Professions & Public Health Subcommittee Meeting Packet, March 16, 2021

Summary

The meeting packet for the Professions & Public Health Subcommittee of the House of Representatives on Tuesday, March 16, 2021, 9:30 AM to 11:30 AM in Webster Hall (212 Knott), with Chris Sprowls as Speaker and Will Robinson as Chair. Bills listed for consideration include HB 239 Regulation of Smoking by Counties and Municipalities, HB 541 Veterans' Preference in Employment, HB 697 Injured Police Canines and HB 6095 Scheduling of Drug Products Containing Cannabidiol. Proposed committee substitutes for HB 1063, Administration of Vaccines, and HB 1565, Department of Health, are also listed. The packet reproduces the bills and staff analyses.

Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used

Cite this document

“2021 03 16 3093 Professions Public Health Subcommittee Meeting Packets Mtg12909.” Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2021-03-16-3093-professions-public-health-subcommittee-meeting-packets-41b2e172a3/, SHA-256 a49c125460800d3cd11288473c45d726beefa1b9f2014d230a331cb2c8315bd5.

Full text

Note: this text does not show the bill's strike-through (deleted) and underline (added) coding; see the original PDF for which words are struck.

Professions and Public Health
Subcommittee
Tuesday, March 16, 2021
9:30 AM – 11:30 AM
Webster Hall (212 Knott)

Meeting Packet

Chris Sprowls Will Robinson
Speaker Chair
Committee Meeting Notice
HOUSE OF REPRESENTATIVES

Professions & Public Health Subcommittee

Start Date and Time: Tuesday, March 16, 2021 09:30 am

End Date and Time: Tuesday, March 16, 2021 11:30 am

Location: Webster Hall (212 Knott)
Duration: 2.00 hrs

Consideration of the following bill(s):

HB 239 Regulation of Smoking by Counties and Municipalities by Altman
HB 541 Veterans' Preference in Employment by Buchanan, DiCeglie
HB 543 Occupational Therapy by Koster
HB 697 Injured Police Canines by Killebrew
HB 1097 Health Care Licensure Requirements by Learned
HB 6095 Scheduling of Drug Products Containing Cannabidiol by Fischer

Consideration of the following bill(s) with proposed committee substitute(s):

PCS for HB 1063 -- Administration of Vaccines
PCS for HB 1565 -- Department of Health

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 03/12/2021 4:10PM by Dewees.Cheryl

03/12/2021 04:10:46PM Leagis ® Page 1 of 1
HB 239
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 239 Regulation of Smoking by Counties and Municipalities
SPONSOR(S): Altman
TIED BILLS: IDEN./SIM. BILLS:

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

1) Professions & Public Health Subcommittee Morris McElroy

2) Environment, Agriculture & Flooding
Subcommittee

3) Health & Human Services Committee

SUMMARY ANALYSIS
The Florida Clean Indoor Air Act (FCIAA), implements Article X, Section 20 of the Florida Constitution. Article
X, Section 20 of the Florida Constitution prohibits a person from smoking tobacco or using a vapor-generating
electronic device in an enclosed indoor workplace, with certain exceptions.

The state preempts the regulation of smoking and does not allow counties or municipalities to regulate
smoking. HB 239 amends the FCIAA to allow counties and municipalities to restrict smoking within the
boundaries of any public beach or park they own.

The bill changes the title of the “Florida Clean Indoor Air Act” to the “Florida Clean Air Act” to account for the
broader application of the act proposed in the bill.

The bill has no fiscal impact on state governments. The bill may have an indeterminate, negative fiscal impact
on local governments.

The bill provides and 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: h0239.PPH
DATE: 3/15/2021
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Present Situation

Smoking Regulation in Florida

While the Food and Drug Administration (FDA) regulates the manufacture, distribution, and marketing
of tobacco and vaping products, it does not regulate smoking or vaping in public places – leaving that
to the states.

In 1985, the Florida Legislature enacted the Florida Clean Indoor Air Act (FCIAA) 1 to protect the public
health, comfort, and environment by creating areas in public places and at public meetings that were
reasonably free from tobacco smoke. The FCIAA originally prohibited smoking in certain indoor public
places (e.g. government buildings, elevators, public transportation, hospitals, day care centers) or
common areas of an indoor public place (e.g. lobby, hallway, stairwell, restrooms), but did permit
designated smoking areas of specified indoor public places such as places of employment, retail
stores, indoor arenas, and restaurants.

Under the FCIAA, smoking means inhaling, exhaling, burning, carrying, or possessing any lighted
tobacco product, including cigarettes, cigars, pipe tobacco, and any other lighted product. 2 Currently,
the state preempts the regulation of smoking and does not allow counties or municipalities to regulate
smoking, except school districts may further restrict smoking on school district property. 3 Local
governments may impose more restrictive regulation on the use of vapor-generated electronic
devices. 4

Article X, Section 20 of the Florida Constitution

In the November 2002 General Election, Floridians voted to create Article X, Section 20 of the Florida
Constitution, titled “Workplaces without tobacco smoke,” which further restricted smoking indoors. 5 The
purpose of this citizens’ initiative was to protect people from the health hazards of secondhand tobacco
smoke by prohibiting smoking in enclosed indoor workplaces, which are defined as:

Any place where one or more persons engage in work, 6 and which place is
predominantly or totally bounded on all sides and above by physical barriers,
regardless of whether such barriers consist of or include uncovered openings,
screened or otherwise partially covered openings; or open or closed windows,
jalousies, doors, or the like. 7

1 Ch. 386, Part II, F.S.; ch. 85-257, Laws of Fla.
2 S. 386.203(11), F.S.
3 S. 386.209, F.S.
4 Id.; “Vapor-generating electronic devices” means any product that employs an electronic, a chemical, or a mechanical means capable

of producing vapor or aerosol from a nicotine product or any other substance, including, but not limited to, an electronic cigarette,
electronic cigar, electronic cigarillo, electronic pipe, or other similar device or product, any replacement cartridge for such device, and
any other container of a solution or other substance intended to be used with or within an electronic cigarette, electronic cigar,
electronic cigarillo, electronic pipe, or other similar device or product.
5 Text available at: https://dos.elections.myflorida.com/initiatives/fulltext/pdf/34548-1.pdf (last visited March 14, 2021). The constitutional

provision does not preclude the Legislature from enacting more restrictive regulation of tobacco smoking.
6 “Work” is defined as “any persons providing any employment or employment-type service for or at the request of another individual or

individuals or any public or private entity, whether for compensation or not, whether full or part-time, whether legally or not.” Fla. Const.,
art. X, s. 20. “Work” includes, without limitation, any such service performed by an employee, independent contractor, agent, partner,
proprietor, manager, officer, director, apprentice, trainee, associate, servant, volunteer, and the like. The term does not include
noncommercial activities performed by members of a membership association. S. 386.203(12), F.S.
7 The smoking ban applies to all enclosed indoor workplaces regardless of whether work is occurring at any given time, Fla. Const., art.

X, s. 20.
STORAGE NAME: h0239.PPH PAGE: 2
DATE: 3/15/2021
The provision also provided various other definitions and exceptions to the smoking ban, and required
the Legislature to implement the section in law by the following legislative session. Accordingly, in
2003, the Legislature amended the FCIAA to conform existing law and implement the constitutional
provision in a manner consistent with its broad purpose and stated terms. 8

In the November 2018, General Election, Floridians passed Amendment No. 9, which amended Article
X, Section 20 of the Florida Constitution, banning the use of vapor-generating electronic devices, or
vaping, in enclosed indoor workplaces, consistent with the prohibition on tobacco smoking. 9

The FCIAA prohibits smoking and vaping in an enclosed indoor workplace, unless it is a: 10

• Private residence that is not being used commercially to provide child care, adult care, or health
care, or any combination thereof;
• Retail tobacco shop;
• Designated smoking guest room in a public lodging establishment;
• Stand-alone bar; 11
• Smoking cessation program or medical or scientific research; or
• Customs smoking room in an airport.

