue that payment parity should at least be introduced in the beginning to encourage medical professionals to start using telehealth. 

Temporary adjustments due to COVID-19 public health emergency

Following the proclamation of the COVID-19 national health emergency, Florida Surgeon General, Scott Rivkees, M.D., of the Florida Department of Health (DOH) has issued an order that temporarily suspends some statutory laws regarding telehealth services in the state to make healthcare accessible to everyone. These include:

  • Healthcare provider licensure extension
  • Out-of-state provider licensure acceptance
  • Remote board hearings
  • Remote nursing education programs

Another relevant order is the one issued by Governor DeSantis, which mandates insurance coverage for telehealth services during the coronavirus national emergency. 

Have a successful telehealth start in Florida with Curogram

If you want to start practicing telehealth, but don’t know how, Curogram can help. It is a two-way messaging and telehealth platform that allows you to set up an online clinic in no time. Curogram complies with all the HIPAA rules and has all the required safeguards to ensure that your virtual clinic and protected health information (PHI) are safe at all times.

Our platform gives you the tools to provide remote patient care in the smoothest way possible. It is easy to use, both for patients and doctors, and it comes with a variety of features that will make your clinic thrive online.

The best thing about Curogram is that it allows you to manage all your telehealth appointments and communication with patients from a single platform.

Take a look at some of our features:

Curogram feature

How it works

Two-way SMS texting

You can send your patients auto-generated text messages that they can reply to. You will see all your patients on your web-based dashboard that lets you send SMS messages directly to the patients’ phones. Texting is much more time-efficient than phone calls, and it will save your staff tons of time.

Smart appointment reminders

As Curogram syncs with your schedule, your staff doesn’t have to manually remind each and every patient about their visit. All you have to do is customize the types of reminders you’d like to send out, and Curogram will distribute these to your patients as ordered. They can reschedule or ask for further information by responding to your text.

HIPAA-secure apps for internal and external communication

Curogram offers both provider and patient apps for HIPAA-secure communication. You can use it on any device, be it a laptop, smartphone, or tablet. The patient app is completely free, and it is the first such app on the market that you can use to exchange PHI. With ample staff-to-staff secure messaging options, you get an all-in-one communication platform.

Natural workflows support

As a telehealth solution, Curogram can offer you what not many platforms can—support for your doctors’ and staff’s natural workflows. Curogram allows you to send electronic patient forms prior to the visit to save time on the day of the appointment. When the patient arrives at your online clinic, they go through the same processes they would in person. The nurse greets them and gets them ready, then the doctor takes over, etc.

Virtual waiting room

Curogram provides a virtual waiting room, which helps you streamline the process of seeing patients and make it smooth. The virtual waiting room makes it possible for your doctors to see who’s ready and for the nurses to prepare the waiting patients. This way, everyone is allowed to do their job without hindrances.

Multi-user video chat

If you need more people present at the appointment—no problem! Several medical providers can be with the patient at the same time. This also means that the doctor can have an assistant with them to take notes while they focus on the patient.

Integrates with any EHR

Curogram integrates with almost any EHR. This can save your staff a lot of time they would have spent entering all data twice. We can complete the integration with your electronic system in less than 48 hours!

If you want to start practicing telehealth in Florida, look no further than Curogram!

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.

Telemedicine by State in the US

Alabama

Indiana

Nebraska

South Carolina

Alaska

Iowa

Nevada

South Dakota

Arizona

Kansas

New Hampshire

Tennessee

Arkansas

Kentucky

New Jersey

Texas

California

Louisiana

New Mexico

Utah

Colorado

Maine

New York

Vermont

Connecticut

Maryland

North Carolina

Virginia

Delaware

Massachusetts 

North Dakota

Washington

Florida

Michigan

Ohio

West Virginia

Georgia

Minnesota

Oklahoma

Wisconsin

Hawaii

Mississippi

Oregon

Wyoming

Idaho

Missouri

Pennsylvania

 

Illinois

Montana

Rhode Island

 

Topics: telemedicine, florida

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