Florida has taken one other step in direction of increasing telemedicine. On April 6, 2022, Governor Ron DeSantis signed into regulation laws to take away Florida’s prior restrictions on telemedicine prescribing of managed substances. Beforehand, Florida had a normal prohibition on prescribing managed substances by way of telemedicine, with solely slim exceptions. The brand new regulation (SB 312) eliminates the ban for all managed substances besides Schedule II. Schedule II medication will be prescribed by way of telemedicine, however provided that the scientific state of affairs meets one of many 4 slim exceptions (extra on that beneath).
The regulation is an enormous win for Florida sufferers with medical circumstances requiring managed substances as a part of the remedy routine. This contains, for instance, endocrinology or substance use dysfunction (each of which use Schedule III drugs now permitted beneath the brand new regulation), permitting these sufferers to acquire higher entry to extra fulsome care. The regulation will even enable Florida clinicians to extra simply prescribe refills in reference to their ongoing care administration as a result of the clinician can periodically conduct affected person exams by way of telemedicine as a substitute of requiring in-person exams even when these exams is perhaps considered as medically pointless.
Some stimulant drugs generally prescribed in psychiatry are Schedule II medication, which may doubtlessly meet one of many pre-existing exceptions if they’re prescribed for remedy of a psychiatric dysfunction. Most opioids are Schedule II medication not allowed beneath this new regulation.
Florida as a Nationwide Chief in Telemedicine Coverage
Effectively earlier than the COVID Public Well being Emergency, Florida policymakers had the foresight to favorably place the Sunshine State with among the most forward-thinking telemedicine legal guidelines in the USA. This imaginative and prescient was mirrored within the Board of Drugs granting waivers to telemedicine suppliers beneath pilot applications relationship again to 2014 (e.g., telepsychiatry, asynchronous prescribing, weight problems). The Legislature then created a groundbreaking State-sponsored Telehealth Advisory Council in 2016. That very same 12 months, the Board of Drugs allowed telemedicine prescribing of managed substances for remedy of psychiatric problems. In 2019, lawmakers enacted a full overhaul of Florida telehealth legal guidelines and created a registration course of to permit out-of-state clinicians to rapidly and simply get hold of permission to deal with Florida sufferers by way of telemedicine. And there’s a rulemaking workshop at present rewriting sure rules to higher accommodate telemedicine fashions. (Learn Foley’s feedback on that rule right here.)
The results of this multi-year effort allowed Florida residents to take pleasure in elevated entry to medical care, together with behavioral well being, whereas nonetheless giving the Division of Well being regulatory oversight on high quality. When the COVID Public Well being Emergency occurred, Florida applied extra waivers permitting much more broad use of telemedicine, ultimately sunsetting them final 12 months. (Our prior discussions of Florida’s telehealth waivers can be found right here, right here, and right here.)
What’s Florida’s Managed Substance Telemedicine Prescribing Regulation?
The brand new regulation amends Florida’s telehealth statute as follows (new textual content is underlined):
Florida Statutes 456.47 Use of telehealth to offer providers.
(2) PRACTICE STANDARDS.
(c) A telehealth supplier might not use telehealth to prescribe a managed substance listed in Schedule II of s. 893.03 except the managed substance is prescribed for the next:
1. The remedy of a psychiatric dysfunction;
2. Inpatient remedy at a hospital licensed beneath chapter 20 395;
3. The remedy of a affected person receiving hospice providers as outlined in s. 400.601; or
4. The remedy of a resident of a nursing house facility as outlined in s. 400.021.
The regulation is efficient beginning July 1, 2022.
What About Federal Legal guidelines?
Clinicians ought to proceed to be aware of prescribing necessities beneath federal legal guidelines, as telemedicine prescribing of managed substances can be ruled by the Ryan Haight Act. Amongst different issues, the Ryan Haight Act requires a threshold in-person examination between the prescriber and the affected person, though there are seven exceptions for the apply of telemedicine.
Florida regulation have to be learn in concord with the Ryan Haight Act necessities, and a prescriber should adjust to each Florida and federal legal guidelines on this regard. Clinicians delivering care by way of telemedicine, significantly throughout a number of states, should perceive and navigate many intersecting state and federal legal guidelines on telemedicine, medical apply, fraud and abuse, and managed substances.
Wish to Study Extra?
For extra data on telemedicine, telehealth, digital care, distant affected person monitoring, digital well being, and different well being improvements, together with the staff, publications, and consultant expertise, go to Foley’s Telemedicine & Digital Well being Business Crew.