However, an owner, lessee, or a person otherwise in control of an enclosed indoor workplace may
further prohibit or limit smoking or vaping therein. 12

Additionally, no one under the age of 18 years old may smoke tobacco or vape in, on, or within 1,000
feet of a public or private grade school between 6 a.m. and midnight. 13 Violators of this provision are
subject to a citation from a law enforcement officer. 14

Persons in charge of enclosed indoor workplaces are required to develop and implement smoking and
vaping prohibition policies in line with the FCIAA requirements. 15 Persons in charge of a smoking or
vaping cessation program, medical or scientific research, or an airport terminal that includes a customs
smoking room must all post signs clearly stating that smoking is only permitted in the designated
areas. 16 Additionally, public transportation carriers in certain locations are required to make regular
announcements regarding the smoking and vaping prohibition. 17

The Department of Health (DOH) and the Department of Business and Professional Regulation (DBPR)
are each responsible for the enforcement of the FCIAA as it relates to their respective areas of
regulatory authority. 18 If an enclosed indoor work place violates the FCIAA and does not correct the
violation within 30 days, DOH or DBPR may impose fines against the owner and pursue compliance in
circuit court, if necessary. 19 Additionally, any person who violates the FCIAA by smoking or vaping in

8 Ch. 2003-398, Laws of Fla.
9 Text available at: p. 26-30 https://dos.myflorida.com/media/699824/constitutional-amendments-2018-general-election-english.pdf (last

visited March 14, 2021). Note: Amendment No. 9 also amended article II, section 7 of the Florida Constitution to ban offshore oil and
gas drilling.
10 Ss. 386.204 and 386.2045, F.S. Additionally, s. 386.203(5)(c), F.S., by definition of an “enclosed indoor workplace,” excludes any

facility owned or leased by and used exclusively for noncommercial activities performed by the members and guests of a membership
association, including social gatherings, meetings, dining, and dances, if no person or persons are engaged in work.
11 A stand-alone bar is a licensed premises that predominantly or totally serves alcoholic beverages and in which serving food is merely

incidental to the sale of alcohol. Also, it must not share a common entryway or indoor area with a business that predominantly serves
food during the hours the stand-alone bar is operating its business, s. 386.203(11), F.S. See also s. 561.695, F.S.
12 Fla. Const., art X, sec. 20(b).
13 S. 386.212(1), F.S.
14 S. 386.212(2), F.S.
15 S. 386.206(1), F.S.
16 S. 386.206(2)-(3), F.S.
17 S. 386.211, F.S.
18 Ss. 386.207(1) and 561.695, F.S. DBPR enforces the FCIAA in restaurants, bowling centers, dog tracks, horse tracks, bars, billiards,

bingo halls (with food service), and civic/fraternal organizations. DOH enforces the FCIAA in all facilities not regulated by DBPR. Florida
Department of Health, Florida Clean Indoor Air Act, Enforcement, http://www.floridahealth.gov/environmental-health/indoor-air-
quality/indoor-air-act/index.html (last visited March 14, 2021).
19 S. 386.207(3), F.S.

STORAGE NAME: h0239.PPH PAGE: 3
DATE: 3/15/2021
an enclosed indoor work place commits a noncriminal violation and may be subject to a fine of up to
$100 for the first violation and up to $500 for each subsequent violation. 20

County and Municipally Owned Parks
The Division of Recreation and Parks within the Florida Department of Environmental Protection
maintains a comprehensive inventory of the existing park facilities and outdoor resources in Florida.
The inventory provides details about the parks and recreation areas in the state and contains
information on more than 13,000 outdoor recreational facilities in Florida, the majority of which are
county and municipal parks. 21

There are 67 county park systems and more than 400 municipal park systems in the state. 22 Such
parks provide a wide variety of activities to the public, including nature trails, bird watching, youth and
adult athletics, bike paths, horse trails, boat ramps, fishing piers, outdoor gyms, and outdoor
pavilions. 23 For example, Orange County maintains and operates 118 county-owned parks, which
consist of a wide array of available activities and facilities. 24 Additionally, municipalities within Orange
County also own and operate parks and outdoor recreational facilities, For example, the City of Winter
Park owns and operates 11 city parks, which offer similar recreational activities to county-owned
parks. 25

Public Beaches

Florida has 825 miles of sandy coastline, attracting over 18 million tourists each year. 26 A significant
portion of Florida’s beaches is publicly owned, including federally-owned areas managed by the
National Park Service, parts of Florida’s 175 state parks, and the many beaches owned and managed
by local governments on the coast. 27 In general, access to these beaches is free through the numerous
public access points along the coast however; some state parks, counties and municipalities charge an
access fee.

Health Concerns

In 2020, an estimated 15 percent of the adults in Florida were tobacco smokers. 28 Tobacco smoke
contains over 7,000 chemicals, including hundreds that are toxic and up to 69 that are known to cause
cancer. 29 More than 480,000 deaths annually in the United States are caused by cigarette smoking,

20 S 386.208, F.S.
21 Florida Division of Recreation and Parks, Florida Outdoor Recreation Inventory, available at: https://floridadep.gov/parks/florida-

outdoor-recreation-inventory (last visited March 14, 2021)
22 Florida Department of Environmental Protection, Division of Recreation and Parks, Frequently Asked Questions,

https://prodenv.dep.state.fl.us/DrpOrpcr/StaticFiles/FAQ.pdf (last visited March 14, 2021).
23 Id.
24 Orange County Government Florida, Parks, http://www.orangecountyfl.net/CultureParks/Parks.aspx (last visited March 14, 2021).
25 City of Winter Park, Parks, https://cityofwinterpark.org/departments/parks-recreation/parks-playgrounds/parks/ (last visited March 14,

2021).
26 Department of Environmental Protection, Beaches, https://floridadep.gov/water/beaches (last visited at March 14, 2021).
27 National Park Service, Canaveral National Seashore, Nature and Science, https://www.nps.gov/cana/learn/nature/index.htm (last

visited March 14, 2021). Canaveral National Seashore’s 24 miles of undeveloped beach is the longest such stretch on the east coast of
Florida; National Park Service, Gulf Islands National Seashore, Things To Do, https://www.nps.gov/guis/planyourvisit/things2do.htm
(last visited March 14, 2021). Gulf Islands National Seashore stretches for 160 miles along the coasts of both Florida and Mississippi;
DEP, Beaches and Coasts at Florida State Parks, https://www.floridastateparks.org/learn/beaches-and-coasts-florida-state-parks (last
visited March 14, 2021). Florida’s state parks include 100 miles of beaches; DEP, Map of Florida’s Coastal Counties,
https://floridadep.gov/fco/fcmp/documents/map-floridas-coastal-counties (last visited March 14, 2021); Office of Economic &
Demographic Research, Annual Assessment of Florida’s Water Resources and Conservation Lands, 2018 Edition, 9, 17 (2018),
available at http://edr.state.fl.us/content/natural-resources/LandandWaterAnnualAssessment_2018Edition.pdf (last visited March 14,
2021). Beaches in coastal counties are important for tourism and Florida’s “brand”; DEP, Florida Coastal Management Program, Final
Assessment and Strategies, FY 2016 – FY 2020, 30 (2015) available at https://floridadep.gov/sites/default/files/FCMP_FY2016-
20_Assessment.pdf (last visited March 14, 2021). Based on shoreline access sites, there are approximately 439 miles of public
saltwater beach in Florida.
28 United Health Foundation, America’s Health Rankings, Annual Report, available at:

https://www.americashealthrankings.org/explore/annual/measure/Smoking/state/FL (last visited March 14, 2021).
29 Id.; U.S. Department of Health and Human Services, The Health Consequences of Smoking—50 Years of Progress: A Report of the

Surgeon General, 148 (2014), https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf (last visited March 14,
2021).
STORAGE NAME: h0239.PPH PAGE: 4
DATE: 3/15/2021
with exposure to secondhand smoke causing an estimated 41,000 deaths each year. 30 Exposure to
secondhand smoke can cause numerous health problems and has been causally linked to cancer and
other fatal diseases. 31 Secondhand smoke is generally defined as smoke from burning tobacco
products or smoke that is exhaled by a tobacco smoker. 32 Studies suggest that secondhand smoke in
crowded outdoor areas can cause concentrations of air contaminants comparable to those caused by
indoor smoking. 33

Effect of Proposed Changes

The bill authorizes counties and municipalities to further restrict smoking within the boundaries of any
public beaches and public parks they own. Municipalities may further restrict smoking within the
boundaries of public beaches and public parks that are within their jurisdiction, but owned by the
county, unless such restriction conflicts with county ordinance.

The bill changes the title of Part II of ch. 386, F.S., from “Indoor Air: Smoking and Vaping” to “Smoking
and Vaping.”

The bill provides an effective date of July 1, 2021.

