Telehealth in Florida — Laws and Regulations | Blog

A Florida practice that turns away phone visits because audio-only does not count as telehealth is following a rule that expired four years ago. The exclusion was real once.

Senate Bill 312 struck it on July 1, 2022, and email and fax are now the only things Florida's telehealth definition leaves out.

That gap costs appointments. A patient who cannot get a video link working is still a patient your schedule can keep.

Guidance on telehealth in Florida ages badly, because Section 456.47 keeps moving and the payment rules move separately from it.

The statute took effect on July 1, 2019. Lawmakers have amended it five times since, once in 2020, once in 2022, and three times in 2023. The controlled substance ban narrowed to Schedule II. Venue rules appeared. So did a ban on using telehealth to perform an abortion.

Payment ran the other direction. Florida Medicaid covered audio-only visits during the federal emergency, then stopped on May 11, 2023, a year after state law started allowing them.

Commercial contracts stayed voluntary the whole time, with no parity requirement behind them. Whatever rate you negotiated is the rate you get.

What follows works through the current text. Who qualifies as a telehealth provider. Which practice standards apply. What an out-of-state registration demands after approval, and where the insurance rules leave your billing.

Two federal dates sit on top of all of it, one for prescribing controlled substances and one for Medicare coverage. Both have moved before, and neither is settled.

Telehealth in Florida Before House Bill 23

Remote care happened in Florida long before 2019, without a rulebook to govern it. No statute defined telehealth, named who could deliver it, or set a standard of care. Practices made their own calls and hoped the licensing boards would agree.

Lawmakers moved on that gap in 2016. Chapter 2016-240 created the Telehealth Advisory Council.

The same law told the Agency for Health Care Administration, the Department of Health, and the Office of Insurance Regulation to survey practices, facilities, and insurers on how telehealth was actually being used. Those findings became the council's raw material.

Its report, Expanding Florida's Use and Accessibility of Telehealth, was approved on October 17, 2017. Four recommendations carried the most weight:

• A working definition of telehealth
• Coverage and payment conditions for payers
• Support for asynchronous (store-and-forward) telehealth
• Remote patient monitoring under Medicaid

Senate Bill 280 reached the legislature days before those recommendations were final. Senator Aaron Bean sponsored it.

The bill set a standard of care, let providers evaluate patients by telehealth, and added recordkeeping rules. It cleared the Senate. Then, on March 10, 2018, it died in Messages in the House.

Parity is what sank it. The council had asked for coverage parity and payment parity on commercial plans, with Medicare left out. Insurers argued they should set telehealth rates themselves. The two chambers never agreed on a version, and the session ended with no telehealth law on the books.

Current Florida Telehealth Law Breakdown

House Bill 23 gave Florida its first full telehealth statute. Lawmakers passed it on April 29, 2019. Governor DeSantis signed it on June 25. The law took effect on July 1 that year.

HB 23 drew on the 2017 Telehealth Advisory Council report, but not all of it. Mandatory payment parity was a council recommendation. It did not survive. Insurer contracts stayed voluntary.

Most of the law lives in Section 456.47 of the Florida Statutes. HB 23 also created Section 627.42396 and amended Section 641.31. Those two govern what insurers and HMOs put in provider contracts.

Section 456.47 now has seven parts:

Section 456.47 has changed since 2019. Five rounds of amendments followed, once in 2020, once in 2022, and three times in 2023. Anything written about Florida telehealth before 2022 describes a version of the law that no longer applies.

What is Telehealth in Florida?

Two kinds of technology count under Section 456.47. Synchronous means live, in real time. Asynchronous means the information travels with a lag. Either one can carry health care services, and both are telehealth.

The statute spells out what a provider may deliver this way:

What Type of Communication Does Telehealth Entail?

Live video is the common form. Store-and-forward counts too. So does a plain phone call, which surprises a lot of Florida practices.

Audio-only sat outside the definition when the law took effect in 2019. Senate Bill 312 struck that exclusion on July 1, 2022. Two methods remain outside it.

One caution before you build phone visits into the schedule. Florida Medicaid stopped paying for audio-only telehealth on May 11, 2023. Legal and billable are separate questions here. For the video side, Curogram runs HIPAA-compliant visits from any device.

What is the Difference Between Telemedicine and Telehealth in Florida?

Before House Bill 23, Florida regulated telemedicine instead. The Florida Board of Medicine defined it narrowly. Only a Florida-licensed physician or physician assistant qualified. The care had to involve medical information sent from one site to another.

