Meeting Packet - Professions and Public Health Subcommittee (March 3, 2021)
Summary
Meeting packet of the Professions and Public Health Subcommittee for Wednesday, March 3, 2021, 10:00 AM to 12:00 PM at Webster Hall (212 Knott), opening with a committee meeting notice that lists the bills for consideration, from HB 17 Podiatric Medicine to HB 7001 OGSR/Nurse Licensure Compact. The House of Representatives staff analysis of HB 17 says the bill requires podiatric physicians to complete a 2-hour continuing education course on safe and effective prescribing of controlled substances as part of the 40 hours of continuing professional education required for biennial licensure renewal. The packet ends with the text of HB 7001, whose Section 2 gives an effective date of October 1, 2021 and which deletes, as stricken text, the provision under which the section would stand repealed on October 2, 2021 unless reviewed and saved from repeal through reenactment.
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Professions and Public Health
Subcommittee
Wednesday, March 3, 2021
10:00 AM - 12:00 PM
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, March 03, 2021 10:00 am
End Date and Time: Wednesday, March 03, 2021 12:00 pm
Location: Webster Hall (212 Knott)
Duration: 2.00 hrs
Consideration of the following bill(s):
HB 17 Podiatric Medicine by Bell, Killebrew
HB 29 Dispensing Medicinal Drugs by Willhite
HB 245 Massage Therapy by Chaney
HB 497 Dentistry and Dental Hygiene Examinations by Buchanan
HB 725 Nonopioid Alternatives Educational Materials by Plakon
HB 803 Access to Health Care Practitioner Services by Caruso
HB 7001 OGSR/Nurse Licensure Compact by Government Operations Subcommittee, Garrison
This meeting will be live-streamed on https://thefloridachannel.org/. Persons who wish to attend must
register at www.myfloridahouse.gov, and pick up a pass at the Legislative Welcome Center on the 4th Floor
of the Capitol beginning one hour before the start of the meeting. Audience seating will be socially
distanced and will be available on a first-come, first-served basis. Registration closes three hours before
the meeting starts.
NOTICE FINALIZED on 03/01/2021 4:01PM by Osborne.Erin
03/01/2021 04:01:53PM Leagis ® Page 1 of 1
HB 17
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 17 Podiatric Medicine
SPONSOR(S): Bell and others
TIED BILLS: IDEN./SIM. BILLS: SB 170
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Rahming McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
A podiatric physician diagnoses or provides medical, surgical, palliative, and mechanical treatment of ailments affecting
the human foot and leg. Podiatric medicine also includes the amputation of toes and other parts of the foot, but does not
include amputation of the entire leg or foot.
Medical assistants are non-licensed personnel that may assist a physician in all aspects of a medical practice under the
direct supervision and responsibility of a physician. Current law does not specifically authorize podiatric physicians to
utilize medical assistants in their practices.
Section 456.0301, F.S., requires health care practitioners with authority to prescribe controlled substances to take a
board-approved 2-hour continuing education course on safe and effective prescribing of controlled substances biennially
offered by certain statewide professional organizations of physicians. However, if a licensee’s practice act requires the
licensee to complete a 2-hour course on safe and effective prescribing of controlled substances, the licensee is exempt
from the requirements of s. 456.0301, F.S. Podiatric physicians are required to complete 40 hours of continuing
professional education biennially, but their practice act does not specifically require continuing education on controlled
substances.
The bill requires podiatric physicians to complete a 2-hour continuing education course on safe and effective prescribing
of controlled substances as a part of the 40 hours of continuing professional education required for biennial licensure
renewal. Podiatric physicians will no longer be subject to the requirements of s. 456.0301, F.S., including the requirement
that the course be offered only by certain physician organizations.
Currently, individuals may enter into direct health care agreements with allopathic physicians, osteopathic physicians,
chiropractic physicians, nurses, or dentists, or a health care group practice for the provision of health care services. The
bill adds podiatric physicians to the list of health care providers who may offer such agreements.
The bill has no fiscal impact on the Department of Health. The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Podiatric Medicine
Podiatric medicine is the diagnosis or medical, surgical, palliative, and mechanical treatment of
ailments of the human foot or leg. 1 It also includes the amputation of toes or other parts of the foot, but
does not include the amputation of the entire foot or leg. A podiatric physician is authorized to prescribe
drugs specifically related to his or her scope of practice. 2
Licensure Requirements
Florida law requires a podiatric physician to meet the following requirements for licensure: 3
• Be at least 18 years of age;
• Hold a degree from a school or college of podiatric medicine or chiropody recognized and
approved by the Council on Podiatry Education of the American Podiatric Medical Association;
• Have successfully completed one of the following clinical experience requirements:
o One year of residency in a residency program approved by the Board of Podiatric
Medicine (board); 4 or
o Ten years of continuous, active licensed practice of podiatric medicine in another state
immediately preceding application and completion of at least the same continuing
education requirements during those ten years as are required of podiatric physicians
licensed in this state;
• Successfully complete a background screening; and
• Obtain passing scores on the national examinations administered by the National Board of
Podiatric Medical Examiners. 5
A license to practice podiatric medicine must be renewed biennially.
Continuing Education
A podiatric physician must complete 40 hours of continuing education as a part of the biennial licensure
renewal, which must include: 6
• At least one hour on risk management (five hours for first renewal 7);
• At least one hour on the laws and rules related to podiatric medicine;
• At least two hours on the prevention of medical errors;
• A board approved course on HIV/AIDS (first renewal only) 8; and
• One hour on human trafficking (first renewal only). 9
1 S. 461.003(5), F.S.
2 Id.
3 S. 461.006, F.S.
4 If it has been more than four years since the completion of the residency, an applicant must have two years of active, licensed
practice of podiatric medicine in another jurisdiction in the four years immediately preceding application or successfully complete a
board-approved postgraduate program or board-approved course within the year preceding application.
5 R. 64B18-11.002, F.A.C.
6 S. 461.007(3), F.S., and r. 64B18-17, F.A.C.
7 R. 64B18-17.005, F.A.C.
8 R. 64B18-17.001(12), F.A.C.
9 S. 456.0341, F.S.
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Controlled Substance Prescribers
Effective July 1, 2018, every person registered with the United States Drug Enforcement Administration
and authorized to prescribe controlled substances, must complete a 2-hour continuing education
course on prescribing controlled substances. 10 The course must include information on the current
standards for prescribing controlled substances, particularly opiates; alternatives to these standards;
nonpharmacological therapies; prescribing emergency opioid antagonists; and the risks of opioid
addiction following all stages of treatment in the management of acute pain.
The course can only be offered by a statewide professional association of physicians in this state that is
accredited to provide educational activities designated for the American Medical Association
Physician’s Recognition Award Category 1 Credit or the American Osteopathic Category 1-A continuing
medical education credit as part of each biennial license renewal. 11 Currently the course is provided by
the: 12
• Florida Medical Association;
• Florida Osteopathic Medical Association;
• Florida Academy of Family Physicians;
• InforMed; and
• Emergency Medicine Learning and Resource Center
This requirement does not apply to a licensee who is required by his or her applicable practice act to
complete a minimum of two hours of continuing education on the safe and effective prescribing of
controlled substances. 13 This requirement applies to podiatric physicians because their practice act
does not specifically require completion of two hours of continuing education on the safe and effective
prescribing of controlled substances.
Medical Assistants
A medical assistant is a multi-skilled person that assists in all aspects of a medical practice under the
direct supervision and responsibility of a physician. 14 There are no formal educational requirements for
becoming a medical assistant in most states, including Florida. 15 Most medical assistants have
postsecondary education, such as a certificate; however, others enter the occupation with a high school
diploma and learn through on-the-job training. 16
A medical assistant assists with patient care management, executes administrative and clinical
procedures, and performs managerial and supervisory functions. In Florida, a medical assistant may
perform the following duties under the direct supervision of a physician: 17
• Clinical procedures, including:
o Performing aseptic procedures;
o Taking vital signs;
o Preparing patients for physician care;
o Performing venipunctures and nonintravenous injections; and
o Observing and reporting patients’ signs and symptoms;
• Administering basic first aid;
• Assisting with patient examinations or treatments;
10 S. 1, ch. 2018-13, Laws of Fla., codified at s. 456.0301, F.S.
11 Id.
12 Department of Health, Take Control of Controlled Substances, http://www.flhealthsource.gov/FloridaTakeControl/ (last visited Jan.
26, 2021). To access a list of providers, select Podiatric Medicine.
13 Section 456.0301, F.S.
14 Section 458.3485, F.S.
15 United States Department of Labor, Occupational Outlook Handbook: Medical Assistants, (last rev. Sept. 1, 2020),
https://www.bls.gov/ooh/healthcare/medical-assistants.htm#tab-4 (last visited Jan. 26, 2021).
16 Id.
17 S. 458.3485(2), F.S
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• Operating office medical equipment;
• Collecting routine laboratory specimens as directed by the physician;
• Administering medication as directed by the physician;
• Performing basic laboratory procedures;
• Performing office procedures and general administrative duties required by the physician; and
• Performing dialysis procedures, including home dialysis.
Medical assistants are not required to be licensed, certified, or registered to practice in Florida.
Direct Health Care Agreements
Under current law, individuals may contract directly with certain health care providers, outside the
scope of insurance, for the provision of health care services. 18 Since a direct health care agreement is
not considered health insurance, it is exempt from the Florida Insurance Code and the Office of
Insurance Regulation does not have authority to regulate such agreements. 19 These direct health care
agreements must: 20
• Be in writing;
• Be signed by the health care provider or their agent and the patient, the patient's legal
representative, or the patient’s employer;
• Allow either party to terminate the agreement by giving the other party 30 days’ advance written
notice; 21
• Describe the scope of health care services that are covered by the monthly fee;
• Specify the monthly fee and any fees for health care services not covered by the monthly fee;
• Specify the duration of the agreement and any automatic renewal provisions;
• Offer a refund to the patient, the patient's legal representative, or the patient's employer of
monthly fees paid in advance if the health care provider stops offering health care services for
any reason;
• State that the agreement is not health insurance and that the health care provider will not bill the
patient's health insurance policy or plan for services covered under the agreement;
• State that the agreement does not qualify as minimum essential coverage to satisfy the
individual responsibility provision of the Patient Protection and Affordable Care Act; and
• State that the agreement is not workers’ compensation insurance and does not replace the
employer’s workers’ compensation obligations.
Currently, individuals may only contract with allopathic physicians, osteopathic physicians, chiropractic
physicians, nurses, or dentists, or a health care group practice for health care services that are within
the competency and training of the health care provider. 22 An individual may not directly contract with a
podiatric physician for the provision of health care services.
Effect of Proposed Bill
Medical Assistants
The bill defines “physician” as a person who is licensed as a physician under ch. 458, F.S., or as a
podiatric physician under ch. 461, F.S.
The bill authorizes podiatric physicians to use medical assistants in the same manner and under the
same conditions as an allopathic physician.
18 S. 624.27, F.S. Health care services means the screening, assessment, diagnosis, and treatment of a patient conducted within the
competency and training of the health care provider for the purpose of promoting health or detecting and managing disease or injury.
19 S. 624.27(2), F.S.
20 S. 624.27(4), F.S.
21 The agreement may provide for immediate termination due to a violation of the physician-patient relationship or a breach of the terms
of the agreement.
22 S. 624.27(1)(b), F.S.
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Continuing Education
The bill requires podiatric physicians to complete two hours of continuing education on safe and
effective prescribing of controlled substances, as a part of the 40 hours of continuing professional
education required for each biennial licensure renewal. This will exempt podiatric physicians from the
requirement in s. 456.0301, F.S., including the requirement that the course be offered only by certain
physician organizations.
Direct Health Care Agreements
The bill authorizes individuals to directly contract with podiatric physicians for the provision of health
care services. The bill retains the contract requirements that are currently required for other health care
practitioners offering direct health care agreements.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 458.3485, F.S., relating to medical assistants.
Section 2: Amends s. 461.007, F.S., relating to renewal of license.
Section 3: Creates s. 461.0155, F.S., relating to medical assistants.
Section 4: Amends s. 624.27, F.S., relating to direct health care agreements; exemption from code.
Section 5: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Organizations currently authorized to offer the course may experience a loss in revenue since
additional organizations may be eligible to provide the controlled substances continuing education
course.
Podiatric physicians may establish practices that use direct health care agreements to provide health
care services without concern of facing regulatory action, which may increase access to podiatric care.
D. FISCAL COMMENTS:
None.
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III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
Current law provides sufficient rule-making authority to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
On January 27, 2021, the Senate Committee on Health Policy adopted an amendment to SB 170 and
reported the bill favorably as a committee substitute. The amendment:
• Removed Section 1 of the bill.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 17 2021
1 A bill to be entitled
2 An act relating to podiatric medicine; amending s.
3 458.3485, F.S.; defining the term "physician" to
4 include podiatric physicians; amending s. 461.007,
5 F.S.; authorizing the Board of Podiatric Medicine to
6 require a specified number of continuing education
7 hours related to the safe and effective prescribing of
8 controlled substances; creating s. 461.0155, F.S.;
9 providing for governance of podiatric physicians who
10 are supervising medical assistants; amending s.
11 624.27, F.S.; revising the definition of the term
12 "health care provider" to include podiatric
13 physicians; providing an effective date.
14
15 Be It Enacted by the Legislature of the State of Florida:
16
17 Section 1. Subsection (1) of section 458.3485, Florida
18 Statutes, is amended to read:
19 458.3485 Medical assistant.—
20 (1) DEFINITION.—As used in this section:,
21 (a) "Medical assistant" means a professional multiskilled
22 person dedicated to assisting in all aspects of medical practice
23 under the direct supervision and responsibility of a physician.
24 This practitioner assists with patient care management, executes
25 administrative and clinical procedures, and often performs
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CODING: Words stricken are deletions; words underlined are additions.
hb0017-00
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 17 2021
26 managerial and supervisory functions. Competence in the field
27 also requires that a medical assistant adhere to ethical and
28 legal standards of professional practice, recognize and respond
29 to emergencies, and demonstrate professional characteristics.
30 (b) "Physician" means a person who is licensed as a
31 physician under this chapter or as a podiatric physician under
32 chapter 461.
33 Section 2. Subsection (3) of section 461.007, Florida
34 Statutes, is amended to read:
35 461.007 Renewal of license.—
36 (3) The board may by rule prescribe continuing education,
37 not to exceed 40 hours biennially, as a condition for renewal of
38 a license, with a minimum of 2 hours of continuing education
39 related to the safe and effective prescribing of controlled
40 substances. The criteria for such programs or courses shall be
41 approved by the board.
42 Section 3. Section 461.0155, Florida Statutes, is created
43 to read:
44 461.0155 Medical assistants.—A podiatric physician who is
45 supervising a medical assistant shall be governed by s.
46 458.3485.
47 Section 4. Paragraph (b) of subsection (1) of section
48 624.27, Florida Statutes, is amended to read:
49 624.27 Direct health care agreements; exemption from
50 code.—
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 17 2021
51 (1) As used in this section, the term:
52 (b) "Health care provider" means a health care provider
53 licensed under chapter 458, chapter 459, chapter 460, chapter
54 461, chapter 464, or chapter 466, or a health care group
55 practice, who provides health care services to patients.
56 Section 5. This act shall take effect July 1, 2021.
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hb0017-00
HB 29
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 29 Dispensing Medicinal Drugs
SPONSOR(S): Willhite and others
TIED BILLS: IDEN./SIM. BILLS: SB 262
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Rahming McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
Pharmacists and authorized prescribers may dispense medicinal drugs in this state. Authorized prescribers
include allopathic and osteopathic physicians, podiatrists, dentists, optometrists, advanced practice registered
nurses and physician assistants.
Currently, an authorized prescriber may dispense up to a 24-hour supply of a medicinal drug to an emergency
department patient of a hospital that holds an appropriate institutional pharmacy permit, provided that the
treating physician determines that the medicinal drug is needed and that community pharmacy services are not
readily accessible to the patient. If the patient needs more than a 24-hour supply of a drug, the prescriber must
provide the patient with a prescription for use after the initial 24-hour period.
HB 29 expands this authorization to allow all authorized prescribers treating hospital patients, not just
physicians, to prescribe medicinal drugs under these circumstances and extends patient eligibility to include a
hospital inpatient upon discharge. The bill also authorizes a hospital pharmacy to dispense the greater of a 48-
hour supply of a medicinal drug or a supply of a medicinal drug that is sufficient to last a patient until the end of
next business day. The bill also authorizes a hospital pharmacy to dispense up to a 72-hour supply of a
medicinal drug if the patient is located in an area in which a state of emergency is declared.
The bill corrects current statutory language to reflect that it is the hospital pharmacy that dispenses the
medicinal drug, rather than the prescriber.
The bill has an insignificant, negative fiscal impact on the Department of Health, which current resources are
adequate to absorb. The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Practice of Pharmacy
The Florida Pharmacy Act (Act) regulates Florida pharmacies and imposes minimum requirements for
safe practice. 1 The Board of Pharmacy (board) within the Department of Health (DOH) is tasked with
adopting rules to implement the provisions of the Act and setting standards of practice. 2
Dispensing of Medicinal Drugs
Pharmacists, licensed under the Act, are authorized to dispense medicinal drugs 3 in this state, and
authorized prescribers may dispense medicinal drugs to their patients. 4 Authorized prescribers include
allopathic and osteopathic physicians, podiatrists, dentists, optometrists, advanced practice registered
nurses and physician assistants. 5 A prescriber who dispenses medicinal drugs for a fee or
remuneration of any kind, must: 6
• Register with his or her professional licensing board as a dispensing practitioner and pay the
fee established by the board;
• Comply with and be subject to all state and federal laws, rules, and regulations applicable to
pharmacists and pharmacies;
• Give each patient a written prescription and advise the patient that the prescription may be filled
in the practitioner’s office or at any pharmacy, orally or in writing; and
• Verify the identity of a patient who is not known to the dispenser before dispensing a controlled
substance.
Pharmacy Regulation
A person must obtain a DOH-issued permit to operate one of five types of pharmacies:
• Community pharmacy – Where medicinal drugs are compounded, dispensed, stored, or sold
or where prescriptions are filled or dispensed on an outpatient basis. 7
• Institutional pharmacy – Hospital, clinic, nursing home, dispensary, sanitarium, extended care
facility, or other facility locations where medicinal drugs are compounded, dispensed, stored, or
sold. 8
• Nuclear pharmacy – Where radioactive drugs and chemicals within the classification of
medicinal drugs are compounded, dispensed, stored, or sold, other than hospitals. 9
• Special pharmacy - Locations where medicinal drugs are compounded, dispensed, stored, or
sold if these locations do not otherwise meet an applicable pharmacy definition in s. 465.003,
F.S. 10
1 Ch. 465, F.S.
2 Ss. 465.005, 465.0155(1), and 465.022, F.S.
3 A medicinal drug is a substance or preparation commonly known as a prescription or legend drug, which by federal or state law may
only be dispensed pursuant to a prescription. See s. 465.003(8), F.S.
4 Section 465.0276, F.S.
5 For limitations on an optometrist’s authority to prescribe or dispense a medicinal drug, see s. 463.0055, F.S.; for an advanced practice
registered nurse’s limitations, see s. 464.012; and for a physician assistant’s limitations, see ss. 458.347(4)(e) or 459.022(4)(e), F.S.
6 S. 465.0276(2), F.S.
7 Ss. 465.003(11)(a)1. and 465.018, F.S.
8 Ss. 465.003(11)(a)2. and 465.019, F.S.
9 Ss. 465.003(11)(a)3. and 465.0193, F.S.
10 Ss. 465.003(11)(a)4. and 465.0196, F.S.
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• Internet pharmacy – Locations not otherwise licensed or issued a pharmacy permit within or
outside this state, which use the Internet to communicate with or obtain information from
consumers in this state to fill or refill prescriptions or to dispense, distribute, or otherwise
practice pharmacy in this state. 11
All permitted pharmacies must pass an on-site inspection before DOH will issue an initial permit and
any time a pharmacy changes its ownership or address. 12
Institutional Pharmacies
All institutional pharmacies must designate a consultant pharmacist of record. 13 The consultant
pharmacist’s responsibilities include: 14
• Maintaining all drug records required by law;
• Ordering and evaluating laboratory or clinical testing when necessary for the proper
performance of the consultant pharmacist’s responsibilities; 15
• Conducting drug regimen reviews as required by state or federal law; and
• Inspecting the facility and preparing a written report to be filed at the permitted facility monthly.
There are four types of institutional pharmacy permits issued by the board to institutional pharmacies: 16
• Class I Institutional permits are issued to institutional pharmacies in which all medicinal drugs
are administered from individual prescription containers to individual patients and in which
medicinal drugs are not dispensed on the premises, except that licensed nursing homes 17 may
purchase medical oxygen for administration to residents.
• Class II Institutional permits are issued to institutional pharmacies that employ a registered
pharmacist who consults with and dispenses medicinal drugs to patients on the premises of the
institution, for use on the premises of the institution.
• Modified Class II Institutional permits are issued to institutional pharmacies in a short-term,
primary care treatment center that meet all the requirements for a Class II permit, except space
and equipment requirements.
• Class III Institutional permits are issued to institutional pharmacies, including central distribution
facilities, affiliated with a hospital that provide the same services that are authorized by a Class
II institutional pharmacy permit. Additionally, an Class III Institutional pharmacy may:
o Dispense, distribute, compound, and fill prescriptions for medicinal drugs;
o Prepare prepackaged drug products;
o Conduct other pharmaceutical services for the affiliated hospital and for entities under
common control that are appropriately permitted;
o Provide the above-listed services to an entity under common control which holds an
active health care clinic establishment permit. 18
Class III Institutional pharmacies must also maintain policies and procedures which address: 19
11 Ss. 465.003(11)(a)5. and 465.0197, F.S.
12 R. 64B16-28(1)(d), F.A.C.
13 S. 465.019(5), F.S., and r. 64B16-28.501, F.A.C.
14 S. 465.0125, F.S., and r. 64B16-28.501, F.A.C.
15 A consultant pharmacist may only order these tests for patients under the care of a licensed home health agency and when
authorized by a licensed allopathic physician, osteopathic physician, podiatric physician, or dentist. The consultant pharmacist must
complete additional training and meet additional qualifications in the practice of institutional pharmacy, as required by the board. See s.
