Florida

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: No
  • Remote Patient Monitoring: No
  • Audio Only: No

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: CC, NLC
  • Consent Requirements: No

FQHCs

  • Originating sites explicitly allowed for Live Video: No
  • Distant sites explicitly allowed for Live Video: No
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

  1. Medicaid Program: Florida Medicaid
  2. Administrator: Florida Dept. of Children and Families
  3. Regional Telehealth Resource Center: Southeast Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 10/26/2022

Audio Only Delivery

Medicaid 1915(c) Waiver: Appendix K Developmental Disabilities Individual Budgeting (iBudget) Waiver

STATUS: Active, extended until 6 months after the conclusion of the public health emergency (see combined waiver)

Medicaid 1915(c) Waiver: Appendix K Florida Long-Term Care Program

STATUS: Active, extended until 6 months after the conclusion of the public health emergency (see combined waiver)

Medicaid 1915(c) Waiver: Appendix K Model Waiver and Familial Dysautonomia

STATUS: Active, extended until 6 months after the conclusion of the public health emergency (see combined waiver)

Last updated 10/26/2022

Cross State Licensing

Medicaid: Telehealth FAQs

STATUS: Active

Department of Health: Florida Telehealth 

STATUS: Active

Department of Health: Telehealth FAQs

STATUS: Active

Florida Board of Medicine: Updates for health care providers regarding expiration of emergency orders

STATUS: Active

Last updated 10/26/2022

Easing Prescribing Requirements

Department of Health: Florida Telehealth 

STATUS: Active

Department of Health: Telehealth FAQs

STATUS: Active

Florida Board of Medicine: Updates for health care providers regarding expiration of emergency orders

STATUS: Active

Last updated 10/26/2022

Miscellaneous

Medicaid 1915(c) Waiver: Appendix K Developmental Disabilities Individual Budgeting Waiver, Florida Long Term Care Program, Model Waiver, and Familial Dysautonomia Waiver

STATUS: Active, extends current waivers 6 months after the conclusion of the public health emergency

HB 5001: Appropriations – includes telehealth

STATUS: Enacted

Florida State of Emergency Expired June 26, 2021

SOURCE: Governor’s EO-21-94; FDOH Declaration

Last updated 10/26/2022

Originating Site

No Reference Found

Last updated 10/26/2022

Private Payer

No Reference Found

Last updated 10/26/2022

Provider Type

Medicaid: Telehealth FAQs

STATUS: Active

Department of Health: Florida Telehealth 

STATUS: Active

Department of Health: Telehealth FAQs

STATUS: Active

Last updated 10/26/2022

Service Expansion

No Reference Found

Last updated 10/26/2022

Definitions

“Telehealth” means the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include audio-only telephone calls, e-mail messages, or facsimile transmissions.

SOURCE: FL Statute 456.47. (Accessed Oct. 2022).

Last updated 10/26/2022

Parity

SERVICE PARITY

Insurers and providers must mutually agree on payment rates and payment methodologies for telehealth delivered services.

SOURCE: FL Statute 641.31 (45). & 627.42396. (Accessed Oct. 2022).


PAYMENT PARITY

Any contract provision that distinguishes between payment rates or payment methodologies for services provided through telehealth and the same services provided without the use of telehealth must be initialed by the telehealth provider.

SOURCE: FL Statute 641.31. & 641.42396. (Accessed Oct. 2022).

Last updated 10/26/2022

Requirements

Contracts between health insurers or health maintenance organizations and telehealth providers must be voluntary and must establish mutually acceptable payment rates or payment methodologies for services provided through telehealth.  Any contract provision that distinguishes between payment rates or payment methodologies for services provided through telehealth and the same service provided without telehealth must be initialed by the telehealth provider.

SOURCE: FL Statute 641.31 (45). & 627.42396. (Accessed Oct. 2022).

Last updated 10/26/2022

Definitions

Telemedicine – The practice of health care delivery by a practitioner who is located at a site other than the site where a recipient is located for the purposes of evaluation, diagnosis, or treatment.