B. SECTION DIRECTORY:
Section 1 Renames Part II of chapter 386, F.S., from “INDOOR AIR: SMOKING AND VAPING” to
“SMOKING AND VAPING.”
Section 2 Amends s. 386.201, F.S., relating to popular name.
Section 3 Amends s. 386.209, F.S., relating to regulation of smoking preempted to state.
Section 4 Amends s. 381.84, F.S., relating to Comprehensive Statewide Tobacco Education and
Use Prevention Program.
Section 5 Amends s. 386.211, F.S., relating to public announcements in mass transportation
terminals.
Section 6 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:

30 Centers for Disease Control and Prevention, Tobacco-Related Mortality,

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm (last visited March 14,
2021).
31 U.S. Department of Health and Human Services, The Health Consequences of Smoking—50 Years of Progress: A Report of the

Surgeon General, 7 (2014); Center for Disease Control and Prevention, Secondhand Smoke (SHS) Facts,
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm (last visited March 14, 2021).
32 Center for Disease Control and Prevention, Secondhand Smoke (SHS) Facts,

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm (last visited March 14, 2021).
33 Nipapun Kungskulniti et al., Secondhand Smoke Point-Source Exposures Assessed By Particulate Matter At Two Popular Public

Beaches in Thailand, 40 J. Public Health 3, 527–532 (2017),
https://academic.oup.com/jpubhealth/article/40/3/527/4110319?guestAccessKey=5947c328-fd75-4b6c-acfe-28f989c4c639 (last visited
March 14, 2021); James Repace, Benefits of Smoke-free Regulations in Outdoor Settings: Beaches, Golf Courses, Parks, Patios and in
Motor Vehicles, 34 WM Mitchell L. Rev. 1621, 1622–1624, 1638 (2008), https://open.mitchellhamline.edu/wmlr/vol34/iss4/15/ (last
visited March 14, 2021).
STORAGE NAME: h0239.PPH PAGE: 5
DATE: 3/15/2021
1. Revenues:
To the extent that any imposed smoking restrictions deter or encourage visitation of county and
municipal beaches and parks, local governments may experience and indeterminate fluctuation in
revenues generated by any fees for beach and park admittance.

2. Expenditures:
Counties and municipalities that opt to restrict smoking within the boundaries of public parks may
incur indeterminate expenses related to enacting and enforcing such restrictions.

C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Visitors to county or municipal parks who violate smoking restrictions imposed by a county or
municipality may be subject to any applicable fines or civil penalties for such violations.

D. FISCAL COMMENTS:
None.

III. COMMENTS

A. CONSTITUTIONAL ISSUES:

1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to require counties or municipalities to spend funds or take
action requiring the expenditure of funds; reduce the authority that counties or municipalities have to
raise revenues in the aggregate; or reduce the percentage of state tax shared with counties or
municipalities.

2. Other:
None.

B. RULE-MAKING AUTHORITY:
Rulemaking authority is not needed to implement the provisions of the bill.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: h0239.PPH PAGE: 6
DATE: 3/15/2021
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 239 2021

1 A bill to be entitled
2 An act relating to the regulation of smoking by
3 counties and municipalities; revising the title of
4 part II of ch. 386, F.S.; amending s. 386.201, F.S.;
5 revising a short title; amending s. 386.209, F.S.;
6 authorizing counties and municipalities to further
7 restrict smoking within the boundaries of public
8 beaches and public parks under certain circumstances;
9 amending ss. 381.84 and 386.211, F.S.; conforming
10 provisions to changes made by the act; providing an
11 effective date.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15 Section 1. Part II of chapter 386, Florida Statutes,
16 entitled "INDOOR AIR: SMOKING AND VAPING," is renamed "SMOKING
17 AND VAPING."
18 Section 2. Section 386.201, Florida Statutes, is amended
19 to read:
20 386.201 Short title Popular name.—This part may be cited
21 as by the popular name the "Florida Clean Indoor Air Act."
22 Section 3. Section 386.209, Florida Statutes, is amended
23 to read:
24 386.209 Regulation of smoking preempted to state.—This
25 part expressly preempts regulation of smoking to the state and

Page 1 of 3

CODING: Words stricken are deletions; words underlined are additions.
hb0239-00
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 239 2021

26 supersedes any municipal or county ordinance on the subject;
27 however, counties and municipalities may further restrict
28 smoking within the boundaries of any public beaches and public
29 parks that they own. Municipalities may further restrict smoking
30 within the boundaries of public beaches and public parks that
31 are within their jurisdiction but are owned by the county,
32 unless such restriction conflicts with a county ordinance.
33 School districts may further restrict smoking by persons on
34 school district property. This section does not preclude the
35 adoption of municipal or county ordinances that impose more
36 restrictive regulation on the use of vapor-generating devices
37 than is provided in this part.
38 Section 4. Paragraph (h) of subsection (3) of section
39 381.84, Florida Statutes, is amended to read:
40 381.84 Comprehensive Statewide Tobacco Education and Use
41 Prevention Program.—
42 (3) PROGRAM COMPONENTS AND REQUIREMENTS.—The department
43 shall conduct a comprehensive, statewide tobacco education and
44 use prevention program consistent with the recommendations for
45 effective program components contained in the 1999 Best
46 Practices for Comprehensive Tobacco Control Programs of the CDC,
47 as amended by the CDC. The program shall include the following
48 components, each of which shall focus on educating people,
49 particularly youth and their parents, about the health hazards
50 of tobacco and discouraging the use of tobacco:

Page 2 of 3

CODING: Words stricken are deletions; words underlined are additions.
hb0239-00
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 239 2021

51 (h) Enforcement and awareness of related laws.—In
52 coordination with the Department of Business and Professional
53 Regulation, the program shall monitor the enforcement of laws,
54 rules, and policies prohibiting the sale or other provision of
55 tobacco to minors, as well as the continued enforcement of the
56 Florida Clean Indoor Air Act prescribed in chapter 386. The
57 advertisements produced in accordance with paragraph (a) may
58 also include information designed to make the public aware of
59 these related laws and rules. The departments may enter into
60 interagency agreements to carry out this program component.
61 Section 5. Section 386.211, Florida Statutes, is amended
62 to read:
63 386.211 Public announcements in mass transportation
64 terminals.—Announcements about the Florida Clean Indoor Air Act
65 shall be made regularly over public address systems in terminals
66 of public transportation carriers located in metropolitan
67 statistical areas with populations over 230,000 according to the
68 latest census. These announcements shall be made at least every
69 30 minutes and shall be made in appropriate languages. Each
70 announcement must include a statement to the effect that Florida
71 is a clean indoor air state and that smoking and vaping are
72 prohibited except as provided in this part.
73 Section 6. This act shall take effect July 1, 2021.

Page 3 of 3

CODING: Words stricken are deletions; words underlined are additions.
hb0239-00
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 239 (2021)
Amendment No.1

COMMITTEE/SUBCOMMITTEE ACTION
ADOPTED (Y/N)
ADOPTED AS AMENDED (Y/N)
ADOPTED W/O OBJECTION (Y/N)
FAILED TO ADOPT (Y/N)
WITHDRAWN (Y/N)
OTHER

1 Committee/Subcommittee hearing bill: Professions & Public
2 Health Subcommittee
3 Representative Sabatini offered the following:
4
5 Amendment (with title amendment)
6 Remove everything after the enacting clause and insert:
7 Section 1. This act shall be cited as the "Stop the Nanny
8 State, Big Government, and Abolition of Individual Choice Act."
9 Section 2. Any county or municipality that enacts an
10 ordinance regulating smoking on public beaches or in public
11 parks is subject to a $10 million fine payable to Cigar Rights
12 of America for each ordinance enacted.
13 Section 3. This act shall take effect July 1, 2021.
14
15 -----------------------------------------------------
16 T I T L E A M E N D M E N T
205139 - h0239-strikeall.docx
Published On: 3/15/2021 5:54:55 PM
Page 1 of 2
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 239 (2021)
Amendment No.1

17 Remove everything before the enacting clause and insert:
18 A bill to be entitled
19 An act relating to the regulation of smoking by
20 counties and municipalities; providing a short title;
21 providing that any county or municipality that enacts
22 an ordinance regulating smoking on public beaches or
23 in public parks is subject to a fine for each such
24 ordinance enacted; providing an effective date.
25
26 WHEREAS, commercial cigar rolling first came to Florida in
27 the 1830s, and
28 WHEREAS, in the decades after the United States Civil War,
29 cigar making became one of the most important industries in
30 Florida, and
31 WHEREAS, cigar rolling grew from small-scale operations
32 started by Cuban immigrants to encompass large factory
33 operations that attracted immigrants from throughout Europe and
34 Latin America to Florida's growing cities, and
35 WHEREAS, Florida and the cigar industry have a rich and
36 extensive history, and
37 WHEREAS, the history of cigar rolling is intertwined and
38 synonymous with the state's immigrant story, and
39 WHEREAS, any law limiting or deterring cigar smoking is
40 abhorrent to Floridians and must not be allowed, NOW, THEREFORE,

205139 - h0239-strikeall.docx
Published On: 3/15/2021 5:54:55 PM
Page 2 of 2
HB 541
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 541 Veterans' Preference in Employment
SPONSOR(S): Buchanan
TIED BILLS: IDEN./SIM. BILLS: SB 922

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

1) Local Administration & Veterans Affairs 18 Y, 0 N Renner Miller
Subcommittee

2) Professions & Public Health Subcommittee Rahming McElroy

3) State Affairs Committee

SUMMARY ANALYSIS
Current law requires the state and its political subdivisions to give employment preference in hiring and
retention to all veterans, Florida National Guard members, reserve components of the United States Armed
Forces, Gold Star Mothers and Fathers, widows/widowers, legal guardians, and certain spouses who meet
specified criteria. Certain government positions are exempt from the veterans’ preference requirements
including, but not limited to, heads of departments, personal secretaries of elected or appointed officers, and
certain physicians.