465.0125.
16 S. 465.019, F.S.
17 Nursing homes are licensed under part II, ch. 400, F.S.
18 A health care clinic establishment permit is required for the purchase of a prescription drug by a place of business at one general
physical location that provides health care or veterinary services, which is owned or operated by a business entity. See s. 499.01(2)(r),
F.S.
19 S. 465.019(1)(d), F.S.
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• Safe practices for the preparation, dispensing, prepackaging, distribution, and transportation of
medicinal drugs and prepackaged drug products;
• Recordkeeping to monitor the movement, distribution, and transportation of medicinal drugs and
prepackaged drug products;
• Recordkeeping of pharmacy staff responsible for each step in the preparation, dispensing,
prepackaging, transportation, and distribution of medicinal drugs and prepackaged drug
products; and
• Medicinal drugs and prepackaged drug products that may not be safely distributed among Class
III institutional pharmacies.
Dispensing by Institutional Pharmacies
An institutional pharmacy must hold a community pharmacy permit to dispense medicinal drugs to
outpatients. 20 However, an authorized prescriber may dispense up to a 24-hour supply of a medicinal
drug to any patient of an emergency department of a hospital that operates a Class II or Class III
institutional pharmacy, provided that the treating physician determines that the medicinal drug is
warranted and community pharmacy services are not readily accessible. 21 If the patient needs more
than a 24-hour supply of a medicinal drug, an authorized prescriber must dispense a 24-hour supply of
the medicinal drug and provide the patient with a prescription for use after the initial 24-hour period. 22
Such dispensing must be in accordance with the hospital’s procedures.
For any drug dispensed from the emergency department of a hospital, the prescriber must create, and
the consultant pharmacist of record must maintain, a patient record which includes the following: 23
• Patient name and address;
• Drug and strength of the prescribed and/or dispensed;
• Quantity prescribed and/or dispensed;
• Directions for use;
• Prescriber/Dispenser;
• Prescriber’s Drug Enforcement Administration (DEA) registration, if applicable; and
• Reason community pharmacy services were not readily accessible.
Any dispensed medications must be properly labeled and may not exceed the greater of a 24-hour
supply or the minimal dispensable quantity. 24
Effect of Proposed Changes
HB 29 expands the authorization to prescribe and dispense medicinal drugs in hospital settings. It
allows all authorized prescribers treating hospital patients, not just physicians, to prescribe, and allows
hospital pharmacies to dispense, a limited supply of medicinal drugs when the prescriber determines
the medicinal drug is warranted and community pharmacy services are unavailable.
The bill authorizes a hospital pharmacy to dispense the greater of a 48-hour supply of a medicinal drug
or a supply of a medicinal drug that is sufficient to last a patient of the hospital’s emergency department
until the end of the next business day. The bill also authorizes a hospital inpatient, upon discharge, to
receive this limited supply of a medicinal drug if community pharmacy services are not available. The
bill further authorizes a hospital pharmacy to dispense a supply of a medicinal drug that will last up to
72 hours if the patient is located in an area of the state in which a state of emergency is declared.
Prescribers and pharmacies must comply with current law when prescribing or dispensing controlled
substances. The bill corrects current statutory language to reflect that it is the hospital pharmacy that
dispenses the medicinal drug, rather than the prescriber.
20 S. 465.019(4), F.S.
21 Id.
22 Id.
23 R. 64B16-28.6021, F.A.C.
24 Id.
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The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 465.019, F.S., relating to institutional pharmacies; permits.
Section 2: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
DOH will incur insignificant, nonrecurring costs associated with amending adopted rules, which
current resources are adequate to absorb.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
The bill may reduce costs that may be incurred by patients who have difficulty accessing a community
pharmacy after visiting an emergency department of a hospital or being discharged from inpatient care
at a hospital from returning to the emergency department or hospital to obtain additional relief.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The Board of Pharmacy has sufficient rulemaking authority under s. 465.005, F.S., to implement the
bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
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IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 29 2021
1 A bill to be entitled
2 An act relating to dispensing medicinal drugs;
3 amending s. 465.019, F.S.; authorizing certain
4 hospitals to dispense a limited supply of medicinal
5 drugs to a patient of an emergency department of a
6 hospital or a patient discharged from a hospital under
7 certain circumstances; providing drug supply
8 requirements for the prescribing or dispensing of such
9 drugs in specified areas; authorizing a prescriber to
10 provide a patient with a prescription for medicinal
11 drugs for use beyond the initial prescription period
12 under certain circumstances; requiring the prescribing
13 or dispensing of a controlled substance to comply with
14 certain statutory requirements; providing an effective
15 date.
16
17 Be It Enacted by the Legislature of the State of Florida:
18
19 Section 1. Subsection (4) of section 465.019, Florida
20 Statutes, is amended to read:
21 465.019 Institutional pharmacies; permits.—
22 (4)(a) Medicinal drugs shall be dispensed in an
23 institutional pharmacy to outpatients only when that institution
24 has secured a community pharmacy permit from the department.
25 However, an individual licensed to prescribe medicinal drugs in
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26 this state may be dispensed by dispense up to a 24-hour supply
27 of a medicinal drug to any patient of an emergency department of
28 a hospital that operates a Class II or Class III institutional
29 pharmacy to a patient of the hospital's emergency department or
30 a hospital inpatient upon discharge, if the prescriber provided
31 that the physician treating the patient in such hospital
32 hospital's emergency department determines that the medicinal
33 drug is warranted and that community pharmacy services are not
34 readily accessible, geographically or otherwise, to the patient.
35 Such prescribing and dispensing must be for a supply of the drug
36 that will last:
37 1. Up to 48 hours; or
38 2. Through the end of the next business day,
39
40 whichever is greater.
41 (b) Notwithstanding subparagraph (a)1., if a state of
42 emergency has been declared and is in effect for an area of the
43 state pursuant to s. 252.36, a supply of a medicinal drug that
44 will last up to 72 hours may be prescribed and dispensed under
45 paragraph (a) in that area from the emergency department must be
46 in accordance with the procedures of the hospital. For any such
47 patient for whom a medicinal drug is warranted for a period to
48 exceed 24 hours, an individual licensed to prescribe such drug
49 must dispense a 24-hour supply of such drug to the patient and
50 must provide the patient with a prescription for such drug for
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51 use after the initial 24-hour period.
52 (c) A prescriber who prescribes medicinal drugs under this
53 subsection may provide the patient with a prescription for such
54 drug for use beyond the initial prescription period if the
55 prescriber determines that such use is warranted. Any
56 prescribing or dispensing of a controlled substance under this
57 subsection must comply with the applicable requirements of ss.
58 456.44 and 465.0276.
59 (d) The board may adopt rules necessary to implement carry
60 out the provisions of this subsection.
61 Section 2. This act shall take effect July 1, 2021.
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HB 245
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 245 Massage Therapy
SPONSOR(S): Chaney
TIED BILLS: IDEN./SIM. BILLS: SB 352
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Guzzo McElroy
2) Insurance & Banking Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
Massage practice is the manipulation of the soft tissues of the human body with the hand, foot, arm, or elbow,
and may be aided by hydrotherapy, including colonic irrigation or thermal therapy, or any electrical or
mechanical device, or the application of a chemical or herbal preparation to the human body. The Board of
Massage Therapy (Board), within the Department of Health (DOH), regulates massage practice in this state.
HB 245 expands the scope of practice for massage therapy by authorizing a massage therapist to perform a
massage therapy assessment to determine the course of massage therapy treatment.
Current law authorizes a message therapist to use their hand, foot, arm, or elbow during the course of
message therapy treatment. The bill authorizes a message therapist to also use their knee during the course of
massage therapy treatment.
The bill also changes the term “massage” to “massage therapy” throughout statutes to standardize
terminology.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0245.PPH.DOCX
DATE: 1/25/2021
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Massage Therapy
Massage practice is the manipulation of the soft tissues of the human body with the hand, foot, arm, or
elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation or
thermal therapy, or any electrical or mechanical device, or the application of a chemical or herbal
preparation to the human body. 1 Massage is therapeutic and a massage therapist must know anatomy
and physiology and understand the relationship between the structure and function of the tissues being
treated and the total function of the body. 2
Chapter 480, F.S., entitled the “Massage Practice Act” governs the practice of massage therapy in
Florida. The Board of Massage Therapy (Board), within the Department of Health (DOH), regulates
massage practice, including massage therapists and massage establishments. 3
Massage Therapist Licensure
A massage therapist is a person who administers massage for compensation. 4 To qualify for licensure
as a massage therapist, an applicant must:
• Be at least 18 years of age or have received a high school diploma or graduate equivalency
diploma;
• Complete a course of study at a Board-approved massage school;
• Undergo background screening; and
• Pass an examination. 5
A massage therapist is required to renew its license every two years and must complete 24 hours of
continuing education for each renewal period. 6
As of February 24, 2021, there are 38,875 actively licensed massage therapists in Florida. 7
Massage Schools
A person seeking licensure as a massage therapist is required to complete a course of study at a
Board-approved massage school. The Board requires the course of study to be comprised of at least
500 hours, completed at a rate of no more than six hours per day and no more than 30 hours per week.
1 S. 480.033(3), F.S.
2 S. 480.032, F.S.
3 S. 480.035, F.S.
4 S. 480.033(4), F.S.
5 S. 480.041(1), F.S.
6 S. 480.0415, F.S., and rule 64B7-28.009, F.A.C.
7 Department of Health, FLHealthSource.gov, Public Data Portal (search by Board/Council “Board of Massage Therapy”, then by
Profession “massage therapist”, then by license status “practicing statuses only”), available at https://mqa-
internet.doh.state.fl.us/MQASearchServices/HealthCareProviders, (last visited February 24, 2021).
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The education must include:
• 150 hours of anatomy and physiology;
• 100 hours of basic massage theory and history;
• 125 hours of clinical practicum;
• 76 hours of allied modalities;
• 15 hours of business;
• 15 hours of theory and practice of hydrotherapy;
• 10 hours of Florida laws and rules;
• 4 hours of professional ethics;
• 3 hours of HIV/AIDS education; and
• 2 hours of medical errors. 8
In addition to the training above, a massage therapy student seeking to provide colonic irrigation 9
services must be certified by the Board to provide such services. Prior to passing an exam, the student
must complete a course of study in colonic irrigation, which must include a minimum of 100 classroom
hours, consisting of:
• 50 hours in theory, anatomy, physiology, pathology of the colon and digestive system and
principles of colon hygiene;
• 45 hours of clinical practicum that includes 20 treatments; and
• 5 hours in sterilization techniques and equipment training. 10
Colonic Irrigation Apprenticeship Training Programs
As an alternative to completing a course of study in colonic irrigation, a licensed massage therapist may
be certified to provide colonic irrigation services upon completing a colonic irrigation apprenticeship
training program. 11 An apprentice must act under the direct supervision of a sponsor who is a licensed
massage therapist, certified to practice colonic irrigation, and have practiced colonic irrigation for at
least three years. 12
The apprenticeship must be completed within 12 months of commencement and must consist of at
least 1,448 hours of training, including:
• 300 hours of anatomy;
• 300 hours of physiology;
• 20 hours of basic massage theory and history;
• 50 hours of theory and the practice of hydrotherapy;
• 25 hours of Florida Laws and Rules regulating the practice of massage therapy;
• 50 hours of allied modalities;
• 700 hours of clinical practicum; and
• 3 hours of HIV/AIDS instruction. 13
Upon completion of the above training, the apprentice must pass a Board-approved exam. 14
Effect of the Bill
8 Rule 64B7-32.003(1), F.A.C.
9 Colonic irrigation is a method of hydrotherapy used to cleanse the colon with the aid of a mechanical device and water (s. 480.033(6),
F.S.).
10 Rule 64B7-32.005(1), F.A.C.
11 S. 480.041(5)(b), F.S., and rule 64B7-29, F.A.C.
12 Rule 64B7-29.001, F.A.C.
13 Rule 64B7-29.003, F.A.C.
14 Rule 64B7-25.001(2)(d), F.A.C.
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HB 245 expands the scope of practice for massage therapy to include performing massage therapy
assessment. The bill defines “massage therapy assessment” as the determination of the course of
massage therapy treatment by a massage therapist. Currently, a massage therapist may perform a
massage on a patient, but there is no specific statutory authority for a massage therapist to assess the
patient to determine the course of treatment.
Current law authorizes a message therapist to use their hand, foot, arm, or elbow during the course of
message therapy treatment. The bill authorizes a message therapist to also use their knee during the
course of massage therapy treatment.
The bill changes the term “massage” to “message therapy” throughout statutes to standardize
terminology, including revising the title of ch. 480, F.S., from “Massage Practice” to “Massage Therapy
Practice.”
B. SECTION DIRECTORY:
Section 1: Renames ch. 480, F.S.
Section 2: Amends s. 480.031, F.S., relating to the “Massage Practice Act.”
Section 3: Amends s. 480.032, F.S., relating to purpose.
Section 4: Amends s. 480.033, F.S., relating to definitions.
Section 5: Amends s. 477.013, F.S., relating to definitions.
Section 6: Amends s. 477.0135, F.S., relating to exemptions.
Section 7: Amends s. 477.0265, F.S., relating to prohibited acts.
Section 8: Amends s. 480.034, F.S., relating to exemptions.
Section 9: Amends s. 480.035, F.S., relating to Board of Massage Therapy.
Section 10: Amends s. 480.041, F.S., relating to massage therapists; qualifications; licensure;
endorsement.
Section 11: Amends s. 480.043, F.S., relating to massage establishments; requisites; licensure;
inspection; human trafficking awareness training and policies.
Section 12: Amends s. 480.046, F.S., relating to grounds for disciplinary action by the board.
Section 13: Amends s. 480.0465, F.S., relating to advertisement.
Section 14: Amends s. 480.047, F.S., relating to penalties.
Section 15: Amends s. 480.052, F.S., relating to power of county or municipality to regulate massage.
Section 16: Amends s. 480.0535, F.S., relating to documents required while working in a massage
establishment.
Section 17: Amends s. 627.6407, F.S., relating to massage.
Section 18: Amends s. 627.6619, F.S., relating to massage.
Section 19: Amends s. 627.736, F.S., relating to required personal injury protection benefits;
exclusions; priority; claims.
Section 20: Amends s. 641.31, F.S., relating to health maintenance contracts.
Section 21: Amends s. 823.05, F.S., relating to places and groups engaged in certain activities
declared a nuisance; abatement and enjoinment.
Section 22: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
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1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
B. RULE-MAKING AUTHORITY:
None.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 245 2021
1 A bill to be entitled
2 An act relating to massage therapy; renaming ch. 480,
3 F.S., as "Massage Therapy Practice"; amending s.
4 480.031, F.S.; conforming a provision to changes made
5 by the act; amending s. 480.032, F.S.; revising the
6 purpose of ch. 480, F.S.; amending s. 480.033, F.S.;
7 revising and providing definitions; amending ss.
8 477.013, 477.0135, 477.0265, 480.034, 480.035,
9 480.041, 480.043, 480.046, 480.0465, 480.047, 480.052,
10 480.0535, 627.6407, 627.6619, 627.736, 641.31, and
11 823.05, F.S.; conforming provisions to changes made by
12 the act; making technical changes; providing an
13 effective date.
14
15 Be It Enacted by the Legislature of the State of Florida:
16
17 Section 1. Chapter 480, Florida Statutes, entitled
18 "Massage Practice," is renamed "Massage Therapy Practice."
19 Section 2. Section 480.031, Florida Statutes, is amended
20 to read:
21 480.031 Short title.—This act shall be known and may be
22 cited as the "Massage Therapy Practice Act."
23 Section 3. Section 480.032, Florida Statutes, is amended
24 to read:
25 480.032 Purpose.—The Legislature recognizes that the
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26 practice of massage therapy is potentially dangerous to the
27 public in that massage therapists must have a knowledge of
28 anatomy and physiology and an understanding of the relationship
29 between the structure and the function of the tissues being
30 treated and the total function of the body. Massage therapy is a
31 therapeutic health care practice, and regulations are necessary
32 to protect the public from unqualified practitioners. It is
33 therefore deemed necessary in the interest of public health,
34 safety, and welfare to regulate the practice of massage therapy
35 in the this state; however, restrictions shall be imposed to the
36 extent necessary to protect the public from significant and
37 discernible danger to health and yet not in such a manner which
38 will unreasonably affect the competitive market. Further,
39 consumer protection for both health and economic matters shall
40 be afforded the public through legal remedies provided for in
41 this act.
42 Section 4. Section 480.033, Florida Statutes, is amended
43 to read:
44 480.033 Definitions.—As used in this act:
45 (1)(5) "Apprentice" means a person approved by the board
46 to study colonic irrigation under the instruction of a licensed
47 massage therapist practicing colonic irrigation.
48 (2)(1) "Board" means the Board of Massage Therapy.
49 (3)(9) "Board-approved massage therapy school" means a
50 facility that meets minimum standards for training and
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51 curriculum as determined by rule of the board and that is
52 licensed by the Department of Education pursuant to chapter 1005
53 or the equivalent licensing authority of another state or is
54 within the public school system of this state or a college or
55 university that is eligible to participate in the William L.
56 Boyd, IV, Effective Access to Student Education Grant Program.
57 (4)(6) "Colonic irrigation" means a method of hydrotherapy
58 used to cleanse the colon with the aid of a mechanical device
59 and water.
60 (5)(2) "Department" means the Department of Health.
61 (6)(11) "Designated establishment manager" means a massage
62 therapist who holds a clear and active license without
63 restriction, who is responsible for the operation of a massage
64 establishment in accordance with the provisions of this chapter,
65 and who is designated the manager by the rules or practices at
66 the establishment.
67 (7) "Establishment" or "massage establishment" means a
68 site or premises, or portion thereof, wherein a massage
69 therapist practices massage therapy.
70 (8)(10) "Establishment owner" means a person who has
71 ownership interest in a massage establishment. The term includes
72 an individual who holds a massage establishment license, a
73 general partner of a partnership, an owner or officer of a
74 corporation, and a member of a limited liability company and its
75 subsidiaries who holds a massage establishment license.
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76 (9)(8) "Licensure" means the procedure by which a person,
77 hereinafter referred to as a "practitioner," applies to the
78 board for approval to practice massage or to operate an
79 establishment.
80 (10)(4) "Massage therapist" means a person licensed as
81 required by this act, who performs administers massage therapy,
82 including massage therapy assessment, for compensation.
83 (11)(3) "Massage therapy" means the manipulation of the
84 soft tissues of the human body with the hand, foot, knee, arm,
85 or elbow, regardless of whether or not such manipulation is
86 aided by hydrotherapy, including colonic irrigation, or thermal
87 therapy; any electrical or mechanical device; or the application
88 to the human body of a chemical or herbal preparation.
89 (12) "Massage therapy assessment" means the determination
90 of the course of massage therapy treatment.
91 Section 5. Subsection (13) of section 477.013, Florida
92 Statutes, is amended to read:
93 477.013 Definitions.—As used in this chapter:
94 (13) "Skin care services" means the treatment of the skin
95 of the body, other than the head, face, and scalp, by the use of
96 a sponge, brush, cloth, or similar device to apply or remove a
97 chemical preparation or other substance, except that chemical
98 peels may be removed by peeling an applied preparation from the
99 skin by hand. Skin care services must be performed by a licensed
100 cosmetologist or facial specialist within a licensed cosmetology
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101 or specialty salon, and such services may not involve massage
102 therapy, as defined in s. 480.033 s. 480.033(3), through
103 manipulation of the superficial tissue.
104 Section 6. Paragraph (a) of subsection (1) of section
105 477.0135, Florida Statutes, is amended to read:
106 477.0135 Exemptions.—
107 (1) This chapter does not apply to the following persons
108 when practicing pursuant to their professional or occupational
109 responsibilities and duties:
110 (a) Persons authorized under the laws of this state to
111 practice medicine, surgery, osteopathic medicine, chiropractic
112 medicine, massage therapy, naturopathy, or podiatric medicine.
113 Section 7. Paragraph (f) of subsection (1) of section
114 477.0265, Florida Statutes, is amended to read:
115 477.0265 Prohibited acts.—
116 (1) It is unlawful for any person to:
117 (f) Advertise or imply that skin care services, as
118 performed under this chapter, have any relationship to the
119 practice of massage therapy as defined in s. 480.033 s.
120 480.033(3), except those practices or activities defined in s.
121 477.013.
122 Section 8. Subsection (4) of section 480.034, Florida
123 Statutes, is amended to read:
124 480.034 Exemptions.—
125 (4) An exemption granted is effective to the extent that
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126 an exempted person's practice or profession overlaps with the
127 practice of massage therapy.
128 Section 9. Subsection (2) of section 480.035, Florida
129 Statutes, is amended to read:
130 480.035 Board of Massage Therapy.—
131 (2) Five members of the board shall be licensed massage
132 therapists and shall have been engaged in the practice of
133 massage therapy for not less than 5 consecutive years prior to
134 the date of appointment to the board. The Governor shall appoint
135 each member for a term of 4 years. Two members of the board
136 shall be laypersons. Each board member shall be a high school
137 graduate or shall have received a high school equivalency
138 diploma. Each board member shall be a citizen of the United
139 States and a resident of this state for not less than 5 years.
140 The appointments are will be subject to confirmation by the
141 Senate.
142 Section 10. Subsections (1) and (4) and paragraph (b) of
143 subsection (5) of section 480.041, Florida Statutes, are amended
144 to read:
145 480.041 Massage therapists; qualifications; licensure;
146 endorsement.—
147 (1) Any person is qualified for licensure as a massage
148 therapist under this act who:
149 (a) Is at least 18 years of age or has received a high
150 school diploma or high school equivalency diploma;
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151 (b) Has completed a course of study at a board-approved
152 massage therapy school that meets standards adopted by the
153 board; and
154 (c) Has received a passing grade on a national examination
155 designated by the board.
