Professions and Public Health Subcommittee Meeting Packet, January 27, 2021
Summary
Meeting Packet for the Professions & Public Health Subcommittee, Wednesday, January 27, 2021, 10:00 am to 11:00 am, Webster Hall, beginning with the Committee Meeting Notice. The notice lists an introduction of Dr. Scott Rivkees, State Surgeon General, and an implementation briefing by Cassandra Pasley, Director of Medical Quality Assurance, Florida Department of Health, on HB 1061, HB 607, HB 389 and HB 23. It says no filed bills or draft legislation will be considered. The packet then includes a Department of Health implementation update by Jennifer Wenhold covering the Nurse Licensure Compact, autonomous APRNs, pharmacy and telehealth, and reports 1,867 autonomous APRN applications received and 1,262 approved.
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Professions and Public Health
Subcommittee
Wednesday, January 27, 2021
10:00 AM - 11:00 AM
Webster Hall (212 Knott)
Meeting Packet
Chris Sprowls Will Robinson
Speaker Chair
Committee Meeting Notice
HOUSE OF REPRESENTATIVES
Professions & Public Health Subcommittee
Start Date and Time: Wednesday, January 27, 2021 10:00 am
End Date and Time: Wednesday, January 27, 2021 11:00 am
Location: Webster Hall (212 Knott)
Duration: 1.00 hrs
Introduction of Dr. Scott Rivkees, State Surgeon General, Florida Department of Health
Implementation briefing by Cassandra Pasley, Director of Medical Quality
Assurance, Florida Department of Health on:
- HB 1061 (2016) Nurse Licensure Compact
- HB 607 (2020) Autonomous Advanced Practice Registered Nurses (APRN)
- HB 389 (2020) Practice of Pharmacy
- HB 23 (2019) Telehealth
Autonomous Advanced Nursing Practice – Vicky Stone-Gale, DNP, APRN, FNP-BC
This meeting will be live-streamed on https://thefloridachannel.org/. As no filed bills or draft legislation will
be considered at this meeting, public testimony will not be solicited and seating will be limited to the
Members, invited presenters, and the press. As always, you may contact any Representative prior to the
start of the meeting. Contact information may be found at
https://www.myfloridahouse.gov/Representatives.
NOTICE FINALIZED on 01/20/2021 4:06PM by Osborne.Erin
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DOH
Implementation Update
Department of Health
Medical Quality Assurance
Legislative Implementation Update
Jennifer Wenhold, MSW, Chief
Bureau of Health Care Practitioner Regulation
Division of Medical Quality Assurance
Florida House of Representatives
Professions & Public Health Subcommittee
January 27, 2021
Regulatory Updates
Nurse Licensure Compact
HB 1061 (2016), Chapter 2016-139, Laws of Florida
Autonomous Advanced Practice Registered Nurses (APRN)
HB 607 (2020), Chapter 2020-9, Laws of Florida
Practice of Pharmacy
HB 389 (2020), Chapter 2020-7, Laws of Florida
Telehealth
HB 23 (2019), Chapter 2019-137, Laws of Florida
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Nursing By the Numbers
Profession Total Licensees
Advanced Practice Registered Nurse 40,850
Certified Nursing Assistant 183,347
Licensed Practical Nurse 77,199
Registered Nurse 361,726
Total 663,122
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Nurse Licensure Compact – HB 1061 (2016)
The Nurse Licensure Compact (NLC) is an interstate compact.
• It allows a registered nurse (RN) or licensed practical
nurse (LPN) to have a multistate license (in primary state
of residency).
• This permits the nurse to practice in other member
states (both physically and via telehealth) subject to each
state’s practice laws.
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Nurse Licensure Compact - Summary
• Legislation passed during 2016 session.
• Compact went into effect in Florida on January 19, 2018.
• Board Executive Director serves as Florida’s Commissioner.
• Compact currently has 34 party states.
• Total Florida multistate licenses issued: RNs – 72,412
LPNs – 10,704
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Nurse Licensure Compact - Timeline
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Nurse Licensure Compact –
Uniform Licensure Requirements
To receive a multistate license, a nurse must:
Meet the home state’s qualifications.
Graduate from qualifying education program (or graduate from a foreign program verified
by independent credentials review agency).
Pass the NCLEX-RN® or NCLEX-PN® exam (or predecessor).
Have no active discipline on a license.
Submit to a federal criminal background check.
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Nurse Licensure Compact –
Discipline Process
• The state that issues a Compact license has jurisdiction to
discipline the licensee.