Point preferences are given to veterans and family members grouped into certain categories when a
numerically based selection process is used for hiring.

The bill authorizes state agencies and political subdivisions to waive a postsecondary education requirement
for a position of employment for a current member of any reserve component of the United States Armed
Forces or the Florida National Guard or a veteran who has been honorably discharged if the person is
otherwise qualified for the position.

The bill removes certain positions that are exempt from veterans’ preference requirements as they appear to
be redundant under current law.

The bill requires, rather than authorizes, political subdivisions to develop and implement a veterans’
recruitment plan that establishes annual goals for ensuring the full use of veterans in the agency’s or political
subdivision’s workforce.

The bill increases the point preferences given to veterans and their family members when a numerically based
selection process is used for hiring by five points for each category.

The bill does not appear to have a fiscal impact on the state or local governments.

The bill has 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: h0541b.PPH
DATE: 3/15/2021
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Present Situation
State Personnel System

The State Personnel System is the largest of the state government employers within Florida. 1 State
Personnel System employees fall into four service categories: 2
• Career Service;
• Senior Management Service (SMS);
• Selected Exempt Service (SES); and
• Other Personal Services (OPS).

SES and SMS employees hold established positions, receive employee benefits, and are exempt from
career service provisions. SES and SMS employees serve at the pleasure of the agency head and may
be terminated at any time, with or without cause. Positions categorized as OPS are considered
temporary positions and these employees are not eligible for benefits.

Career Service System

The Career Service System includes the majority of State employees. 3 These employees hold
established positions, accrue benefits, and have certain employment rights afforded to them, such as
the right to collectively bargain. 4

Under s. 110.205(2), certain positions are exempt from the Career Service System, including but not
limited to: 5
• The personal secretary of either elected or appointed officers;
• Heads of departments; and
• Positions that require licensure as a physician, an osteopathic physician, and a chiropractic
physician.

Veterans’ Employment Preference

Current law defines a “veteran” as a person who served in the active military, naval, or air service and
who was discharged or released under honorable conditions, or who later received an upgraded
discharge under honorable conditions. 6 Florida has the nation’s third-largest veteran population with
roughly 1.5 million veterans. 7

1 Department of Management Services (DMS), For State Personnel System Employees,

https://www.dms.myflorida.com/workforce_operations/human_resource_management/for_state_personnel_system_employees#:~:text=
Employees%20of%20the%20State%20Personnel,positions%20and%20receive%20certain%20benefits. (last visited Mar. 10, 2021).
2 S. 110.2035, F.S.
3 See, DMS, State of Florida New Employee Orientation, available at https://www.dms.myflorida.com/content/download/14847/82111

(last visited Mar. 11, 2021).
4 Collective bargaining is the negotiation between an employer and a bargaining agent chosen by a group of employees to determine

the terms and conditions of employment. Collective bargaining for state employees in Florida is provided by the Florida Constitution and
is governed by the provisions of ch. 447, F.S.
5 S. 110.205(2), F.S.
6 S. 1.01(14), F.S.
7 Enterprise Florida, Florida Defense Factbook, p. 1 (2020), https://www.enterpriseflorida.com/wp-content/uploads/Florida-Defense-

Factbook-2020.pdf (last visited Jan. 29, 2021).
STORAGE NAME: h0541b.PPH PAGE: 2
DATE: 3/15/2021
Florida has included some form of veterans’ employment preference in law since 1947. 8 The purpose
of having a veterans’ preference is to reward those who served their country in a time of need and to
recognize the qualities and traits developed by military service. 9

The state and its political subdivisions 10 must give employment preference in hiring and retention to the
following: 11
• Disabled veterans who have served on active duty in any branch of the United States Armed
Forces 12 and who presently have an existing service-connected disability which is compensable
under public laws administered by the United States Department of Veterans Affairs (VA) or are
receiving compensation, disability retirement benefits, or pension by reason of public laws
administered by the VA and the United States Department of Defense (DoD).
• The spouse of a veteran who:
o Has a total and permanent service-connected disability and who, because of this
disability, cannot qualify for employment; or
o Is missing in action, captured in line of duty by a hostile force, or forcibly detained or
interned in line of duty by a foreign government or power.
• A veteran of any war who has served at least one day during that wartime period or who has
been awarded a campaign or expeditionary medal. Active duty for training may not be allowed
for eligibility under this provision.
• The unremarried widow or widower of a veteran who died of a service-connected disability.
• The mother, father, legal guardian, or unremarried widow or widower of a member of the Armed
Forces who died in the line of duty under combat-related conditions, as verified by the DoD.
• A veteran as defined in s. 1.01(14), F.S.
• A current member of any reserve component 13 of the United States Armed Forces or the Florida
National Guard.

The following government positions are exempt from the veterans’ preference requirements: 14
• Positions that are currently exempt from the state Career Service System under s. 110.205(2);
however, all positions under the University Support Personnel System of the State University
System and all Career Service System positions under the Florida College System and the
School for the Deaf and the Blind, or the equivalent positions at state universities, Florida
College System institutions, or the School for the Deaf and the Blind are included.
• Positions in political subdivisions which are filled by officers elected by popular vote or persons
appointed to fill vacancies in such offices and the personal secretary of such officer; members
of boards and commissions; persons employed on a temporary basis without benefits; heads of
departments; positions that require licensure as a physician, osteopathic physician, or
chiropractic physician; and positions that require employees to be a member of the Florida Bar.

Each state agency must, and each political subdivision may, develop and implement a veterans’
recruitment plan that establishes annual goals for ensuring the full use of veterans in the entity’s
workforce. 15 Additionally, the Department of Management Services (DMS) is required to collect
statistical data for each state agency on the number of persons who claim veterans’ preference, the
number of persons who were hired through veterans’ preference, and the number of persons who were

8 Ch. 24201, s. 1, Laws of Fla.
9 Yates v. Rezeau, 60 So. 2d 726, 727 (Fla. 1952); See ch. 98-33, Laws of Fla.
10 S. 1.01(8), F.S., defines the term “political subdivision” as counties, cities, towns, villages, special tax school districts, special road

and bridge districts, bridge districts, and all other districts in the state.
11 S. 295.07(1)(a)-(g), F.S.
12 10 USC §101(a) defines the term “Armed Forces” as the Army, Navy, Air Force, Marine Corps, Space Force, and Coast Guard.
13 10 USC §10102 provides that the purpose of reserve components is to provide trained units and qualified persons available for active

duty in the United States Armed Forces, in time of war or national emergency, and at such other times as the national security may
require, to fill the needs of the United States Armed Forces whenever more units and persons are needed than are in the regular
components.
14 S. 295.07(4)(a)-(b), F.S.
15 S. 295.07(5)(a), F.S.

STORAGE NAME: h0541b.PPH PAGE: 3
DATE: 3/15/2021
hired as a result of the veterans’ recruitment plan. DMS must update the statistical data annually on its
website and include the statistics in its annual workforce report. 16

Hiring Point Preferences
If an examination is used to determine qualification for employment, points are added to the final
examination score as follows: 17

Category Points
Disabled veteran 15
Spouse of person with total disability, missing in 15
action, captured in line of duty, etc.
Wartime veteran 10
Un-remarried widow/widower of person who died 10
of a service-connected disability
Gold Star family 10
Veteran 5
National Guard/Reserve 5

Each government employer is required to enter the names of persons eligible for preference on an
appropriate register or list in accordance with their respective ratings. 18 For most positions, the names
of all persons qualified to receive a fifteen-point preference whose service-connected disabilities have
been rated to be 30 percent or more must be placed at the top of the appropriate register or
employment list, in accordance with their respective ratings. 19

If an examination is not used to determine qualification for a position, preference is given as follows: 20
• First preference is given to disabled veterans who have served on active duty in any branch of
the Armed Forces and who presently have an existing service-connected disability which is
compensable under public laws administered by the VA or are receiving compensation,
disability retirement benefits, or pension by reason of public laws administered by the VA and
DoD; and the spouse of a veteran who has a total and permanent service-connected disability
and who, because of this disability, cannot qualify for employment, or who is missing in action;
captured in the line of duty by a hostile force, or detained or interned in line of duty by a foreign
government or power; and
• Second preference is given to a veteran of any war; the unremarried widow or widower of a
veteran who died of a service-connected disability; the mother, father, legal guardian, or un-
remarried widow or widower of a servicemember who died as a result of military service under
combat-related conditions; a veteran as defined in s. 1.01(14), F.S.; a current member of any
reserve component of the U.S. Armed Forces or the Florida National Guard.