156 (4) Upon an applicant's passing the examination and paying
157 the initial licensure fee, the department shall issue to the
158 applicant a license, valid until the next scheduled renewal
159 date, to practice massage therapy.
160 (5) The board shall adopt rules:
161 (b) Providing for educational standards, examination, and
162 certification for the practice of colonic irrigation, as defined
163 in s. 480.033 s. 480.033(6), by massage therapists.
164 Section 11. Subsection (14) of section 480.043, Florida
165 Statutes, is amended to read:
166 480.043 Massage establishments; requisites; licensure;
167 inspection; human trafficking awareness training and policies.—
168 (14) Except for the requirements of subsection (13), this
169 section does not apply to a physician licensed under chapter
170 457, chapter 458, chapter 459, or chapter 460 who employs a
171 licensed massage therapist to perform massage therapy on the
172 physician's patients at the physician's place of practice. This
173 subsection does not restrict investigations by the department
174 for violations of chapter 456 or this chapter.
175 Section 12. Paragraphs (a), (b), (c), (f), (g), (h), (i),
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176 and (o) of subsection (1) of section 480.046, Florida Statutes,
177 are amended to read:
178 480.046 Grounds for disciplinary action by the board.—
179 (1) The following acts constitute grounds for denial of a
180 license or disciplinary action, as specified in s. 456.072(2):
181 (a) Attempting to procure a license to practice massage
182 therapy by bribery or fraudulent misrepresentation.
183 (b) Having a license to practice massage therapy revoked,
184 suspended, or otherwise acted against, including the denial of
185 licensure, by the licensing authority of another state,
186 territory, or country.
187 (c) Being convicted or found guilty, regardless of
188 adjudication, of a crime in any jurisdiction which directly
189 relates to the practice of massage therapy or to the ability to
190 practice massage therapy. Any plea of nolo contendere shall be
191 considered a conviction for purposes of this chapter.
192 (f) Aiding, assisting, procuring, or advising any
193 unlicensed person to practice massage therapy contrary to the
194 provisions of this chapter or to a rule of the department or the
195 board.
196 (g) Making deceptive, untrue, or fraudulent
197 representations in the practice of massage therapy.
198 (h) Being unable to practice massage therapy with
199 reasonable skill and safety by reason of illness or use of
200 alcohol, drugs, narcotics, chemicals, or any other type of
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201 material or as a result of any mental or physical condition. In
202 enforcing this paragraph, the department shall have, upon
203 probable cause, may authority to compel a massage therapist to
204 submit to a mental or physical examination by physicians
205 designated by the department. Failure of a massage therapist to
206 submit to such examination when so directed, unless the failure
207 was due to circumstances beyond her or his control, constitutes
208 shall constitute an admission of the allegations against her or
209 him, consequent upon which a default and final order may be
210 entered without the taking of testimony or presentation of
211 evidence. A massage therapist affected under this paragraph
212 shall at reasonable intervals be afforded an opportunity to
213 demonstrate that she or he can resume the competent practice of
214 massage therapy with reasonable skill and safety to clients.
215 (i) Gross or repeated malpractice or the failure to
216 practice massage therapy with that level of care, skill, and
217 treatment which is recognized by a reasonably prudent massage
218 therapist as being acceptable under similar conditions and
219 circumstances.
220 (o) Practicing massage therapy at a site, location, or
221 place which is not duly licensed as a massage establishment,
222 except that a massage therapist, as provided by rules adopted by
223 the board rule, may provide massage therapy services, excluding
224 colonic irrigation, at the residence of a client, at the office
225 of the client, at a sports event, at a convention, or at a trade
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226 show.
227 Section 13. Section 480.0465, Florida Statutes, is amended
228 to read:
229 480.0465 Advertisement.—Each massage therapist or massage
230 establishment licensed under the provisions of this act shall
231 include the number of the license in any advertisement of
232 massage therapy services appearing in a newspaper, airwave
233 transmission, telephone directory, or other advertising medium.
234 Pending licensure of a new massage establishment under pursuant
235 to the provisions of s. 480.043(7), the license number of a
236 licensed massage therapist who is an owner or principal officer
237 of the establishment may be used in lieu of the license number
238 for the establishment.
239 Section 14. Paragraphs (a), (b), and (c) of subsection (1)
240 of section 480.047, Florida Statutes, are amended to read:
241 480.047 Penalties.—
242 (1) It is unlawful for any person to:
243 (a) Hold himself or herself out as a massage therapist or
244 to practice massage therapy unless duly licensed under this
245 chapter or unless otherwise specifically exempted from licensure
246 under this chapter.
247 (b) Operate any massage establishment unless it has been
248 duly licensed as provided herein, except that nothing herein
249 shall be construed to prevent the teaching of massage therapy in
250 this state at a board-approved massage therapy school.
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251 (c) Permit an employed person to practice massage therapy
252 unless duly licensed as provided herein.
253 Section 15. Section 480.052, Florida Statutes, is amended
254 to read:
255 480.052 Power of county or municipality to regulate
256 massage therapy.—A county or municipality, within its
257 jurisdiction, may regulate persons and establishments licensed
258 under this chapter. Such regulation shall not exceed the powers
259 of the state under this act or be inconsistent with this act.
260 This section shall not be construed to prohibit a county or
261 municipality from enacting any regulation of persons or
262 establishments not licensed pursuant to this act.
263 Section 16. Subsections (1) and (2) of section 480.0535,
264 Florida Statutes, are amended to read:
265 480.0535 Documents required while working in a massage
266 establishment.—
267 (1) In order to provide the department and law enforcement
268 agencies the means to more effectively identify, investigate,
269 and arrest persons engaging in human trafficking, a person
270 employed by a massage establishment and any person performing
271 massage therapy therein must immediately present, upon the
272 request of an investigator of the department or a law
273 enforcement officer, valid government identification while in
274 the establishment. A valid government identification for the
275 purposes of this section is:
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276 (a) A valid, unexpired driver license issued by any state,
277 territory, or district of the United States;
278 (b) A valid, unexpired identification card issued by any
279 state, territory, or district of the United States;
280 (c) A valid, unexpired United States passport;
281 (d) A naturalization certificate issued by the United
282 States Department of Homeland Security;
283 (e) A valid, unexpired alien registration receipt card
284 (green card); or
285 (f) A valid, unexpired employment authorization card
286 issued by the United States Department of Homeland Security.
287 (2) A person operating a massage establishment must:
288 (a) Immediately present, upon the request of an
289 investigator of the department or a law enforcement officer:
290 1. Valid government identification while in the
291 establishment.
292 2. A copy of the documentation specified in paragraph
293 (1)(a) for each employee and any person performing massage
294 therapy in the establishment.
295 (b) Ensure that each employee and any person performing
296 massage therapy in the massage establishment is able to
297 immediately present, upon the request of an investigator of the
298 department or a law enforcement officer, valid government
299 identification while in the establishment.
300 Section 17. Section 627.6407, Florida Statutes, is amended
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301 to read:
302 627.6407 Massage.—Any policy of health insurance that
303 provides coverage for massage shall also cover the services of
304 persons licensed to practice massage therapy pursuant to chapter
305 480, where the massage therapy, as defined in chapter 480, has
306 been prescribed by a physician licensed under chapter 458,
307 chapter 459, chapter 460, or chapter 461, as being medically
308 necessary and the prescription specifies the number of
309 treatments.
310 Section 18. Section 627.6619, Florida Statutes, is amended
311 to read:
312 627.6619 Massage.—Any policy of health insurance that
313 provides coverage for massage shall also cover the services of
314 persons licensed to practice massage therapy pursuant to chapter
315 480, where the massage therapy, as defined in chapter 480, has
316 been prescribed by a physician licensed under chapter 458,
317 chapter 459, chapter 460, or chapter 461, as being medically
318 necessary and the prescription specifies the number of
319 treatments.
320 Section 19. Paragraph (a) of subsection (1) of section
321 627.736, Florida Statutes, is amended to read:
322 627.736 Required personal injury protection benefits;
323 exclusions; priority; claims.—
324 (1) REQUIRED BENEFITS.—An insurance policy complying with
325 the security requirements of s. 627.733 must provide personal
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326 injury protection to the named insured, relatives residing in
327 the same household, persons operating the insured motor vehicle,
328 passengers in the motor vehicle, and other persons struck by the
329 motor vehicle and suffering bodily injury while not an occupant
330 of a self-propelled vehicle, subject to subsection (2) and
331 paragraph (4)(e), to a limit of $10,000 in medical and
332 disability benefits and $5,000 in death benefits resulting from
333 bodily injury, sickness, disease, or death arising out of the
334 ownership, maintenance, or use of a motor vehicle as follows:
335 (a) Medical benefits.—Eighty percent of all reasonable
336 expenses for medically necessary medical, surgical, X-ray,
337 dental, and rehabilitative services, including prosthetic
338 devices and medically necessary ambulance, hospital, and nursing
339 services if the individual receives initial services and care
340 pursuant to subparagraph 1. within 14 days after the motor
341 vehicle accident. The medical benefits provide reimbursement
342 only for:
343 1. Initial services and care that are lawfully provided,
344 supervised, ordered, or prescribed by a physician licensed under
345 chapter 458 or chapter 459, a dentist licensed under chapter
346 466, a chiropractic physician licensed under chapter 460, or an
347 advanced practice registered nurse registered under s. 464.0123
348 or that are provided in a hospital or in a facility that owns,
349 or is wholly owned by, a hospital. Initial services and care may
350 also be provided by a person or entity licensed under part III
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351 of chapter 401 which provides emergency transportation and
352 treatment.
353 2. Upon referral by a provider described in subparagraph
354 1., followup services and care consistent with the underlying
355 medical diagnosis rendered pursuant to subparagraph 1. which may
356 be provided, supervised, ordered, or prescribed only by a
357 physician licensed under chapter 458 or chapter 459, a
358 chiropractic physician licensed under chapter 460, a dentist
359 licensed under chapter 466, or an advanced practice registered
360 nurse registered under s. 464.0123, or, to the extent permitted
361 by applicable law and under the supervision of such physician,
362 osteopathic physician, chiropractic physician, or dentist, by a
363 physician assistant licensed under chapter 458 or chapter 459 or
364 an advanced practice registered nurse licensed under chapter
365 464. Followup services and care may also be provided by the
366 following persons or entities:
367 a. A hospital or ambulatory surgical center licensed under
368 chapter 395.
369 b. An entity wholly owned by one or more physicians
370 licensed under chapter 458 or chapter 459, chiropractic
371 physicians licensed under chapter 460, advanced practice
372 registered nurses registered under s. 464.0123, or dentists
373 licensed under chapter 466 or by such practitioners and the
374 spouse, parent, child, or sibling of such practitioners.
375 c. An entity that owns or is wholly owned, directly or
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376 indirectly, by a hospital or hospitals.
377 d. A physical therapist licensed under chapter 486, based
378 upon a referral by a provider described in this subparagraph.
379 e. A health care clinic licensed under part X of chapter
380 400 which is accredited by an accrediting organization whose
381 standards incorporate comparable regulations required by this
382 state, or
383 (I) Has a medical director licensed under chapter 458,
384 chapter 459, or chapter 460;
385 (II) Has been continuously licensed for more than 3 years
386 or is a publicly traded corporation that issues securities
387 traded on an exchange registered with the United States
388 Securities and Exchange Commission as a national securities
389 exchange; and
390 (III) Provides at least four of the following medical
391 specialties:
392 (A) General medicine.
393 (B) Radiography.
394 (C) Orthopedic medicine.
395 (D) Physical medicine.
396 (E) Physical therapy.
397 (F) Physical rehabilitation.
398 (G) Prescribing or dispensing outpatient prescription
399 medication.
400 (H) Laboratory services.
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401 3. Reimbursement for services and care provided in
402 subparagraph 1. or subparagraph 2. up to $10,000 if a physician
403 licensed under chapter 458 or chapter 459, a dentist licensed
404 under chapter 466, a physician assistant licensed under chapter
405 458 or chapter 459, or an advanced practice registered nurse
406 licensed under chapter 464 has determined that the injured
407 person had an emergency medical condition.
408 4. Reimbursement for services and care provided in
409 subparagraph 1. or subparagraph 2. is limited to $2,500 if a
410 provider listed in subparagraph 1. or subparagraph 2. determines
411 that the injured person did not have an emergency medical
412 condition.
413 5. Medical benefits do not include massage therapy as
414 defined in s. 480.033 or acupuncture as defined in s. 457.102,
415 regardless of the person, entity, or licensee providing massage
416 therapy or acupuncture, and a licensed massage therapist or
417 licensed acupuncturist may not be reimbursed for medical
418 benefits under this section.
419 6. The Financial Services Commission shall adopt by rule
420 the form that must be used by an insurer and a health care
421 provider specified in sub-subparagraph 2.b., sub-subparagraph
422 2.c., or sub-subparagraph 2.e. to document that the health care
423 provider meets the criteria of this paragraph. Such rule must
424 include a requirement for a sworn statement or affidavit.
425
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426 Only insurers writing motor vehicle liability insurance in this
427 state may provide the required benefits of this section, and
428 such insurer may not require the purchase of any other motor
429 vehicle coverage other than the purchase of property damage
430 liability coverage as required by s. 627.7275 as a condition for
431 providing such benefits. Insurers may not require that property
432 damage liability insurance in an amount greater than $10,000 be
433 purchased in conjunction with personal injury protection. Such
434 insurers shall make benefits and required property damage
435 liability insurance coverage available through normal marketing
436 channels. An insurer writing motor vehicle liability insurance
437 in this state who fails to comply with such availability
438 requirement as a general business practice violates part IX of
439 chapter 626, and such violation constitutes an unfair method of
440 competition or an unfair or deceptive act or practice involving
441 the business of insurance. An insurer committing such violation
442 is subject to the penalties provided under that part, as well as
443 those provided elsewhere in the insurance code.
444 Section 20. Subsection (37) of section 641.31, Florida
445 Statutes, is amended to read:
446 641.31 Health maintenance contracts.—
447 (37) All health maintenance contracts that provide
448 coverage for massage must also cover the services of persons
449 licensed to practice massage therapy pursuant to chapter 480 if
450 the massage is prescribed by a contracted physician licensed
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451 under chapter 458, chapter 459, chapter 460, or chapter 461 as
452 medically necessary and the prescription specifies the number of
453 treatments. Such massage services are subject to the same terms,
454 conditions, and limitations as those of other covered services.
455 Section 21. Subsection (3) of section 823.05, Florida
456 Statutes, is amended to read:
457 823.05 Places and groups engaged in certain activities
458 declared a nuisance; abatement and enjoinment.—
459 (3) A massage establishment as defined in s. 480.033 s.
460 480.033(7) which operates in violation of s. 480.0475 or s.
461 480.0535(2) is declared a nuisance and may be abated or enjoined
462 as provided in ss. 60.05 and 60.06.
463 Section 22. This act shall take effect July 1, 2021.
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HB 497
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 497 Dentistry and Dental Hygiene Examinations
SPONSOR(S): Buchanan
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Rahming McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
The Board of Dentistry, within the Department of Health (DOH), regulates dental practice in Florida, including
dentists, dental hygienists, and dental assistants under the Dental Practice Act. A dentist is licensed to
examine, diagnose, treat, and care for conditions within the human oral cavity and its adjacent tissues and
structures. A dental hygienist provides education and preventive and delegated therapeutic dental services.
Currently, all applicants for licensure as a dentist or dental hygienist must pass a practical examination
developed by the American Board of Dental Examiners, Inc. (ADEX), in addition to meeting other
qualifications.
HB 497 authorizes the Board of Dentistry to accept passing scores on the examinations produced by the
Western Regional Examining Board for licensure as a dentist or dental hygienist, in addition to the ADEX
examinations it currently accepts.
The bill has an insignificant, negative fiscal impact on the DOH, which current resources are adequate to
absorb. The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Dentistry
The Board of Dentistry, within the Department of Health (DOH), regulates dental practice in Florida,
including dentists, dental hygienists, and dental assistants under the Dental Practice Act. 1 A dentist is
licensed to examine, diagnose, treat, and care for conditions within the human oral cavity and its
adjacent tissues and structures. 2 A dental hygienist provides education, preventive and delegated
therapeutic dental services. 3
Dental Licensure
Any person wishing to practice dentistry in this state must apply to the DOH and meet specified
requirements. Section 466.006, F.S., requires dentistry licensure applicants to sit for and pass the
following licensure examinations:
• The National Board of Dental Examiners dental examination (NBDE);
• A written examination on Florida laws and rules regulating the practice of dentistry; and
• The American Dental Licensing Examination, a practical or clinical examination developed by
the American Board of Dental Examiners. 4
To qualify to take the Florida dental licensure examination, an applicant must be 18 years of age or
older, be a graduate of a dental school accredited by the American Dental Association Commission on
Dental Accreditation or be a student in the final year of a program at an accredited institution, and have
successfully completed the NBDE dental examination. 5
Dental Hygiene Licensure
Any person wishing to be licensed as a dental hygienist must apply to DOH and meet the following
qualifications: 6
• Be 18 years of age or older;
• Be a graduate of an accredited dental hygiene college or school; 7 and
• Obtain a passing score on the:
o National Board Dental Hygiene Examination;
o Dental Hygiene Examination, a practical or clinical examination developed by the
American Board of Dental Examiners, Inc.; and
o A written examination on Florida laws and rules regulating the practice of dental
hygiene.
A dental hygienist may also apply to be certified to administer local anesthesia, under the direct
supervision of a dentist, to a non-sedated, adult patient if the dental hygienist is certified in basic or
1 S. 466.004, F.S.
2 S. 466.003(3), F.S.
3 Ss. 466.003(4)-(5), F.S.
4 A passing score is valid for 365 days after the date the official examination results are published. The same is true for a passing score
on the American Dental Licensing Examination administered in another state on or after Oct. 1, 2011.
5 S. 466.006(2), F.S.
6 S. 466.007, F.S.
7 If the school is not accredited, the applicant must have completed a minimum of 4 years of postsecondary dental education and
received a dental school diploma, which must be reviewed and approved by the Board of Dentistry.
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advanced cardiac life support and successfully completes an accredited course that includes a
minimum of 30 hours of didactic training, 30 hours of clinical experience, and additional training in
specified areas. 8
American Board of Dental Examiners
The American Board of Dental Examiners, Inc. (ADEX) is an organization of state and regional dental
boards that provides for the ongoing development of uniform national dental and dental hygiene
licensure examinations. 9 ADEX was created in 2003, with representatives from four regional testing
agencies and 12 states. At the time ADEX was created, there were 16 different dental and dental
hygiene examinations. 10
The Commission on Dental Competency Assessment (CDCA), formerly known as the Northeast
Regional Board, and the Council of Interstate Testing Agencies (CITA) administers the ADEX dental
licensure examination to graduates of accredited dental schools and students in their senior year at an
accredited dental school. 11 The ADEX dental examination consists of three portions: a computer-based
examination, simulated clinical examinations, and clinical examinations on live patients. 12 The ADEX
examination is widely accepted for dental licensure. 13
As with the dental examination, CDCA and CITA administer the ADEX dental hygiene examination. 14
The ADEX dental hygiene examination consists of two portions: a computer-simulated examination and
a clinical examination on live patients. 15 The ADEX examination is widely accepted for dental hygiene
licensure. 16
8 S. 466.017(5), F.S.
9 American Board of Dental Examiners, Inc., About ADEX, https://adexexams.org/about-adex/ (last visited Feb. 22, 2021).
10 Id.
11 Commission on Dental Competency Assessments (CDCA), Registration and DSE OSCE Manual: 2020 ADEX Dental Examination
Series, https://www.cdcaexams.org/documents/manuals/Dental_DSE_OSCE2020.pdf (last visited Feb. 22, 2021).The cost of the ADEX
dental examinations is $2,295; however, additional fees may be assessed, such as a facility or score report fee. The fee is reduced for
partial exams and retakes. See CDCA, Dental (ADEX), https://www.cdcaexams.org/dental-exams/ (last visited Feb. 22, 2021).
12 Id. at p. 4. The simulated clinical examinations assesses skills related to endodontics and fixed prosthodontics. The clinical
examinations on live patients assesses skills related to restorative and periodontal procedures.
13 CDCA, 2021 ADEX Acceptance Map, https://www.cdcaexams.org/adex-acceptance-map/ (last visited Feb. 22, 2021).
14 CDCA, Candidate Registration and CSCE OSCE Manual: 2020 ADEX Dental Hygiene Examination, available at
https://www.cdcaexams.org/documents/manuals/Dental_Hygiene_Candidate_Registration2020.pdf (last visited Feb. 22, 2020). The
cost of the ADEX dental hygiene examinations is $995; however, additional fees may be assessed, such as a facility or score report
fee. See CDCA, Dental Hygiene (ADEX), https://www.cdcaexams.org/dental-hygiene-adex-exam/ (last visited Feb. 22, 2021).