Two things changed with the switch. The current definition spells out which services and which technologies qualify. It also reaches far past physicians and physician assistants.

Telemedicine now sits inside telehealth as a subset. Section 456.47 never uses the word. Florida Medicaid rules still use it, so the same visit can carry two labels. Rule 64B8-9.0141 held the old definition until its repeal on October 14, 2019.

Who Can Provide Telehealth Services in Florida?

Section 456.47 does not name job titles. It cites license chapters, then treats anyone holding one of those licenses as a telehealth provider. Florida's Department of Health translates that into plain professions, and the list runs past 40.

The department calls its list open-ended. A profession that is missing may still qualify, so check your own practice act. Hold a Florida license and you are already covered. No extra registration applies. Providers licensed elsewhere have two routes in.

A compact license comes first. Florida belongs to six: nursing, medicine, psychology, counseling, physical therapy, and audiology with speech-language pathology. Your home-state license carries over when your profession has a compact and Florida is a member.

Out-of-state telehealth registration is the second route. It suits providers whose field has no compact, or whose home state has not joined one. Requirements for it sit further down this guide.

The nursing compact has a limit worth knowing. An RN or LPN with a multistate license can treat Florida patients without registering. Advanced practice registered nurses are not part of that compact. A nurse practitioner licensed in another state still needs a registration or a Florida license.

One more path exists if you want full licensure. MOBILE endorsement grants a Florida license without asking you to live in the state. You cannot hold that license and a telehealth registration at the same time.

Practice Standards for Telehealth Providers in Florida

Section 456.47 sets six practice standards in subsection two. Records sit in a subsection of their own, though they work like a fifth standard and are covered below.

Standard of Care

Two duties apply here. Work inside your scope of practice. Meet the same professional standard that governs in-person care in Florida.

Boards enforce this the way they would for an office visit. For an out-of-state registrant, a violation can cost the registration itself.

Establishing a Doctor-Patient Relationship

Many states require an in-person visit before the first telehealth appointment. That limits a practice to patients it has already seen.

Florida does not. A provider may evaluate a patient by telehealth from the start. When that evaluation is enough to diagnose and treat, no chart review and no physical exam come first.

For scheduling, that means a new patient can go straight into a video slot.

Prescription Requirements

This rule changed in 2022. Florida once barred every controlled substance by telehealth. Senate Bill 312 narrowed the ban to Schedule II on July 1, 2022. Schedule III, IV, and V prescriptions are now allowed within your scope.

Schedule II stays off limits except in four situations:

1. Treating a psychiatric disorder
2. Inpatient treatment at a licensed hospital
3. Treating a patient receiving hospice care
4. Treating a nursing home facility resident

Federal rules sit on top of state rules. The DEA waiver that lifts the in-person visit requirement runs through December 31, 2026. Check both layers before writing.

Handling Patient Medical Records

Document a telehealth visit to the same standard as an office visit. Everything the visit generates stays confidential. That covers video, audio, and any electronic files.

Curogram handles the communication side under HIPAA. Our platform pulls appointment and patient data from your EMR, which cuts double entry at the front desk. Clinical notes still belong in your chart, since our sync runs one way, from the EMR into Curogram. See integrations here.

Out-of-State Providers Registration in Florida

Providers licensed in another state can treat Florida patients without holding a Florida license. The route is registration with the Florida Department of Health. Approval brings a registration number and an approval letter, not a license.

Six requirements govern the application:

1. Submit the completed application form
2. Hold an active license from another state, territory, or the District of Columbia, with no restrictions on it. A provisional license will not qualify.
3. Carry no disciplinary action from the past five years, and nothing pending.
4. Designate a Florida registered agent, chosen from the list of these agents kept by the Division of Corporations.
5. Maintain liability coverage or financial responsibility for telehealth to Florida patients, at Florida levels.
6. Pharmacists only: dispense through a Florida-permitted pharmacy, a registered nonresident pharmacy, or a licensed outsourcing facility.

Approval carries ongoing duties, and they run for as long as the registration does.

Registration costs nothing. No application fee, no registration fee, and the registration never expires.

House Bill 23 anticipated a $150 fee. Florida requires a separate bill to set fees, though. Lawmakers passed one. The Governor vetoed it, and no fee has been set since.

Free is not the same as no cost. Registered agents are private services, and most charge a yearly fee to keep the designation active. Budget for that line rather than the state.