The Florida Department of Veterans’ Affairs (FDVA) is responsible for promulgating rules or procedures
to ensure that eligible persons are given special consideration in the selection and retention processes
of government employers. 21 These procedures must ensure that, for positions not requiring an
examination, eligible persons receive special consideration at each step of the employment selection
process and receive special consideration in the retention of employees where layoffs are
necessitated. 22

16 S. 295.07(5)(b), F.S.
17 S. 295.08, F.S.
18 Id.
19 Id.
20 S. 295.085, F.S.
21 S. 296.07(2), F.S.
22 Id.

STORAGE NAME: h0541b.PPH PAGE: 4
DATE: 3/15/2021
Effect of the Bill

The bill authorizes state agencies and political subdivisions to waive a postsecondary education
requirement for a position of employment for a current member of any reserve component of the United
States Armed Forces or the Florida National Guard or a veteran who has been honorably discharged if
the person is otherwise qualified for the position.

The bill removes the following Career Service positions that are exempt from veterans’ preference
requirements in s. 295.07(4)(b), as they are also exempt under the Career Service provisions of s.
295.07(4)(a), F.S., and are redundant:
• The personal secretary of either elected or appointed officers;
• Heads of departments; and
• Positions that require licensure as a physician, an osteopathic physician, and a chiropractic
physician.

The bill increases the point preferences given to veterans and their family members when a numerically
based selection process is used for hiring by five points for each category described in the chart above.
As a result of the point increase, the names of the persons who are qualified to receive a twenty-point
preference whose service-connected disabilities are rated to be 30 percent or more, must be placed at
the top of the employment list.

Lastly, the bill makes conforming changes.

B. SECTION DIRECTORY:
Section 1 Amends s. 295.065, F.S., revising legislative intent to conform provisions.

Section 2 Amends s. 295.07, F.S., relating to preference in appointment and retention.

Section 3 Amends s. 295.08, F.S., relating to positions for which a numerically based selection
process is used.

Section 4 Amends s. 295.085, F.S., conforming provisions and cross-references.

Section 5 Amends s. 295.09, F.S., conforming provisions and cross-references.

Section 6 Amends s. 1002.36, F.S., conforming provisions and cross-references.

Section 7 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.

STORAGE NAME: h0541b.PPH PAGE: 5
DATE: 3/15/2021
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:

1. Revenues:
None.

2. Expenditures:
None.

C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
The bill will likely have a positive impact on veterans in the state. Recruiting veterans to the state and
local government workforce may increase employment for veterans.

D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:

1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to require counties or municipalities to spend funds or take
action requiring the expenditures of funds; reduce the authority that counties or municipalities have
to raise revenues in the aggregate; or reduce the percentage of state tax shared with counties or
municipalities.

2. Other:
None.

B. RULE-MAKING AUTHORITY:
The bill neither authorizes nor requires administrative rulemaking by executive branch agencies.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
None.

STORAGE NAME: h0541b.PPH PAGE: 6
DATE: 3/15/2021
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 541 2021

1 A bill to be entitled
2 An act relating to veterans' preference in employment;
3 amending s. 295.065, F.S.; revising legislative intent
4 to conform to changes made by the act; amending s.
5 295.07, F.S.; authorizing the state and its political
6 subdivisions to waive certain postsecondary
7 educational requirements for employment for
8 servicemembers and veterans who meet specified
9 criteria; revising the list of positions that are
10 exempt from veterans' preference requirements;
11 requiring, rather than authorizing, each political
12 subdivision to develop and implement a veterans'
13 recruitment plan for specified purposes; amending s.
14 295.08, F.S.; modifying point preferences given to
15 veterans and their family members when a numerically
16 based selection process is used for hiring; amending
17 ss. 295.085, 295.09, and 1002.36, F.S.; conforming
18 provisions and cross-references to changes made by the
19 act; providing an effective date.
20
21 Be It Enacted by the Legislature of the State of Florida:
22
23 Section 1. Section 295.065, Florida Statutes, is amended
24 to read:
25 295.065 Legislative intent.—It is the intent of the

Page 1 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
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 541 2021

26 Legislature to provide preference, and priority, and waivers for
27 certain educational requirements in the hiring practices of this
28 state and its political subdivisions as set forth in this
29 chapter. All written job announcements and audio and video
30 advertisements used by employing agencies of the state and its
31 political subdivisions must include a notice stating that
32 certain servicemembers and veterans, and the spouses and family
33 members of such the servicemembers and veterans, receive
34 preference and priority, and that certain servicemembers and
35 veterans may be eligible to receive waivers for postsecondary
36 educational requirements, in employment by the state and its
37 political subdivisions and are encouraged to apply for the
38 positions being filled.
39 Section 2. Section 295.07, Florida Statutes, is amended to
40 read:
41 295.07 Preference in appointment and retention.—
42 (1) The state and its political subdivisions shall give
43 preference in appointment and retention in positions of
44 employment to:
45 (a) Those disabled veterans:
46 1. Who have served on active duty in any branch of the
47 United States Armed Forces, have received an honorable
48 discharge, and have established the present existence of a
49 service-connected disability that is compensable under public
50 laws administered by the United States Department of Veterans

Page 2 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
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 541 2021

51 Affairs; or
52 2. Who are receiving compensation, disability retirement
53 benefits, or pension pursuant to by reason of public laws
54 administered by the United States Department of Veterans Affairs
55 and the United States Department of Defense.
56 (b) The spouse of a person who has a total disability,
57 permanent in nature, resulting from a service-connected
58 disability and who, because of this disability, cannot qualify
59 for employment, and the spouse of a person missing in action,
60 captured in line of duty by a hostile force, or forcibly
61 detained or interned in line of duty by a foreign government or
62 power.
63 (c) A wartime veteran as defined in s. 1.01(14), who has
64 served at least 1 day during a wartime period. Active duty for
65 training may not be allowed for eligibility under this
66 paragraph.
67 (d) The unremarried widow or widower of a veteran who died
68 of a service-connected disability.
69 (e) The mother, father, legal guardian, or unremarried
70 widow or widower of a member of the United States Armed Forces
71 who died in the line of duty under combat-related conditions, as
72 verified by the United States Department of Defense.
73 (f) A veteran as defined in s. 1.01(14). Active duty for
74 training may not be allowed for eligibility under this
75 paragraph.

Page 3 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
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 541 2021

76 (g) A current member of any reserve component of the
77 United States Armed Forces or the Florida National Guard.
78 (2) The state and its political subdivisions may waive a
79 postsecondary educational requirement for a position of
80 employment, other than those positions made exempt under
81 subsection (5), for a current member of any reserve component of
82 the United States Armed Forces or the Florida National Guard or
83 a veteran who has been honorably discharged if the person is
84 otherwise qualified for the position.
85 (3) The Department of Veterans' Affairs shall adopt rules
86 to ensure that veterans are given special consideration in the
87 employing agency's selection and retention processes. The rules
88 must include the award of point values as articulated in s.
89 295.08, if applicable, or, where point values are not relevant,
90 must include procedures to ensure that veterans are given
91 special consideration at each step of the employment selection
92 process, unless the sponsoring governmental entity is a party to
93 a collective bargaining agreement, in which case the collective
94 bargaining agreement must comply within 90 days following
95 ratification of a successor collective bargaining agreement or
96 extension of any existing collective bargaining agreement.
97 (4)(3) Preference in employment and retention, or
98 educational waivers, may be given only to eligible persons who
99 are described in subsection (1) or subsection (2).
100 (5)(4) The following positions are exempt from this

Page 4 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
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 541 2021

101 section:
102 (a) Those positions that are exempt from the state Career
103 Service System under s. 110.205(2); however, all positions under
104 the University Support Personnel System of the State University
105 System as well as all Career Service System positions under the
106 Florida College System and the School for the Deaf and the
107 Blind, or the equivalent of such positions at state
108 universities, Florida College System institutions, or the School
109 for the Deaf and the Blind, are not exempt included.
110 (b) Positions in political subdivisions of the state which
111 are filled by officers elected by popular vote or persons
112 appointed to fill vacancies in such offices and the personal
113 secretary of each such officer, members of boards and
114 commissions, persons employed on a temporary basis without
115 benefits, heads of departments, positions that require licensure
116 as a physician, licensure as an osteopathic physician, licensure
117 as a chiropractic physician, and positions that require that the
118 employee be a member of The Florida Bar.
119 (6)(a)(5)(a) Each state agency and political subdivision
120 shall, and each political subdivision of the state may, develop
121 and implement a written veterans' recruitment plan that
122 establishes annual goals for ensuring the full use of veterans
123 in the agency's or political subdivision's workforce. Each
124 veterans' recruitment plan must be designed to meet the
125 established goals.