15 Id.
16 CDCA, supra note 13.
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Florida only accepts the ADEX examinations and the Legislature found, when specifying the ADEX
examination for use in dental licensure, that the ADEX examinations, in both structure and functions,
consistently meet generally accepted testing standards and that it adequately and reliably measures an
applicant’s ability to practice dentistry. 17 The DOH contracts with the CDCA to administer the ADEX
examinations, as well as the jurisprudence examinations. 18 In Fiscal Year 2019-2020, 869 dentists and
562 dental hygienists applied to the take the ADEX examinations. 19
Western Regional Examining Board
The Western Regional Examining Board (WREB) was created in 1976, after Utah and Oregon made an
arrangement to have a simultaneous dental licensure examination. 20 WREB offered its first dental
examination in 1977 and its dental hygiene examination in 1979. 21
The WREB dental examination consists of three sections: operative, endodontics, and comprehensive
treatment planning. 22 The operative section is performed on a live patient and the candidate must
complete up to two restorative procedures. The endodontics section is simulated and the
comprehensive treatment planning section is a computer-based written examination. A periodontal
examination, which is performed on a live patient, and a prosthodontics examination, which is a
simulated examination, are available for candidates in those states that require the examinations. 23
The WREB dental hygiene examination assesses the candidates on patient qualification, extraoral and
intraoral evaluation, calculus detection and removal, tissue management, periodontal assessment, and
professional judgment. 24
17 S. 466.006(1)(a), F.S.
18 Florida Department of Health (DOH), 2021 Agency Legislative Bill Analysis for HB 497, p. 3 (Feb. 24, 2021).
19 Id.
20 Western Regional Examining Board (WREB), About Us, available at https://wreb.org/about-us/ (last visited Mar. 1, 2021). The
members of the Western Regional Examining Board include Alaska, Arizona, Arkansas, Idaho, Illinois, Iowa, Kansas, Minnesota,
Mississippi, Missouri, Montana, Nebraksa, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, Texas, Utah, Washington, West
Virginia, and Wyoming. California and Hawaii are dental member states only.
21 Id.
22 Western Regional Examining Board, 2021 WREB Exam Procedures, available at
https://wreb.org/Candidates/Dental/2021_Dental_PDFs/2021_WREB_Exam_Procedures.pdf (last visited Feb. 11, 2021). The WREB
dental examination costs $2,560 plus an additional school use fee that varies by site. See Western Regional Examining Board, 2021
Dental Exam Fees, available at https://wreb.org/dental-candidates/2019-dental-exam-fees/ (last visited Feb. 11, 2021).
23 Id. Florida requires a periodontal examination for licensure.
24 WREB, 2020 Dental Hygiene Examination Candidate Guide, available at
https://wreb.org/Candidates/Hygiene/hygienePDFs/2020_DH_Forms/2020_WREB_Candidate_Guide_HYG_v11012019.pdf (last visited
Feb. 22, 2021). The WREB dental hygiene examination costs $1,175 plus a school use fee, which varies by site. See Western Regional
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The Western Regional Examining Board’s licensure examinations are widely accepted for licensure. 25
The WREB does not administer a state-specific jurisprudence examination. Florida does not accept the
WREB dentist or dental hygiene examinations for licensure.
Effect of Proposed Changes
HB 497 authorizes the Board of Dentistry to accept passing scores on the examinations produced by
the Western Regional Examining Board for licensure as a dentist or dental hygienist, in addition to the
ADEX examinations it currently accepts.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 466.006, F.S., relating to examination of dentists.
Section 2: Amends s. 466.007, F.S., relating to examination of dental hygienists.
Section 3: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The DOH will experience a non-recurring increase in workload and costs associated with updating
the Licensing and Enforcement Information Database System (LEIDS) to record examination
results received from the WREB dental examination. Additionally, a new web service will be
required to support receiving examination results from the WREB on candidates applying for
licensure in Florida, which current resources can absorb. 26
Examining Board, Dental Hygiene, Local Anesthesia, and Restorative Exam Fees, https://wreb.org/hygiene-candidates/2018-hygiene-
exam-fees/ (last visited Feb. 22, 2021).
25 WREB, supra note 20.
26 DOH, supra note 18, pp. 5-6.
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B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Dentists and dental hygienists who have received acceptable scores on the WREB examinations will
not incur additional expenses to take the ADEX examinations when applying for Florida licensure.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The Board of Dentistry has sufficient rulemaking authority to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 497 2021
1 A bill to be entitled
2 An act relating to dentistry and dental hygiene
3 examinations; amending ss. 466.006 and 466.007, F.S.;
4 authorizing the use of certain examinations produced
5 by the Western Regional Examining Board to measure an
6 applicant's ability to practice the profession of
7 dentistry or dental hygiene; providing an effective
8 date.
9
10 Be It Enacted by the Legislature of the State of Florida:
11
12 Section 1. Subsection (1), paragraph (b) of subsection
13 (4), paragraph (a) of subsection (5), and paragraph (a) of
14 subsection (6) of section 466.006, Florida Statutes, are amended
15 to read:
16 466.006 Examination of dentists.—
17 (1)(a) It is the intent of the Legislature to reduce the
18 costs associated with an independent state-developed practical
19 or clinical examination to measure an applicant's ability to
20 practice the profession of dentistry and to use the American
21 Dental Licensing Examination developed by the American Board of
22 Dental Examiners, Inc., or the Western Regional Examining Board
23 (WREB) Dental Examination in lieu of an independent state-
24 developed practical or clinical examination. The Legislature
25 finds that the American Dental Licensing Examination and the
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26 WREB Dental Examination, in both their its structure and
27 function, consistently meet meets generally accepted testing
28 standards and have has been found, as they are it is currently
29 organized and operating, to adequately and reliably measure an
30 applicant's ability to practice the profession of dentistry.
31 (b) Any person desiring to be licensed as a dentist shall
32 apply to the department to take the licensure examinations and
33 shall verify the information required on the application by
34 oath. The application shall include two recent photographs.
35 There shall be an application fee set by the board not to exceed
36 $100 which shall be nonrefundable. There shall also be an
37 examination fee set by the board, which shall not exceed $425
38 plus the actual per-applicant per applicant cost to the
39 department for purchase of some or all of the examination from
40 the American Board of Dental Examiners, the WREB, or a its
41 successor entity, if any, provided the board finds the successor
42 entity's clinical examination complies with the provisions of
43 this section. The examination fee may be refundable if the
44 applicant is found ineligible to take the examinations.
45 (4) Notwithstanding any other provision of law in chapter
46 456 pertaining to the clinical dental licensure examination or
47 national examinations, to be licensed as a dentist in this
48 state, an applicant must successfully complete both of the
49 following:
50 (b) A practical or clinical examination, which must be the
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51 American Dental Licensing Examination produced by the American
52 Board of Dental Examiners, Inc., the WREB Dental Examination, or
53 an examination produced by a its successor entity, if any, that
54 is administered in this state, provided that the board has
55 attained, and continues to maintain thereafter, representation
56 on the board of directors of the American Board of Dental
57 Examiners, the examination development committee of the American
58 Board of Dental Examiners, and such other committees of the
59 American Board of Dental Examiners or the Western Regional
60 Examining Board as the board deems appropriate by rule to ensure
61 assure that the standards established herein are maintained
62 organizationally. A passing score on the American Dental
63 Licensing Examination or the WREB Dental Examination
64 administered in this state is valid for 365 days after the date
65 the official examination results are published.
66 1. As an alternative to such practical or clinical
67 examination, an applicant may submit scores from an American
68 Dental Licensing Examination or a WREB Dental Examination
69 previously administered in a jurisdiction other than this state
70 after October 1, 2011, and such examination results shall be
71 recognized as valid for the purpose of licensure in this state.
72 A passing score on the American Dental Licensing Examination or
73 the WREB Dental Examination administered out of state shall be
74 the same as the passing score for the American Dental Licensing
75 Examination or the WREB Dental Examination administered in this
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76 state. The examination results are valid for 365 days after the
77 date the official examination results are published. The
78 applicant must have completed the examination after October 1,
79 2011. This subparagraph may not be given retroactive
80 application.
81 2. If the date of an applicant's passing American Dental
82 Licensing Examination or passing WREB Dental Examination scores
83 from an examination previously administered in a jurisdiction
84 other than this state under subparagraph 1. is older than 365
85 days, such scores are nevertheless valid for the purpose of
86 licensure in this state, but only if the applicant demonstrates
87 that all of the following additional standards have been met:
88 a. The applicant completed the American Dental Licensing
89 Examination or the WREB Dental Examination after October 1,
90 2011. This sub-subparagraph may not be given retroactive
91 application.;
92 b. The applicant graduated from a dental school accredited
93 by the American Dental Association Commission on Dental
94 Accreditation or its successor entity, if any, or any other
95 dental accrediting organization recognized by the United States
96 Department of Education. Provided, However, if the applicant did
97 not graduate from such a dental school, the applicant may submit
98 proof of having successfully completed a full-time supplemental
99 general dentistry program accredited by the American Dental
100 Association Commission on Dental Accreditation of at least 2
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101 consecutive academic years at such accredited sponsoring
102 institution. Such program must provide didactic and clinical
103 education at the level of a D.D.S. or D.M.D. program accredited
104 by the American Dental Association Commission on Dental
105 Accreditation. For purposes of this sub-subparagraph, a
106 supplemental general dentistry program does not include an
107 advanced education program in a dental specialty.;
108 c. The applicant currently possesses a valid and active
109 dental license in good standing, with no restriction, which has
110 never been revoked, suspended, restricted, or otherwise
111 disciplined, from another state or territory of the United
112 States, the District of Columbia, or the Commonwealth of Puerto
113 Rico.;
114 d. The applicant submits proof that he or she has never
115 been reported to the National Practitioner Data Bank, the
116 Healthcare Integrity and Protection Data Bank, or the American
117 Association of Dental Boards Clearinghouse. This sub-
118 subparagraph does not apply if the applicant successfully
119 appealed to have his or her name removed from the data banks of
120 these agencies.;
121 e.(I)(A) The applicant submits proof of having been
122 consecutively engaged in the full-time practice of dentistry in
123 another state or territory of the United States, the District of
124 Columbia, or the Commonwealth of Puerto Rico in the 5 years
125 immediately preceding the date of application for licensure in
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126 this state; or
127 (B) If the applicant has been licensed in another state or
128 territory of the United States, the District of Columbia, or the
129 Commonwealth of Puerto Rico for less than 5 years, the applicant
130 submits proof of having been engaged in the full-time practice
131 of dentistry since the date of his or her initial licensure.
132 (II) As used in this section, "full-time practice" is
133 defined as a minimum of 1,200 hours per year for each and every
134 year in the consecutive 5-year period or, when applicable, the
135 period since initial licensure, and must include any combination
136 of the following:
137 (A) Active clinical practice of dentistry providing direct
138 patient care.
139 (B) Full-time practice as a faculty member employed by a
140 dental or dental hygiene school approved by the board or
141 accredited by the American Dental Association Commission on
142 Dental Accreditation.
143 (C) Full-time practice as a student at a postgraduate
144 dental education program approved by the board or accredited by
145 the American Dental Association Commission on Dental
146 Accreditation.
147 (III) The board shall develop rules to determine what type
148 of proof of full-time practice is required and to recoup the
149 cost to the board of verifying full-time practice under this
150 section. Such proof must, at a minimum, be:
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151 (A) Admissible as evidence in an administrative
152 proceeding;
153 (B) Submitted in writing;
154 (C) Submitted by the applicant under oath with penalties
155 of perjury attached;
156 (D) Further documented by an affidavit of someone
157 unrelated to the applicant who is familiar with the applicant's
158 practice and testifies with particularity that the applicant has
159 been engaged in full-time practice; and
160 (E) Specifically found by the board to be both credible
161 and admissible.
162 (IV) An affidavit of only the applicant is not acceptable
163 proof of full-time practice unless it is further attested to by
164 someone unrelated to the applicant who has personal knowledge of
165 the applicant's practice. If the board deems it necessary to
166 assess credibility or accuracy, the board may require the
167 applicant or the applicant's witnesses to appear before the
168 board and give oral testimony under oath.;
169 f. The applicant submits documentation that he or she has
170 completed, or will complete before he or she is licensed in this
171 state, continuing education equivalent to this state's
172 requirements for the last full reporting biennium.;
173 g. The applicant proves that he or she has never been
174 convicted of, or pled nolo contendere to, regardless of
175 adjudication, any felony or misdemeanor related to the practice
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176 of a health care profession in any jurisdiction.;
177 h. The applicant has successfully passed a written
178 examination on the laws and rules of this state regulating the
179 practice of dentistry and the computer-based diagnostic skills
180 examination.; and
181 i. The applicant submits documentation that he or she has
182 successfully completed the applicable examination administered
183 by the Joint Commission on National Dental Examinations or its
184 successor organization.
185 (5)(a) The practical examination required under subsection
186 (4) shall be the American Dental Licensing Examination developed
187 by the American Board of Dental Examiners, Inc., the WREB Dental
188 Examination, or an examination developed by a its successor
189 entity, if any, provided the board finds that the successor
190 entity's clinical examination complies with the provisions of
191 this section, and includes shall include, at a minimum, all of
192 the following:
193 1. A comprehensive diagnostic skills examination covering
194 the full scope of dentistry and an examination on applied
195 clinical diagnosis and treatment planning in dentistry for
196 dental candidates.;
197 2. Two restorations on a live patient or patients. The
198 board by rule shall determine the class of such restorations.;
199 3. A demonstration of periodontal skills on a live
200 patient.;
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201 4. A demonstration of prosthetics and restorative skills
202 in complete and partial dentures and crowns and bridges and the
203 utilization of practical methods of evaluation, specifically
204 including the evaluation by the candidate of completed
205 laboratory products such as, but not limited to, crowns and
206 inlays filled to prepared model teeth.;
207 5. A demonstration of restorative skills on a mannequin
208 which requires the candidate to complete procedures performed in
209 preparation for a cast restoration.;
210 6. A demonstration of endodontic skills.; and
211 7. A diagnostic skills examination demonstrating ability
212 to diagnose conditions within the human oral cavity and its
213 adjacent tissues and structures from photographs, slides,
214 radiographs, or models pursuant to rules of the board. If an
215 applicant fails to pass the diagnostic skills examination in
216 three attempts, the applicant is shall not be eligible for
217 reexamination unless she or he completes additional educational
218 requirements established by the board.
219
220 The department shall require a mandatory standardization
221 exercise for all examiners before prior to each practical or
222 clinical examination and shall retain for employment only those
223 dentists who have substantially adhered to the standard of
224 grading established at such exercise.
225 (6)(a) It is the finding of the Legislature that absent a
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226 threat to the health, safety, and welfare of the public, the
227 relocation of applicants to practice dentistry within the
228 geographic boundaries of this state, who are lawfully and
229 currently practicing dentistry in another state or territory of
230 the United States, the District of Columbia, or the Commonwealth
231 of Puerto Rico, based on their scores from the American Dental
232 Licensing Examination or the WREB Dental Examination
233 administered in a state other than this state, is substantially
234 related to achieving the important state interest of improving
235 access to dental care for underserved citizens of this state and
236 furthering the economic development goals of the state.
237 Therefore, in order to maintain valid active licensure in this
238 state, all applicants for licensure who are relocating to this
239 state based on scores from the American Dental Licensing
240 Examination or the WREB Dental Examination administered in a
241 state other than this state must actually engage in the full-
242 time practice of dentistry inside the geographic boundaries of
243 this state within 1 year after of receiving such licensure in
244 this state. The Legislature finds that, if such applicants do
245 not actually engage in the full-time practice of dentistry
246 within the geographic boundaries of this state within 1 year
247 after of receiving such a license in this state, access to
248 dental care for the public will not significantly increase,
249 patients' continuity of care will not be attained, and the
250 economic development goals of the state will not be
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251 significantly met.
252 Section 2. Paragraph (b) of subsection (4) and subsections
253 (5) and (6) of section 466.007, Florida Statutes, are amended to
254 read:
255 466.007 Examination of dental hygienists.—
256 (4) Effective July 1, 2012, to be licensed as a dental
257 hygienist in this state, an applicant must successfully complete
258 the following:
259 (b) A practical or clinical examination approved by the
260 board. The examination shall be the Dental Hygiene Examination
261 produced by the American Board of Dental Examiners, Inc.,
262 (ADEX), the Western Regional Examining Board (WREB) Dental
263 Hygiene Examination, or an examination produced by a its
264 successor entity, if any, if the board finds that the successor
265 entity's clinical examination meets or exceeds the provisions of
266 this section. The board shall approve the ADEX Dental Hygiene
267 Examination or the WREB Dental Hygiene Examination if the board
268 has attained and continues to maintain representation on the
269 ADEX House of Representatives, the ADEX Dental Hygiene
270 Examination Development Committee, and such other ADEX Dental
271 Hygiene or WREB Dental Hygiene committees as the board deems
272 appropriate through rulemaking to ensure that the standards
273 established in this section are maintained organizationally. The
274 ADEX Dental Hygiene Examination, the WREB Dental Hygiene
275 Examination, or an the examination produced by a its successor
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276 entity is a comprehensive examination in which an applicant must
277 demonstrate skills within the dental hygiene scope of practice
278 on a live patient and any other components that the board deems
279 necessary for the applicant to successfully demonstrate
280 competency for the purpose of licensure.
281 (5) Effective July 1, 2012, an applicant who has completed
282 the ADEX Dental Hygiene Examination or the WREB Dental Hygiene
283 Examination in a jurisdiction other than this state and who has
284 obtained a passing score may practice dental hygiene in this
285 state if the applicant:
286 (a) Has successfully completed the National Board Dental
287 Hygiene Examination at any time before the date of application;
288 (b) Has been certified by the American Dental Association
289 Joint Commission on National Dental Examinations at any time
290 before the date of application, as specified by state law;
291 (c) Has successfully completed a written examination on
292 the laws and rules of this state regulating the practice of
293 dental hygiene;
294 (d) Has not been disciplined by a board, except for
295 citation offenses or minor violations; and
296 (e) Has not been convicted of or pled nolo contendere to,
297 regardless of adjudication, any felony or misdemeanor related to
298 the practice of a health care profession.
299 (6)(a) A passing score on the ADEX Dental Hygiene
300 Examination or the WREB Dental Hygiene Examination administered
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301 out of state must be considered the same as a passing score for
302 the ADEX Dental Hygiene Examination or the WREB Dental Hygiene
303 Examination administered in this state.
304 (b) If an applicant fails to pass the ADEX Dental Hygiene
305 Examination or the WREB Dental Hygiene Examination in three
306 attempts, the applicant is not eligible to retake the
307 examination unless the applicant completes additional education
308 requirements as specified by the board.
309 Section 3. This act shall take effect July 1, 2021.
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HB 725
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 725 Nonopioid Alternatives Educational Materials
SPONSOR(S): Plakon
TIED BILLS: IDEN./SIM. BILLS: SB 530
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Grabowski McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
Substance abuse affects millions of people in the U.S. each year. Drug overdoses have steadily increased and
now represent the leading cause of accidental death in the U.S., the majority of which involve an opioid. In
Florida, opioids (licit and illicit) were responsible for more than 6,000 deaths in 2019. The National Institute of
Health reports that the majority of heroin users first misused a prescription opioid.
The Department of Health (DOH) publishes an educational pamphlet regarding the use of non-opioid
alternatives to treat pain on its website. Current law requires that health care practitioners, except pharmacists,
discuss non-opioid alternatives with a patient or the patient’s representative prior to prescribing, ordering,
dispensing, or administering opioids. A health care practitioner must also provide a printed copy of the DOH-
developed pamphlet to a patient or the patient’s representative and document the discussion in the patient’s
medical record. The law exempts emergency and hospice care from these requirements.
HB 725 modifies the existing requirements by allowing practitioners to provide each patient with an
electronically transmitted copy of the DOH pamphlet as an alternative to a printed pamphlet.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Substance Abuse
Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol
and illicit drugs. 1 Substance abuse disorders occur when the chronic use of alcohol or drugs causes
significant impairment, such as health problems, disability, and failure to meet major responsibilities at
work, school, or home. 2 Repeated drug use leads to changes in the brain’s structure and function that
can make a person more susceptible to developing a substance abuse disorder. 3 Brain imaging studies
of persons with substance abuse disorders show physical changes in areas of the brain that are critical
to judgment, decision making, learning and memory, and behavior control. 4
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, a diagnosis of
substance abuse disorder is based on evidence of impaired control, social impairment, risky use, and
pharmacological criteria. 5 The most common substance abuse disorders in the United States are from
the use of alcohol, tobacco, cannabis, stimulants, hallucinogens, and opioids. 6
Opioid Abuse
Opioids are psychoactive substances derived from the opium poppy, or their synthetic analogues. 7
They are commonly used as pain relievers to treat acute and chronic pain. An individual experiences
pain as a result of a series of electrical and chemical exchanges among his or her peripheral nerves,
spinal cord, and brain. 8 Opioid receptors occur naturally and are distributed widely throughout the
central nervous system and in peripheral sensory and autonomic nerves. 9 When an individual
experiences pain, the body releases hormones, such as endorphins, which bind with targeted opioid
receptors. 10 This disrupts the transmission of pain signals through the central nervous system and
reduces the perception of pain. 11 Opioids function in the same way by binding to specific opioid
receptors in the brain, spinal cord, and gastrointestinal tract, thereby reducing the perception of pain. 12
Opioids include: 13
• Buprenorphine (Subutex, Suboxone);
1 World Health Organization, Substance Abuse, available at http://www.who.int/topics/substance_abuse/en/ (last visited February 23,
2021).
2 Substance Abuse and Mental Health Services Administration, Mental Health and Substance Use Disorders, (last rev. April 2019),
available at http://www.samhsa.gov/disorders/substance-use (last visited February 23, 2021).
3 National Institute on Drug Abuse, Drugs, Brains, and Behavior: The Science of Addiction, available at
https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-abuse-addiction (last visited February 23, 2021).
4 Id.
5 Supra note 2.
6 Id.
7 World Health Organization, Information Sheet on Opioid Overdose, (Aug. 2018), available at
http://www.who.int/substance_abuse/information-sheet/en/ (last visited February 23, 2021).
8 National Institute of Neurological Disorders and Stroke, Pain: Hope through Research, (last rev. Aug. 13, 2019), available at
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Pain-Hope-Through-Research (last visited
February 23, 2021).
