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                                                                                 Center for Connected Health Policy

           Florida


           Medicaid Program:  Florida Medicaid

           Program Administrator:  Florida Dept. of Children and Families

           Regional Telehealth Resource Center:
           Southeast Telehealth Resource Center
           PO Box 1408
           Waycross, GA 31501
           (888) 138-7210
           www.setrc.us


            STATE LAW                                          MEDICAID PROGRAM

            Definition of telemedicine/telehealth
             “’Telemedicine’ means the practice of medicine by a   “Telemedicine” is “the use of telecommunication and
            licensed Florida physician or physician assistant where   information technology to provide clinical care to
            patient care, treatment, or services are provided through  individuals at a distance, and to transmit the information
            the use of medical information exchanged from one site  needed to provide that care.”
            to another via electronic communications. Telemedicine
            shall not include the provision of health care services   Source: FL Dept. of Health, Child Protection Team Program,
            only through an audio only telephone, email messages,   Policy and Procedure Handbook, p.79 (Jun. 2014).
            text messages, facsimile transmission, U.S. Mail or     “Telemedicine is the use of medical information
            other parcel service, or any combination thereof.”   exchanged from one site to another via electronic

            Source: FL Admin Code 64B8-9.0141 & 64B15-14.0081.   communications to improve a patient’s health. Electronic
                                                               communication means the use of interactive
                                                               telecommunications equipment that includes, at a
                                                               minimum, audio and video equipment permitting two
                                                               way, real time interactive communication between the
                                                               patient, and the physician at the distant site.”

                                                               Source: FL Dept. of Health, Practitioner Services Coverage and
                                                               Limitations Handbook, p.136 (Apr. 2014).

                                                               “Telemedicine is the practice of health care using
                                                               telecommunication equipment by the treating provider
                                                               (at the spoke site) for the provision of approved covered
                                                               services by the consulting provider (at the hub site) for
                                                               the purpose of evaluation, diagnosis or treatment.”

                                                               Source: FL Dept. of Health, Specialized Therapeutic Services
                                                               Coverage and Limitations Handbook, p.12 (Mar. 2014) & FL
                                                               Community Behavioral Health Services Coverage and Limitations
                                                               Handbook, p. 10 (Mar. 2014).
            Live Video Reimbursement

            No reference found.                                Reimbursement is available through Florida Medicaid.

                                                               Only physicians can provide and receive reimbursement
                                                               for telemedicine services.

                                                               A physician, ARNP or PA may initiate a consultation
                                                               from the spoke site. The referring practitioner must be
                                                               present during the consultation as well as the recipient.


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                                                                                 Center for Connected Health Policy

            STATE LAW                                          MEDICAID PROGRAM


                                                               Special documentation:  When telemedicine services
                                                               are provided, the clinical record must include:
                                                                   •   A brief explanation of why the services were not
                                                                       provided face to face;
                                                                   •   Documentation of telemedicine service provided
                                                                       including the results of the assessment; and
                                                                   •   Signed patient consent.

                                                               Only certain consultation codes are reimbursed for
                                                               telemedicine.

                                                               Source: FL Dept. of Health, Practitioner Services Coverage and
                                                               Limitations Handbook, p.137 (Apr. 2014).

                                                               For Community Behavioral Health Services Coverage
                                                               providers must implement technical written policies and
                                                               procedures for telemedicine systems that comply with
                                                               HIPAA, as well as state and federal laws related to
                                                               patient privacy.

                                                               Source:  FL Community Behavioral Health Services Coverage and
                                                               Limitations Handbook, p. 10 (Mar. 2014).

                                                               Florida Medicaid will reimburse for live video in the Child
                                                               Protection Team Program (see Comments), and for the
                                                               following dental services:

                                                                   •   Oral prophylaxis;
                                                                   •   Topical fluoride application;
                                                                   •   Oral hygiene instructions.

                                                               All dental services must be delivered by a registered
                                                               dental hygienist, with a supervising dentist.

                                                               Source (Child Protection Team Program): FL Dept. of Health,
                                                               Child Protection Team Program, Policy and Procedure Handbook,
                                                               p.119 (Jun. 2014).

                                                               Source (dental services): FL Dental Services Coverages and
                                                               Limitations Handbook, p. 2-26, (November 2011).
            Store and Forward Reimbursement

            No reference found.                                Store and forward reimbursement is not available.

                                                               Source: FL Dept. of Health, Practitioner, Policy and Procedure
                                                               Handbook, p.137 (Apr. 2014).
            Remote Patient Monitoring Reimbursement

            No reference found.                                No reference found.
            Email/Phone/FAX Restrictions
            “Telemedicine shall not include the provision of health   No telephone reimbursement
            care services only through an audio only telephone,   No Email reimbursement
            email messages, text messages, facsimile transmission,  No Fax reimbursement
            U.S. Mail or other parcel service, or any combination   No video cell phone conversations reimbursement
            thereof.”