Page 5 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
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 541 2021

126 (b) The Department of Management Services shall collect
127 statistical data from each state agency on the number of persons
128 who claim veterans' preference, the number of persons who are
129 hired through veterans' preference, and the number of persons
130 who are hired as a result of the veterans' recruitment plan. The
131 department shall annually update the statistical data required
132 by this paragraph on its website and include such statistical
133 data in its annual workforce report.
134 (c) For purposes of this subsection, the veterans'
135 recruitment plan applies to the eligible persons described in
136 subsections subsection (1) and (2).
137 Section 3. Section 295.08, Florida Statutes, is amended to
138 read:
139 295.08 Positions for which a numerically based selection
140 process is used.—For positions for which an examination is used
141 to determine the qualifications for entrance into employment
142 with the state or any of its political subdivisions in the
143 state, 20 15 points must shall be added to the earned ratings of
144 a person included under s. 295.07(1)(a) or (b), 15 10 points
145 must shall be added to the earned ratings of a person included
146 under s. 295.07(1)(c), (d), or (e), and 10 5 points must shall
147 be added to the earned rating of a person included under s.
148 295.07(1)(f) or (g), if the person has obtained a qualifying
149 score on the examination for the position. The names of persons
150 eligible for preference must shall be entered on an appropriate

Page 6 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
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 541 2021

151 register or list in accordance with their respective augmented
152 ratings. However, except for classes of positions with Federal
153 Government designations of professional or technician, the names
154 of all persons who are qualified to receive a 20-point 15-point
155 preference whose service-connected disabilities have been rated
156 by the United States Department of Veterans Affairs or its
157 predecessor or the United States Department of Defense to be 30
158 percent or more must shall be placed at the top of the
159 appropriate register or employment list, in accordance with
160 their respective augmented ratings. The respective augmented
161 rating is the examination score or evaluated score in addition
162 to the applicable veteran's preference points.
163 Section 4. Section 295.085, Florida Statutes, is amended
164 to read:
165 295.085 Positions for which a numerically based selection
166 process is not used.—In all positions in which the appointment
167 or employment of persons is not subject to a written
168 examination, not including with the exception of positions that
169 are exempt under s. 295.07(5) s. 295.07(4), first preference in
170 appointment, employment, and retention must shall be given by
171 the state and political subdivisions in the state to a person
172 included under s. 295.07(1)(a) or (b), and second preference
173 must shall be given to a person included under s. 295.07(1)(c),
174 (d), (e), (f), or (g), who possess the minimum qualifications
175 necessary to discharge the duties of the position involved.

Page 7 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
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 541 2021

176 Section 5. Paragraph (a) of subsection (1) of section
177 295.09, Florida Statutes, is amended to read:
178 295.09 Reinstatement or reemployment; promotion
179 preference.—
180 (1)(a) When an employee of the state or any of its
181 political subdivisions employed in a position subject or not
182 subject to a career service system or other merit-type system,
183 not including with the exception of those positions that which
184 are exempt pursuant to s. 295.07(5) s. 295.07(4), has served in
185 the Armed Forces of the United States and is discharged or
186 separated therefrom with an honorable discharge, the state or
187 its political subdivision shall reemploy or reinstate such
188 person to the same position that he or she held before prior to
189 such service in the armed forces, or to an equivalent position,
190 provided that such person returns to the position within 1 year
191 after of his or her date of separation or, in cases of extended
192 active duty, within 1 year after of the date of discharge or
193 separation subsequent to the extension. Such person must shall
194 also be awarded preference in promotion and shall be promoted
195 ahead of all others who are as well qualified or less qualified
196 for the position. When an examination for promotion is used
197 utilized, such person must shall be awarded preference points,
198 as provided in s. 295.08, and shall be promoted ahead of all
199 those who appear in an equal or lesser position on the
200 promotional register, provided that he or she first successfully

Page 8 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
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 541 2021

201 passes the examination for the promotional position.
202 Section 6. Paragraph (f) of subsection (4) of section
203 1002.36, Florida Statutes, is amended to read:
204 1002.36 Florida School for the Deaf and the Blind.—
205 (4) BOARD OF TRUSTEES.—
206 (f) The board of trustees shall:
207 1. Prepare and submit legislative budget requests for
208 operations and fixed capital outlay, in accordance with chapter
209 216 and ss. 1011.56 and 1013.60, to the Department of Education
210 for review and approval. The department must analyze the amount
211 requested for fixed capital outlay to determine if the request
212 is consistent with the school's campus master plan, educational
213 plant survey, and facilities master plan. Projections of
214 facility space needs may exceed the norm space and occupant
215 design criteria established in the State Requirements for
216 Educational Facilities.
217 2. Approve and administer an annual operating budget in
218 accordance with ss. 1011.56 and 1011.57.
219 3. Require all funds received other than gifts, donations,
220 bequests, funds raised by or belonging to student clubs or
221 student organizations, and funds held for specific students or
222 in accounts for individual students to be deposited in the State
223 Treasury and expended as authorized in the General
224 Appropriations Act.
225 4. Require all purchases to be in accordance with the

Page 9 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
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 541 2021

226 provisions of chapter 287 except for purchases made with funds
227 received as gifts, donations, or bequests; funds raised by or
228 belonging to student clubs or student organizations; or funds
229 held for specific students or in accounts for individual
230 students.
231 5. Administer and maintain personnel programs for all
232 employees of the board of trustees and the Florida School for
233 the Deaf and the Blind who shall be state employees, including
234 the personnel classification and pay plan established in
235 accordance with ss. 110.205(2)(d) and 216.251(2)(a)2. for
236 academic and academic administrative personnel, the provisions
237 of chapter 110, and the provisions of law that grant authority
238 to the Department of Management Services over such programs for
239 state employees.
240 6. Give preference in appointment and retention in
241 positions of employment as provided within s. 295.07(1) and (2).
242 7. Ensure that the Florida School for the Deaf and the
243 Blind complies with s. 1013.351 concerning the coordination of
244 planning between the Florida School for the Deaf and the Blind
245 and local governing bodies.
246 8. Ensure that the Florida School for the Deaf and the
247 Blind complies with s. 112.061 concerning per diem and travel
248 expenses of public officers, employees, and authorized persons
249 with respect to all funds other than funds received as gifts,
250 donations, or bequests; funds raised by or belonging to student

Page 10 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
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 541 2021

251 clubs or student organizations; or funds held for specific
252 students or in accounts for individual students.
253 9. Adopt a master plan which specifies the mission and
254 objectives of the Florida School for the Deaf and the Blind. The
255 plan shall include, but not be limited to, procedures for
256 systematically measuring the school's progress toward meeting
257 its objectives, analyzing changes in the student population, and
258 modifying school programs and services to respond to such
259 changes. The plan shall be for a period of 5 years and shall be
260 reviewed for needed modifications every 2 years. The board of
261 trustees shall submit the initial plan and subsequent
262 modifications to the Speaker of the House of Representatives and
263 the President of the Senate.
264 10. Designate a portion of the school as "The Verle Allyn
265 Pope Complex for the Deaf," in tribute to the late Senator Verle
266 Allyn Pope.
267 Section 7. This act shall take effect July 1, 2021.

Page 11 of 11

CODING: Words stricken are deletions; words underlined are additions.
hb0541-00
HB 543
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 543 Occupational Therapy
SPONSOR(S): Koster
TIED BILLS: IDEN./SIM. BILLS: SB 990

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

1) Professions & Public Health Subcommittee Morris McElroy

2) Health & Human Services Committee

SUMMARY ANALYSIS
The Division of Medical Quality Assurance (MQA) within the Department of Health (DOH), has general
regulatory authority over health care practitioners. The MQA works in conjunction with 22 boards and four
councils to license and regulate seven types of health care facilities and more than 40 health care professions,
including occupational therapy.

Occupations are all the activities or tasks a person performs each day. Occupational therapy is the use of
purposeful activity or interventions to maximize independence and maintain health. HB 543 amends the
statutes that regulate the practice of occupational therapy. Specifically, the bill:

• Revises the practice of occupational therapy by including:
o The therapeutic use of occupations with individuals, groups, or populations, along with their
families or organizations in the home, school, workplace, community, and other settings;
o Evaluation of factors that affect activities of daily living and instrumental activities of daily living;
o Methods or approaches to direct the process of interventions; and
o Interventions and procedures to promote or enhance safety and performance in daily living.
• Revises the fieldwork experience requirement for licensure as an occupational therapist;
• Authorizes licensed occupational therapists to use the title “occupational therapist doctorate” or the
initials “O.T.D.” in connection with his or her name or business;
• Prohibits the use of the title “occupational therapist doctorate” or the initials “O.T.D.” by individuals not
licensed as an occupational therapist; and
• Makes conforming changes.