• The state where a Compact licensee is practicing (remote
state) has jurisdiction to discipline the privilege to practice in
that state.
• Florida has disciplined two out-of-state Compact licensees.
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Nurse Licensure Compact –
National Implementation
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Autonomous APRN – HB 607 (2020)
Authorizes eligible APRNs to practice autonomously if they meet
certain legislatively mandated eligibility criteria.
No discipline within previous five years.
Registration Three hours of graduate-level education in pharmacology and differential
diagnosis or an equivalency determined by the Board of Nursing.
Criteria
3,000 hours of supervised clinical practice within previous five years.
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Autonomous APRN
APRNs Autonomous APRNs
Practice under a supervisory Practice primary care or
protocol with a physician. midwifery without a supervisory
• Some physicians charge fees to supervise protocol with a physician.
APRNs. • Primary care includes family medicine,
• APRNs may not provide health care services if general pediatrics and general internal
the protocol is terminated or if the supervising medicine.
physician leaves the practice.
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Autonomous APRN
• Registration application in Rule 64B9-4.020, F.A.C., became
effective on October 14, 2020.
• First applications were received on October 19, 2020.
o Number of applications received: 1,867
o Number of applications approved: 1,262
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Autonomous APRN
County Licenses
Miami-Dade 281
Broward 117
Palm Beach 75
Orange 72
Hillsborough 72
Duval 69
Pinellas 60
Lee 33
Pasco 29
Brevard 24
Marion 24
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Autonomous APRN - Rulemaking
Board directed Board approved
to define Board approved
proposed rule on
“primary care text on December 4, 2020;
practice” as part August 7, 2020; sent to OFARR on
of the practice Rules workshop January 6, 2021;
requirements held on becomes effective
[Rule 64B9- on approximately
October 9, 2020. February 24, 2021.
4.001, F.A.C.].
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Council on APRN Autonomous Practice
Council comprising of appointees from the Boards of Medicine (2),
Osteopathic Medicine (2), and Nursing (4) along with the State Surgeon
General’s designee to recommend standards of practice to the Board for
adoption by rule.
Council met on August 28, 2020, and November The Board of Nursing approved the
19, 2020. recommended language on December 4, 2020;
sent to OFARR on January 6, 2021; becomes
Council recommended language at the effective on approximately March 18, 2021.
November meeting. [Rule 64B9-4.021, F.A.C.]
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Autonomous APRN Medical Education
Reimbursement and Loan Repayment Program
• Authorizes an annual reimbursement of up to $15,000 to eligible
autonomous APRNs for tuition, books, medical equipment/supplies,
uniforms, and living expenses.
• Department of Health is currently adopting rules to implement this
program - Notice of Rule Development published on December 4, 2020.
• $5 million was appropriated for this program in recurring funds.
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Pharmacy By the Numbers
Profession Total Licensees
Consultant Pharmacist 3,641
Pharmacist 36,579
Pharmacy Intern 13,727
Registered Pharmacy Technician 57,699
Pharmacy 10,201
Total 121,847
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Practice of Pharmacy – HB 389 (2020)
Expands the scope of practice for eligible pharmacists to:
• Provide specified patient care services through a written collaborative
practice agreement with a physician.
• Test for and treat minor, nonchronic health conditions through a written
protocol with a physician.
Requires consultation with the Boards of Medicine and Osteopathic Medicine.
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Practice of Pharmacy - Certification for
Collaborative Practice Pharmacists
Hold an active, unencumbered Florida pharmacist license.
Have a doctor of pharmacy degree or five years of experience.
Certification
Criteria Complete a 20-hour initial certification course.
Maintain at least $250,000 of professional liability coverage.
Have a system to maintain records of patients receiving services.
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Practice of Pharmacy - Certification for Test
and Treat Pharmacists
Hold an active, unencumbered Florida pharmacist license.
Complete a 20-hour initial certification course.
Certification
Criteria Maintain at least $250,000 of professional liability coverage.
Have a system to maintain records of patients receiving services.
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Practice of Pharmacy - Rulemaking
Rules developed by the Board of Pharmacy: Rules developed in consultation with the Boards of
• Developed and incorporated certification Medicine and Osteopathic Medicine:
application forms. • Certification requirements.
• Submission requirements for collaborative practice • Initial course requirements.
agreements and written protocols.
• Additional chronic health conditions for
• A formulary of medicinal drugs for the treatment of
collaborative management.
minor, nonchronic health conditions.