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                                                                                 Center for Connected Health Policy

            STATE LAW                                          MEDICAID PROGRAM

                                                               Source: FL Dept. of Health, Practitioner, Policy and Procedure
            Source: FL Admin Code 64B8-9.0141 & 64B15-14.0081.   Handbook p.137 (Apr. 2014).

            Online Prescribing

            Controlled substances shall not be prescribed through   No reference found.
            the use of telemedicine.

            Exception:  physicians can order controlled substances
            through the use of telemedicine for patients hospitalized
            in a facility licensed pursuant to Ch. 395,F.S.

            A physician-patient relationship may be established
            through telemedicine.

            Source: FL Admin Code 64B8-9.0141 & 64B15-14.0081.

            Prior to e-prescribing, physicians and physician
            assistants must document a patient evaluation, including
            history and physical examination, to establish the
            diagnosis for which any drug is prescribed, and discuss
            treatment options with the patient.

             These rules don’t apply in emergency situations.

             Source: FL Admin. Code 64B8-9.014.
            Consent

            No reference found.                                Patient informed consent is required.  It can be for a set
                                                               period of treatment or a one-time visit, as applicable to
                                                               the services provided.

                                                               Source: FL Dept. of Health, Practitioner, Policy and Procedure
                                                               Handbook, p.137 (Apr. 2014).

            Location
            No reference found.                                Telecommunication with recipient at a location other
                                                               than the spoke site is not allowed.

                                                               Telemedicine services are limited to:
                                                                   •   Hospital outpatient setting
                                                                   •   Inpatient setting
                                                                   •   Physician office

                                                               Source: FL Dept. of Health, Practitioner, Policy and Procedure
                                                               Handbook, p.137 (Apr. 2014).

                                                               For Specialized Therapeutic Services & Community
                                                               Behavioral Health Services, the service must be
                                                               delivered from a facility that is enrolled in Medicaid as a
                                                               community behavioral health services provider.

                                                               Source: FL Dept. of Health, Specialized Therapeutic Services
                                                               Coverage and Limitations Handbook, p.46 (Mar. 2014) & FL
                                                               Community Behavioral Health Services Coverage and Limitations
                                                               Handbook, p. 24 (Mar. 2014).

                                                               Both the hub and spoke sites must be located in Florida.


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                                                                                 Center for Connected Health Policy

            STATE LAW                                          MEDICAID PROGRAM


                                                               Source: FL Dept. of Health, Specialized Therapeutic Services
                                                               Coverage and Limitations Handbook, p.9-12 (Mar. 2014) FL
                                                               Community Behavioral Health Services Coverage and Limitations
                                                               Handbook, p. 9-10 (Mar. 2014).  .
            Cross State Licensing

            No reference found.                                No reference found.
            Private Payers
            No reference found.                                No reference found.

            Site/Transmission Fee
            No reference found.                                Medicaid does not reimburse for the costs or fees of any
                                                               of equipment.

                                                               Source: FL Dept. of Health, Practitioner, Policy and Procedure
                                                               Handbook, p.138-9 (Apr. 2014).

            Miscellaneous
            Florida’s Board of Medicine and Osteopathic Medicine
            adopted “Standards for Telemedicine Practice”.  See
            “Comments” for details not included in the categories
            above.

            Source: FL Admin Code 64B8-9.0141.

           Comments:    In 1998, the Child Protection Team (CPT) Program implemented a telemedicine network that links
                         CPT teams with remote or satellite CPT offices, or local facilities, such as hospital emergency rooms,
                         county health departments, or child advocacy centers, to facilitate telemedicine assessments for
                         abuse, abandonment, and neglect of children in remote or rural areas.

                         Only specially trained CPT physicians, advanced registered nurse practitioners or physician
                         assistants can perform these exams. And only specifically trained registered nurses at presenting
                         sites may participate in the exam.

                         Source: Florida Department of Health, Child Protection Team Program, Policy and Procedure Handbook, p. 30 (Jun.
                         2014).

                         Florida Children’s Medical Services (CMS) is a collection of programs for special needs children.  CMS’
                         Telemedicine Program services are provided by approved CMS Network providers to Medicaid
                         children enrolled in CMS.  Eligible sites are limited.

                         Source: Florida Children’s Medical Services, Families, Health Services, < http://www.cms-

                         kids.com/families/health_services/telemedicine.html>. Accessed Feb. 18, 2014.

                         New Regulations Passed
                             •   FL Board of Medicine (Source: FL Admin Code 64B8-9.0141)
                             •   FL Board of Osteopathic Medicine (Source: 64B15-14.0081)











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