The bill has an indeterminate, insignificant, negative fiscal impact on DOH. The bill does not have a 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.
STORAGE NAME: h0543.PPH
DATE: 3/15/2021
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Current Situation

Department of Health

The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners. 1 MQA works in conjunction with 22 boards and 4
councils to license and regulate 7 types of health care facilities and more than 40 health care
professions. 2 Each profession is regulated by an individual practice act and by ch. 456, F.S., which
provides general regulatory and licensure authority for MQA.

Occupational Therapy

Occupations are all the activities or tasks a person performs each day. Getting dressed, playing sports,
taking a class, cooking, and working at a job are examples of occupations. 3

Occupational therapy is the use of purposeful activity or interventions to achieve functional outcomes,
meaning maximizing independence and maintaining health. 4 Occupational therapy may be used by
individuals with a limiting physical injury or illness, cognitive impairment, psychosocial dysfunction,
mental illness, developmental or learning disability, or adverse environmental condition. 5 Occupational
therapy services routinely include: 6

• An evaluation to determine the patient’s goals;
• Intervention to improve the patient’s ability to perform needed activities and reach goals; and
• An evaluation of outcomes to determine if goals are being achieved, and changing plans as
necessary.

Occupational therapy is performed by licensed occupational therapists (OT), licensed occupational
therapy assistants (OTA) who work under the responsible supervision and control 7 of a licensed OT,
and occupational therapy aides who are not licensed but assist in the practice of occupational therapy
under the direct supervision of a licensed OT or occupational therapy assistant. 8 However, physicians,
physician assistants, nurses, physical therapists, osteopathic physicians or surgeons, clinical
psychologists, speech-language pathologists, and audiologists are permitted to use occupational
therapy skills and techniques as part of their professions, when they practice their profession under
their own practice acts. 9

1 Pursuant to s. 456.001(4), F.S., health care practitioners are defined to include acupuncturists, physicians, physician assistants,

chiropractors, podiatrists, naturopaths, dentists, dental hygienists, optometrists, nurses, nursing assistants, pharmacists, midwives,
speech language pathologists, nursing home administrators, occupational therapists, respiratory therapists, dieticians, athletic trainers,
orthotists, prosthetists, electrologists, massage therapists, clinical laboratory personnel, medical physicists, dispensers of optical
devices or hearing aids, physical therapists, psychologists, social workers, counselors, and psychotherapists, among others.
2 Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year 2019-2020,

available at http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/2019-2020-annual-report.pdf
(last visited March 9, 2021).
3 Britannica, Occupational Therapy, https://www.britannica.com/science/occupational-therapy (last visited March 9, 2021).
4 Section 468.203(4), F.S.
5 Id.
6 Department of Health, Agency Analysis of 2021 House Bill 543, p. 2 (Feb. 5, 2021).
7 Section 468.203(8), F.S. Responsible supervision and control by the licensed OT includes providing both the initial direction in

developing a plan of treatment and periodic inspection of the actual implementation of the plan. The plan of treatment must not be
changed by the supervised individual without prior consultation and approval of the supervising OT. The supervising OT is not always
required to be physically present or on the premises when the occupational therapy assistant is performing services; but, supervision
requires the availability of the supervising occupational therapist for consultation with and direction of the supervised individual.
8 Section 468.203, F.S.
9 Section 468.225, F.S.

STORAGE NAME: h0543.PPH PAGE: 2
DATE: 3/15/2021
Occupational therapy services include, but are not limited to: 10

• The assessment, treatment, and education of, or consultation with, the individual, family, or
other persons;
• Interventions directed toward developing daily living skills, work readiness or work performance,
play skills or leisure capacities, or enhancing educational performance skills;
• Providing for the development of:
o Sensory-motor, perceptual, or neuromuscular functioning;
o Range of motion; or
o Emotional, motivational, cognitive, or psychosocial components of performance.

These services require skilled assessment to determine the need for use of interventions, including: 11

• The design, development, adaptation, application, or training needed to use the assistive
devices;
• The design, fabrication, or application of rehabilitative technology such as selected orthotic
devices;
• Training in the use of assistive technology;
• Orthotic or prosthetic devices;
• The application of physical modalities as an adjunct to or in preparation for activity;
• The use of ergonomic principles;
• The adaptation of environments and processes to enhance functional performance; or
• The promotion of health and wellness.

Education
There are four degree level programs available to individuals seeking to enter the profession of
occupational therapy: 12

• The Doctoral-Degree-Level Occupational Therapist (Ph.D.);
• Master’s-Degree-Level Occupational Therapist (O.T.R.);
• Baccalaureate-Degree-Level Occupational Therapy Assistant (certified occupational therapy
assistant or C.O.T.A.); and
• Associate-Degree-Level Occupational Therapy Assistant (also a C.O.T.A.).

Such programs are available through institutions accredited by the Accreditation Council for
Occupational Therapy Education (ACOTE), which is the certifying arm of the American Occupational
Therapy Association (AOTA). ACOTE requirements for accreditation for occupational therapy
curriculum vary by degree levels, but all levels must include theory, basic tenets of occupational
therapy, and supervised educational fieldwork for accreditation. Examples of required theory and basic
tenets for occupational therapy accreditation include:

• Theory:
o Preparation to Practice as a Generalist;
o Preparation and Application of In-depth Knowledge;
o Human Body, Development, and Behavior;
o Sociocultural, Socioeconomic, Diversity Factors, and Lifestyle Choices; and

10 Section 468.203(4)(b), F.S.
11 Section 468.203(4)a.2.,F.S. “Assessment” means the use of skilled observation or the administration and interpretation of

standardized or non-standardized tests and measurements to identify areas for occupational therapy services.
12 National Board of Certification in Occupational Therapy, 2018 Accreditation Council for Occupational Therapy Education (ACOTE®)

Standards and Interpretive Guide (effective July 31, 2020) August 2020 Interpretive Guide Version, at pp. 20 and 49,
https://acoteonline.org/wp-content/uploads/2020/10/2018-ACOTE-Standards.pdf (last visited March 9, 2021). The Ph.D. in occupational
therapy requires a minimum of six years of full time academic education and a Doctorial Capstone which is an in-depth exposure to a
concentrated area, which is an integral part of the program’s curriculum design. This in-depth exposure may be in one or more of the
following areas: clinical practice skills, research skills, scholarship, administration, leadership, program and policy development,
advocacy, education, and theory development. The doctoral capstone consists of two parts: the capstone experience and the capstone
project.
STORAGE NAME: h0543.PPH PAGE: 3
DATE: 3/15/2021
o Social Determinants of Health.
• Basic Tenets:
o Therapeutic Use of Self;
o Clinical Reasoning;
o Behavioral Health and Social Factors;
o Remediation and Compensation; 13
o Orthoses and Prosthetic Devices; 14
o Functional Mobility; 15
o Community Mobility; 16
o Technology in Practice; 17
o Dysphagia 18 and Feeding Disorders;
o Superficial Thermal, Deep Thermal, and Electrotherapeutic Agents and Mechanical
Devices; and
o Effective Communication.

Occupational therapy candidates are required to complete two levels of fieldwork, the second of which
depends on the degree level sought. 19 Level I fieldwork required for Ph.D., O.T.R., and C.O.T.A.
candidates can be met through one or more of the following instructional methods: 20

• Simulated environments;
• Standardized patients;
• Faculty practice;
• Faculty-led site visits; and
• Supervision by a fieldwork instructor.

Level II fieldwork required for Doctorate level and Master’s level candidates includes a minimum of 24
weeks of full-time level II fieldwork which may be completed in one setting if reflective of more than one
practice area, or in a maximum of four different settings. 21 Baccalaureate level and Associate degree
level candidates are required to complete a minimum of 16 weeks full-time level II fieldwork which may
be completed in one setting if reflective of more than one practice area, or in a maximum of three
different settings. 22

Licensure
To be licensed as an occupational therapist, or occupational therapy assistant, an individual must: 23

• Submit the licensure application and required application fee of $100;
• Be of good moral character;
• Have graduated from an ACOTE/AOTA accredited occupational therapy program or
occupational therapy assistant program;

13 Supra note 12, p. 29. Remediation and Compensation includes the design and implement intervention strategies to remediate and/or

compensate for functional cognitive deficits, visual deficits, and psychosocial and behavioral health deficits that affect occupational
performance.
14 Supra note 12, p. 30. Orthoses and Prosthetic Devices requires the assessment of the need for orthotics, and design, fabricate,

apply, fit, and train in orthoses and devices used to enhance occupational performance and participation.
15 Id. Functional Mobility provides recommendations and training in techniques to enhance functional mobility, including physical

transfers, wheelchair management, and mobility devices.
16 Supra note 12, p. 30. Community Mobility designs programs that enhance community mobility, and implement transportation

transitions, including driver rehabilitation and community access.
17 Supra note 12, p. 31. Technology in Practice requires the demonstration of knowledge of the use of technology in practice, which

must include: Electronic documentation systems; virtual environments; and telehealth technology.
18Tabor’s Cyclopedia Medical Dictionary, 17th Edition, pub.1993, F.A. Davis and Co., Dysphonia is the inability to swallow or difficulty

swallowing.
19 Supra note 12, p. 39.
20 Id.
21 Id at p. 42.
22 Id.
23 Section 468.209, F.S. and ch. 64B-11.2003, F.A.C.

