Category: Florida

35 States with Any Willing Provider laws

As a provider, if your request to join a payer network in the following markets has been denied, you might have some recourse for appeals.

As a provider, if your request to join a payer network in the following markets has been denied, you might have some recourse for appeals.

Any Willing Provider and Freedom of Choice laws restrict the ability of managed care
entities, including pharmacy benefit managers, to selectively contract with providers. The
managed care entities argue this limits their ability to generate cost savings, while proponents of
the laws suggest that such selective contracts limit competition, leading to an increase in
aggregate costs.

These laws generally require health insurance companies to allow any qualified healthcare provider who is willing to meet the terms and conditions of the insurer’s contract to participate in their networks.

States listed below have some form of Any Willing Provider laws:

Alabama:

Section 27-1-19: The agreement providing coverage to an insured may not exclude assignment of benefits to any provider at the same benefit paid to a contract provider.

Section 27-45-3: Plan Beneficiaries may choose the licensed pharmacist or pharmacy of their choice. Health insurance policies and employee benefit plans may not deny licensed pharmacies or pharmacists the right to participate.

Arkansas:

Sections 23-201, 23-202, 23-203, 23-204, 23-205, 23-206, 23-207, 23-208, 23-209 : Benefit differentials are prohibited. Insurers must give qualified health care providers the opportunity to participate if providers are willing to accept the plan’s terms and conditions.

Colorado:

Section 10-16-122: Any PBM/intermediary whose contract with a carrier includes an open network must allow all area pharmacy providers to participate if they agree to the terms and conditions of the contract. PBms/Intermediaries may contract with exclusive pharmacy networks if a 60-day notice is given before the termination or the effective date of such contract by publication in a newspaper of general circulation.

Connecticut:

Section 38a-471: A prescription program administrator shall allow a pharmacy to enroll in a program absent cause for excluding it.

Delaware:

Sections 18-7301, 18-7302, 18-7303: Beneficiaries may choose any pharmacy that has agreed to participate according to the terms.  Benefit differentials are prohibited.

Florida:

Section 110.12315: The state employees’ prescription drug program requires the Department of Management services to allow prescriptions to be filled by any licensed pharmacy pursuant to contractual claims processing provisions.

Section 440.13(3) (j): The worker’s compensation statute allows for a sick or injured employee to have free, full and absolute choice in the selection of the pharmacy.

Georgia:

Section 26-2-144(a)(9): That at least 30 days prior to the date a program becomes effective, the program contract therefor shall be offered to all pharmacies located within those counties wherein reside enrollees in that program, which pharmacies shall have at least 30 days from the time they receive the offer to accept that offer and become participating pharmacies.

Section 33-30-25: Insurers may impose “reasonable limits” on the number/classes of preferred providers that meet the insurers’ standards. Insurers must give all licensed and qualified providers within a defined service are the opportunity to become a preferred provider.

Section 33-30-4.3: Beneficiaries who do not use mail-order shall not be penalized if the provider used by the insured has agreed to the same terms and conditions applicable to mail-order and has agreed to accept payment or reimbursement at no more than the same amount that would be paid for the same mail-order services.

Hawai’i:

Section 451 R-1: It shall be a violation of this section for a prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager to refuse to accept an otherwise qualified retail community pharmacy as part of a pharmacy benefit manager’s retail pharmacy network.

Idaho:

Sections 41-2872 & 41-3927: Any insurance company or health maintenance organization issuing benefits must be willing to contract with qualified providers who meet the terms of the organization. Organizations issuing benefits must be willing to contract with qualified providers who meet the terms of the organization

Illinois:

Section 215-5/370h: Insurers/administrators must be willing to enter into agreements with any non- institutional providers who meet the established terms and conditions. The terms and conditions may not discriminate unreasonably against or among non-institutional providers.

Section 215-134/72(a) : A plan may not refuse to contract with a pharmacy provider that meets the terms and conditions established by the plan.

Indiana:

Section 27-8-11-3 : Pharmacists who agree to comply with established terms and conditions

are entitled to enter into contracts with insurers. Terms and conditions established by insurers may not discriminate unreasonably against or among providers.

Iowa:

Section 514C.5: Policies or contracts providing for third-party payment may not require a beneficiary to order prescriptions by mail if the pharmacy chosen by the beneficiary agrees to comply with the same terms and conditions as the mail-order pharmacy.

