Is Any Telemedicine Permitted in Florida?

Is Any Telemedicine Permitted in Florida? Is Any Telemedicine Permitted in Florida?
The Florida legislature recently attempted to pass a telemedicine law, which would have significantly expanded the scope of permissible telemedicine in Florida. But, the bill (CS/SB 1646) died in appropriations on May 2, 2014.[1]

As part of that bill, the legislature prepared a "Bill Analysis and Fiscal Impact Statement," which included the following excerpt providing an overview of the current state of telemedicine in Florida.[2] (The footnotes have not been renumbered, but have been changed to L-, to designate them as the legislative footnotes.) As can be seen from the summary, compared to a number of other states, Florida is lagging behind in its coverage.

[Start of Excerpt]

Telemedicine Services in Florida

The University of Miami (UM) initiated telehealth services in 1973 and claims the first teleheath service in Florida, the first use of nurse practitioners in telemedicine in the nation, and the first telemedicine program in correctional facilities.[L-23] Today, UM has several initiatives in the areas of tele-dermatology, tele-trauma, humanitarian and disaster response relief telehealth, school telehealth services, and acute teleneurology or telestroke.[L-24] While some of the UM’s activities reach their local community, others reach outside of Florida including providing Haiti earthquake relief and teledermatology to cruise line employees. Telehealth communications are also used for monitoring patients in the hospital and conducting training exercises.

The UM also utilizes telemedicine to research the effectiveness of telemedicine in different trauma situations with the United States military. The research utilizes a robot which is operated from a control station using a joystick. The control station is on a laptop that allows the provider to operate the robot from any location with a wireless connection.[L-25] Lessons learned from this research are intended to provide assistance to deployed surgeons on the battlefield treating injured solders.

The UM along with other designated trauma centers participate in the Florida Emergency Trauma Telemedicine Network (FETTN). Coordinated by the department, the FETTN, facilitates the treatment of trauma patients between trauma centers and community or rural hospitals.[L-26] The FETTN allows for multiple interface options and currently 7 out of 25 trauma centers are part of the network.[L-27] In 2011-12, the seven Level 1 or Level 2 trauma centers that participated as a hub site, known as the location where the consulting physician is delivering the services, were Holmes Regional Medical Center, Tallahassee Memorial Hospital, Sacred Heart Hospital, University of Miami, Shands-Gainesville, Shands-Jacksvonille, and Orlando Health.[L-28]

According to the department, the trauma centers and their satellites as well as the rural hospitals that currently participate in the FETTN are not reimbursed for the consultation and treatment services provided within the telemedicine network.

Florida Medicaid Program
Florida’s Medicaid program reimburses for a limited number of telemedicine services by designated practitioners.[L-29] Audio only, email messages, facsimile transmissions, or communications with an enrollee through another mechanism other than the spoke site, known as the site where the patient is located, are not covered under Florida Medicaid.

Telemedicine is currently covered by Medicaid for the following services and settings:[L-30]
Behavioral Health
  • Tele-psychiatry services for psychiatric medication management by practitioners licensed under s. 458 or 459, F.S.
  • Tele-behavioral health services for individual and family behavioral health therapy services by qualified practitioners licensed under ch s.490 or 491, F.S.
Dental Services
  • Video conferencing between a registered dental hygienist employed by and under contract with a Medicaid-enrolled group provider and under the supervision of a supervising dentist.
  • Services include oral prophylaxis, topical fluoride, and oral hygiene instructions.
Physician Services
  • Services provided using audio and video equipment that allow for two-way, real time interactive communication between physician and patient.
  • State plan waiver specifically authorizes reimbursement for specialty physician services for Children’s Medical Services Network.
  • Physicians may bill for consultation services only provided via telemedicine.
The distant or hub site, where the provider is located, is eligible for reimbursement; the spoke site, where the patient is located, is not eligible for reimbursement unless a separate service is performed on the same day. Medicaid also requires that the referring physician and the patient be present during the consultation.[L-31]

Medicaid requires the following specific clinical records documentation to qualify for reimbursement as a telemedicine service:
[L-32]
  • A brief explanation of why services were not provided face-to-face;
  • Documentation of telemedicine services, including results of assessment; and,
  • A signed statement from the patient (or parent or guardian, if a child), indicating their choice to receive services through telemedicine.
Medicaid services are reimbursable only in the hospital outpatient, inpatient and physician office settings. During the 2013 Legislative Session, Medicaid provider enrollment requirements were revised to allow the enrollment of physicians actively licensed in Florida to interpret diagnostic testing results through telecommunications and information technology provided from a distance.[L-33]