9 Gjermund Henriksen, Frode Willoch; Brain Imaging of Opioid Receptors in the Central Nervous System, 131 BRAIN 1171-1196 (2007),
available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367693/ (last visited February 23, 2021).
10 Id.
11 Id.
12 Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, SAMHSA Opioid
Overdose Prevention Toolkit: Facts for Community Members (2013, rev. 2014) 3, available at
https://www.integration.samhsa.gov/Opioid_Toolkit_Community_Members.pdf (last visited February 23, 2021).
13 Florida Department of Law Enforcement, Medical Examiners Commission, Drugs Identified in Deceased Persons by Florida Medical
Examiners 2019 Annual Report, (Nov. 2020), available at http://www.fdle.state.fl.us/MEC/Publications-and-Forms/Documents/Drugs-in-
Deceased-Persons/2019-Annual-Drug-Report.aspx (last visited February 23, 2021).
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• Codeine;
• Fentanyl (Duragesic, Fentora);
• Fentanyl Analogs;
• Heroin;
• Hydrocodone (Vicodin, Lortab, Norco);
• Hydromorphone (Dilaudid, Exalgo);
• Meperidine;
• Methadone;
• Morphine;
• Oxycodone (OxyContin, Percodan, Percocet);
• Oxymorphone;
• Tramadol; and
• U-47700.
Opioids are commonly abused, with an estimated 15 million people worldwide suffering from opioid
dependence. 14 Opioids can create a euphoric feeling because they affect the regions of the brain
involved with pleasure and reward, which can lead to abuse. 15 Continued use of these drugs can lead
to the development of tolerance and psychological and physical dependence. 16 This dependence is
characterized by a strong desire to take opioids, impaired control over opioid use, persistent opioid use
despite harmful consequences, a higher priority given to opioid use than to other activities and
obligations, and a physical withdrawal reaction when opioids are discontinued. 17 Nearly 80 percent of
people who use heroin first misused prescription opioids. 18
An overabundance of opioids in the body can lead to a fatal overdose. In addition to their presence in
major pain pathways, opioid receptors are also located in the respiratory control centers of the brain. 19
Opioids disrupt the transmission of signals for respiration in the identical manner that they disrupt the
transmission of pain signals. This leads to a reduction, and potentially cessation, of an individual’s
respiration. Oxygen starvation will eventually stop vital organs like the heart, then the brain, and can
lead to unconsciousness, coma, and possibly death. 20 Within three to five minutes without oxygen,
brain damage starts to occur, soon followed by death. 21 However, this does not occur instantaneously
as people will commonly stop breathing slowly, minutes to hours after the drug or drugs were used. 22
An opioid overdose can be identified by a combination of three signs and symptoms referred to as the
“opioid overdose triad”: pinpoint pupils, unconsciousness, and respiratory depression. 23
The drug overdose death rate involving opioids has increased by 200% since 2000 and has now
become the leading cause of accidental deaths in the United States. 24 Opioid-involved overdoses
accounted for 69 percent of drug overdose deaths in 2018. 25 Nationwide, in 2017, there were 47,600
14 Supra note 7.
15 National Institute on Health, National Institute on Drug Abuse, Misuse of Prescription Drugs: What Classes of Prescription Drugs Are
Commonly Misused?, (rev. Dec. 2018), available at https://www.drugabuse.gov/publications/research-reports/misuse-prescription-
drugs/which-classes-prescription-drugs-are-commonly-misused (last visited February 23, 2021).
16 Supra note 9.
17 Supra note 7.
18 National Institute on Health, National Institute on Drug Abuse, Prescription Opioids and Heroin: Prescription Opioid Use Is a Risk
Factor for Heroin Use, (rev. Jan. 2018), available at https://www.drugabuse.gov/publications/research-reports/relationship-between-
prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use (last visited February 23, 2021).
19 K.T.S. Pattinson, Opioids and the Control of Respiration, BRITISH JOURNAL OF ANAESTHESIA, Volume 100, Issue 6, pp. 747-758,
available at http://bja.oxfordjournals.org/content/100/6/747.full (last visited February 23, 2021).
20 Harm Reduction Coalition, Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects (Fall 2012),
http://harmreduction.org/wp-content/uploads/2012/11/od-manual-final-links.pdf (last visited February 23, 2021).
21 Id. at 9.
22 Id. at 9.
23 Supra note 7.
24 Rose Rudd, MSPH, et. al., Increases in Drug and Opioid Overdose Deaths – United States, 2000-2014, Morbidity and Mortality
Weekly Report (MMWR) 64(50); Jan. 1, 2016, at 1378-82, available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm?s_cid=mm6450a3_w (last visited February 23, 2021).
25 Centers for Disease Control and Prevention, Drug Overdose Deaths, (last rev. Mar 19, 2020), available at
https://www.cdc.gov/drugoverdose/data/statedeaths.html (last visited February 23, 2021).
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deaths that involved an opioid (licit or illicit), and 17,029 people died from overdoses involving
prescription opioids. 26 In 2019, Florida had the following opioid-involved deaths: 27
Opioid Caused Death Present at Death
Oxycodone 510 671
Hydrocodone 165 393
Methadone 174 144
Morphine 984 871
Fentanyl 3,244 411
Fentanyl Analogs 922 496
Heroin 809 145
Controlled Substance Prescribing in Florida: Chronic Pain
Every physician, podiatrist, or dentist, who prescribes controlled substances in the state to treat chronic
nonmalignant pain, 28 must register as a controlled substance prescribing practitioner and comply with
certain practice standards specified in statute and rule. 29 Before prescribing controlled substances to
treat chronic nonmalignant pain, a practitioner must: 30
• Complete a medical history and a physical examination of the patient which must be
documented in the patient’s medical record and include:
o The nature and intensity of the pain;
o Current and past treatments for pain;
o Underlying or coexisting diseases or conditions;
o The effect of the pain on physical and psychological function;
o A review of previous medical records and diagnostic studies;
o A history of alcohol and substance abuse; and
o Documentation of the presence of one or recognized medical indications for the use of a
controlled substance.
• Develop a written plan for assessing the patient’s risk for aberrant drug-related behavior and
monitor such behavior throughout the course of controlled substance treatment;
• Develop a written individualized treatment plan for each patient stating the objectives that will be
used to determine treatment success;
• Discuss the risks and benefits of using controlled substances, including the risks of abuse and
addiction, as well as the physical dependence and its consequences with the patient; and
• Enter into a controlled substance agreement with each patient that must be signed by the
patient or legal representative and by the prescribing practitioner and include:
o The number and frequency of prescriptions and refills;
o A statement outlining expectations for patient’s compliance and reasons for which the
drug therapy may be discontinued; and
o An agreement that the patient’s chronic nonmalignant pain only be treated by a single
treating practitioner unless otherwise authorized and documented in the medical record.
A prescribing practitioner must see a patient being treated with controlled substances for chronic
nonmalignant pain at least once every three months and must maintain detailed medical records
relating to such treatment. 31 Patients at special risk for drug abuse or diversion may require
26 L. Scholl, et. al. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017, Morbidity and Mortality Weekly Report
(MMWR) 64(50); Jan. 4, 2019, at 1378-82, available at
https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm?s_cid=mm675152e1_w (last visited February 23, 2021).
27 Supra note 13. “Caused death” means that the medical examiner determined the drug played a causal role in the death. “Present at
death” means the medical examiner determine that the drug is present or identifiable but may not have played a causal role in the
death.
28 “Chronic nonmalignant pain” is defined as pain unrelated to cancer which persists beyond the usual course of disease or the injury
that is the cause of the pain or more than 90 days after surgery. Section 456.44(1)(e), F.S.
29 Chapter 2011-141, s. 3, Laws of Fla. (creating s. 456.44, F.S., effective July 1, 2011).
30 Section 456.44(3), F.S.
31 Section 456.44(3)(d), F.S.
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consultation with or a referral to an addiction medicine physician or a psychiatrist. 32 The prescribing
practitioner must immediately refer a patient exhibiting signs or symptoms of substance abuse to a pain
management physician, an addiction medicine specialist, or an addiction medicine facility. 33
Controlled Substance Prescribing in Florida: Acute Pain
The Boards of Dentistry, Medicine, Nursing, Optometry, Osteopathic Medicine, and Podiatric Medicine,
have adopted rules establishing guidelines for prescribing a controlled substance to treat acute pain. 34
Under these guidelines, a health care practitioner must: 35
• Conduct a medical history and physical examination of the patient and document the patient’s
medical record, including the presence of one or more recognized medical indications for the
use of a controlled substance;
• Create and maintain a written treatment plan, including any further diagnostic evaluations or
other treatments planned including non-opioid medications and treatments;
• Obtain informed consent and agreement for treatment, including discussing the risks and
benefits of using a controlled substance; expected pain intensity, duration, options; and use of
pain medications, non-medication therapies, and common side effects;
• Periodically review the treatment plan;
• Refer the patient, as necessary, for additional evaluation and treatment in order to meet
treatment goals;
• Maintain accurate and complete medical records; and
• Comply with all controlled substance laws and regulations.
A health care practitioner who fails to follow the guidelines established by the appropriate regulatory
board is subject to disciplinary action against his or her license.
Continuing Education on Controlled Substance Prescribing
All health care practitioners who are authorized to prescribe controlled substances must complete a
board-approved 2-hour continuing education course, if not already required to complete such a course
under his or her practice act. 36 The course must address:
• Current standards on prescribing controlled substances, particularly opiates;
• Alternatives to the current standards on controlled substance prescribing;
• Nonpharmacological therapies;
• Prescribing emergency opioid antagonists; and
• Information on the risks of opioid addiction following all stages of treatment in the management
of acute pain.
The course may be taken in a long-distance format and must be included in the continuing education
required for the biennial renewal of a health care practitioner’s license. The Department of Health
(DOH) may not renew the license of a prescriber who fails to complete this continuing education
requirement.
32 Section 456.44(3)(e), F.S.
33 Section 456.44(3)(g), F.S.
34 Rules 64B5-17.0045, 64B8-9.013, 64B9-4.017, 64B13-3.100, 64B15-14.005, 64B18-23.002, F.A.C., respectively. See also s.
456.44(4), F.S.
35 Id.
36 Section 456.0301, F.S. Pursuant to s. 464.013(3)(b), F.S., an advanced registered nurse practitioner must complete at least 3 hours
of continuing education hours on the safe and effective prescribing of controlled substances each biennial renewal cycle. Section
466.0135, F.S., requires dentists to complete at least 2 continuing education hours on the safe and effective prescribing of controlled
substances for license renewal. Rules 64B8-30.005(6) and 64B15-6.0035(6), F.A.C., requires physician assistants who prescribe
controlled substances to complete 3 hours of continuing education on the safe and effective prescribing of controlled substance
medications.
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Non-Opioid Alternatives
Using a non-opioid treatment option may eliminate the need for an opioid or reduce the amount of
opioids used. The Center for Disease Control and Prevention’s (CDC) guidelines for treating chronic
pain indicate that non-pharmacologic therapy and non-opioid pharmacologic therapy are the preferred
manners of treatment for chronic pain. 37 Examples of non-opioid treatments include: 38
• Non-opioid medications, such as non-steroidal anti-inflammatory agents (NSAIDs),
acetaminophen, corticosteroids, and topical products;
• Behavioral interventions, such as meditation;
• Environmental-based interventions, such as lighting alterations and music therapy; and
• Physical interventions, such as surgery, chiropractic care, acupuncture, physical therapy, and
massage therapy.
The CDC also advises that opioid therapy should only be considered if the expected benefit to the
patient outweighs the risk, and if used, should be combined with non-pharmacologic and non-opioid
pharmacologic therapy. 39
Florida Law on Non-Opioid Alternatives
DOH is required to develop and publish on its website, an educational pamphlet regarding the use of
non-opioid alternatives to treat pain under current law. 40 The pamphlet addresses: 41
• Nonopioid alternatives, including non-opioid medications and non-pharmacological therapies;
and
• Advantages and disadvantages of using each of the non-opioid alternatives.
All health care practitioners, except pharmacists, must discuss non-opioid alternatives for treating pain
with their patients prior to providing anesthesia or prescribing, ordering, dispensing, or administering an
opioid. 42 The health care practitioner must discuss the advantages and disadvantages of using a non-
opioid alternative, document the discussion in the patient’s record, and provide the patient with a
printed copy of the DOH-developed pamphlet. 43 The only exception to this requirement is when a
health care practitioner is providing emergency care or hospice services. 44
The law also allows for a practitioner to inform the patient’s representative, instead of the patient, of
non-opioid alternatives for treating pain and discuss the advantages and disadvantages of using such
alternatives. A health care practitioner must document any such discussion in the patient’s medical
record. 45
Effect of the Proposed Changes
37 Centers for Disease Control and Prevention, Nonopioid Treatments for Chronic Pain, available at
https://www.cdc.gov/drugoverdose/pdf/nonopioid_treatments-a.pdf (last visited February 23, 2021).
38 The Joint Commission, Non-Pharmacologic and Non-Opioid Solutions for Pain Management, QUICK SAFETY 44 (Aug. 2018), available
at https://www.jointcommission.org/assets/1/23/QS_Nonopioid_pain_mgmt_8_15_18_FINAL1.PDF (last visited February 23, 2021).
39 Supra note 37.
40 Chapter 2019-123, L.O.F., codified at s. 456.44(7), F.S. The website and pamphlet may be accessed at
http://www.floridahealth.gov/programs-and-services/non-opioid-pain-management/index.html (last visited February 23, 2021).
41 Id.
42 Section 456.44(7)(c), F.S.
43 Id.
44 “Emergency care and services” means medical screening, examination, and evaluation by a physician or other authorized personnel
under the supervision of a physician to determine if an emergency medical condition exists and, if it does, the care, treatment, or
surgery by a physician necessary to relive or eliminate the emergency medical condition, within the service capability of the facility (s.
395.002, F.S.). “Hospice services” means items and services furnished to a patient and family by a hospice, or by others under
arrangements with such a program, in a place of temporary or permanent residence used as the patient’s home for the purpose of
maintaining the patient at home; or, if the patient needs short-term institutionalization, the services shall be furnished in cooperation
with those contracted institutions or in the hospice inpatient facility (s. 400.601, F.S.).
45 Supra note 42.
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HB 725 modifies the existing requirements on practitioners by allowing them to provide each patient
with an electronically transmitted copy of the DOH pamphlet as an alternative to a printed pamphlet.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 456.44, F.S., relating to controlled substance prescribing.
Section 2: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
Rulemaking is not necessary to implement the bill’s provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
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None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 725 2021
1 A bill to be entitled
2 An act relating to nonopioid alternatives educational
3 materials; amending s. 456.44, F.S.; authorizing
4 certain health care practitioners to provide an
5 educational pamphlet regarding the use of nonopioid
6 alternatives for the treatment of pain to certain
7 persons electronically; providing an effective date.
8
9 Be It Enacted by the Legislature of the State of Florida:
10
11 Section 1. Paragraph (c) of subsection (7) of section
12 456.44, Florida Statutes, is amended to read:
13 456.44 Controlled substance prescribing.—
14 (7) NONOPIOID ALTERNATIVES.—
15 (c) Except when a patient is receiving care in a hospital
16 critical care unit or emergency department or a patient is
17 receiving hospice services under s. 400.6095, before providing
18 care requiring the administration of anesthesia involving the
19 use of an opioid drug listed as a Schedule II controlled
20 substance in s. 893.03 or 21 U.S.C. s. 812, or prescribing or
21 ordering an opioid drug listed as a Schedule II controlled
22 substance in s. 893.03 or 21 U.S.C. s. 812 for the treatment of
23 pain, a health care practitioner who prescribes or orders an
24 opioid drug must:
25 1. Inform the patient or the patient's representative of
Page 1 of 2
CODING: Words stricken are deletions; words underlined are additions.
hb0725-00
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 725 2021
26 available nonopioid alternatives for the treatment of pain,
27 which may include nonopioid medicinal drugs or drug products,
28 interventional procedures or treatments, acupuncture,
29 chiropractic treatments, massage therapy, physical therapy,
30 occupational therapy, or any other appropriate therapy as
31 determined by the health care practitioner.
32 2. Discuss with the patient or the patient's
33 representative the advantages and disadvantages of the use of
34 nonopioid alternatives, including whether the patient is at a
35 high risk of, or has a history of, controlled substance abuse or
36 misuse and the patient's personal preferences.
37 3. Provide the patient or the patient's representative
38 with an electronically transmitted or a printed copy of the
39 educational pamphlet described in paragraph (b).
40 4. Document the nonopioid alternatives considered in the
41 patient's record.
42 Section 2. This act shall take effect July 1, 2021.
Page 2 of 2
CODING: Words stricken are deletions; words underlined are additions.
hb0725-00
HB 803
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 803 Access to Health Care Practitioner Services
SPONSOR(S): Caruso
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Morris McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
HB 803 incentivizes physicians to provide pro bono health care services to certain low-income individuals and
provides an opportunity for physicians from other jurisdictions and retired physicians to provide health services
to low-income and medically underserved individuals in this state.
The bill requires Department of Health (DOH) to waive the renewal fee of a physician who demonstrates the
provision of at least 160 hours of pro bono medical services to certain populations within the biennial licensure
renewal period. Demonstration of 120 hours gains an exemption from the 40 hours of continuing medical
education required for license renewal.
The bill authorizes both the Board of Medicine and the Board of Osteopathic Medicine to issue a limited
number of restricted licenses to physicians not licensed in Florida who contract to practice for 36 months solely
in the employ of the state, a federally funded community health center, a migrant health center, a free clinic, or
a health provider in a health professional shortage area or medically underserved area. An applicant for a
restricted license must hold an active, unencumbered license to practice medicine in another jurisdiction of the
U.S. or Canada and pass a background screening. Prior to the end of the 36-month contract, the physician
must take and pass the appropriate licensing exam to become fully licensed in this state. Breach of contract
precludes full licensure.
The bill also creates a registration process for retired physicians to provide volunteer health care services if the
physician held an active license status to practice and maintained such license in good standing in this state or
in another jurisdiction of the United States or Canada for at least 20 years and contracts with a health care
provider to provide free, volunteer health care services to indigent persons or medically underserved
populations in a health professional shortage area or medically underserved area. Such a physician must work
under the supervision of a non-retired physician who holds an active, unencumbered license, provide only
medical services of the type and within the specialty performed by the physician prior to retirement, and not
perform surgery or prescribe controlled substances. These physicians are exempt from any application,
licensure, unlicensed activity, and renewal fees. Registration must be renewed biennially to demonstrate
compliance with registration requirements.
The “Access to Health Care Act” was enacted in 1992 to encourage health care providers to provide care to
low-income persons. The bill redefines low-income persons to include individuals that do not have health
insurance and have a family income that does not exceed 400 percent of the federal poverty level, rather than
the 200 percent in current law.
The bill has an indeterminate, insignificant, negative fiscal impact on DOH. The bill has no impact on local
governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Allopathic Physicians
Chapter 458, F.S., governs licensure and regulation of the practice of medicine by the Florida Board of
Medicine (allopathic board) in conjunction the Department of Health (DOH). The chapter provides,
among other things, licensure requirements by examination for medical school graduates and licensure
by endorsement requirements.
Allopathic Licensure by Examination
To be licensed by examination as an allopathic physician, an individual must: 1
• Be at least 21 years of age;
• Be of good moral character;
• Have not committed an act or offense that would constitute the basis for disciplining a physician,
pursuant to s. 458.331, F.S.;
• Have completed 2 years of post-secondary education which includes, at a minimum, courses in
fields such as anatomy, biology, and chemistry prior to entering medical school;
• Meet one of the following medical education and postgraduate training requirements:
o Graduated from an allopathic medical school recognized and approved by an accrediting
agency recognized by the U.S. Office of Education or recognized by an appropriate
governmental body of a U.S. territorial jurisdiction, and has completed at least one year
of approved residency training;
o Graduated from an allopathic foreign medical school registered with the World Health
Organization and certified pursuant to statute as meeting the standards required to
accredit U.S. medical schools, and has completed at least one year of approved
residency training; or
o Graduated from an allopathic foreign medical school that has not been certified pursuant
to statute; has an active, valid certificate issued by the Educational Commission for
Foreign Medical Graduates (ECFMG), 2 has passed that commission’s examination; and
has completed an approved residency or fellowship of at least 2 years in one specialty
area;
• Submit to a background screening by the DOH; and
• Have obtained a passing score on:
o The United States Medical Licensing Examination (USMLE);
o A combination of the USMLE, the examination of the Federation of State Medical Boards
of the United States, Inc. (FLEX), or the examination of the National Board of Medical
Examiners up to the year 2000; or
o The Special Purpose Examination of the Federation of State Medical Boards of the
United States (SPEX), if the applicant was licensed on the basis of a state board
examination, is currently licensed in at least one other jurisdiction of the United States or
Canada, and has practiced for a period of at least 10 years.
Allopathic Licensure by Endorsement
1 Section 458.311(1), F.S.
2 A graduate of a foreign medical school does not need to present an ECFMG certification or pass its exam if the graduate received his
or bachelor’s degree from an accredited U.S. college or university, studied at a medical school recognized by the World Health
Organization, and has completed all but the internship or social service requirements, has passed parts I and II of the National Board
Medical Examiners licensing examination or the ECFMG equivalent examination. (Section 458.311, F.S.)