Kentucky:

Section 304.17A-270: A health insurer shall not discriminate against any provider who is located within the geographic coverage area of the plan and who is willing to meet the terms and conditions for participation established by the plan, including the Kentucky State Medicaid program and Medicaid partnerships.

Section 304.17A-505: …if the provider meets the insurer’s enrollment criteria and is willing to meet the terms and conditions for

participation, the provider has the right to become a provider for the insurer.

Louisiana:

Section: 22:1964: Policies/plans must allow beneficiaries to select the pharmacy/pharmacist of their choice as long as the chosen pharmacy agrees to meet the terms and conditions of the plan.

Pharmacies that agree to meet the established terms and conditions have the right to participate as contract providers. Renamed from Section 22:1214(15).

Section 22:2181: The Louisiana State University Health Sciences Center Health Maintenance Organization shall enter into a contract with any willing provider licensed by the Louisiana State Board of Medical Examiners or the Louisiana State Board of Dental Examiners to provide primary care services delivered in an outpatient setting including medical and surgical services.

Maine:

24-A M.R.S.A. § 4317: insurance carriers offering health plans subject to the Maine Health Plan Improvement Act that provide prescription drug benefits through a network of participating pharmacies may not refuse to contract with a pharmacy that is willing to meet the terms and conditions for participation in the health plan’s pharmacy network. If the network is a tiered network, Maine pharmacies must be offered the opportunity to participate in each tier. A pharmacy benefits manager may not require a pharmacist or pharmacy to participate in one network in order to participate in another network. The pharmacy benefits manager may not exclude an otherwise qualified pharmacist or pharmacy from participation in one network solely because the pharmacist or pharmacy declined to participate in another network managed by the pharmacy benefits manager.

Massachusetts:

Section 176D(3B): Carriers who offer restricted pharmacy networks must follow certain requirements in contracting. Carriers must neither exclude nor favor individual pharmacies and must not impose greater restrictions on non-network pharmacies than those required on in-network pharmacies.

Mississippi:

Section 83-9-6: Beneficiaries may choose any pharmacy that has agreed to participate in the plan according to the insurer’s terms. Pharmacies that accept those terms are entitled to participate.

Benefit differentials are prohibited. Plans that restrict pharmacy participation shall give 60 days notice of offer to participate to all pharmacies in the geographic area.

Missouri:

Section 354.535: Every Health maintenance organization has to apply the same coinsurance, co- payment and deductible factors to all prescriptions filled by a pharmacy provider who participates in the network if the provider meets the contact’s product cost determination. Also HMOs may not set a limit on the quantity of drugs which an enrollee may obtain at any one time with a prescription unless such limit is applied uniformly to all pharmacy providers in the network.

Montana:

Section 33-22-1704: A preferred provider agreement must provide all providers with the opportunity to participate on the basis of a competitive bid.

Nebraska:

Section 44-513.02: Beneficiaries shall not be required to obtain pharmaceutical services from mail- order in order to obtain reimbursement.

Section 44-313(2) :…an insurer may contract with a licensed pharmacist for pharmacist professional

services. Nothing in this section shall prohibit an insurer from contracting with a licensed pharmacist who is not employed or associated with a pharmacy. Nothing in this section shall require a licensed pharmacist to contract with an insurer for pharmacist professional services.

New Hampshire:

Section 420-B:12(V): HMOs seeking bids from pharmacies for agreements to be preferred providers must admit and list all pharmacies that meet the bid.

New Jersey:

Sections 17:48-6j & 26:2J-4.7: An enrollee/subscriber shall be permitted to select a pharmacy/pharmacist provided the pharmacist or pharmacy is registered. Pharmacies/pharmacists shall have the right to participate as preferred providers if the agreement provides for coverage by preferred providers, so long as the pharmacy/pharmacist complies with the terms of the agreement. Benefit differentials shall not be imposed. Enrollees/subscribers shall not be required to use a mail- order pharmacy.

New Mexico:

Section16.19.6.7(f): “Point of care vendor” means an entity contracted with a prescriber to generate or transmit electronic prescriptions authorized by a practitioner directly to a pharmacy or to a “contracted” intermediary or “network vendor”, who will ultimately transmit the prescription order to a patient’s pharmacy of choice. Vendor must provide an unbiased listing of provider pharmacies and not use

pop-ups or other paid advertisements to influence the prescriber’s choice of therapy or to interfere with patient’s freedom of choice of pharmacy. Presentation of drug formulary information, including preferred and non-preferred drugs and co-pay information if available, is allowed.