SOURCE: FL Admin Code 59G-1.057. (Accessed Oct. 2022).

Substance Abuse Services

“Telehealth” means the mode of providing care, treatment, or services by a Florida qualified professional, as defined under subsection 397.311(34), F.S., within the scope of his or her practice, through the use of clinical and medical information exchanged from one site to another via electronic communication. Telehealth does not include the provision of health services only through an audio only telephone, email messages, text messages, facsimile transmission, U.S. mail or other parcel service, or any combination thereof.

SOURCE: FL Admin Code 65D-30.002. (Accessed Oct. 2022).

Children’s Medical Services

Telemedicine is “the use of telecommunication and information technology to provide clinical care to individuals at a distance, and to transmit the information needed to provide that care.”

SOURCE: FL Dept. of Health, Child Protection Team Program, Program Handbook, p.65 (Jun. 28, 2019). & FL Admin Code 64C-8-001(6). (Accessed Oct. 2022).

Last updated 10/26/2022

Email, Phone & Fax

No reimbursement for telephone, chart review, electronic mail messages or facsimile transmissions.

SOURCE: FL Admin Code 59G-1.057. (Accessed Oct. 2022).

Last updated 10/26/2022

Live Video

POLICY

FL Medicaid reimburses for real time, two-way, interactive telemedicine.

Providers must include the GT modifier.

SOURCE: FL Admin Code 59G-1.057. (Accessed Oct. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Florida Medicaid reimburses the practitioner who is providing the evaluation, diagnosis, or treatment recommendation located at a site other than where the recipient is located.

SOURCE: FL Admin Code 59G-1.057. (Accessed Oct. 2022).

Child Protective Team (CPT) Services

Real-time CPT telemedicine services for the evaluation of children suspected to be abused or neglected has been implemented in rural or remote areas.

SOURCE: FL Dept. of Health, Child Protection Team Program, Program Handbook, p. 24 (Jun. 28, 2019). (Accessed Oct. 2022).


ELIGIBLE PROVIDERS

Telemedicine is available for use by all providers of Florida Medicaid services that are enrolled in or registered with the Florida Medicaid program and who are licensed within their scope of practice to perform the service.

SOURCE: FL Admin Code 59G-1.057. (Accessed Oct. 2022).

Child Protective Team (CPT) Services

Real-time CPT telemedicine services for the evaluation of children suspected to be abused or neglected has been implemented in rural or remote areas.  Only CPT medical providers approved as CMS medical providers and are specifically trained to do telemedicine exams can perform exams at the hub site.  Only registered nurses trained to assist in telemedicine exams can participate in the CPT medical exam at the remote site. All persons at remote site must act under the direct supervision of the telemedicine physician or physician extender.

SOURCE: FL Dept. of Health, Child Protection Team Program, Program Handbook, p. 24 (Jun. 28, 2019). (Accessed Oct. 2022).


ELIGIBLE SITES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No Reference Found

Last updated 10/26/2022

Miscellaneous

Substance Abuse Services

Prior to initiating services utilizing telehealth, providers shall submit detailed procedures outlining which services they intend to provide. Providers delivering any services by telehealth are responsible for the quality of the equipment and technology employed and are responsible for its safe use. Providers utilizing telehealth equipment and technology must be able meet or exceed the prevailing standard of care. Service providers must meet the following additional requirements:

  • Must be capable of two-way, real-time electronic communication, and the security of the technology must be in accordance with applicable federal confidentiality regulations 45 CFR §164.312;
  • The interactive telecommunication equipment must include audio and high-resolution video equipment which allows the staff providing the service to clearly understand and view the individual receiving services;
  • Clinical screenings, assessments, medication management, and counseling are the only services allowable through telehealth; and
  • Telehealth services must be provided within the state of Florida except for those licensed for outpatient, intervention, and prevention.

SOURCE: FL Admin Code Sec. 65D-30.004. (Accessed Oct. 2022).