Licensure Exceptions for Practicing Telehealth in Florida

Two situations let an out-of-state provider treat a Florida patient with no registration at all. Both assume you already hold an active license somewhere else. Neither is broad.

Emergency medical condition is a defined term. That is not a judgment call. It means acute symptoms, which may include severe pain. They have to be bad enough that waiting could cause serious harm. Section 395.002 spells out what counts:

• Serious jeopardy to the patient's health
• Serious impairment of a bodily function
• Serious dysfunction of an organ or body part

Pregnancy carries its own criteria. One is too little time for a safe transfer before delivery.

Consultation turns on who decides. A Florida-licensed professional has to hold ultimate authority over the diagnosis and the care. Sharing a decision with a peer falls outside it.

Work outside these two situations and you need a registration, a compact privilege, or a Florida license.

Insurance Coverage for Telehealth Services in Florida

Florida has a private payer telehealth law. It does not require any plan to cover telehealth, and it does not require equal pay.

Sections 627.42396 and 641.31 set the rule. A contract between an insurer or HMO and a telehealth provider is voluntary. Both sides negotiate the rates and the payment method. A payer that declines to contract for telehealth is within the law.

One protection sits inside that rule. When a contract pays a different rate for telehealth than for the same service in person, you have to initial that provision. A lower telehealth rate cannot slip past you in a signature block.

Nationally, Florida sits in the minority on parity.

Insurers pushed for this outcome and made their case openly. Virtual care cuts overhead, they argued, so it should not cost a payer what an office visit costs. Rate-setting belongs at the negotiating table rather than in statute.

Physician groups took the opposite position. The Florida Medical Association treated payment parity as a top priority during the 2019 debate. Same work, same pay was the core of it. Advocates also wanted parity early on, as a way to get practices to try telehealth at all.

Commercial plans are only part of the picture.

What Happened to Florida's COVID-19 Telehealth Flexibilities?

Florida's pandemic telehealth rules are gone. Every one rested on an emergency order. Those orders ended years ago.

Governor DeSantis declared a state of emergency on March 9, 2020, through Executive Order 20-52. Agency orders followed. Florida's Surgeon General at the time, Scott Rivkees, M.D., of the Florida Department of Health (DOH) has issued an order that temporarily suspends some statutory laws regarding telehealth services in the state. Four suspensions applied:

• Healthcare provider licensure extension
• Out-of-state provider licensure acceptance
• Remote board hearings
• Remote nursing education programs

Everything lapsed on June 26, 2021. DeSantis let the last extension of that order expire, and the agency orders fell with it.

The rollback hit fast. Phone visits stopped counting as telehealth for patients outside Medicare. Telehealth scripts for long-term pain not caused by cancer stopped. Out-of-state clinicians lost their waiver and needed a Florida license again.

A separate order from the Governor had made health plans cover telehealth. That one expired too.

Some of what practices lost in 2021 came back later. New laws brought it back, not new orders.

Any workflow built on a 2020 or 2021 order rests on nothing now. Check the statute instead.

Have a Successful Telehealth Start in Florida with Curogram

Florida sets the rules covered above. Your platform has to hold up under them from the first visit.

Curogram runs two-way messaging and telehealth in one place. Curogram complies with all the HIPAA rules to keep your virtual clinic and protected health information (PHI) secure.

Section 456.47 asks you to document a telehealth visit to the same standard as an office visit. A new patient can be evaluated by video first, so a first appointment can start online. Florida Medicaid pays for video but not audio-only, which puts weight on the video path.

Patients text you back from their own phones, and your team works the whole thread from one dashboard instead of the phone queue. Reminders pull from your schedule and go out on the rules you set. Electronic forms arrive before the visit, so the day itself runs shorter.

A virtual waiting room shows providers who has checked in and lets nurses prep whoever is next. Video visits hold more than one provider, so a scribe can take notes while the doctor works.

Provider and patient apps run on laptop, phone, or tablet, with staff-to-staff messaging beside patient messaging. Curogram connects with almost any EHR, which ends double entry at the front desk.

Reminders confirm more than 75% of appointments across our client base. Atlas Medical Center cut no-shows from 14.20% to 4.91% in three months. Our clients run no-show rates 53% below the industry average, based on our internal case study data.

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.

Telemedicine by State in the US

Book a demo to see how Curogram handles a Florida telehealth schedule, from the first reminder through the visit itself.

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