North Carolina:

Section 58-51-37: Beneficiaries may choose any pharmacy that has agreed to participate according to the insurer’s terms. Pharmacies that accept such terms are entitled to participate and must participate if offered the opportunity. Benefit differentials are prohibited. Plans that limit pharmacy participation shall give 60 days notice of an offer to participate to all pharmacies in the geographic area.

North Dakota:

Section 26.1-36-12.2: Beneficiaries may choose any licensed pharmacy/pharmacist to provide services. Benefit differentials are prohibited. Licensed pharmacists who accept the terms may participate in the plan.

Oklahoma:

Section 36-3634.3 & 36-4511: Pharmacies must be provided the right to bid on a periodic basis on any pharmacy contract to provider pharmacy services. Employers may not require employees to obtain drugs from a mail-order pharmacy as a condition for reimbursement. Employers may not impose benefit differentials if they do not use mail-order.

Title 15 § 15-788(c): No third party prescription program administrator shall deny any pharmacy the opportunity to participate in any third party prescription program offered in this state in a manner which will restrain the right of a consumer to select a pharmacy.

Rhode Island:

Sections 27-18-33, 27-19-26, 27-20-23, 27-41-38: Insurers may not require covered persons to obtain prescriptions from a mail-order pharmacy as a condition of obtaining benefits.

RI Gen. Laws 27-29-1: Unfair competition and practices.

South Carolina:

Section 38-71-147: No individual or group accident and health or health insurance policy or HMO may prohibit a participant/beneficiary from selecting pharmacies/pharmacists that agreed to participate in the plan according to the terms of the insurer, or may deny pharmacies/pharmacists the right to participate as contract providers if they agree to insurer’s terms and conditions.

South Dakota:

Section 58-18-37: Group health insurance policies may not refuse to accept licensed pharmacies/pharmacists as participating providers if they agree to the same terms and conditions offered to other providers of pharmacy services under the policy.

Tennessee:

Section 56-7-117: Group medical benefit contracts covering prescriptions may not require a covered person to obtain prescriptions from mail-order, or to pay an additional fee, or be subjected to a penalty for declining to use a designated mail-order pharmacy.

Section 56-7-2359: Licensed pharmacies may not be denied right to participate on the same terms and conditions offered other participants; benefit differentials are prohibited.

Texas:

Section 21.52B 2(a) (2): A pharmacy/pharmacist may not be denied the right to participate as a contract provider under the plan if the pharmacy/pharmacist agrees to provide pharmaceutical services that meet all terms and requirements and to include the same administrative, financial, and professional conditions that apply to pharmacies/pharmacists that have been designated as providers under plan.

Utah:

Section 31A-22-617: Insurers must allow providers to apply for and be designated as preferred providers if they agree to meet established terms and conditions. “Reasonable limitations” may be placed on the number of designated preferred providers.

Virginia:

Section 38.2-3407: Insurers shall establish terms and conditions in order to receive payment as a preferred provider. The terms and conditions shall not discriminate unreasonably against or among such health care providers and cannot exclude any provider willing to meet the terms and conditions.

Section 38.2-3407.7: Insurers shall not prohibit any person receiving pharmacy benefits from selecting, without limitation, the pharmacy of his choice.

Section 38.2-4209: Providers who are willing to accept established terms and conditions may qualify for payment under preferred provider contracts.

Section 38.2-4209.1: Corporations must allow beneficiaries to select the pharmacy of their choice if pharmacies that are non-preferred providers have previously notified the corporation of their agreement to accept reimbursement at rates applicable to preferred providers.

Section 38.2-4312.1: No Health maintenance organization shall prohibit any person receiving pharmaceutical benefits from selecting, without limitation, the pharmacy of his choice. No monetary penalty which would affect or influence any person’s choice of pharmacy shall be imposed.

Wisconsin:

Section 628.36 (2m): An annual 30-day open enrollment period during which any pharmacist may elect to participate is required.

Wyoming:

Section 26-22-503: Any provider willing to meet the established requirements has the right to enter into contracts relating to health care services.

Section 26-34-134: Providers willing to meet an HMO’s established terms shall not be denied the right to contract. An HMO may not discriminate against a provider on the basis of the provider’s academic degree.

Please note that laws can change over time, so it’s always a good idea to verify the current status of AWP laws in specific states if you need the most up-to-date information.

Comprehensive Medicaid Actuarial Data (FL)

Advanced financial and statistical support relating to Capitation Rates, Risk Adjustment Models, and Payment Methodologies.

