Telemedicine is Coming to Florida (Slowly but Surely)

Telemedicine is Coming to Florida (Slowly but Surely) Telemedicine is Coming to Florida (Slowly but Surely) Telemedicine is Coming to Florida (Slowly but Surely) Telemedicine is Coming to Florida (Slowly but Surely) Telemedicine is Coming to Florida (Slowly but Surely) Telemedicine is Coming to Florida (Slowly but Surely) Telemedicine is Coming to Florida (Slowly but Surely) Telemedicine is Coming to Florida (Slowly but Surely) Telemedicine is Coming to Florida (Slowly but Surely)
The Florida Boards of Medicine and Osteopathic Medicine are Moving Closer to Proposing a Rule on Standards for Telemedicine Practice.

In a joint meeting of the Florida Boards of Medicine and Osteopathic Medicine on November 14, 2013, the Telemedicine Subcommittee moved closer to proposing a rule aimed at setting the standards for telemedicine practice in Florida.

The Telemedicine Subcommittee was established during the August 2013 Board of Medicine meeting to address Florida's growing telemedicine field. The Subcommittee is comprised of six Board of Medicine members and three Board of Osteopathic Medicine members.[1]

The current telemedicine rule for each of the Florida Board of Medicine and Osteopathic Medicine is limited to Internet prescribing.[2] But, as Dr. Orr, the Chair of the Telemedicine Subcommittee, explained during the first meeting on September 9, 2013, the Subcommittee's goal is to examine current uses of telemedicine and to amend the Board's rules to address the use of telemedicine [3] in a more comprehensive manner.

The Subcommittee has proposed to define telemedicine as "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. Telemedicine shall not include the provision of health care services only through an audio only telephone, email messages, text messages, facsimile transmission, U.S. Mail or other parcel service, or any combination thereof." [4]

Additionally, "[t]he standard of care, as defined in s. 456.50(1)(e), F.S., shall remain the same regardless of whether a Florida licensed physician or physician assistant provides health care services in person or by telemedicine." [5]

Some members of the public expressed concern during the November 14 meeting that the proposed rule did not provide adequate clarity that use of telemedicine would be subject to compliance with HIPAA and other data privacy and security requirements similar to in-person patient encounters.  But, the subcommittee expressed concerns regarding including an express reference to HIPAA because of Florida's requirements with respect to incorporating other statutes and regulations. That is, under Florida law, a Board may incorporate only the current version of a federal regulation or statute. So, when that regulation or statute changes, the Board must convene to incorporate the new version. This may be problematic if a particular regulation or statute is routine modified.

However, the Subcommittee agreed that language should be added to clarify obligations with respect to patient confidentiality and proposed language that, "[t]he practice of medicine by telemedicine does not alter any obligation of the physician or the physician assistant regarding patient confidentiality or recordkeeping."

One issue that was raised, but not yet addressed, is whether Florida will permit out of state doctors to treat Florida patients via telemedicine. That is, several other states do have limited telemedicine licenses.  Texas, for example, provides that:
(a) For a person to be eligible for an out-of-state telemedicine license to practice medicine across state lines under the Medical Practice Act, §151.056, and §163.1 of this title (relating to Definitions), the person must:
  (1) be 21 years of age or older;
  (2) be actively licensed to practice medicine in another state which is recognized by the board for purposes of licensure, and not the recipient of a previous disciplinary action by any other state or jurisdiction;
  (3) not be the subject of a pending investigation by a state medical board or another state or federal agency;
  (4) be currently certified by a member board of the American Board of Medical Specialties or Bureau of Osteopathic Specialists, or by the American Board of Oral and Maxillofacial Surgery, obtained by passing, within the ten years prior to date of applying for licensure, a monitored:  (A) specialty certification examination; (B) maintenance of certification examination; or (C) continuous certification examination;
  (5) have passed the Texas Medical Jurisprudence Examination;
  (6) complete a board-approved application for an out-of-state telemedicine license for the practice of medicine across state lines and submit the requisite initial fee; and
  (7) not be determined ineligible for licensure under subsection (b) of this section.
Texas Administrative Code, 22-9-172(C) Rule §172.12.

The Subcommittee advised that it would research the licensure issue and further discuss it at a later meeting.

The Subcommittee made clear that it was eager to move quickly on developing telemedicine rule.

Nonetheless, for now, reimbursement for telemedicine (or telehealth) services in Florida remains an issue because it is limited to a very narrow set of circumstances under the Medicaid program and no state law requires reimbursement by private insurers.

References and Resources

[1] Florida Board of Medicine, Newsletter: Updates on Telemedicine, Sept. 25, 2013. (PDF)

[2] For Florida Board of Medicine, see Rule 64B8-9.014. Standards for Telemedicine Prescribing Practice. For Florida Board of Osteopathic Medicine, see Rule 64B15-14.008 Standards for Telemedicine Practice.

[3] Florida Board of Medicine, Joint Meeting of the Florida Boards of Medicine & Osteopathic
Medicine Telemedicine Subcommittee Meeting Report, Sept. 9, 2013 (opening comments by Dr. Orr). (PDF)

[4] For a full record of the materials, see the Public Book for the Nov. 14, 2013 Telemedicine Subcommittee Meeting. (PDF). The Rules as proposed are Rule 64B8-9.0141 (Medicine) and Rule 64B15-14.0081 (Osteopathic Medicine) and are available here. See also Telemedicine Subcommittee, Public Book, Sept. 9, 2013 for the full materials and click here for the rules as proposed on Sept. 9. (PDF)

[5] Telemedicine Subcommittee, Public Book, Nov. 14, 2013. (PDF)

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