Last updated 11/17/2023
Consent Requirements
No Reference Found
Last updated 11/17/2023
Definitions
Telemedicine is the practice of health care delivery by a practitioner who is in a site other than the site where a recipient is located, using interactive telecommunications equipment that minimally includes real time, two-way interactive communication between a recipient and a practitioner using audio and video equipment.
SOURCE: FL Medicaid, Alert, Ending of Federal Public Health Emergency: Updated Co-Payment and Telemedicine Guidance for Medical and Behavioral Health Providers, May 4, 2023, (Accessed Nov. 2023).
Telemedicine – The practice of health care delivery by a practitioner who is located at a site other than the site where a recipient is located for the purposes of evaluation, diagnosis, or treatment.
SOURCE: FL Admin Code 59G-1.057. (Accessed Nov. 2023).
Substance Abuse Services
“Telehealth” as defined in Section 456.47(1)(a), F.S.
“Telehealth” means the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include e-mail messages or facsimile transmissions.
SOURCE: FL Admin Code 65D-30.002 & FL Statute 456.47, (Accessed Nov. 2023).
Children’s Medical Services
Telemedicine is “the use of telecommunication and information technology to provide clinical care to individuals at a distance, and to transmit the information needed to provide that care.”
SOURCE: FL Admin Code 64C-8-001(6). (Accessed Nov. 2023).
Last updated 11/17/2023
Email, Phone & Fax
Florida Medicaid will cover telehealth services in accordance with the Agency’s promulgated Telemedicine rule and will no longer cover audio-only telehealth services.
SOURCE: FL Medicaid, Alert, Ending of Federal Public Health Emergency: Updated Co-Payment and Telemedicine Guidance for Medical and Behavioral Health Providers, May 4, 2023, (Accessed Nov. 2023).
No reimbursement for telephone, chart review, electronic mail messages or facsimile transmissions.
SOURCE: FL Admin Code 59G-1.057. (Accessed Nov. 2023).
Last updated 11/17/2023
Live Video
POLICY
During the federal PHE, the Agency provided expansive coverage for telemedicine services. Effective May 11, 2023, Florida Medicaid will cover telehealth services in accordance with the Agency’s promulgated Telemedicine rule and will no longer cover audio-only telehealth services. Florida Medicaid will continue to cover store-and-forward and remote patient monitoring services.
As a reminder, Statewide Medicaid Managed Care (SMMC) plans may provide more expansive coverage than what is in Agency rule, including telemedicine and waiving co-payments. However, SMMC plans may not be more restrictive than Agency rule.
SOURCE: FL Medicaid, Alert, Ending of Federal Public Health Emergency: Updated Co-Payment and Telemedicine Guidance for Medical and Behavioral Health Providers, May 4, 2023, (Accessed Nov. 2023).
FL Medicaid reimburses for real time, two-way, interactive telemedicine.
Providers must include the GT modifier.
SOURCE: FL Admin Code 59G-1.057. (Accessed Nov. 2023).
Statewide Medicaid Managed Care Telemedicine/Teledentistry policy available. Provides reimbursement requirements of plans for telemedicine and teledentistry.
SOURCE: FL Agency for Health Care Administration, Statewide Medicaid Managed Care Telemedicine/Teledentistry, Aug. 2018, (Accessed Nov. 2023).
ELIGIBLE SERVICES/SPECIALTIES
List of eligible community behavioral health services is provided in Provider Alert. See alert for procedure codes, modifiers and telemedicine modifiers.
SOURCE: FL Medicaid, Alert, Community Behavioral Health Telemedicine-Eligible Services, May 12, 2023, (Accessed Nov. 2023).
Florida Medicaid reimburses the practitioner who is providing the evaluation, diagnosis, or treatment recommendation located at a site other than where the recipient is located.
SOURCE: FL Admin Code 59G-1.057. (Accessed Nov. 2023).
Alcohol and/or drug screenings can be delivered with a telehealth place of service.
SOURCE: FL Medicaid Alert, Screening, Brief Intervention, and Referral to Treatment (SBIRT) Continuing Medical Education (CME) Opportunity for Providers, Apr. 13, 2023, (Accessed Nov. 2023).
ELIGIBLE PROVIDERS
Telemedicine is available for use by all providers of Florida Medicaid services that are enrolled in or registered with the Florida Medicaid program and who are licensed within their scope of practice to perform the service.
SOURCE: FL Admin Code 59G-1.057. (Accessed Nov. 2023).
ELIGIBLE SITES
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Continuing Medical Education (CME) Opportunity for Providers
The place of service is open for office visits, telehealth, all hospital settings and clinics, and ambulatory surgical centers.
SOURCE: FL Medicaid, Alert, Screening, Brief Intervention, and Referral to Treatment (SBIRT) Continuing Medical Education (CME) Opportunity for Providers, July 7, 2023, (Accessed Nov. 2023).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
No Reference Found
Last updated 11/17/2023
Miscellaneous
Substance Abuse Services – Telehealth
Providers shall maintain policies and procedures outlining how they will provide services through telehealth as described in subsection 65D-30.003(1), F.A.C.
Providers delivering services through telehealth shall provide the service to the same extent the service would be delivered if provided through an in-person service delivery with a provider.
Providers delivering any services by telehealth are responsible for the quality of the equipment and technology employed. Providers are responsible for its safe use. Providers utilizing telehealth equipment and technology must be able meet or exceed the prevailing standard of care. Service providers must meet the following additional requirements:
Must be capable of two (2)-way, real-time electronic communication, and the security of the technology must be in accordance with applicable federal confidentiality regulations 45 CFR §164.312;
The interactive telecommunication equipment must include audio and high-resolution video equipment which allows the staff providing the service to clearly understand and view the individual receiving services;
SOURCE: FL Admin Code Sec. 65D-30.004. (Accessed Nov. 2023).