Agency: Florida Agency for Health Care Administration

Market: Florida

Line of Business: Medicaid

Market: Florida

Line of Business: Medicaid

Agency: Florida Agency for Health Care Administration

Source: Medicaid Actuarial Services

Advanced financial and statistical support relating to Capitation Rates, Risk Adjustment Models, and Payment Methodologies.

Medicaid Actuarial Services

This post is useful for those seeking information on Medicaid actuarial services and related rates in Florida.

  • Outlines Medicaid actuarial services provided by the Bureau, including advanced financial and statistical support for Capitation Rates, Risk Adjustment Models, and Payment Methodologies.
  • Provides information on Managed Medical Assistance (MMA), Long-Term Care (LTC), and Dental Capitation Rates for various years.
  • Includes a link to a Special Needs Plan Revenue and Expense Schedule Statement Template Tool.

Unit Responsibilities include:

  • Support of Capitation Rate Development and Adjustment
  • Management of External Actuarial Service Contracts
  • Monitoring Medicaid Program Changes
  • Trend Analysis
  • Rate Impact Analysis

Medicaid Actuarial Services

This post is useful for those seeking information on Medicaid actuarial services and related rates in Florida.

  • Outlines Medicaid actuarial services provided by the Bureau, including advanced financial and statistical support for Capitation Rates, Risk Adjustment Models, and Payment Methodologies.
  • Provides information on Managed Medical Assistance (MMA), Long-Term Care (LTC), and Dental Capitation Rates for various years.
  • Includes a link to a Special Needs Plan Revenue and Expense Schedule Statement Template Tool.

For Institutional Reimbursement rates, please click here.

SMMC Capitation Information

Managed Medical Assistance (MMA)

Long-Term Care (LTC)

Dental

Medicare Dual Eligible Special Needs Plans (D-SNPs) and Fully Liable Medicare Advantage Plans

Special Needs Plan Revenue and Expense Schedule Statement Template Tool [ excel 160.5 kB ] Effective July 1

Birth Count Query System (Florida)

The Birth Count Query System is a highly useful online tool provided by the Florida Department of Health. It offers a plethora of data on birth counts in Florida, and can be accessed easily through this link: https://www.flhealthcharts.gov/FLQUERY_New/Birth/Count.

This comprehensive tool is an excellent resource for researchers and analysts who are interested in delving deeper into birth trends in Florida. The system provides data that is updated regularly, offering a wealth of information on birth counts across different areas of the state, as well as various demographics. By using this system, researchers and analysts can gain valuable insights into the factors that affect birth rates in Florida, and can make informed decisions based on the data provided by the tool. Additionally, the system can also be used to identify areas where further research is needed, helping to drive innovation in the field of birth rate analysis.

Florida Law Reminder for Early Prescription Refills (Managed Care Plans)

​Tallahassee, Fla. – Following Governor DeSantis’ Executive Orders 21-150 and 21-151 in response to Tropical Storm Elsa, the Florida Office of Insurance Regulation (OIR) issued the following notice to all health insurers, managed care organizations and other health entities licensed by OIR.

Florida Law Reminder for Early Prescription RefillsTuesday,

July 6, 2021

Contact Info:

​(850) 413-2515
press@floir.com

  
​Tallahassee, Fla. – Following Governor DeSantis’ Executive Orders 21-150 and 21-151 in response to Tropical Storm Elsa, the Florida Office of Insurance Regulation (OIR) issued the following notice to all health insurers, managed care organizations and other health entities licensed by OIR.

To: All Health Insurers, Managed Care Organizations, and Other Health Entities Authorized to do Business in Florida RE: Tropical Storm Elsa – Notice of Florida Law for Early Prescription Refills 

This notice is a reminder that all health insurers, managed care organizations, and other health entities must comply with must comply with the provisions of section 252.358, Florida Statutes, which allows for early prescription refills in the event that the Governor issues an Executive Order declaring a State of Emergency or when a county Emergency Operations Center (EOC) is activated.This statute has now been triggered due to Tropical Storm Elsa for Alachua, Charlotte, Citrus, Collier, Columbia, Dixie, Franklin, Gilchrist, Hamilton, Hernando, Hillsborough, Jefferson, Lafayette, Lake, Lee, Levy, Madison, Manatee, Marion, Monroe, Pasco, Pinellas, Sarasota, Sumter, Suwanee, Taylor, and Wakulla counties. This mandate remains in effect until the Governor’s Executive Orders are rescinded or expires.

