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Florida Telehealth Licensing Outlook

Generally, telehealth providers must be licensed within the state where the patient resides or is receiving care. In response to the COVID-19 pandemic, nearly every state issued temporary waivers to medical professionals licensed in other U.S. states, which allowed providers to offer telehealth services to patients across state lines without the need to obtain licensing from the particular state in which the patient resided or received care. To combat the pandemic and expand telehealth services within the state, the Florida Department of Health issued an emergency order on March 16, 2020, which permitted medical professionals unlicensed in Florida to provide healthcare services to Florida residents affected by the coronavirus. Florida’s telehealth emergency waivers ended on June 26, 2021, after Governor Ron DeSantis decided to let the waivers expire.

Now, other states are also gradually rolling back these telehealth emergency waivers afforded to out-of-state healthcare providers during the early stages of the pandemic in favor of more permanent changes to regulate interstate telehealth delivery. In particular, Florida has been a first mover in establishing a permanent registration telehealth policy. During the 2019 legislative session, Florida lawmakers passed section 456.47, Florida Statutes, which authorized out-of-state healthcare providers to furnish telehealth services to patients residing in Florida and established standards of practice for telehealth services. After Governor DeSantis signed the law on June 25, 2019, the law took effect on July 1, 2019. Under section 456.47, all out-of-state healthcare providers are required to register with the Florida Department of Health in order to furnish telehealth services and may not provide in-person services to Florida patients.

More recently, Governor DeSantis signed a new law amending Chapter 456.47 to remove prior restrictions on the prescription of controlled substances via telehealth on April 6, 2022. Under the new law, telehealth providers may prescribe Florida patients all controlled substances except for Schedule II substances. While this amendment does permit out-of-state healthcare providers to prescribe controlled substances to Florida patients via telehealth, providers should also be aware of federal law that also governs the prescription of controlled substances. Under the Ryan Haight Online Pharmacy Consumer Protection Act, a controlled substance may not be prescribed by means of the internet without a valid prescription. Providers are required to conduct at least one in-person medical examination of a patient before prescribing a controlled substance to patients. The Ryan Haight Act law does provide seven exceptions to the in-person requirement, but these exceptions are narrow and apply only to providers in an institutional setting.

Another approach to telehealth licensing that has started to gain traction involves the adoption of an interstate compact, such as the Interstate Medical Licensure Compact. The compact was created to allow medical professionals an expedited alternative to obtain additional state medical licensure to qualify to practice medicine among IMLC member states. To date, the IMLC is composed of 33 states, the District of Colombia, and Guam. Other states such as Massachusetts, New York, and North Carolina have passed legislation to be admitted to the IMLC. Under the current administration, Florida is unlikely to join the IMLC as admission to the compact would require the Florida Legislature to overhaul the state’s health care policy and pass new stand-alone bills which would be a significant commitment.

Looking forward to 2023, two key issues to keep an eye out for includes potential legislation surrounding telehealth payment parity and the increase of telehealth fraud.

Payment Parity

In April 2022, the Federation of State Medical Boards (FSMB) released an updated telemedicine policy for the first time since 2014. The FSMB acknowledged that rapid growth and utilization of telemedicine technologies have dramatically transformed conventional healthcare delivery. As such, the FMSB intends to advise state medical boards on proper procedures to regulate the use of telemedicine technologies in medical practice for the benefit of the public. The FMSB observed that limiting insurance coverage for healthcare services delivered via telehealth may increase inequities in the access to healthcare. The FMSB recommends that health insurance plans should provide the same coverage extended for the cost of healthcare services delivered in-person on the same basis as those delivered through telemedicine.

Who Can Sign off on a Death Certificate in Florida?

Death Certificates: Definitions, Requirements, and Purpose

What Is A Death Certificate?

By definition, a death certificate is an official government issued document that declares the known data of a deceased person at their time of death. A death certificate is a legal record of death. This can include but is not limited to, the identifying statistics of the decedent along with the specific information of the death in question such as the time of death, exact location of death, and cause of death.

What Information Should Be Reported On A Death Certificate?

Other than the identifying information of the deceased individual, there are common details that should always be listed on a death certificate. At a minimum, death certificates should include the following information:

  • Probable Manner of Death: The statement on the manner of death should be as specific as possible. For example, the manner of death should not be listed as “natural causes”, but rather a list of illnesses likely to have prompted the mortality of the decedent.
  • Time of Death: The time of death must be written in the standard 24-hour universal time clock.
  • Known or Significant Conditions: This can include identified underlying illness or diseases that conceivably lead to the death; it can also include smoking habits or drug use.

Who Can Sign Off On A Death Certificate?

According to the Florida Statutes (FS § 382.008), the death certificate is to be signed within 72 hours by the appropriate party. The typical certifier of the death certificate is the medical practitioner in charge of the decedent’s care for the illness or disorder which resulted in the death of the decedent. The death certificate may also be signed by the medical physician that was attending to the decedent at the time of death or immediately after death. In the instance of a natural death, it is expected that the medical practitioner that was caring for the decedent (withing the previous 3 months) will sign the death certificate. At times there will be no specific illness or conditional circumstances which resulted in the death of the decedent. The signing medical practitioner or medical examiner will declare the cause of death to the best of his or her knowledge and belief. It is common to use terminology such as “probable” and “likely” for a decedent whose cause of death is not certain. It is up to the medical practitioner to use their best medical opinion at the time of signing the death certificate.

Should the case be deemed a suicide, a homicide, or an accident it is not unlikely for a medical examiner to certify the Death Certificate. Any case that is under investigation or indeterminate will fall under the responsibility of the assigned medical examiner to certify and complete.

It is required that the funeral director file the death certificate within 5 days. There is also a 5-day extension period if the funeral director needs additional time to meet with family to certify information requested. Should any supplementary evidence be discovered after the death certificate has been certified and filed, it is possible to have the death certificate amended.

The Bureau of Vital Statistics along with the Florida Association of Medical Examiners combined efforts and have created a tutorial on completing a Death Certificate. Should any medical professional be interested in viewing, it can be found at:

https://register.gotowebinar.com/recording/3534793941604824833

What Is The Purpose Of A Death Certificate?

There are many instances where a death certificate is useful, and even necessary. The Department of Public Health keeps records of death certificates and can create reports detailing leading causes of death and produce reports for public or private knowledge on information such as: suicide and homicide related deaths, infant death rates, occupational related death, etc.

The death certificate is also necessary for the decedent’s family, or next of kin, to have for a variety of legal purposes. Should a probate case need to be opened, a death certificate is necessary. A death certificate is also needed for a family member to claim any potential veteran’s benefits, social security benefits, or life insurance. Financial institutions such as banks, vehicle loan holders, credit card claims, etc. will also require a death certificate to process any requested information for the next of kin.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

 

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