Florida health care providers are going back in time.
The growing emergence of telehealth, or telemedicine, as a way to deliver health care has been a silver lining during the COVID-19 pandemic.
But after Gov. Ron DeSantis let an executive order declaring a public health emergency expire Saturday, many regulatory flexibilities that health care providers received during the pandemic, including flexibilities related to telehealth, also expired.
As of Saturday, telephones no longer are an acceptable platform for delivering telehealth services to non-Medicare patients in Florida.
Physicians also cannot use telehealth to prescribe controlled substances to existing patients for treating chronic non-malignant pain. Also, physicians cannot use telehealth to recertify medical-marijuana patients.
But those aren’t the only health care flexibilities that were offered during the pandemic that have expired or are set to expire.
During the pandemic, Department of Health Secretary Scott Rivkees waived a state law that requires doctors and nurses to be licensed in Florida to work in the state. That gave the green light to out-of-state providers to come to Florida and help prevent potential staffing shortages.
The Agency for Health Care Administration has issued a notice that, effective Thursday, it will limit the frequency and duration of Medicaid behavioral-health services and that, effective July 15, it will reinstate prior-authorization requirements for behavioral-health services.
Also effective Thursday, Medicaid is reinstating preadmission-screening and resident-review requirements for nursing-home placements.
DeSantis issued an executive order March 9, 2020, declaring a state of emergency because of the pandemic. The executive order was renewed several times before DeSantis let it quietly expire this weekend. When the order expired, so did the subsequent orders issued by agency secretaries, such as Rivkees.
Knowing the waivers wouldn’t last forever, physician organizations sought to make permanent some of the temporary changes that Rivkees authorized, such as using telehealth for the recertification of medical-marijuana patients. But in the end, they came up short.
“I was absolutely thrilled because it made sense,” medical marijuana lobbyist Ron Watson said of Rivkees authorizing the use of telehealth to recertify medical-marijuna patients.
Watson estimated that as many as 400,000 patients who were certified before the start of the pandemic could have benefited from the telehealth provision. But Watson could not get lawmakers to include the permanent change in telehealth legislation during this spring’s session.
“Drinks to go made it into permanency but telehealth didn’t,” Watson said, referring to a new law that authorizes restaurants to sell alcohol with to-go food orders. “We can get support for (alcohol) but not for medicine.”
Physician groups also wanted to amend the state’s telehealth laws to make other changes. Chief among the proposals was seeking to require commercial health insurance plans and managed-care offerings to pay the same amounts to providers regardless of how care is delivered to patients.
Florida Medical Association president Michael Patete told The News Service of Florida in a statement that the state’s largest physicians’ organization will continue its push next session to make the changes permanent.
Patete said the organization wants to increase telehealth access by “ensuring insurance companies are required to reimburse telehealth services at the same rate as in-person visits.”
The issue of “payment parity” pits physicians and other providers against insurers and managed-care plans.
The Republican-controlled Legislature, which is loath to pass mandates on insurance and managed-care companies, approved a telehealth law in 2019 that didn’t require payment parity.
That means the payment policy is set by the insurer.
The state’s largest health insurer, Florida Blue, issued a news release in March 2020 noting that during the pandemic, its “network of primary care doctors and specialists will be able to treat patients virtually at their normal office visit rates.” The company did not respond as of Monday afternoon to a question about whether the policy still was in place.
Meanwhile, the federal Centers for Medicare & Medicaid Services in March 2020 increased the types of services that could be provided via telehealth in government-sponsored health programs and said Medicare would reimburse the same amount for services whether they were provided through telehealth or in person.
The state Agency for Health Care Administration said payment parity exists in what is known as the “fee for service” portion of Florida’s Medicaid program. But reimbursements are set by managed-care plans and can vary in the larger portion of the Medicaid program in which beneficiaries enroll in managed care.
Along with seeking parity in reimbursements, physicians also advocated during the 2021 legislative session for deductibles, coinsurance and copayments to be the same regardless of whether care is delivered via telehealth or in-person.
While the efforts fell short, physician Lisa A. Gwynn said parity is essential if physicians are going to continue using telemedicine. Gwynn, who has practiced medicine in Southeast Florida for 25 years, is the medical director for the University of Miami Miller School of Medicine’s pediatric mobile clinic.
She said the clinic has embraced telehealth during the pandemic, in part to help limit the numbers of children and parents in the waiting room to ensure that the sickest children can continue to be seen face to face.
But with the elimination of the executive order, Gwynn worries that insurers might not be as willing to reimburse for the care.
“There’s a lot of gray area and a lot of uncertainty. But at the end of the day it’s the managed-care and the insurance companies that are going to be controlling this,” she said, adding, “it will fall by the wayside if we are not being reimbursed for it,”