Declaration of Emergency by Governor DeSantisThe Governor’s Executive Orders 21-150, and 21-151 are available here. In accordance with section 252.358, Florida Statutes, Emergency-preparedness prescription medication refills:

  • All health insurers, managed care organizations, and other entities that are licensed by the Office of Insurance Regulation and provide prescription medication coverage as part of a policy or contract shall waive time restrictions on prescription medication refills, which include suspension of electronic “refill too soon” edits to pharmacies, to enable insureds or subscribers to refill prescriptions in advance, if there are authorized refills remaining, and shall authorize payment to pharmacies for at least a 30-day supply of any prescription medication, regardless of the date upon which the prescription had most recently been filled by a pharmacist, when the following conditions occur:
  • (1) The person seeking the prescription medication refill resides in a county that:
    • (a) Is under a hurricane warning issued by the National Weather Service;
    • (b) Is declared to be under a state of emergency in an executive order issued by the Governor; or
    • (c) Has activated its emergency operations center and its emergency management plan.

  • (2) The prescription medication refill is requested within 30 days after the origination date of the conditions stated in this section or until such conditions are terminated by the issuing authority or no longer exist. The time period for the waiver of prescription medication refills may be extended in 15- or 30-day increments by emergency orders issued by the Office of Insurance Regulation.

This section does not excuse or exempt an insured or subscriber from compliance with all other terms of the policy or contract providing prescription medication coverage.

PLEASE BE GOVERNED ACCORDINGLY.

FLORIDA: Policing Reforms to Reduce Violence Against Minorities Effective Immediately

House Bill 7051, the package of policing reforms negotiated this spring by members of Florida’s Legislative Black Caucus and Republican leaders, was signed into law late Tuesday by Gov. Ron DeSantis, along with 93 other approved bills. The reforms take effect immediately and would impact not only minorities but other people facing trouble with the law.

House Bill 7051, the package of policing reforms negotiated this spring by members of Florida’s Legislative Black Caucus and Republican leaders, was signed into law late Tuesday by Gov. Ron DeSantis, along with 93 other approved bills. The reforms take effect immediately and would impact not only minorities but other people facing trouble with the law.

Policing reforms to reduce violence against minorities and others take effect immediately

by Laura Cassels, Florida Phoenix
June 30, 2021

New limits on use of force by police, new training standards, and greater focus on identifying dangerous police practices are now in effect in Florida, though Black legislative leaders say those efforts don’t go far enough.

House Bill 7051, the package of policing reforms negotiated this spring by members of Florida’s Legislative Black Caucus and Republican leaders, was signed into law late Tuesday by Gov. Ron DeSantis, along with 93 other approved bills. The reforms take effect immediately and would impact not only minorities but other people facing trouble with the law.

State Rep. Fentrice Driskell, a key sponsor of the reforms, said they constitute a first step toward safer relations between police and people of color in Florida and that the bipartisan legislative effort is worthy of celebration.

“I’m very glad to see the governor sign this into law. The entire Legislature should be proud of it,” Driskell, a Hillsborough County Democrat, told the Phoenix in a phone interview.

That said, the new policing law doesn’t ban chokeholds and vascular neck restraints but limits the use of them to encounters when an officer “perceives an immediate threat of serious bodily injury or death to himself, herself, or another person.” That kind of restraint was used of by former Minneapolis policeman Derek Chauvin, now convicted of murder, to kill George Floyd, an unarmed, handcuffed suspect in his custody.

The killing of Floyd in May 2020, recorded on video seen around the world, ignited national and international protests against police brutality and inspired a movement for policing reform.

Members of the Black Caucus, led by Rep. Driskell and Sen. Randolph Bracy, an Orlando Democrat, said when the reforms were approved in the final days of the 2021 legislative session, they were considered a good first step for preventing deadly encounters between police and the policed.

The reforms do not include, for instance, requirements that Florida law enforcement officers use bodycams and dashboard cameras to record their activities, as was sought by Black Caucus members and their allies.

“Police reform is long overdue in this state and this country. … People of color are disproportionately affected and in some horrifying cases have cost someone their life,” House Co-leader Bobby DuBose, a Broward Democrat, said in a press statement on Wednesday.  “We will continue having conversations with our communities and law enforcement agencies to propose new legislation at the state and federal levels to ensure there is fair and just policing for all.”

