Although many people think that telemedicine is new, it actually has a long history. (Learn More)
Currently, there is a lack of uniformity regarding the use and coverage for telemedicine services across America. (Learn More) The standards and coverage regarding the use of telemedicine services in Florida remains in flux after the failure to pass a recent bill that would help to organize telemedicine in the state. (Learn More)
Florida does have a definition regarding what constitutes telemedicine. (Learn More) There are various good resources to get information regarding the state of telemedicine in Florida. (Learn More)
Currently, only licensed physicians or PAs can provide telemedicine services in Florida. (Learn More) These medical professionals must be licensed within the state. (Learn More)
Other than Medicaid, insurance providers are not required to provide coverage for telemedicine. (Learn More) Only Medicaid is required to have the same limits for mental health services as it does for other types of telemedicine services. (Learn More)
You can have an initial evaluation with a physician via a telemedicine conference. (Learn More)
Medicaid does list reimbursement rates for mental health services covered under the use of telemedicine. (Learn More) Prescription coverage obtained through the use of a telemedicine conference is limited in Florida. (Learn More)
Currently, you have to check with your insurance provider if you are not covered by Medicaid to determine if you have any coverage for telemedicine services. In emergency cases, some of the restrictions may be relaxed, but this is not well defined, (Learn More)
History of Telemedicine
Telemedicine actually began with the implementation of radio in the United States and the use of electronic medical transfer in the 1940s. In 1959, a two-way television transmission for medical students to be able to acquire medical information was set up at the University of Nebraska.
These early beginnings of the use of media to impart medical information set the stage for today’s telemedicine.
Currently, telemedicine has significant practical uses in rural areas where access to medical care is limited and for situations where someone needs immediate medical advice.
As the field expands, more and more routine visits may be given through telecommunications, pending uniform legislation across states regarding how these services should be delivered and what services should be covered.
Lack of a Uniform System
The regulations and laws regarding telehealth and telemedicine policies are quite variable from state to state.
For instance, many states still do not allow or have not described the policy on store-and-forward telemedicine, the collection of clinical information by one medical site and then sending it to another site to be evaluated. Most of the policies regarding telemedicine are designed toward real-time evaluations and delivery of services.
Reimbursements, the types of services covered, and many other issues are not uniform across different states.
Florida Standards on Telemedicine Still Remain Relatively Undefined
A senate bill in Florida designed to clarify the guidelines for telemedicine died in committee in September 2018, thus leaving the guidelines for telemedicine in Florida still subject to the general and relatively poorly defined standards passed by the legislation in 2016.
The guidelines on how physicians should establish a relationship with potential patients and the guidelines regarding services that can be rendered through telemedicine remain relatively unclear at the current time.
Telemedicine in Florida: The Definition
The State of Florida basically defines telemedicine as the use of information technology or telecommunication to provide “clinical care” to people at a distance and to be able to transfer needed information to provide private care to potential patients.
Basically, this means that the actual services that can be provided through telemedicine are relatively broadly defined. Specifications regarding what services and coverages are available through the use of telemedicine have not been regulated within the state.
Where to Go for Information
Legislation is still being proposed and developed regarding how to deliver telemedicine services within the state of Florida. At the current time, the situation appears to be in a state of flux.
You can access these sources if you want to get updated information regarding your specific needs:
- Center for Connected Health Policy – Florida
- Southeastern Telehealth Resource Center
- Telehealth Advisory Council Report
Licensing Issues
Part of the issue with getting the new legislation approved was that lawmakers could not decide whether out-of-state physicians should be allowed to treat patients who are in Florida via telemedicine. At the current time, it appears that only physicians licensed in the state of Florida can treat patients located in Florida via telecommunication and telemedicine appointments.
Insurance Requirements
The State of Florida does not require private insurance companies or Medicaid to provide coverage for telemedicine services in the same way that these requirements are enacted for services provided on site or in person.
Who Can Provide Telemedicine Services in Florida?
Currently, only licensed physicians or licensed physician assistants (PA) within the state of Florida can provide telemedicine services and be reimbursed for the services.
The services defined as telemedicine services in the state do not include the use of cellphones or other audio phones, text messages, emails, or faxes. Only real-time consultations through telecommunications that utilize video and audio services or the transfer of information from one site to another are designated as being telemedicine services.
Can I Develop a Relationship With a Physician Via Telemedicine?
The current state statutes provide for the establishment of a medical relationship between a physician and a patient through telemedicine. This means you can have an initial consultation with a physician or PA through telecommunication services as defined above. You do not need to have a relationship with these medical professionals already established by an in-person visit.
There are no current regulations regarding the need for the physician to get consent from the patient to provide a telemedicine intervention or session.
Medicaid Coverage for Telemedicine
Medicaid coverage is primarily limited to behavioral health services, particularly community behavioral health services. This means that mental health services delivered through telemedicine are the areas primarily covered under Medicaid.
Limits on Coverage
Parity only applies to Medicaid coverage for telemedicine in Florida. This means that any limits on telemedicine service coverage by Medicaid must be equal to the limits set for other types of coverages for physical ailments and conditions. Coverage and reimbursement rates must be equivalent for in-person services and other types of medical services.
There is no parity establishment for private insurance coverage as it applies to telemedicine services, meaning that private insurance companies are not required to cover telemedicine services by the state. If you have private insurance, you need to check with your insurance provider regarding any coverage you have for telemedicine services under your policy.
Can I Get a Prescription Through Telemedicine?
The Florida policy specifically states that providers are unable to prescribe controlled substances through telemedicine, except for psychiatric disorders or for patients who are already hospitalized.
Before the physician can write a prescription, they must complete an evaluation, including a medical history, in order to establish a psychiatric diagnosis. The prescription cannot be made based solely on the use of medical text delivered through telecommunications services.
Emergency Situations
Some of the above stipulations may be relaxed in the case of identifiable emergency situations. This does not appear to be well defined at the current time.
Conclusions
Florida is still in the process of defining and organizing the types of services that can be delivered through telemedicine type venues. Currently, only licensed physicians and PAs within the state provide a limited array of services via telemedicine.
As state and national guidelines regarding the use of telemedicine begin to change, the situation will also change to allow broader use of these services for people in need.
References
Telemedicine: Adventures in Time and Space. (December 2011). KBIM Talk Radio.
Telemedicine: A Guide to Assessing Telecommunications for Health Care. (November 1996). Institute of Medicine, Committee on Evaluating Clinical Applications of Telemedicine.
Florida Dumps Telehealth Bill, Leaving Some Questions Unanswered. (September 2018). Mheath Intelligence.
The State Telehealth Laws. (September 2018). Center for Connected Health Policy
Southeastern Telehealth Resource Center. (2019).
Expanding Florida’s Use and Accessibility of Telehealth. (October 2017). Telehealth Advisory Council.
Community Behavioral Health Services Fee Schedule. (January 2017). The Agency for Health Care Administration.