Children’s Medical Services

There is a webpage dedicated to explaining what telemedicine services are to families.

SOURCE: FL Children’s Medical Services: Special Services for children with special needs. Telemedicine Services. (Accessed Oct. 2022).

No reimbursement for equipment used to provide telemedicine services.

SOURCE: FL Admin Code 59G-1.057. (Accessed Oct. 2022).

Telehealth Minority Maternity Care Pilot Programs

 By July 1, 2022, the department shall establish a telehealth minority maternity care pilot program in Duval County and Orange County which uses telehealth to expand the capacity for positive maternal health outcomes in racial and ethnic minority populations. The department shall direct and assist the county health departments in Duval County and Orange County to implement the programs. The pilot programs shall adopt the use of telehealth or coordinate with prenatal home visiting programs to provide services and education to eligible pregnant women up to the last day of their postpartum periods and provide training to participating health care practitioners and other perinatal professionals.

SOURCE: FL Statute 383.2163. (Accessed Oct. 2022).

School-Based Mental Health Assistance Allocation

The mental health assistance allocation is created to provide funding to assist school districts in establishing or expanding school-based mental health care. Before the distribution of the allocation, the school district must develop and submit a detailed plan outlining the local program and planned expenditures to the district school board for approval. The plans must include elements related to Contracts or interagency agreements with one or more local community behavioral health providers or providers of Community Action Team services to provide a behavioral health staff presence and services at district schools. Services may include, but are not limited to, mental health screenings and assessments, individual counseling, family counseling, group counseling, psychiatric or psychological services, trauma-informed care, mobile crisis services, and behavior modification. These behavioral health services may be provided on or off the school campus and may be supplemented by telehealth.

SOURCE: FL Statute 1011.62. (Accessed Oct. 2022).

Last updated 10/26/2022

Out of State Providers

No Reference Found

Last updated 10/26/2022

Overview

FL Medicaid reimburses for real time interactive telemedicine according to administrative code, however there is no indication of reimbursement in any Medicaid Manual.  No reference was found in regards to reimbursement for store-and-forward or remote patient monitoring.

Last updated 10/26/2022

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 10/26/2022

Store and Forward

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 10/26/2022

Cross State Licensing

A health care professional not licensed in this state may provide health care services to a patient located in this state using telehealth if the health care professional registers with the applicable board, or the department if there is no board, and provides health care services within the applicable scope of practice established by Florida law or rule.

See law for specific provider requirements.

An out-of-state provider must have professional liability coverage or financial responsibility that includes coverage for telehealth services provided to patients not located in the provider’s home state.  A health care professional registered under this section may not open an office or provide in-person services.  The Department is required to publish all registrants on its website with specific requirements outlined in the law.

SOURCE: FL Statute 456.47 & Florida Board of Medicine. (Accessed Oct. 2022).

Last updated 10/26/2022

Definitions

“Telehealth” means the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include audio-only telephone calls, e-mail messages, or facsimile transmissions.

SOURCE: FL Statute 456.47. (Accessed Oct. 2022).

“Telehealth” means the mode of providing care, treatment, or services by a Florida qualified professional, as defined under subsection 397.311(34), F.S., within the scope of his or her practice, through the use of clinical and medical information exchanged from one site to another via electronic communication. Telehealth does not include the provision of health services only through an audio only telephone, email messages, text messages, facsimile transmission, U.S. mail or other parcel service, or any combination thereof.

SOURCE: FL Admin Code 65D-30.002. (Accessed Oct. 2022).

Children’s Medical Services

“Telemedicine” means “the use of telecommunication and information technology to provide clinical care to individuals at a distance and to transmit the information needed to provide that care.

SOURCE: FL Admin Code 64C-8.001. (Accessed Oct. 2022).

Professional Counselor Licensure Compact

“Telehealth” means the application of telecommunication technology to deliver professional counseling services remotely to assess, diagnose, and treat behavioral health conditions.