Since 2006, the Children’s Medical Services Network (CMS Network) has been authorized to provide specified telemedicine services under Florida’s 1915(b) Medicaid Managed Care waiver. Authorized services include physician office visits (evaluation and management services) and consultation services already covered by the Medicaid state plan in select rural counties. Currently, the CMS Network provides telemedicine services in 57 of Florida’s 67 counties.[L-34]

The CMS Networkworks with the University of Florida’s (UF) pediatric endocrinology staff to provide telehealth services for enrollees with diabetes and other endocrinology diseases in the Dayton a Beach service area.[L-35] Additional partnerships with the Institute for Child Health Policy at UF include referring children with special health care needs to community health centers for consults via telehealth for nutritional, neurological, and orthopedics in Southeast Florida.[L-36]

Child Protection Teams

The Child Protection Team (CPT) program under Children’s Medical Services utilizes a telemedicine network to perform child assessments. The CPT is a medically directed multi-disciplinary program that works with local Sheriff’s offices and the Department of Children and Families in cases of child abuse and neglect to supplement investigative activities.[L-37] The CPT patient is seen at a remote site and a registered nurse assists with the medical exam. A physician or Advanced Registered Nurse Practitioner (ARNP) is located at the hub site and has responsibility for directing the exam.

Hub sites are comprehensive medical facilities that offer a wide range of medical and interdisciplinary staff whereas the remote sites tend to be smaller facilities that may lack medical diversity. In 2013, CPT telehealth services were available at 14 sites and 437 children were provided medical or other assessments via telemedicine technology.[L-38]

Other Department of Health Initiatives
The department utilizes tele-radiology through the Tuberculosis(TB) Physician’s Network.[L-39] The ability to read electronic chest X-Rays remotely can lead to a faster diagnosis, treatment and a reduction in the spread of the disease, according to the department. This service is not currently reimbursed by Medicaid.

[End of Excerpt]


Related Posts
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[1] Florida Senate, CS/SB 1646: Telemedicine, http://www.flsenate.gov/Session/Bill/2014/1646/?Tab=BillHistory.
[2] Florida Senate Health Policy Committee, Bill Analysis and Fiscal Impact Statement: Telemedicine, SB 1646 (Mar. 5, 2014) (analysis prepared by Jennifer Lloyd, Chief Legislative Analyst for the Senate Health Policy Committee) (pdf).

[L-23] University of Miami, Miller School of Medicine, UM Telehealth-Our History, http://telehealth.med.miami.edu/about-us/our-history (last visited Jan. 31, 2014).

[L-24] University of Miami, Miller School of Medicine, UM Telehealth, http://telehealth.med.miami.edu/featured/teledermatology (last visited Jan. 28, 2014).
[L-25] University of Miami, Miller School of Medicine, UM Telehealth-Teletrauma, http://telehealth.med.miami.edu/featured/teletrauma (last visited Jan. 31, 2014).
[L-26] Florida Department of Health, 2014 Agency Legislative Bill Analysis of SB 70, p.2, on file with the Senate Health Policy Committee (August 26, 2013).
[L-27] Id., at 3.
[L-28] Florida Department of Health, Long Range Program Plan (September 28, 2012), on file with the Senate Health Policy Committee.
[L-29] Agency for Health Care Administration, Highlights of Practitioner Services Coverage and Limitations Handbook Presentation, Bureau of Medicaid Services, Summer 2013, p.30.
[L-30] Agency for Health Care Administration, 2014 Legislative Bill Analysis of SB 70, November 7, 2013, p. 3, on file with the Senate Health Policy Committee.
[L-31] Agency for Health Care Administration, supra, note 29, at 34.
[L-32] Id. at p. 36.
[L-33] See Chapter 2013-150, L.O.F., sec. 1.
[L-34] Florida Department of Health, supra, note 28, at 2.
[L-35] Florida Department of Health, Maternal and Child Health Block Grant Narrative for 2013, http://www.floridahealth.gov/healthy-people-and-families/womens-health/pregnancy/mch-fl-2013-1narrative.pdf, p.21, (last visited: Jan. 31, 2014).

[L-36] Id.
[L-37] Florida Department of Health, Child Protection Teams, http://www.floridahealth.gov/AlternateSites/CMS-Kids/families/child_protection_safety/child_protection_teams.html (last visited Jan. 7, 2014).
[L-38] Florida Department of Health, supra note 35, at 21.
[L-39] Florida Department of Health, supra note 26, at 2.


Posted by Tatiana Melnik May 26, 2014.

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