• Additional requirements for the written protocol.
• Furnishing patient records.
• Information on when to seek follow-up care.
• Continuing education requirements.
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Practice of Pharmacy – Joint Committee
Joint committee comprises members from the Board of Pharmacy (5), the
Board of Medicine (2), and the Board of Osteopathic Medicine (2) to develop
and recommend rules regarding collaborative practice and the testing and
treating for minor conditions to the Board of Pharmacy.
Beginning in March 2020, the Board
of Pharmacy held five meetings and Engaged with association
three joint committee meetings to partners and stakeholders.
draft rules.
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Pharmacy Implementation Timeline - 2020
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Telehealth – HB 23 (2019)
• Established standards of practice.
• Authorized out-of-state
telehealth provider registration.
www.flhealthsource.gov/telehealth/
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Telehealth – Registration Requirements
Submit Application for Out-of-State Telehealth Provider Registration.
Maintain an active, unencumbered license.
Not have a pending investigation, discipline, or revocation within the last five years.
Designate a duly appointed registered agent for service of process in Florida.
Maintain liability coverage or financial responsibility.
•Not open a Florida office or provide in-person health care services to Florida patients.
•Only use a Florida-licensed pharmacy, registered nonresident pharmacy, or outsourcing facility to
dispense medicinal drugs to patients in Florida (pharmacists only).
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Telehealth
• The first application for out-of-state telehealth provider registration was
received on October 23, 2019.
• As of December 31, 2020, 4,089 out-of-state telehealth providers have been
registered with the Department of Health and a total of 4,517 applications
have been submitted.
• Physicians represent the largest number of registrants.
• Mental health professionals and psychologists represent the second largest group.
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Registrations Issued 129 109
136
203
Total: 4,089 (as of December 31, 2020) 1,178
Medical Doctor 284
Licensed Mental Health Counselor
Psychologist
Licensed Clinical Social Worker 385
Other
Advanced Practice Registered Nurse
Licensed Marriage & Family Therapist
Physical Therapist 498 615
Osteopathic Physician
Speech-Language Pathologist 552
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Next Steps
• Nurse Licensure Compact: Forms discussion on future compacts.
• Autonomous APRNs: Continue to expedite licensure and increase access to
care.
• Pharmacy: Joint committee will continue to receive and consider initial
certification courses for approval.
• Telehealth: Continue to expedite registration and monitor the provision of
telehealth in Florida.
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Questions?
Contact:
Jennifer Wenhold, MSW
Medical Quality Assurance
(850) 245-4460
Jennifer.Wenhold@flhealth.gov
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Dr. Stone-Gale Bio
Dr. Stone-Gale received her diploma in nursing from Massillon Community Hospital School of
Nursing in Massillon, Ohio, and her BSN and MSN, both from Barry University in Miami. She
received her Doctor of Nursing Practice degree from the University of Alabama at
Birmingham and completed coursework towards her PhD at UAB. She has practiced as a Family
Nurse Practitioner in primary care for 28 years and currently practices in Plantation, Florida. She
also is an Associate Professor in the Family Nurse Practitioner program at Frontier Nursing
University where she teaches students in Primary Care I and is on various university committees,
and currently is the Research Committee Chair. She is double board certified by the ANCC and
AANP and was inducted as a Fellow of the American Association of Nurse Practitioners in 2016.
Currently she serves on the Selection committee for FAANP.
Dr. Stone-Gale received a gubernatorial appointment to serve on the Florida Board of Nursing
which she did for four years, serving as Chair for the BON, Chair of the Advanced Practice
committee, and member of the Legislative committee and the Credentialing committee.
Dr. Stone-Gale was appointed to the Florida Board of Nursing Controlled Substance formulary
committee to work with pharmacists and physicians to develop the formulary for prescribing and
was appointed to the Council on Advanced Practice Registered Nurse Autonomous Practice. She
is the Chair of the Florida Board of Nursing North Probable Cause Panel.
She also has served in various organizational leadership positions and is currently the President
of the South Florida Council of Advanced Practice Nurses and First Vice President of
Legislation for the Florida Nurse Practitioner Network. She was on the Board of Directors for the
Florida Nurses Association and remains a current member. Dr. Stone-Gale has been actively
involved with NP legislation for over 27 years. She has been a presenter at local and national
conferences on various primary care and education topics and is an abstract and scholarship
reviewer for two national organizations, National Organization of Nurse Practitioners and
AANP. She is also on the Fellows Selection committee for AANP.
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