SOURCE: FL Statute 491.017 (Article II (25)). (Accessed Oct. 2022).

Last updated 10/26/2022

Licensure Compacts

Member of the Nurses Licensure Compact.

SOURCE: Current NLC States & Status. Nurse Licensure Compact. (Accessed Oct. 2022).

Member of the Counseling Compact.

SOURCE: Counseling Compact Map. (Accessed Oct. 2022).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 10/26/2022

Miscellaneous

HB 5001 makes appropriations to certain telehealth programs and pilots.

SOURCE: FL State Senate. HB 5001 (Mar. 19, 2020). (Accessed Oct. 2022).

The Florida Mental Health Act or Baker Act – Involuntary Examination

Telehealth is the delivery of an evaluation, assessment, consultation, treatment planning, or other allowable service via non-public facing live videoconference between a licensed clinician and an individual.

Telehealth be used to form the basis of a professional certificate initiating Baker Act involuntary examination. The licensed clinician must have examined the individual within the preceding 48 hours (whether in person or by telehealth) and must conclude that the individual meets criteria for examination. For the purposes of a Baker Act initiation, the licensed clinician must be a physician, clinical psychologist, psychiatric nurse, advanced practice registered nurse registered under s. 464.0123 F.S., mental health counselor, marriage and family therapist, clinical social worker, or physician assistant. The licensed clinician should have a protocol in place to address the provision of telehealth services with staff that includes obtaining/verifying the location of the individual at the beginning of each telehealth session.

Telehealth may be used by a receiving facility to conduct involuntary examinations, to form the basis of a first and second opinion supporting involuntary inpatient placement, and to form the basis of a second opinion supporting outpatient services. Telehealth may not be used to form the basis of a first opinion supporting involuntary outpatient placement.

SOURCE: FL Department of Children and Families. Telehealth and Florida’s Baker Act: FAQs. March 2021. (Accessed Oct. 2022).

Mental health and substance abuse facilities are authorized to release individuals subject to involuntary examination upon documented approval of a provider. The release may be approved through telehealth.

SOURCE: FL Statute 394.463(2)(f). As amended by SB 1262 (2022 Session) & FL Department of Children and Families. Telehealth and Florida’s Baker Act: FAQs. March 2021. (Accessed Oct. 2022).

 

Last updated 10/26/2022

Online Prescribing

A telehealth provider may use telehealth to perform a patient evaluation. If a telehealth provider conducts a patient evaluation sufficient to diagnose and treat the patient, the telehealth provider is not required to research a patient’s medical history or conduct a physical examination of the patient before using telehealth to provide health care services to the patient.

A telehealth provider may not use telehealth to prescribe a controlled substance listed in Schedule II of s. 893.03 unless the controlled substance is prescribed for the following:

  1. The treatment of a psychiatric disorder;
  2. Inpatient treatment at a hospital licensed under chapter 395;
  3. The treatment of a patient receiving hospice services as defined in s. 400.601; or
  4. The treatment of a resident of a nursing home facility as defined in s. 400.021.

SOURCE: FL Statute 456.47. (Accessed Oct. 2022).

Last updated 10/26/2022

Professional Boards Standards

Health Professional Telehealth Practice Standards and Related Requirements

SOURCE: FL Statute 456.47. (Accessed Oct. 2022).

Florida Department of Health Telehealth Frequently Asked Questions

SOURCE: FL Department of Health. Telehealth FAQs. (Accessed Oct. 2022).

Last updated 10/26/2022

Definition of Visit

Encounter: A face-to-face contact between a recipient and a health care professional who exercises independent judgment in the provision of health services to the individual recipient. For a health service to be defined as an encounter, the provision of the health service shall be recorded in the recipient’s record and completed on site.