No reimbursement for equipment used to provide telemedicine services.
SOURCE: FL Admin Code 59G-1.057. (Accessed Nov. 2023).
Telehealth Minority Maternity Care Pilot Programs
By July 1, 2022, the department shall establish a telehealth minority maternity care pilot program in Duval County and Orange County which uses telehealth to expand the capacity for positive maternal health outcomes in racial and ethnic minority populations. The department shall direct and assist the county health departments in Duval County and Orange County to implement the programs. The pilot programs shall adopt the use of telehealth or coordinate with prenatal home visiting programs to provide services and education to eligible pregnant women up to the last day of their postpartum periods and provide training to participating health care practitioners and other perinatal professionals.
SOURCE: FL Statute 383.2163. (Accessed Nov. 2023).
Early Learning Mental Health Assistance Program
Contracts or interagency agreements with one or more local community behavioral health providers or providers of Community Action Team services to provide a behavioral health staff presence and services at district schools. Services may include, but are not limited to, mental health screenings and assessments, individual counseling, family counseling, group counseling, psychiatric or psychological services, trauma-informed care, mobile crisis services, and behavior modification. These behavioral health services may be provided on or off the school campus and may be supplemented by telehealth as defined in s. 456.47(1).
Policies of the school district which must require that in a student crisis situation, school or law enforcement personnel must make a reasonable attempt to contact a mental health professional who may initiate an involuntary examination pursuant to s. 394.463, unless the child poses an imminent danger to themselves or others, before initiating an involuntary examination pursuant to s. 394.463. Such contact may be in person or through telehealth. The mental health professional may be available to the school district either by a contract or interagency agreement with the managing entity, one or more local community-based behavioral health providers, or the local mobile response team, or be a direct or contracted school district employee.
SOURCE: FL Statute Sec. 1006.041. (Accessed Nov. 2023).
Last updated 11/17/2023
Out of State Providers
No Reference Found
Last updated 11/17/2023
Overview
FL Medicaid reimburses for real time interactive telemedicine according to administrative code, however there is no indication of reimbursement in any Medicaid Manual. A recently released Medicaid notice to clarify Medicaid policy post-COVID public health emergency states that FL Medicaid will continue to cover store-and-forward and remote patient monitoring services, but will no longer cover audio-only telehealth services.
Last updated 11/17/2023
Remote Patient Monitoring
POLICY
Florida Medicaid will continue to cover store-and-forward and remote patient monitoring services.
SOURCE: FL Medicaid, Alert, Ending of Federal Public Health Emergency: Updated Co-Payment and Telemedicine Guidance for Medical and Behavioral Health Providers, May 4, 2023, (Accessed Nov. 2023).
Statewide Medicaid Managed Care Telemedicine/Teledentistry, which includes remote patient monitoring, policy available. Provides reimbursement requirements of plans for telemedicine and teledentistry.
SOURCE: FL Agency for Health Care Administration, Statewide Medicaid Managed Care Telemedicine/Teledentistry, Aug. 2018, (Accessed Nov. 2023).
Subject to the availability of funds and subject to any limitations or directions provided in the General Appropriations Act, the agency must provide coverage for a continuous glucose monitor under certain circumstances.
SOURCE: FL Statute Sec. 409.9063, (Accessed Nov. 2023).
CONDITIONS
Subject to the availability of funds and subject to any limitations or directions provided in the General Appropriations Act, the agency must provide coverage for a continuous glucose monitor under the Medicaid pharmacy benefit for the treatment of a Medicaid recipient if:
- The recipient has been diagnosed by his or her primary care physician, or another licensed health care practitioner authorized to make such diagnosis, with Type 1 diabetes, Type 2 diabetes, gestational diabetes, or any other type of diabetes that may be treated with insulin; and
- A health care practitioner with the applicable prescribing authority has prescribed insulin to treat the recipient’s diabetes and a continuous glucose monitor to assist the recipient and practitioner in managing the recipient’s diabetes.
SOURCE: FL Statute Sec. 409.9063, (Accessed Nov. 2023).
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
Coverage under this section includes the cost of any necessary repairs or replacement parts for the continuous glucose monitor.
To qualify for continued coverage under this section, the Medicaid recipient must participate in follow-up care with his or her treating health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months after the first prescription of the continuous glucose monitor for the recipient has been issued under this section, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur at least once every 12 months.
SOURCE: FL Statute Sec. 409.9063, (Accessed Nov. 2023).
Last updated 11/17/2023
Store and Forward
POLICY
Florida Medicaid will continue to cover store-and-forward and remote patient monitoring services.
SOURCE: FL Medicaid, Alert, Ending of Federal Public Health Emergency: Updated Co-Payment and Telemedicine Guidance for Medical and Behavioral Health Providers, May 4, 2023, (Accessed Nov. 2023).
Statewide Medicaid Managed Care Telemedicine/Teledentistry, which includes store-and-forward, policy available. Provides reimbursement requirements of plans for telemedicine and teledentistry.
SOURCE: FL Agency for Health Care Administration, Statewide Medicaid Managed Care Telemedicine/Teledentistry, Aug. 2018, (Accessed Nov. 2023).
ELIGIBLE SERVICES/SPECIALTIES
No Reference Found
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