Sen. Bobby Powell, a Palm Beach Democrat and chair of the Florida Legislative Black Caucus, said [This law] acknowledges there is a systemic issue in the hiring, training and accountability of law enforcement and correctional officers. I am hopeful that this is the first step of many towards substantial change.”

On Wednesday, Police Chiefs Association President and Satellite Beach Police Chief Jeff Pearson praised the new law in a statement to the Phoenix:

“In the wake of George Floyd’s murder last year, the Florida Police Chiefs Association established a Subcommittee on Accountability and Social Change that hosted over 23 meetings with community leaders to determine how law enforcement can better serve communities. Their recommendations largely formed the basis for HB 7051.”

Pearson wrote that the new law “approaches reform correctly — factual and balanced, ever mindful of the dedication and sacrifice of law enforcement officers, but equally committed to public safety and accountability.”

Pearson said the subcommittee is working to finalize a detailed report of additional recommendations “that law enforcement and community leaders can use to continue making progress together.”

The new law also:

/Requires an officer who observes another officer engaging or attempting to engage in excessive use of force to intervene;

/Require law enforcement agencies to report quarterly to the Florida Department of Law Enforcement on use-of-force incidents that result in serious bodily injury, death, or the discharge of a firearm at a person;

/Require applicants for law-enforcement, corrections or probation jobs to disclose their history of any pending criminal, civil, or administrative investigation;

/Require a law enforcement or correctional agency to maintain records on why an officer was terminated, resigned or retired;

/Requires the Criminal Justice Standards and Training Commission to establish standards for police training in use of force, and requires agencies to develop policies in proportional use of force and de-escalation techniques;

/Establishes that an officer has a duty to render medical assistance to a person in custody who is injured by an officer’s use of force;

/Requires instruction on recognizing symptoms and characteristics of a person with a substance abuse disorder or mental illness and how to appropriately respond;

/Requires independent reviews of officers’ use of force resulting in a death or the intentional firing of a firearm resulting in injury or death;

/Prohibits children younger than seven from being arrested, except if the child commits a forcible felony.

The Police Chiefs Association is holding its annual summer conference in Plantation. Association President Pearson will step down, and his successor, Stephan Dembinsky, director of the Daytona Beach Shores Public Safety Department, will be installed as the new president tonight, said association spokesman William Stander.

Rep. Driskell was invited to speak at the conference but was unable to attend.

The Florida Sheriffs Association has not yet responded to a request for comment.

Florida Phoenix is part of States Newsroom, a network of news outlets supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Diane Rado for questions: info@floridaphoenix.com. Follow Florida Phoenix on Facebook and Twitter.

Florida Market Telehealth Rule & Controlled Substances

Rules regarding telehealthcare in Florida.

During the 2019 legislative session, Florida passed Chapter 2019-137, Laws of Florida, which establishes standards of practice for telehealth services, including patient evaluations, record-keeping, and controlled substances prescribing. The law also authorizes out-of-state health care practitioners to perform telehealth services for patients in Florida. Signed by the Governor on June 25, 2019, this law became effective on July 1, 2019.

Out-of-state health care practitioners must be registered with the Florida Department of Health to perform telehealth services for patients in Florida.

Health care providers must be licensed within their scope of practice by the appropriate licensing body to practice telehealth in Florida.

Providers must also use two-way, interactive communication tools, such as live video, instead of email or audio-only communication. If you use Medicaid, your telehealth provider must be registered with the Florida Medicaid program to receive reimbursement for telehealth services. Florida doesn’t require private insurers to cover telehealth, so check with your insurance company to determine if you’re eligible for the service. Some of these regulations may be altered during the COVID-19 pandemic.

In Florida, telehealth providers are permitted to prescribe medications if the medications aren’t listed as controlled substances.

Controlled substances shall not be prescribed through the use of telemedicine except for the treatment of psychiatric disorders. This provision does not preclude physicians from ordering controlled substances through the use of telemedicine for patients hospitalized in a facility licensed pursuant to Chapter 395, F.S.

Telemedicine Rule, Rule 64B8-9.0141, F.A.C.

However, there is one important exception to this rule: If you need a controlled substance to manage a mental health condition, your telehealth provider is allowed to prescribe it.

Before prescribing medication, your telehealth provider must conduct an evaluation and explain the risks and benefits of the medication to you.

Filling out a questionnaire before your telehealth appointment isn’t enough to satisfy the evaluation requirement, so you should expect the provider to ask multiple questions about your symptoms and health history.