Categorically, encounters are:

  1. An encounter between a physician and a recipient during which medical services are provided for the prevention, diagnosis, treatment, and rehabilitation of illness or injury.
  2. Midlevel practitioner. An encounter between an advanced registered nurse practitioner (ARNP) or a physician’s assistant (PA) and a recipient when the ARNP or PA exercises independent judgement in providing health services
  3. An encounter between a dentist and a recipient for the purpose of prevention, assessment, or treatment of a dental problem, including restoration.
  4. Mental Health. An encounter between a licensed psychologist or licensed clinical social worker and recipient for the diagnosis and treatment of mental illness.

SOURCE: Florida FQHC and RHC Reimbursement Plan. July 1, 2014. (Accessed Oct. 2022).

Last updated 10/26/2022

Eligible Distant Site

No Reference Found.

Last updated 10/26/2022

Eligible Originating Site

No Reference Found.

Last updated 10/26/2022

Facility Fee

No Reference Found.

Last updated 10/26/2022

Home Eligible

No Reference Found.

Last updated 10/26/2022

Modalities Allowed

Live Video

No explicit reference to telehealth for FQHCs/RHCs.

Generally, FL Medicaid reimburses for real time, two-way, interactive telemedicine.

See: FL Medicaid Live Video


Store and Forward

There is no reference found for store-and-forward in Medicaid generally or for FQHCs.

See: FL Medicaid Store-and-Forward.


Remote Patient Monitoring

There is no reference found for remote patient monitoring in Medicaid generally or for FQHCs.

See: FL Medicaid RPM


Audio-Only

No reimbursement for telephone, chart review, e-mail or fax.

See: FL Medicaid Email, Phone, & Fax

Last updated 10/26/2022

Patient-Provider Relationship

No Reference Found.

For general information about prescribing see: Florida Professional Requirements Online Prescribing

Last updated 10/26/2022

PPS Rate

No explicit reference to telehealth found.

Florida Medicaid reimburses for services provided through the fee-for-service delivery system at an encounter rate. Costs relating to the following services are excluded from the encounter rate: Ambulance services; Home health services; WIC certifications and recertifications; Any health care services rendered away from the center, at a hospital, or a nursing home. (These services include off- site radiology services and off- site clinical laboratory services. However, the health care rendered away from the center may be billed under other Florida Medicaid programs, if eligible.)

SOURCE: FL Admin Code 59G-4.100, FL Admin Code 59G-4.280, & Florida FQHC and RHC Reimbursement Plan. July 1, 2014. (Accessed Oct. 2022).

Medicaid reimburses for ambulatory primary care health care and related diagnostic services to a medically underserved population.

Medicaid reimburses up to three encounters per day, per recipient for the following:

  • Adult health screenings
  • Behavioral health
  • Child Health Check-Up screenings
  • Chiropractic
  • Dental
  • Family planning
  • Immunizations
  • Medical primary care
  • Prenatal care and obstetric care
  • Optometric
  • Podiatry
  • Registered nurse services

This service is one of the minimum covered services for all Managed Medical Assistance plans serving Medicaid enrollees.

SOURCE: AHCA FL Medicaid’s Covered Services and HCBS Waivers – FQHC Services. (Accessed Oct. 2022).

Last updated 10/26/2022

Same Day Encounters

Florida Medicaid reimburses for services provided through the fee-for-service delivery system at an encounter rate. Providers may be reimbursed for up to one medical, one dental, and one behavioral health visit provided to a recipient on the same day.

SOURCE: FL Admin Code 59G-4.100. (Accessed Oct. 2022).

Medicaid reimburses up to three encounters per day, per recipient for the following:

  • Adult health screenings
  • Behavioral health
  • Child Health Check-Up screenings
  • Chiropractic
  • Dental
  • Family planning
  • Immunizations
  • Medical primary care
  • Prenatal care and obstetric care
  • Optometric
  • Podiatry
  • Registered nurse services

This service is one of the minimum covered services for all Managed Medical Assistance plans serving Medicaid enrollees.

SOURCE: AHCA FL Medicaid’s Covered Services and HCBS Waivers – FQHC Services. (Accessed Oct. 2022).