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An individual who holds an active license to practice medicine in another jurisdiction may seek
licensure by endorsement to practice medicine in Florida. 3 The applicant must meet the same
requirements for licensure by examination. To qualify for licensure by endorsement, the applicant must
also submit evidence of the licensed active practice of medicine in another jurisdiction for at least two of
the preceding four years, or evidence of successful completion of either a board-approved
postgraduate training program within two years preceding filing of an application or a board-approved
clinical competency examination within the year preceding the filing of an application for licensure. 4
When the allopathic board determines that any applicant for licensure by endorsement has failed to
meet, to the allopathic board’s satisfaction, each of the appropriate requirements for licensure by
endorsement, it may enter an order requiring one or more of the following terms: 5
• Refusal to certify to DOH an application for licensure, certification, or registration;
• Certification to DOH of an application for licensure, certification, or registration with restrictions
on the scope of practice of the licensee; or
• Certification to DOH of an application for licensure, certification, or registration with placement
of the physician on probation for a period of time and subject to such conditions as the
allopathic board may specify, including, but not limited to, requiring the physician to submit to
treatment, attend continuing education courses, submit to reexamination, or work under the
supervision of another physician.
Allopathic License Renewal
Physician licenses are renewed biennially. The current fee for the timely renewal of a license is $360;
this fee also applies to restricted licenses and temporary certificates for practice in areas of critical
need. 6 However, renewal fees are waived for a physician holding a restricted license or temporary
certificate for practice in areas of critical need who submits a notarized statement from his or her
employer stating that the physician will not receive monetary compensation for the provision of medical
services. 7
Within each biennial licensure renewal period, a physician must complete 40 hours of continuing
medical education (CME) courses approved by the allopathic board. As a part of the 40 hours of CME,
a licensee must also complete the following:
• A two-hour course regarding domestic violence every third biennial; 8
• A one-hour course addressing the Human Immunodeficiency Virus and Acquired Immune
Deficiency Syndrome no later than upon the first biennial licensure renewal; 9
• Two hours of CME relating to the prevention of medical errors; 10 and
• Two hours of CME on prescribing controlled substances. 11
The allopathic board authorizes up to 5 hours of the required CME hours to be fulfilled by the
performance of pro bono services to indigent or underserved persons or in areas of critical need. 12 The
allopathic board has approved as pro bono service sites, federally funded community and migrant
health centers, volunteer health care provider programs contracted to provide uncompensated care
with DOH, and DOH. The licensee must obtain prior approval for such services to apply against the
CME requirement if pro bono services are to be provided to any other entity.
3 Section 458.313, F.S.
4 Section 458.313(c), F.S.
5 Section 458.313(7), F.S.
6 Rule 64B8-3.003, F.A.C. If a practitioner dispenses medicinal drugs, an additional fee of $100 must be paid at the time of renewal.
7 Id.
8 Section 456.031, F.S.
9 Section 456.033, F.S.
10 Section 456.013(7), F.S.
11 Section 456.0301, F.S.
12 Rule 64B8-13.005(9), F.A.C. Indigency is persons of low-income (no greater than 150 percent of the federal poverty level) or
uninsured persons.
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DOH may not renew a license until a licensee complies with all CME requirements. 13 The allopathic
board may also take action against a license for failure to comply with CME requirements.
Osteopathic Physicians
Chapter 459, F.S., governs licensure and regulation of the practice of medicine by the Florida Board of
Osteopathic Medicine (osteopathic board), in conjunction the DOH. The chapter provides, among other
things, general licensure requirements, including by examination for medical school graduates and
licensure by endorsement requirements.
Osteopathic General Licensure
To be licensed as an osteopathic physician, an individual must have: 14
• Completed at least three years of pre-professional post-secondary education;
• Not committed, or be under investigation in any jurisdiction for, an act or offense that would
constitute the basis for disciplining an osteopathic physician, unless the osteopathic board
determines such act does not adversely affect the applicant’s present ability and fitness to
practice osteopathic medicine;
• Not had an application for a license to practice osteopathic medicine denied or a license to
practice osteopathic medicine revoked, suspended, or otherwise acted against by the licensing
authority in any jurisdiction;
• Not received less than a satisfactory evaluation from an internship, residency, or fellowship
training program;
• Submitted to a background screening by the DOH;
• Graduated from a medical college recognized and approved by the American Osteopathic
Association;
• Successfully completes an internship or a residency of at least 12 months in a program
accredited by the American Osteopathic Association or the Accreditation Council for Graduate
Medical Education; and
• Obtained a passing score, as established by rule of the osteopathic board, on the examination
conducted by the National Board of Osteopathic Medical Examiners or other examination
approved by the osteopathic board, no more than five years prior to applying for licensure. 15
Osteopathic Licensure by Endorsement
If an applicant for a license to practice osteopathic medicine is licensed in another state, the applicant
must have actively practiced osteopathic medicine within the two years prior to applying for licensure in
this state. 16 If it has been more than two years since the active practice of osteopathic medicine and
more than two years since completion of a resident internship, residency, or fellowship and if the
osteopathic board determines that the disruption in practice has adversely affected the osteopathic
physician’s present ability to practice, the osteopathic board may: 17
• Deny the application;
• Issue the license with reasonable restrictions or conditions; or
• Issue the license upon receipt of documentation confirming the applicant has met any
reasonable conditions of the osteopathic board.
Osteopathic License Renewal
13 Section 456.031, F.S.
14 Section 459.0055(1), F.S.
15 However, if an applicant has been actively licensed in another state, the initial licensure in the other state must have occurred no
more than five years after the applicant obtained the passing score on the licensure examination.
16 Section 459.0055(2), F.S.
17 Id.
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Osteopathic physician licenses are renewed biennially. The current fee for the timely renewal of a
license is $400; this fee also applies to limited licenses and temporary certificates for practice in areas
of critical need. 18 However, the renewal fees are waived if an osteopathic physician holding a restricted
license or temporary certificate for practice in areas of critical need submits a notarized statement from
his or her employer stating that the physician will not receive monetary compensation for the provision
of medical services. 19
Within each biennial licensure renewal period, an osteopathic physician must complete 40 hours of
CME courses approved by the osteopathic board. As a part of the 40 hours of CME, a licensee must
also complete the following:
• A two-hour course regarding domestic violence every third biennial; 20
• A one-hour course addressing the Human Immunodeficiency Virus and Acquired Immune
Deficiency Syndrome no later than upon the first biennial licensure renewal; 21
• Two hours of CME relating to the prevention of medical errors; 22
• A one-hour course on profession and medical ethics education;
• A one-hour course on the federal and state laws related to the prescribing of controlled
substances; 23 and
• Two hours of CME on prescribing controlled substance. 24
The osteopathic board authorizes up to 10 hours of the required CME hours to be fulfilled by the
performance of pro bono medical services to indigent or underserved persons or in areas of critical
need. 25 The osteopathic board has approved federally-funded community and migrant health centers,
volunteer health care provider programs contracted to provide uncompensated care with DOH, and
DOH as pro bono sites. If pro bono services are to be provided to any other entity, the licensee must
obtain prior approval for such services to apply to the CME requirement.
DOH may not renew a license until a licensee complies with all CME requirements. 26 The osteopathic
board may also take action against a license for failure to comply with CME requirements. 27
Financial Responsibility
Both allopathic and osteopathic physicians must carry malpractice insurance or demonstrate proof of
financial responsibility as a condition of licensure or renewal of licensure. A physician may meet this
requirement by:
• Maintaining financial liability coverage in an amount of at least $100,000 per claim, with a
minimum annual aggregate of at least $300,000 if the licensee does not have hospital
privileges;
• Maintaining financial liability coverage in an amount of at least $250,000 per claim, with a
minimum annual aggregate of at least $750,000 if the licensee has hospital privileges;
• Maintaining an unexpired, irrevocable letter of credit or an escrow account in an amount of at
least $100,000 per claim, with a minimum aggregate availability of at least $300,000 if the
licensee does not have hospital privileges;
• Maintaining an unexpired, irrevocable letter of credit or an escrow account in an amount of at
least $250,000 per claim, with a minimum aggregate availability of at least $750,000 if the
licensee has hospital privileges; or
18 Rule 64B15-10.003, F.A.C. If a practitioner dispenses medicinal drugs, an additional fee of $100 must be paid at the time of renewal.
19 Id.
20 Section 456.031, F.S.
21 Section 456.033, F.S.
22 Section 456.013(7), F.S.
23 Rule 64B15-13.001, F.A.C.
24 Section 456.0301, F.S.
25 Rule 64B15-13.005, F.A.C. Indigency refers to persons of low-income (no greater than 150 percent of the federal poverty level) or
uninsured persons.
26 Section 456.0361, F.S.
27 Section 456.0361(2). F.S.
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• Not obtaining malpractice insurance or demonstrating financial ability but agreeing to satisfy any
adverse judgments and prominently posting a notice in the reception area to notify all patients of
such decision. 28
Physician Licensure for Volunteer and Low-Income Practice
Allopathic Restricted Licenses
Current law authorizes the allopathic board to issue restricted licenses to practice medicine in this state,
without examination, for physicians who contracts to practice for 24 months solely in the employ of the
state or a federally funded community health center or migrant health center. An applicant for a
restricted license must also: 29
• Meet the requirements for licensure by examination; and
• Have actively practiced medicine in another jurisdiction for at least two years of the immediately
preceding four years or has completed board-approved postgraduate training within the year
preceding submission of the application.
A restricted licensee must take and pass the licensure examination prior to completion of the 24-month
practice period. 30 A restricted licensee who breaches the terms of his or her contract is prohibited from
being licensed as a physician in this state. 31
The allopathic board may issue up to 100 restricted licenses annually. 32
Osteopathic Limited Licenses
Current law authorizes the osteopathic board to issue limited licenses to certain osteopathic physicians
who will only practice in areas of critical need or in medically underserved areas. A limited license may
be issued to an individual who: 33
• Submits the licensure application and required application fee of $100;
• Provides proof that he or she has been licensed to practice osteopathic medicine in any
jurisdiction of the United States in good standing for at least 10 years;
• Has completed at least 40 hours of continuing education within the preceding two year period;
and
• Will only practice in the employ of public agencies, nonprofit entities, or agencies or institutions
in areas of critical need or in medically underserved areas.
If it has been more than three years since the applicant has actively practiced osteopathic medicine, the
full-time director of the local county health department must supervise the applicant for at least six
months after issuance of the limited license. 34
The osteopathic board must review the practice of each physician who holds a limited license at least
biennially to ensure that he or she is in compliance with the practice act and rules adopted
thereunder. 35
Temporary Certificate for Practice in Areas of Critical Need
28 Sections 458.320, F.S., and 459.0085, F.S.
29 Section 458.310, F.S.
30 Section 458.310(3), F.S.
31 Section 458.310(4), F.S.
32 Section 458.310(2), F.S.
33 Section 459.0075, F.S., and r. 64B15-12.005, F.A.C.
34 Section 459.0075(2), F.S.
35 Section 459.0075(5), F.S.
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The Boards of Medicine and Osteopathic Medicine (collectively “boards”) may issue a temporary
certificate to practice in areas of critical need to an allopathic or osteopathic physician who will practice
in an area of critical need. An applicant for a temporary certificate must: 36
• Be actively licensed to practice medicine in any jurisdiction of the U.S.;
• Be employed by or practice in a county health department, correctional facility, Department of
Veterans’ Affairs clinic, federally-funded community health care center, or any other agency or
institution designated by the State Surgeon General and provides health care to underserved
populations; or
• Practice for a limited time to address critical physician-specialty, demographic, or geographic
needs for this state’s workforce as determined by the Surgeon General.
The boards are authorized to administer an abbreviated oral examination to determine a physician’s
competency, but a written examination is not required. 37 The boards may deny the application, issue
the temporary certificate with reasonable restrictions, or require the applicant to meet any reasonable
conditions of the allopathic or osteopathic board prior to issuing the temporary certificate if it has been
more than three years since the applicant has actively practiced and the respective board determines
the applicant lacks clinical competency, adequate skills, necessary medical knowledge, or sufficient
clinical decision-making. 38
Fees for the temporary certificate for practice in areas of critical need include a $300 application fee
and $429 initial licensure fee; however, these fees may be waived if the individual is not compensated
for his or her practice. 39 The temporary certificate is only valid for as long as the Surgeon General
determines that critical need remains an issue in this state. 40 However, the boards must review the
temporary certificate holder at least annually to ensure that he or she is in compliance with the practice
act and rules adopted thereunder. 41 A board may revoke or restrict the temporary certificate for practice
in areas of critical need if noncompliance is found. 42
Florida Volunteer Protection Act
The Florida Volunteer Protection Act (FVPA), s. 768.1355, F.S., limits the civil liability for volunteers.
Under the FVPA, any person who volunteers to perform any service for any nonprofit organization,
without compensation from the nonprofit organization, regardless of whether the person is receiving
compensation from another source, is an agent of the nonprofit organization when acting within the
scope of any official duties. 43 The FVPA exempts volunteers from civil liability for any act or omission
which results in personal injury or property damage if: 44
• The volunteer was acting in good faith within the scope of any official duties;
• The volunteer was acting as an ordinary reasonably prudent person would have acted under the
same or similar circumstances; and
• The injury or damage was not caused by any wanton or willful misconduct of the volunteer in
the performance of such duties.
If a volunteer is determined not to be liable pursuant to these provisions, the nonprofit organization for
which the volunteer was performing services when the damages were caused is liable for the damages
36 Sections 458.315, and 459.0076, F.S.
37 Id.
38 Sections 458.315(3)(b), and 459.0076(3)(b), F.S.
39 Rules 64B8-3.003, and 64B15-10.002, F.A.C.
40 Sections 458.315(3), and 459.0076(3), F.S.
41 Sections 458.315(3)(c), and 459.0076(3)(c), F.S.
42 Id.
43 Section 768.1355, F.S. Compensation does not include reimbursement for actual expenses, a stipend under the Domestic Service
Volunteer Act of 1973 (i.e. Americorps and SeniorCorps), or other financial assistance that is valued at less than two-thirds of the
federal minimum wage.
44 Section 768.1355(1), F.S.
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to the same extent as the nonprofit organization would have been liable if the liability limitation under
the Act had not been provided. 45
Access to Health Care Act
The “Access to Health Care Act” (Act), s. 766.1115, F.S., was enacted in 1992 to encourage health
care providers to provide care to low-income persons. 46 Low-income persons include:
• A person who is Medicaid-eligible;
• A person who is without health insurance and whose family income does not exceed 200
percent of the federal poverty level; 47 or
• Any eligible client of DOH who voluntarily chooses to participate in a program offered or
approved by the department.
Health care providers under the Act include, among others, allopathic and osteopathic physicians. 48
DOH administers the Act through the Volunteer Health Services Program, which works with DOH
entities and community and faith-based health care providers to promote access to quality health care
for the medically underserved and uninsured in this state. 49
The Act grants sovereign immunity 50 to health care providers who execute a contract with a
governmental contractor 51 and who, as agents of the state, provide volunteer, uncompensated health
care services to low-income individuals. These health care providers are considered agents of the state
under s. 768.28(9), F.S., so have sovereign immunity while acting within the scope of duties required
under the Act. 52 Therefore, the state will defend a health care provider covered under the Act in any
action alleging harm or injury, and any recovery would be limited to $200,000 for one incident and a
total of $300,000 for all recoveries related to one incident.
A contract under the Act must pertain to volunteer, uncompensated services for which the provider may
not receive compensation from the governmental contractor for any services provided under the
contract and must not bill or accept compensation from the recipient or any public or private third-party
payor for the specific services provided to the low-income recipients covered by the contract. 53
The Act establishes several contractual requirements for government contractors and health care
providers. The contract must require the government contractor to retain the right of dismissal or
45 Section 768.1355(3), F.S.
46 Section 766.1115, F.S.
47 The federal poverty level is $12,880 for a single person and $26,500 for a family of four. U.S. Department of Health and Human
Services, HHS Poverty Guidelines for 2021, (Jan. 13, 2021), available at https://aspe.hhs.gov/poverty-guidelines (last visited Feb. 23,
2021).
48 Section 766.1115(3)(d), F.S.,
49 DOH, Volunteer Health Services, available at http://www.floridahealth.gov/provider-and-partner-resources/getting-involved-in-public-
health/volunteer-health-services-opportunities/index.html (last visited Feb. 23, 2021).
50 The legal doctrine of sovereign immunity prevents a government from being sued in its own courts without its consent. According to
United States Supreme Court Justice Oliver Wendell Holmes, citing the noted 17th century Hobbes work, Leviathan, “a sovereign is
exempt from suit, not because of any formal conception or obsolete theory, but on the logical and practical ground that there can be no
legal right as against the authority that makes the law on which the right depends.” State governments in the United States, as
sovereigns, inherently possess sovereign immunity. Article X, section 13 of the Florida Constitution recognizes the concept of sovereign
immunity and gives the Legislature the power to waive immunity in part or in full by general law. Section 768.28, F.S., contains the
limited waiver of sovereign immunity applicable to the state. Under this statute, officers, employees, and agents of the state will not be
held personally liable in tort or named as a party defendant in any action for any injury or damage suffered as a result of any act, event,
or omission of action in the scope of her or his employment or function. However, personal liability may result from actions committed in
bad faith or with malicious purpose or in a manner exhibiting wanton and willful disregard of human rights, safety, or property. When an
officer, employee, or agency of the state is sued, the state steps in as the party litigant and defends against the claim. A person may
recover no more than $200,000 for one incident and the total for all recoveries related to one incident is limited to $300,000. The
sovereign immunity recovery caps do not prevent a plaintiff from obtaining a judgment in excess of the caps, but the plaintiff cannot
recover the excess damages without action by the Legislature. See Black’s Law Dictionary, 3rd Pocket Edition, 2006; Kawananakoa v
Polyblank, 205 U.S. 349, 353 (1907); Fla. Jur. 2d, Government Tort Liability, Sec. 1.; Section 768.28, F.S.
51 A governmental contractor is the DOH, a county health department, a special taxing district having health care responsibilities, or a
hospital owned and operated by a governmental entity. Section 766.1115(3)(c), F.S.
52 Section 766.1115(4), F.S.
53 Section 766.1115(3)(a), F.S.
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termination of any health care provider delivering services under the contract 54 and to have access to
the patient records of any health care provider delivering services under the contract. 55 The health care
provider must, under the contract, report adverse incidents and information on treatment outcomes to
the governmental contractor. 56 The governmental contractor or the health care provider must make
patient selection and initial referrals. 57 The health care provider is subject to supervision and regular
inspection by the governmental contractor. 58
The governmental contractor must provide written notice to each patient, or the patient’s legal
representative, receipt of which must be acknowledged in writing, that the provider is covered under s.
768.28, F.S., for purposes of legal actions alleging medical negligence. 59
In Fiscal Year 2019-2020, 13,340 licensed health care professionals (plus an additional 8,591 clinic
staff volunteers) provided 421,412 health care services under the Act. 60 The clinics and organizations
who participate in the program report that a total of 879,467 hours were donated at a value of
approximately $183 million. 61
Since February 15, 2000, 12 claims have been filed against the Volunteer Health Services Program. 62
Effect of Proposed Changes
Restricted Licenses to Practice Medicine or Osteopathic Medicine
The bill amends the criteria for the allopathic board to issue restricted licenses to practice allopathic
medicine, and authorizes the osteopathic board to issue restricted licenses to practice osteopathic
medicine to physicians who contract to practice for 36 months in certain settings. The contract must be
for employment by:
• This state;
• A federally funded community health center;
• A migrant health center;
• A free clinic that only delivers medical diagnostic services or nonsurgical medical treatment free
of charge to all low-income residents; or
• A health provider in a health professional shortage area or medical underserved areas, as
designated by the U.S. Department of Health and Human Services. 63
The bill increases the number of restricted licenses that each board may issue from 100 to 300;
however, the bill authorizes the boards to issue an unlimited number of restricted licenses to physicians
who hold active, unencumbered licenses in Canada. To obtain a restricted license, an applicant must:
• Submit a completed application;
• Be at least 21 years old;
• Be of good moral character;
54 Section 766.1115(4)(a), F.S
55 Section 766.1115(4)(b), F.S
56 Section 766.1115(4)(c), F.S
57 Section 766.1115(4)(d), F.S
58 Section 766.1115(4)(f), F.S.
59 Section 766.1115(5), F.S.
60 Department of Health, Volunteer Health Care Provider Program Annual Report, Fiscal Year 2019-2020, (Dec. 2020), available at
http://www.floridahealth.gov/provider-and-partner-resources/getting-involved-in-public-health/volunteer-health-services-
opportunities/VHCPPAnnualReport19-20.pdf (last visited Feb. 23 2021).
61 Id at p. 5.
62 Id at p. 23.
63 As of February 22, 2021, Florida has 751 health professional shortage areas and 130 medically underserved areas. See
https://data.hrsa.gov/topics/health-workforce/shortage-areas (last visited Feb. 23, 2021) (hover over Florida on the map to get the
number of health professional shortage areas and click on the State Summary of Medically Underserved Areas/Populations to obtain
the number of medically underserved areas).
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• Have not committed an act or offense that would constitute the basis for disciplining a physician
pursuant to s. 458.331, F.S., or an osteopathic physician pursuant to ch. 459, F.S.;
• Submit to a background screening by DOH; however, a Canadian applicant must also provide
the applicable board with a printed or electronic copy of his or her fingerprint-based, national
Canadian criminal history records check, which must have been completed within six months of
the date of application;
• Submit evidence of the active licensed practice of medicine or osteopathic medicine, as
appropriate in another jurisdiction for at least two of the immediately preceding four years, or
completion of postgraduate training approved by the appropriate board within the year
immediately preceding the filing of an application;
• Enter into a contract to practice for 36 months solely in the employ of the state, a federally
funded community health center, a migrant health center, a free clinic, or a health provider in a
health professional shortage area or medical underserved areas, as designated by the U.S.
Department of Health and Human Services.
Additionally, an osteopathic physicians applying for a restricted license must demonstrate:
• Completion of at least three years of pre-professional postsecondary education;
• That he or she is not under investigation in any jurisdiction that would constitute a violation of
the osteopathic medicine practice act: and
• That he or she has not had an application for a license to practice osteopathic medicine denied
or a license to practice osteopathic medicine revoked, suspended, or otherwise acted against,
by the licensing authority in any jurisdiction.
