text: Legislative Update - Florida Optometric Association
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  Insight 3RD quarter 2019
  Welcome to the third quarter edition of the FOA Legislative Update. First, a huge thanks to everyone that attended the FOA Annual Convention, held last month at Disney's Yacht Club. Your support for FOA and our legislative efforts is duly noted and greatly appreciated. For those of you that were unable to attend our annual convention, much discussion was centered on telehealth. Telehealth was discussed in great detail at both the FOA legislative lunch and FOA's telemedicine symposium. During these presentations, I observed several factual and perceptual misconceptions regarding telemedicine that I wish to address in the question and answer format presented below:
  Question: Since Florida HB 23 titled "Telehealth" passed and became law in 2019, is the practice of telemedicine about to begin in the state of Florida?
  Answer: NO- Telemedicine began as a form of practice in Florida in 2016 as provided by an MD or DO via a declaratory statement issued by the Florida Board of Medicine for MDs and DOs and listed as follows:
  "The use of telehealth technology by Florida licensed healthcare practitioners for the purpose of providing patient care within the state of Florida is not precluded by Florida law. Telehealth technologies may be employed for patient care as long as such technologies are used in a manner that is consistent with the standard of care. If you are a Florida licensed allopathic or osteopathic physician please see Rules 64B8-9.0141 or 64B15-14.081, Florida Administrative Code, for more specific details about the practice of telemedicine.
  Question: What is now permitted by HB 23, and can an optometrist now practice telehealth in Florida?
  Answer: Yes- chapter 463 was included in the telehealth language for HB 23 and is listed as follows:
  "HB 23: Established standards of practice for telehealth providers (…chapter 463…) ; authorized certain telehealth providers to use telehealth to prescribe certain controlled substances under specified circumstances and provided registration requirements for out-of-state telehealth providers."
  Question: What is the American Academy of Ophthalmology's view on telehealth and eye examinations?
  Answer: please read the excerpts below released by the AAO:
  American Academy of Ophthalmology Telehealth:
  Clearing the Way for Innovative Eye Care Through Technology
  With our information statement on telehealth in ophthalmology, we're well-positioned to continue to shape how our profession uses and supports these new, emerging options. In eye care, this is a critical role that only an ophthalmologist can fill:
  Review: Physicians should determine the appropriateness of a given technology for their patients; state legislatures should not make these decisions.
  Payment: Health insurers should cover and provide fair payment for telemedicine services provided by ophthalmologists.
  Regulation: Federation of State Medical Boards oversight of multi-state physician licensure.
  We're among the most ardent supporters of a successful U.S. Department of Veterans Affairs tele-ophthalmology program that is helping rural veteran's access quality eye care. Technology-based Eye Care Services, or TECS, is a program that improves rural veterans' access to eye screening services for the most common causes of visual impairment. Roughly 8 percent of veterans screened through the program are found to have significant, previously undiagnosed eye disease.
  AAO- exam guidelines
  Adults with no signs or risk factors for eye disease should receive a baseline comprehensive eye evaluation at age 40. The frequency of ocular examinations in the presence of acute or chronic disease will vary widely with intervals ranging from hours to several months, depending on the risks involved, response to treatment, and potential for the disease to progress. Any individual at higher risk for developing disease, based on ocular and medical history, family history, age, or race should have periodic examinations determined by the particular risks, even if no symptoms are present.
  A routine comprehensive annual adult eye examination in individuals under the age of 40 unnecessarily escalates the cost of eye care and is not indicated except as described above.
  Technology advances emerge quickly, disrupting the marketplace and forcing some to reconsider how they fit, business-wise, into the new world technology is helping to shape. For example, when it comes to tele-ophthalmology, optometry has strong interest in maintaining its position as an in-person provider of refraction services. But patients, who might potentially benefit from these new options, also need a voice to speak on their behalf.
  4. Question: So by HB 23 passing, 1800 CONTACTS and Visibly formerly known as Opternative can operate legally by offering an express exam thru telehealth?
  Answer - the standard of care was not changed by HB 23, and whether an entity uses an MD, DO, or OD to sign eyewear prescriptions, there is currently no recognized position or value to support an "express exam" in lieu of a dilated, comprehensive eye health exam. But, this topic and further legislative refinement regarding the provision of telehealth and its real meaning will play out in the upcoming 2020 legislative session.
  5. Question: What is Visibly's "store and forward/express exam?"
  Answer: please read excerpts from Visibly presented below:
  Visibly... formerly known as Opternative
  Visibly uses store and forward technology……for review by a telehealth provider after the data is captured for review purposes. Visibly is not a replacement for a comprehensive eye health examination. Optimized Eye Care Ophthalmologists use Visibly's on-line technology to evaluate a patient's visual acuity and a portion of the ocular health profile and issue a prescription for corrective eyewear, where clinically appropriate. Their services are limited to patients between the ages of 18 and 55 who are in good health. All tests are conducted and all prescriptions are issued based on the independent clinical judgment of an ophthalmologist. Because the services are not a replacement for a comprehensive eye health examination, we encourage everyone to obtain a comprehensive eye health exam at least once every 2 years. Optimized Eye Care prohibits patients from taking a Visibly test more than 4 consecutive years without certifying that they have received a comprehensive eye health exam first. Visibly is an FDA registered device that can only be used to prescribe glasses and contact lens prescriptions by licensed physicians.
  6. Question: Does HB 23 allow out-of-state providers to practice telehealth in Florida?
  Answer: HB23 allows providers licensed in another state and in "good standing" to apply for a license to practice telehealth for Floridian patients. The out-of-state provider cannot perform in-person services in Florida and must be approved by the Florida Department of Health and meet other requirements. Disciplinary actions are handled by the respective provider's Board or thru the Florida Department of Health. Of note: Since Governor DeSantis vetoed the fee portion of the telehealth initiative, uncertainty exists regarding implementation of any out-of-state provider licenses at this time. This too may further play out in the upcoming 2020 session.
  7. Question: What can I do to help?
  Answer: Join FOA and OD-EYEPAC to help us protect Floridians and the noble profession of optometry - now is your chance to have a say in your future.