Prior to the conclusion of the contracted practice period, an allopathic or osteopathic physician must
take the appropriate licensure examination to become fully licensed in this state. However, a physician
who breaches the terms of the employment contract may not be licensed as a physician in this state.
The bill also repeals the authority of the Board of Medicine to adopt rules related to the criteria for the
issuance of restricted licenses. However, both the allopathic and osteopathic boards have broad grants
of rulemaking authority to adopt rules implementing statutes related to the licensure and regulation of
physicians. 64 Therefore, the boards may adopt any rules necessary to implement the restricted
licenses.
The bill maintains current law authorizing limited licenses for osteopathic physicians.
Volunteer Retired Physician Registration
The bill creates a registration program to allow retired physicians to practice medicine under contract
with a health care provider to provide free, volunteer health care services to indigent persons or
medically underserved populations in a health professional shortage area or medically underserved
area, as designated by the U.S. Department of Health and Human Services.
The bill authorizes a retired physician to register as a volunteer retired physician if the physician:
• Submits an application to the board within two years after changing the license to practice from
active status to retired status for an allopathic physician, of if he or submits an application to
board no more than six months before the license permanently expires and no later than two
years after such expiration for an osteopathic physician;
• Provides proof of active medical practice for at least three of the five years immediately
preceding the date on which the license changed from active status to retired status;
• Has held an active license to practice medicine or osteopathic medicine and maintained such
license in good standing in this state or in another jurisdiction or the United States or Canada for
at least 20 years;
64 See s. 458.309 and 459.005, F.S.
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• Works under the supervision of a non-retired allopathic physician or osteopathic physician, as
applicable, who holds an active, unencumbered license;
• Only provides medical services of the type and within the specialty performed by the physician
prior to retirement; and
• Does not perform surgery or prescribe controlled substances.
DOH must waive all application, licensure, unlicensed activity, and renewal fees for retired physicians
who qualify for registration under the provisions of the bill. Registration must be renewed biennially to
demonstrate compliance with registration requirements. A board may deny, revoke, or impose
restrictions or conditions on a registration if there is a violation of the practice act or the core licensing
statute (ch. 456, F.S.). A board may also revoke or deny a registration for failure to comply with
registration requirements.
Licensure Renewals
The bill requires DOH to waive the licensure renewal fee of an allopathic or osteopathic physician who
demonstrates to DOH, in a manner provided by department rule, that he or she has provided at least
160 hours of pro bono medical services to indigent persons or medically underserved populations
within the biennial renewal period.
If an allopathic or osteopathic physician provides documentation to DOH that he or she has provided at
least 120 hours of pro bono medical services within the biennial licensure period, he or she is exempt
from the 40 hours of continuing medical education required for license renewal. This exemption would
also apply to any of the specific courses, such as the courses on domestic violence, prevention of
medical errors, and prescribing controlled substances, that are calculated as a part of the required 40
hours of continuing medical education.
A physician may receive both the waiver of the licensure renewal fee and an exemption from the
continuing medical education requirements if the required number of pro bono hours are provided.
Physician Licensure by Examination
Currently, allopathic physicians who hold an active unencumbered license to practice medicine in
Canada who have practiced at least 10 years may use a passing score for the Special Purpose
Examination of the Federation of State Medical Boards of the United States to qualify for licensure in
this state. The bill clarifies the requirement that allopathic physicians licensed in Canada must practice
for 10 years to use the Special Purpose Examination of the Federation of State Medical Boards of the
United States to qualify for licensure in this state.
Access to Health Care Act
The bill increases the eligibility for services under the Act by amending the definition of low-income to
mean a person without health insurance and whose family income does not exceed 400 percent of the
federal poverty level, rather than the 200 percent in current law.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1 Amends s. 456.013, F.S., relating to department; general licensing provisions.
Section 2 Amends s. 458.310, F.S., relating to restricted licenses.
Section 3 Creates s. 458.3105, F.S., relating to registration of volunteer retired physicians.
Section 4 Amends s. 458.311, F.S., relating to licensure by examination; requirements; fees.
Section 5 Amends s. 458.319, F.S., relating to renewal of license.
Section 6 Creates s. 459.00751, F.S., relating to restricted licenses.
Section 7 Creates s. 459.00752, F.S., relating to registration of volunteer retired osteopathic
physicians.
Section 8 Amends s. 459.008, F.S., relating to renewal of licenses and certificates.
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Section 9 Amends s. 766.1115, F.S., relating to health care providers; creation of agency
relationship with governmental contractors.
Section 10 Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
The bill may have an indeterminate negative fiscal impact on DOH associated with the loss of
application, licensure, unlicensed activity, and/or renewal fees for those physicians who qualify for
the waiver of such fees. It is unknown how many may qualify, but it is not likely to be significant.
2. Expenditures:
The bill has an indeterminate, insignificant, negative fiscal impact on DOH relating to rulemaking
and processing restricted licenses and registrations.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Physicians performing pro bono medical services may not have to pay licensure renewal fees or pay for
continuing education courses.
Entities providing continuing education courses may experience reduced enrollment if physicians
provide at least 120 hours of pro bono medical services and take advantage of the continuing
education exemption.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
Both the allopathic and osteopathic boards have sufficient rulemaking authority to implement the bill’s
provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
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None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 803 2021
1 A bill to be entitled
2 An act relating to access to health care practitioner
3 services; amending s. 456.013, F.S.; exempting
4 physicians and osteopathic physicians who provide a
5 certain number of hours of pro bono services from
6 continuing education requirements; amending s.
7 458.310, F.S.; revising the eligibility criteria for a
8 restricted license; creating s. 458.3105, F.S.;
9 establishing a registration program for volunteer
10 retired physicians; providing eligibility criteria for
11 such registration; requiring biennial registration
12 renewal; requiring the Department of Health to waive
13 certain fees; authorizing the Board of Medicine to
14 deny, revoke, or impose restrictions or conditions on
15 a registration for certain violations and
16 noncompliance; amending s. 458.311, F.S.; revising the
17 physician licensure criteria for Canadian applicants;
18 amending s. 458.319, F.S.; requiring the department to
19 waive a physician's license renewal fee under certain
20 circumstances; deleting an obsolete date; creating s.
21 459.00751, F.S.; providing legislative intent;
22 authorizing the Board of Osteopathic Medicine to issue
23 a restricted license to qualified applicants;
24 providing eligibility criteria for such license;
25 requiring a restricted licensee to take and
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26 successfully complete a specified licensure
27 examination to become fully licensed; prohibiting
28 licensure if a restricted licensee breaches the terms
29 of an employment contract; creating s. 459.00752,
30 F.S.; establishing a registration program for
31 volunteer retired osteopathic physicians; providing
32 eligibility criteria for such registration; requiring
33 biennial registration renewal; requiring the
34 Department of Health to waive certain fees;
35 authorizing the Board of Osteopathic Medicine to deny,
36 revoke, or impose restrictions or conditions on a
37 registration for certain violations or noncompliance;
38 amending s. 459.008, F.S.; requiring the department to
39 waive an osteopathic physician's license or
40 certificate renewal fee under certain circumstances;
41 deleting an obsolete date; amending s. 766.1115, F.S.;
42 revising the definition of the term "low-income" for
43 purposes of the Access to Health Care Act; providing
44 an effective date.
45
46 Be It Enacted by the Legislature of the State of Florida:
47
48 Section 1. Subsections (6) and (9) of section 456.013,
49 Florida Statutes, are amended to read:
50 456.013 Department; general licensing provisions.—
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51 (6) As a condition of renewal of a license, the Board of
52 Medicine, the Board of Osteopathic Medicine, the Board of
53 Chiropractic Medicine, and the Board of Podiatric Medicine shall
54 each require licensees which they respectively regulate to
55 periodically demonstrate their professional competency by
56 completing at least 40 hours of continuing education every 2
57 years. The boards may require by rule that up to 1 hour of the
58 required 40 or more hours be in the area of risk management or
59 cost containment. This provision may shall not be construed to
60 limit the number of hours that a licensee may obtain in risk
61 management or cost containment to be credited toward satisfying
62 the 40 or more required hours. This provision may shall not be
63 construed to require the boards to impose any requirement on
64 licensees except for the completion of at least 40 hours of
65 continuing education every 2 years. Each of such boards shall
66 determine whether any specific continuing education requirements
67 not otherwise mandated by law shall be mandated and shall
68 approve criteria for, and the content of, any continuing
69 education mandated by such board. Notwithstanding any other
70 provision of law, the board, or the department when there is no
71 board, may approve by rule alternative methods of obtaining
72 continuing education credits in risk management. The alternative
73 methods may include attending a board meeting at which another
74 licensee is disciplined, serving as a volunteer expert witness
75 for the department in a disciplinary case, or serving as a
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76 member of a probable cause panel following the expiration of a
77 board member's term. Other boards within the Division of Medical
78 Quality Assurance, or the department if there is no board, may
79 adopt rules granting continuing education hours in risk
80 management for attending a board meeting at which another
81 licensee is disciplined, for serving as a volunteer expert
82 witness for the department in a disciplinary case, or for
83 serving as a member of a probable cause panel following the
84 expiration of a board member's term.
85 (9) Any board that currently requires continuing education
86 for renewal of a license, or the department if there is no
87 board, shall adopt rules to establish the criteria for
88 continuing education courses. The rules may provide that up to a
89 maximum of 25 percent of the required continuing education hours
90 can be fulfilled by the performance of pro bono services to the
91 indigent or to underserved populations or in areas of critical
92 need within the state where the licensee practices. However, a
93 physician licensed under chapter 458 or an osteopathic physician
94 licensed under chapter 459 who submits to the department
95 documentation proving that he or she has completed at least 120
96 hours of pro bono services within a biennial licensure period is
97 exempt from the continuing education requirements established by
98 board rule under subsection (6). The board, or the department if
99 there is no board, must require that any pro bono services be
100 approved in advance in order to receive credit for continuing
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101 education under this subsection. The standard for determining
102 indigency shall be that recognized by the Federal Poverty Income
103 Guidelines produced by the United States Department of Health
104 and Human Services. The rules may provide for approval by the
105 board, or the department if there is no board, that a part of
106 the continuing education hours can be fulfilled by performing
107 research in critical need areas or for training leading to
108 advanced professional certification. The board, or the
109 department if there is no board, may make rules to define
110 underserved and critical need areas. The department shall adopt
111 rules for administering continuing education requirements
112 adopted by the boards or the department if there is no board.
113 Section 2. Subsections (2) and (3) of section 458.310,
114 Florida Statutes, are amended to read:
115 458.310 Restricted licenses.—
116 (2) The board of Medicine may annually, by rule, develop
117 criteria and, without examination, issue restricted licenses
118 authorizing the practice of medicine in this state annually to
119 up to 300 persons and to an unlimited number of physicians who
120 hold active, unencumbered licenses to practice medicine in
121 Canada if such applicants complete all of the following 100
122 persons to practice medicine in this state who:
123 (a) Submit to the department a completed application form.
124 (b)(a) Meet the requirements of s. 458.311(1)(b), (c),
125 (d), and (g). A Canadian applicant must also provide the board
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126 with a printed or electronic copy of his or her fingerprint-
127 based, national Canadian criminal history records check,
128 conducted within 6 months after the date of application.;
129 (c)(b) Show evidence of the active licensed practice of
130 medicine in another jurisdiction for at least 2 years of the
131 immediately preceding 4 years, or completion of board-approved
132 postgraduate training within the year immediately preceding the
133 filing of an application.; and
134 (d)(c) Enter into a contract to practice for a period of
135 up to 36 24 months solely in the employ of the state, or a
136 federally funded community health center, or a migrant health
137 center; or a free clinic that delivers only medical diagnostic
138 services or nonsurgical medical treatment free of charge to all
139 low-income residents; or a health care provider in a health
140 professional shortage area or medically underserved area
141 designated by the United States Department of Health and Human
142 Services, at the current salary level for that position. The
143 board may of Medicine shall designate other areas of critical
144 need in the state where these restricted licensees may practice.
145 (3) Before the end of the contracted 24-month practice
146 period, the restricted licensee physician must take and
147 successfully complete the licensure examination under s. 458.311
148 to become fully licensed in this state.
149 Section 3. Section 458.3105, Florida Statutes, is created
150 to read:
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151 458.3105 Registration of volunteer retired physicians.—
152 (1) A retired physician may register under this section to
153 practice medicine as a volunteer retired physician if he or she
154 completes all of the following:
155 (a) Submits an application to the board on a form
156 developed by the department within 2 years after the date on
157 which his or her license changed from active to retired status.
158 (b) Provides proof to the department that he or she
159 actively practiced medicine for at least 3 of the 5 years
160 immediately preceding the date on which his or her license
161 changed from active to retired status.
162 (c) Has held an active license to practice medicine and
163 maintained such license in good standing in this state or in at
164 least one other jurisdiction of the United States or Canada for
165 at least 20 years.
166 (d) Contracts with a health care provider to provide free,
167 volunteer medical services to indigent persons or medically
168 underserved populations in health professional shortage areas or
169 medically underserved areas designated by the United States
170 Department of Health and Human Services.
171 (e) Works under the supervision of a nonretired physician
172 who holds an active, unencumbered license.
173 (f) Only provides medical services of the type and within
174 the specialty that he or she performed before retirement and
175 does not perform surgery or prescribe a controlled substance as
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176 defined in s. 893.02.
177 (2) The retired physician shall apply biennially to the
178 board for renewal of his or her registration by demonstrating to
179 the board compliance with this section.
180 (3) The department shall waive all application, licensure,
181 unlicensed activity, and renewal fees for qualifying retired
182 physicians under this section.
183 (4) The board may deny, revoke, or impose restrictions or
184 conditions on a registration for any violation of this chapter
185 or chapter 456 or rules adopted thereunder, or deny or revoke a
186 registration for noncompliance with this section.
187 Section 4. Paragraph (h) of subsection (1) of section
188 458.311, Florida Statutes, is amended to read:
189 458.311 Licensure by examination; requirements; fees.—
190 (1) Any person desiring to be licensed as a physician, who
191 does not hold a valid license in any state, shall apply to the
192 department on forms furnished by the department. The department
193 shall license each applicant who the board certifies:
194 (h) Has obtained a passing score, as established by rule
195 of the board, on the licensure examination of the United States
196 Medical Licensing Examination (USMLE); or a combination of the
197 United States Medical Licensing Examination (USMLE), the
198 examination of the Federation of State Medical Boards of the
199 United States, Inc. (FLEX), or the examination of the National
200 Board of Medical Examiners up to the year 2000; or for the
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201 purpose of examination of any applicant who was licensed on the
202 basis of a state board examination and who is currently licensed
203 in at least one other jurisdiction of the United States or
204 Canada, and who has practiced pursuant to such licensure for a
205 period of at least 10 years, or any applicant who holds an
206 active, unencumbered license to practice medicine in Canada and
207 who has practiced pursuant to such licensure for a period of at
208 least 10 years, use of the Special Purpose Examination of the
209 Federation of State Medical Boards of the United States (SPEX)
210 upon receipt of a passing score as established by rule of the
211 board. However, for the purpose of examination of any applicant
212 who was licensed on the basis of a state board examination
213 before prior to 1974, who is currently licensed in at least
214 three other jurisdictions of the United States or Canada, and
215 who has practiced pursuant to such licensure for a period of at
216 least 20 years, this paragraph does not apply.
217 Section 5. Subsection (1) of section 458.319, Florida
218 Statutes, is amended to read:
219 458.319 Renewal of license.—
220 (1) The department shall renew a license upon receipt of
221 the renewal application, evidence that the applicant has
222 actively practiced medicine or has been on the active teaching
223 faculty of an accredited medical school for at least 2 years of
224 the immediately preceding 4 years, and a fee not to exceed $500;
225 provided, however, that if the licensee is either a resident
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226 physician, assistant resident physician, fellow, house
227 physician, or intern in an approved postgraduate training
228 program, as defined by the board by rule, the fee may shall not
229 exceed $100 per annum. If the licensee demonstrates to the
230 department, in a manner set by department rule, that he or she
231 has provided at least 160 hours of pro bono medical services to
232 indigent persons or medically underserved populations within the
233 biennial renewal period, the department shall waive the renewal
234 fee. If the licensee has not actively practiced medicine for at
235 least 2 years of the immediately preceding 4 years, the board
236 shall require that the licensee successfully complete a board-
237 approved clinical competency examination before prior to renewal
238 of the license. "Actively practiced medicine" means that
239 practice of medicine by physicians, including those employed by
240 any governmental entity in community or public health, as
241 defined by this chapter, including physicians practicing
242 administrative medicine. An applicant for a renewed license must
243 also submit the information required under s. 456.039 to the
244 department on a form and under procedures specified by the
245 department, along with payment in an amount equal to the costs
246 incurred by the Department of Health for the statewide criminal
247 background check of the applicant. The applicant must submit a
248 set of fingerprints to the Department of Health on a form and
249 under procedures specified by the department, along with payment
250 in an amount equal to the costs incurred by the department for a
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251 national criminal background check of the applicant for the
252 initial renewal of his or her license after January 1, 2000. If
253 the applicant fails to submit either the information required
254 under s. 456.039 or a set of fingerprints to the department as
255 required by this section, the department shall issue a notice of
256 noncompliance, and the applicant will be given 30 additional
257 days to comply. If the applicant fails to comply within 30 days
258 after the notice of noncompliance is issued, the department or
259 board, as appropriate, may issue a citation to the applicant and
260 may fine the applicant up to $50 for each day that the applicant
261 is not in compliance with the requirements of s. 456.039. The
262 citation must clearly state that the applicant may choose, in
263 lieu of accepting the citation, to follow the procedure under s.
264 456.073. If the applicant disputes the matter in the citation,
265 the procedures set forth in s. 456.073 must be followed.
266 However, if the applicant does not dispute the matter in the
267 citation with the department within 30 days after the citation
268 is served, the citation becomes a final order and constitutes
269 discipline. Service of a citation may be made by personal
270 service or certified mail, restricted delivery, to the subject
271 at the applicant's last known address. If an applicant has
272 submitted fingerprints to the department for a national criminal
273 history check upon initial licensure and is renewing his or her
274 license for the first time, then the applicant need only submit
275 the information and fee required for a statewide criminal
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276 history check.
277 Section 6. Section 459.00751, Florida Statutes, is created
278 to read:
279 459.00751 Restricted licenses.—
280 (1) It is the intent of the Legislature to provide medical
281 services to all residents of this state at an affordable cost.
282 (2) The board may annually issue restricted licenses
283 authorizing the practice of osteopathic medicine in this state
284 to up to 300 persons and to an unlimited number of osteopathic
285 physicians who hold active, unencumbered licenses to practice
286 osteopathic medicine in Canada if such applicants complete all
287 of the following:
288 (a) Submit to the department a completed application form.
289 (b) Meet the requirements of s. 459.0055(1)(b), (c), (d),
290 (e), (f), (g), and (j). A Canadian applicant must also provide
291 the board with a printed or electronic copy of his or her
292 fingerprint-based, national Canadian criminal history records
293 check, conducted within 6 months after the date of application.
294 (c) Show evidence of the active licensed practice of
295 osteopathic medicine in another jurisdiction for at least 2
296 years of the immediately preceding 4 years, or completion of
297 board-approved postgraduate training within the year immediately
298 preceding the filing of an application.
299 (d) Enter into a contract to practice osteopathic medicine
300 for a period of up to 36 months in the employ of the state, a
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301 federally funded community health center, or a migrant health
302 center; a free clinic that delivers only medical diagnostic
303 services or nonsurgical medical treatment free of charge to all
304 low-income residents; or a health care provider in a health
305 professional shortage area or medically underserved area
306 designated by the United States Department of Health and Human
307 Services. The board may designate other areas of critical need
308 in the state where these restricted licensees may practice.
309 (3) Before the end of the contracted practice period, the
310 restricted licensee must take and successfully complete the
311 licensure examination under s. 459.0055 to become fully licensed
312 in this state.
313 (4) If the restricted licensee breaches the terms of the
314 employment contract, he or she may not be licensed as an
315 osteopathic physician in this state under any licensing
316 provisions.
317 Section 7. Section 459.00752, Florida Statutes, is created
318 to read:
319 459.00752 Registration of volunteer retired osteopathic
320 physicians.—
321 (1) A retired osteopathic physician may register under
322 this section to practice osteopathic medicine as a volunteer
323 retired osteopathic physician if he or she completes all of the
324 following:
325 (a) Submits an application to the board on a form
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326 developed by the department no earlier than 6 months before the
327 date on which his or her license permanently expires and no
328 later than 2 years after such expiration.
329 (b) Provides proof to the department that he or she
330 actively practiced osteopathic medicine for at least 3 of the 5
331 years immediately preceding the date on which his or her license
332 changed from active to retired status.
333 (c) Has held an active license to practice osteopathic
334 medicine and maintained such license in good standing in this
335 state or in at least one other jurisdiction of the United States
336 or Canada for at least 20 years.
337 (d) Contracts with a health care provider to provide free,
338 volunteer medical services to indigent persons or medically
339 underserved populations in health professional shortage areas or
340 medically underserved areas designated by the United States
341 Department of Health and Human Services.
342 (e) Works under the supervision of a nonretired
343 osteopathic physician who holds an active, unencumbered license.
344 (f) Only provides medical services of the type and within
345 the specialty that he or she performed before retirement and
346 does not perform surgery or prescribe a controlled substance as
347 defined in s. 893.02.
348 (2) The registrant shall apply biennially to the board for
349 renewal of his or her registration by demonstrating to the board
350 compliance with this section.
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351 (3) The department shall waive all application, licensure,
352 unlicensed activity, and renewal fees for qualifying applicants
353 under this section.
354 (4) The board may deny, revoke, or impose restrictions or
355 conditions on a registration for any violation of this chapter
356 or chapter 456 or rules adopted thereunder, or deny or revoke a
357 registration for noncompliance with this section.
358 Section 8. Subsection (1) of section 459.008, Florida
359 Statutes, is amended to read:
360 459.008 Renewal of licenses and certificates.—
361 (1) The department shall renew a license or certificate
362 upon receipt of the renewal application and fee. If the
363 applicant for a renewed license or certificate demonstrates to
364 the department, in a manner set by department rule, that he or
365 she has provided at least 160 hours of pro bono osteopathic
366 medical services to indigent persons or medically underserved
367 populations in health professional shortage areas or medically
368 underserved areas designated by the United States Department of
369 Health and Human Services within the biennial renewal period,
370 the department shall waive the renewal fee. An applicant for a
371 renewed license must also submit the information required under
372 s. 456.039 to the department on a form and under procedures
373 specified by the department, along with payment in an amount
374 equal to the costs incurred by the department of Health for the
375 statewide criminal background check of the applicant. The
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376 applicant must submit a set of fingerprints to the Department of
377 Health on a form and under procedures specified by the
378 department, along with payment in an amount equal to the costs
379 incurred by the department for a national criminal background
380 check of the applicant for the initial renewal of his or her
381 license after January 1, 2000. If the applicant fails to submit
382 either the information required under s. 456.039 or a set of
383 fingerprints to the department as required by this section, the
384 department shall issue a notice of noncompliance, and the
385 applicant will be given 30 additional days to comply. If the
386 applicant fails to comply within 30 days after the notice of
387 noncompliance is issued, the department or board, as
388 appropriate, may issue a citation to the applicant and may fine
389 the applicant up to $50 for each day that the applicant is not
390 in compliance with the requirements of s. 456.039. The citation
391 must clearly state that the applicant may choose, in lieu of
392 accepting the citation, to follow the procedure under s.
393 456.073. If the applicant disputes the matter in the citation,
394 the procedures set forth in s. 456.073 must be followed.
395 However, if the applicant does not dispute the matter in the
396 citation with the department within 30 days after the citation
397 is served, the citation becomes a final order and constitutes
398 discipline. Service of a citation may be made by personal
399 service or certified mail, restricted delivery, to the subject
400 at the applicant's last known address. If an applicant has
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401 submitted fingerprints to the department for a national criminal
402 history check upon initial licensure and is renewing his or her
403 license for the first time, then the applicant need only submit
404 the information and fee required for a statewide criminal
405 history check.
406 Section 9. Paragraph (e) of subsection (3) of section
407 766.1115, Florida Statutes, is amended to read:
408 766.1115 Health care providers; creation of agency
409 relationship with governmental contractors.—
410 (3) DEFINITIONS.—As used in this section, the term:
411 (e) "Low-income" means:
412 1. A person who is Medicaid-eligible under Florida law;
413 2. A person who is without health insurance and whose
414 family income does not exceed 400 200 percent of the federal
415 poverty level as defined annually by the federal Office of
416 Management and Budget; or
417 3. Any client of the department who voluntarily chooses to
418 participate in a program offered or approved by the department
419 and meets the program eligibility guidelines of the department.
420 Section 10. This act shall take effect July 1, 2021.
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HB 7001
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 7001 PCB GOS 21-01 OGSR/Nurse Licensure Compact
SPONSOR(S): Government Operations Subcommittee, Garrison
TIED BILLS: IDEN./SIM. BILLS: SB 7000
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY
CHIEF
Orig. Comm.: Government Operations 15 Y, 0 N Roth Smith
Subcommittee
1) Professions & Public Health Subcommittee Guzzo McElroy
2) State Affairs Committee
SUMMARY ANALYSIS
The Open Government Sunset Review Act requires the Legislature to review each public record and each
public meeting exemption five years after enactment. If the Legislature does not reenact the exemption, it
automatically repeals on October 2nd of the fifth year after enactment.
The Nurse Licensure Compact (NLC) allows a nurse to have one license, issued by the primary state of
licensure, with the privilege to practice in other compact states. The NLC applies to registered nurses and
licensed practical or vocational nurses. The NLC was enacted into Florida law in 2016.
Current law provides a public record exemption for a nurse’s personal identifying information, other than the
nurse’s name, licensure status, or licensure number held by the Department of Health or the Board of Nursing
pursuant to the NLC. A nurse’s personal identifying information may be disclosed, however, by the state that
originally reported the information to the coordinated licensure information system, to the extent permitted by
the reporting state’s law. Current law also provides a public meeting exemption for portions of a meeting of the
Interstate Commission of Nurse Licensure Compact Administrators at which matters specifically exempted
from disclosure are discussed.
The bill saves from repeal the public record exemption and public meeting exemption, which will repeal on
October 2, 2021, if this bill does not become law.
The bill does not appear to have a fiscal impact on state or local governments.
The bill provides an effective date of October 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Open Government Sunset Review Act
The Open Government Sunset Review Act (Act) 1 sets forth a legislative review process for newly
created or substantially amended public record or public meeting exemptions. It requires an automatic
repeal of the exemption on October 2nd of the fifth year after creation or substantial amendment,
unless the Legislature reenacts the exemption. 2
The Act provides that a public record or public meeting exemption may be created or maintained only if
it serves an identifiable public purpose. In addition, it may be no broader than is necessary to meet one
of the following purposes:
• Allow the state or its political subdivisions to effectively and efficiently administer a
governmental program, which administration would be significantly impaired without the
exemption.
• Protect sensitive personal information that, if released, would be defamatory or would
jeopardize an individual’s safety; however, only the identity of an individual may be exempted
under this provision.
• Protect trade or business secrets. 3
If, and only if, in reenacting an exemption that will repeal, the exemption is expanded (essentially
creating a new exemption), then a public necessity statement and a two-thirds vote for passage are
required. 4 If the exemption is reenacted with grammatical or stylistic changes that do not expand the
exemption, if the exemption is narrowed, or if an exception to the exemption is created then a public
necessity statement and a two-thirds vote for passage are not required.
Access to Public Records and Meetings
The Florida Constitution provides that the public has the right to access government records and
meetings. The public may inspect or copy any public record made or received in connection with the
official business of any public body, officer, or employee of the state, or of persons acting on their
behalf. 5 The public also has a right to be afforded notice and access to meetings of any collegial public
body of the executive branch of state government or of any local government. 6 The Legislature’s
meetings must also be open and noticed to the public, unless there is an exception provided for by the
Constitution. 7
In addition to the Florida Constitution, Florida law specifies conditions under which public access must
be provided to government records and meetings. The Public Records Act 8 guarantees every person’s
1 Section 119.15, F.S.
2 Section 119.15(3), F.S.
3 Section 119.15(6)(b), F.S.
4 Section 24(c), Art. I, FLA. CONST.
5 FLA. CONST. art. I, s. 24(a).
6 FLA. CONST. art. I, s. 24(b).
7 Id.
8 Chapter 119, F.S.
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right to inspect and copy any state or local government public record. 9 The Sunshine Law 10 requires all
meetings of any board or commission of any state or local agency or authority at which official acts are
to be taken to be noticed and open to the public. 11
The Legislature may create an exemption to public records or open meetings requirements. An
exemption must specifically state the public necessity justifying the exemption 12 and must be tailored to
accomplish the stated purpose of the law. 13
Nurse Licensure Compact
The Nurse Licensure Compact (NLC) was designed as a multistate agreement establishing a mutual
recognition system between states for the licensure of registered nurses (RNs) and licensed practical
or vocational nurses (LPN/LVN). Prior to the compact’s enactment, the National Council of State
Boards of Nursing (NCSBN) produced a model bill for state legislatures to enact in order for their
respective states to join the compact. 14 The compact was revised and expanded and was enacted into
Florida law in 2016, 15 and implemented statewide on January 19, 2018. 16
A nurse who is issued a multi-state license 17 from a state that is party to the NLC is permitted to
practice in any state that is also party to the compact. A nurse with a multistate license privilege must
comply with the practice laws of the state in which he or she is practicing or where the patient is
located. 18 A party state may continue to issue a single-state license 19 and authorize practice only in that
state.
The NLC permits a state to take adverse action against the multistate licensure privilege of any nurse
practicing in that state. 20 The home state has the exclusive authority to take adverse action against the
9 Section 119.011(12), F.S., defines “public record” to mean “all documents, papers, letters, maps, books, tapes, photographs, films,
sound recordings, data processing software, or other material, regardless of the physical form, characteristics, or means of
transmission, made or received pursuant to law or ordinance or in connection with the transaction of official business by any agency.”
Section 119.011(2), F.S., defines “agency” to mean “any state, county, district, authority, or municipal officer, department, division,
board, bureau, commission, or other separate unit of government created or established by law including, for the purposes of this
chapter, the Commission on Ethics, the Public Service Commission, and the Office of Public Counsel, and any other public or private
agency, person, partnership, corporation, or business entity acting on behalf of any public agency.” The Public Records Act does not
apply to legislative or judicial records. Locke v. Hawkes, 595 So.2d 32 (Fla. 1992). The Legislature’s records are public pursuant to
section 11.0431, F.S.
10 Section 286.011, F.S.
11 Section 286.011(1)-(2), F.S. The Sunshine Law does not apply to the Legislature; rather, open meetings requirements for the
Legislature are set out in the Florida Constitution. Article III, section 4(e) of the Florida Constitution provides that legislative committee
meetings must be open and noticed to the public. In addition, prearranged gatherings, between more than two members of the
Legislature, or between the Governor, the President of the Senate, or the Speaker of the House of Representatives, the purpose of
which is to agree upon or to take formal legislative action, must be reasonably open to the public.
12 FLA. CONST. art. I, s. 24(c).
13 Id.
14 National Council of State Boards of Nursing (NCSBN), Licensure Compacts, available at https://www.ncsbn.org/compacts.htm (last
visited February 5, 2021). The NCSBN arose out of the recognition that in order to guard the safety of the public, the organization
involved in the regulation of nurses needed to be a separate entity from the American Nurses Association and Council on State Boards
of Nursing, which represents professional nurses. NCSBN’s membership is now comprised of boards of nursing and other nursing
regulatory bodies that are charged with the responsibility of providing regulatory excellence for public health, safety and welfare, and
protecting the public by ensuring that safe and competent nursing care is provided by licensed nurses. The NCSBN is the vehicle
through which these entities act and counsel together on matters of common interest.
15 Chapter 2016-139, L.O.F.; codified as s. 464.0095, F.S.
16 Florida Department of Health, Florida’s Enhanced Nurse Licensure Compact to be Implemented Statewide January 19, 2018,
available at http://www.floridahealth.gov/newsroom/2018/01/011818-nursing-
compact.html#:~:text=Florida's%20Enhanced%20Nurse%20Licensure%20Compact%20to%20be%20Implemented%20Statewide%20J
anuary%2019%2C%202018,-Contact%3A&text=Tallahassee%2C%20Fla.,Nurse%20Licensure%20Compact%2C%20or%20eNLC.
(last visited February 25, 2021).
17 “Multistate license” means a license to practice as a registered nurse (RN) or a licensed practical/vocational nurse (LPN/VN) issued
by a home state licensing board which authorizes the licensed nurse to practice in all party states under a multistate licensure privilege.
Section 464.0095, Art. II, (10), F.S.
18 Section 464.0095, Art. III, (5), F.S.
19 “Single-state license” means a nurse license issued by a party state which authorizes practice only within the issuing state and does
not include a multistate licensure privilege to practice in any other party state. Section 464.0095, Art. II, (15), F.S.
20 Section 464.0095, Art. III, (4), F.S.
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home state license, including revocation and suspension. 21 The NLC requires all participating states to
report to the coordinated licensure information system (CLIS) 22 all adverse actions taken against a
nurse’s license or multistate licensure practice privilege, any current significant investigative
information, and denials of information. 23
The Department of Health (DOH) licenses nurses while the Board of Nursing regulates the practice of
nursing in Florida. DOH collects and provides certain information to the NCSBN CLIS system on all
RNs and LPN/LVNs with NLC multistate licenses practicing in Florida. Some of the information
collected by DOH are the NCSBN ID numbers, mothers’ maiden names, dates of birth, social security
numbers, race, and home phone number of the RNs and LPN/LVNs.
All party states may access the CLIS to see licensure and disciplinary information for nurses licensed in
the party states. 24 The CLIS includes a nurse’s personal identifying information, licensure classification
information and statuses, public emergency and final disciplinary action information, and status
information about multistate licensure privileges from all party states. A party state may designate the
information it contributes to the CLIS as confidential, prohibiting its disclosure to nonparty states. 25
State licensing boards must report disciplinary information, significant investigative information, and
denials of applications to the CLIS promptly. 26
The NLC established the Interstate Commission of Nurse Licensure Compact Administrators
(commission) 27 to oversee and administer the operation and provisions of the NLC. 28 The head of each
state’s licensing board, 29 or his or her designee, must serve as the state’s delegate to the commission.
The NLC grants the commission authority to promulgate uniform rules relating to the implementation
and administration of the NLC. 30 The commission may also take action against a party state if a party
state fails to meet its obligations under the NLC, including termination of membership after exhausting
all other means of compliance. 31
21 Id.
22 “Coordinated licensure information system” means an integrated process for collecting, storing, and sharing information on nurse
licensure and enforcement activities related to nurse licensure laws which is administered by a nonprofit organization composed of and
controlled by licensing boards. Section 464.0095, Art. II, (5), F.S.
23 Section 464.0095, Art. III, (4), F.S.
24 Section 464.0095, Art. IV, (1), F.S.
25 Section 464.0095, Art. VI, (4), F.S.
26 Section 464.0095, Art. VI, (3), F.S.
27 “Commission” means the Interstate Commission of Nurse Licensure Compact Administrators established by this compact. Section
464.0095, Art. II, (3), F.S.
28 NCSBN, The Interstate Commission of Nurse Licensure Compact Administrators: Final Rules (January 1, 2019), available at
https://www.ncsbn.org/finalrules.pdf (last visited February 25, 2021).
29 “Licensing board” means a party state’s regulatory body responsible for issuing nurse licenses. Section 464.0095, Art. II, (9), F.S.
30 Section 464.0095, Art. VII, (7)(a), F.S.
31 Section 464.0095, Art. IX, (4), F.S.
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All commission meetings are open to the public and must be publicly noticed. 32 Both meetings and
hearings for proposed rules must be noticed at least 60 days prior to each meeting on the NLC’s
website and on the website of each party state’s licensing board or published in the publication in which
each state would otherwise post proposed rules. 33 The NLC also provides for public comment
opportunities through both oral and written testimony. 34 Closed meetings are permitted if the
commission is discussing: 35
• A party state’s noncompliance with its obligations under the NLC;
• The employment, compensation, discipline, or other personnel matters, practices, or procedures
related to a specific employee or other matters related to the commission’s internal personnel
practices and procedure;
• Current, threatened, or reasonably anticipated litigation;
• Contract negotiations for the purchase or sale of goods, services, or real estate;
• Accusations against a person of a crime or formal censuring a person;
• Disclosure of trade secrets or commercial or financial information that is privileged or
confidential;
• Disclosure of information of a personal nature where disclosure would constitute a clearly
unwarranted invasion of personal privacy;
• Disclosure of investigatory records compiled for law enforcement purposes;
• Disclosure of information related to any reports prepared by or on behalf of the commission for
the purpose of investigating compliance with the NLC; or
• Matters specifically exempted from disclosure by federal or state law.
The commission must keep comprehensive minutes of matters discussed in its meetings and provide a
full and accurate summary of actions taken. Minutes of a closed meeting will be sealed; however, such
minutes may be released pursuant to a majority vote of the commission or an order of a court of
competent jurisdiction. 36
Public Record and Public Meeting Exemptions under Review
In 2016, the Legislature created a public record exemption for a nurse’s personal identifying
information, other than the nurse’s name, licensure status, or licensure number held by DOH or the
Board of Nursing pursuant to the NLC. 37 Such information is exempt 38 from public record requirements.
However, a nurse’s personal identifying information may be disclosed by the state that originally
reported the information to the coordinated licensure information system, to the extent permitted by the
reporting state’s law. 39 The Legislature also created a public meeting exemption for portions of a
meeting of the commission, at which matters specifically exempted from disclosure are discussed,
including recordings, minutes, and records generated during an exempt meeting. 40
32 Section 464.0095, Art. VII, (2)(d), F.S.
33 Section 464.0095, Art. VIII, (3), F.S.
34 Section 464.0095, Art. VIII, (7)(a), F.S.
35 Section 464.0095, Art. VII, (2)(e), F.S.
36 Section 464.0095, Art. VII (2)(f), F.S.
37 Chapter 2016-97, L.O.F.; codified as s. 464.0096(1), F.S.
38 There is a difference between records the Legislature designates as exempt from public record requirements and those the
Legislature deems confidential and exempt. A record classified as exempt from public disclosure may be disclosed under certain
circumstances. See WFTV, Inc. v. The School Board of Seminole, 874 So.2d 48, 53 (Fla. 5th DCA 2004), review denied 892 So.2d
1015 (Fla. 2004); City of Riviera Beach v. Barfield, 642 So.2d 1135 (Fla. 4th DCA 1994); Williams v. City of Minneola, 575 So.2d 687
(Fla. 5th DCA 1991). If the Legislature designates a record as confidential and exempt from public disclosure, such record may not be
released by the custodian of public records to anyone other than the persons or entities specifically designated in statute. See Attorney
General Opinion 85-62 (August 1, 1985).
39 Section 464.0096(1), F.S.
40 Chapter 2016-97, L.O.F.; codified as s. 464.0096(2), F.S.
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The 2016 public necessity statement 41 for the exemptions provides that:
The Legislature finds that the public record and public meeting exemptions are necessary because
protection of such information is required under the NLC, which the state must adopt in order to
become a party state to the compact. Without the public records exemption, this state will be unable to
effectively and efficiently implement and administer the compact. Furthermore, without the public
meeting exemption, the state will be prohibited from becoming a party state to the NLC. 42
Pursuant to the Open Government Sunset Review Act, the exemptions will repeal on October 2, 2021,
unless reenacted by the Legislature. 43
During the 2020 interim, the House Government Operations Subcommittee sent DOH a questionnaire
as part of its review under the Open Government Sunset Review Act. 44 According to DOH, 18,458 RNs
and 2,744 LPN/LVNs, who received their initial nursing license in Florida, currently hold NLC multistate
licenses. 45 Additionally, 12,988 RNs and 2,375 LPN/LVNs, received their initial nursing license in a
state other than Florida, and currently hold NLC multistate licenses permitting them to practice in
Florida. 46 DOH staff recommends that the exemption be reenacted, noting the exemption language is
uniform throughout the United States. 47
Effect of the Bill
The bill removes the scheduled repeal date of the public record exemption and public meeting
exemption. Thereby maintaining the public record exemption for a nurse’s personal identifying
information, other than the nurse’s name, licensure status, or licensure number held by DOH or the
Board of Nursing pursuant to the NLC; and maintaining the public meeting exemption for portions of a
meeting of the commission at which matters specifically exempted from disclosure are discussed.
B. SECTION DIRECTORY:
Section 1: Amends s. 464.0096, F.S., to save from repeal the public record exemption and public
meeting exemption for certain personal identifying information held by DOH or the Board of
Nursing pursuant to the NLC as well as recordings, minutes, and records generated during
an exempt meeting.
Section 2: Provides an effective date of October 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
41 Article I, s. 24(c), FLA. CONST., requires each public record exemption to “state with specificity the public necessity justifying the
exemption.”
42 Section 2, ch. 2016-97, L.O.F.
43 Section 381.82(3)(d)4., F.S.
44 Open Government Sunset Review Questionnaire, DOH Response, October 5, 2020, on file with the House Government Operations
Subcommittee.
45 Id. at p. 2.
46 Id.
47 Id. at p. 8.
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1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill does not provide a grant of rulemaking authority, nor does it require rulemaking.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
None.
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DATE: 2/23/2021
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 7001 2021
1 A bill to be entitled
2 An act relating to a review under the Open Government
3 Sunset Review Act; amending s. 464.0096, F.S., which
4 provides an exemption from public records requirements
5 for certain information held by the Department of
6 Health or the Board of Nursing pursuant to the Nurse
7 Licensure Compact and an exemption from public meeting
8 requirements for certain meetings of the Interstate
9 Commission of Nurse Licensure Compact Administration;
10 removing the scheduled repeal of the exemptions;
11 providing an effective date.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15 Section 1. Section 464.0096, Florida Statutes, is amended
16 to read:
17 464.0096 Nurse Licensure Compact; public records and
18 meetings exemptions.—
19 (1) A nurse's personal identifying information, other than
20 the nurse's name, licensure status, or licensure number,
21 obtained from the coordinated licensure information system, as
22 defined in s. 464.0095, and held by the department or the board
23 is exempt from s. 119.07(1) and s. 24(a), Art. I of the State
24 Constitution unless the state that originally reported the
25 information to the coordinated licensure information system
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 7001 2021
26 authorizes the disclosure of such information by law. Under such
27 circumstances, the information may only be disclosed to the
28 extent permitted by the reporting state's law.
29 (2)(a) A meeting or portion of a meeting of the Interstate
30 Commission of Nurse Licensure Compact Administrators established
31 under s. 464.0095 at which matters specifically exempted from
32 disclosure by federal or state statute are discussed is exempt
33 from s. 286.011 and s. 24(b), Art. I of the State Constitution.
34 (b) Recordings, minutes, and records generated during an
35 exempt meeting are exempt from s. 119.07(1) and s. 24(a), Art. I
36 of the State Constitution.
37 (3) This section is subject to the Open Government Sunset
38 Review Act in accordance with s. 119.15 and shall stand repealed
39 on October 2, 2021, unless reviewed and saved from repeal
40 through reenactment by the Legislature.
41 Section 2. This act shall take effect October 1, 2021.
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