STORAGE NAME: h0543.PPH PAGE: 4
DATE: 3/15/2021
• Have completed a minimum of six months of supervised fieldwork experience for occupational
therapists, and a minimum of two months for occupational therapy assistants, at a recognized
educational institution or a training program approved by the education institution where you
met the academic requirements; and
• Have passed an examination approved by NBCOT.

Applicants who have practiced as a state-licensed or American Occupational Therapy Association-
certified occupational therapy assistant for four years and who, prior to January 24, 1988, have
completed a minimum of six months of supervised occupational-therapist-level fieldwork experience
may also obtain licensure. Such individuals may take the examination approved by the NBCOT to be
licensed as an occupational therapist without meeting the educational requirements for occupational
therapists to have graduated from a program accredited by the ACOTE/AOTA. 24

Endorsement is another path to licensure for an occupational therapists, or occupational therapist
assistants, in which the Board may waive the examination requirement and grant a license to any
person who presents proof of: 25

• A current certification as an occupational therapist or occupational therapy assistant by a
national certifying organization if the Board determines the requirements for such certification to
be equivalent to the requirements for Florida licensure; or
• A current licensure as an occupational therapist or occupational therapy assistant in another
state, the District of Columbia, or any territory or jurisdiction of the United States or foreign
national jurisdiction which requires standards for licensure determined by the Board to be
equivalent to the requirements for Florida licensure.

In fiscal year 2019-2020, there were 8,764 active licensed occupational therapists and 5,865 active
licensed occupational therapy assistants in Florida. 26

Prohibitions

Currently, a person may not use the title, “occupational therapist,” “licensed occupational therapist,”
“occupational therapist registered,” “occupational therapy assistant,” “licensed occupational therapy
assistant,” “certified occupational therapy assistant;” or the letters “O.T.,” “L.O.T.,” “O.T.R.,” “O.T.A.,”
“L.O.T.A.,” or “C.O.T.A.;” or any other words, letters, abbreviations, or insignia indicating or implying
that he or she is an occupational therapist or an occupational therapy assistant, unless the person
holds a valid license. Any person who does so commits a second degree misdemeanor. 27
Effect of Proposed Changes

Occupational Therapy

The bill revises occupational therapy to include the therapeutic use of occupations with individuals,
groups, or populations, along with their families or organizations to support participation, performance,
and function in roles and situations in the home, school, workplace, community, and other settings.
Under the bill, occupational therapy services are provided for habilitation, rehabilitation, and the
promotion of health and wellness for clients with disability and nondisability-related needs. Such
services include acquisition and preservation of occupational identity for clients who have or are at risk
for developing an:

• Illness;
• Injury;
• Disease;

24 Section 468.209(2), F.S.
25 Section 468.213, F.S.
26 Department of Health, Division of Medical Quality Assurance, Annual Report and Long Range Plan for 2019-2020,

http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/2019-2020-annual-report.pdf (last visited
March 9, 2021).
27 Sections 468.215 and 468.223, F.S.

STORAGE NAME: h0543.PPH PAGE: 5
DATE: 3/15/2021
• Disorder;
• Condition;
• Impairment;
• Disability;
• Activity limitation; or
• Participation restriction.

The bill specifies that occupational therapy supports occupational performance in persons with, or at
risk of experiencing, a range of disorders and disabilities.

The bill revises the practice of occupational therapy to include:

• Evaluation of factors that affect activities of daily living and instrumental activities of daily living;
• Methods or approaches selected to direct the process of interventions, including, but not limited
to:
o Establishment, remediation, or restoration of a skill or ability that has not yet been
developed, is impaired, or is in decline;
o Compensation, modification, or adaptation of activities to improve or enhance
performance;
o Maintenance of capabilities without which everyday life occupations would decline;
o Promotion of health and wellness, including the use of self-management strategies, to
enable or enhance performance in everyday life activities and quality of life and
o Prevention of barriers to performance and participation, including injury and disability
prevention, and occupational deprivation.
• Interventions and procedures to promote or enhance safety and performance in activities of
daily living, instrumental activities of daily living, health management, rest and sleep, education,
work, play, leisure, and social participation, including, but not limited to:
o Therapeutic use of occupations, exercises, and activities;
o Training in self-care, self-management, health management and maintenance, home
management, community or work reintegration, and school activities and work
performance;
o Identification, development, remediation, or compensation of neuro-musculoskeletal,
sensory-perceptual, emotional regulation, visual, mental, and cognitive functions, pain
tolerance and management, mental and behavioral health, praxis, developmental skills,
and behavioral skills;
o Education and training of individuals, including family members, caregivers, groups, and
other populations;
o Care coordination, case management, transition services, and consultative services to
individuals, groups, or populations, along with their families and communities or
organizations;
o Group interventions facilitating learning, skills acquisition, and occupational performance
of groups, populations, or organizations across the life course;
o Mental health services and behavioral health services for the promotion of occupational
performance and participation;
o Facilitating occupational performance of individuals, groups, or populations through
modification of contexts and adaptation of processes, including the application of
ergonomic principles;
o Assessment, design, fabrication, application, fitting, and training in seating and
positioning of assistive technology, adaptive devices, orthotic devices, and custom
orthoses, and training in the use of prosthetic devices;
o Assessment, recommendation, and training in techniques to enhance functional mobility,
including management of wheelchairs and other mobility devices;
o Remediation and compensation of visual deficits including low rehabilitation;
o Driving skills rehabilitation and community mobility;
o Management of feeding, eating, and swallowing to enable eating and feeding
performance;

STORAGE NAME: h0543.PPH PAGE: 6
DATE: 3/15/2021
o Application of physical agent and mechanical modalities and use of a range of
therapeutic procedures to enhance performance skills; and
o Efforts directed toward promoting occupational justice and empowering clients to seek
and obtain resources to fully participate in occupations.
Education

The bill requires an occupational therapy applicant to complete a minimum of 24 weeks, instead of six
months, of the fieldwork needed to obtain licensure because the fieldwork required to obtain a degree
in occupational therapy is tracked by weeks, not months.

Prohibitions

The bill authorizes licensed occupational therapists to use the title “occupational therapist doctorate” or
the initials “O.T.D.” in connection with his or her name or business. The bill also prohibits the use of the
title “occupational therapist doctorate” or the initials “O.T.D.” by individuals not licensed as an
occupational therapist.

The bill makes conforming changes.

The bill provides an effective date of July 1, 2021.

B. SECTION DIRECTORY:
Section 1 Amends s. 468.203, F.S., relating to definitions.
Section 2 Amends s. 468.209, F.S., relating to requirements for licensure.
Section 3 Amends s. 468.215, F.S., relating to issuance of license.
Section 4 Amends s. 468.223, F.S., relating to prohibitions; penalties.
Section 5 Amends s. 468.225, F.S., relating to exemptions.
Section 6 Reenacts s. 1002.385, F.S., relating to the Gardiner Scholarship.
Section 7 Reenacts s. 1002.66, F.S., relating to specialized instructional services for children with
disabilities.
Section 8 Provides an effective date of July 1, 2020.

II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT

A. FISCAL IMPACT ON STATE GOVERNMENT:

1. Revenues:
None.

2. Expenditures:
The bill has an indeterminate, insignificant, negative fiscal impact on DOH. DOH may experience an
increase in workload associated with additional complaints, which current resources are adequate
to absorb. 28

B. FISCAL IMPACT ON LOCAL GOVERNMENTS:

1. Revenues:
None.

2. Expenditures:
None.

28 Supra, note 6 at p. 5.
STORAGE NAME: h0543.PPH PAGE: 7
DATE: 3/15/2021
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.

D. FISCAL COMMENTS:
None.

III. COMMENTS

A. CONSTITUTIONAL ISSUES:

1. Applicability of Municipality/County Mandates Provision:
None. The bill does not appear to affect county of municipal governments.

2. Other:
None.

B. RULE-MAKING AUTHORITY:
The Board of Occupational Therapy has sufficient rulemaking authority to implement the provisions of
this bill.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: h0543.PPH PAGE: 8
DATE: 3/15/2021
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 543 2021

1 A bill to be entitled
2 An act relating to occupational therapy; amending s.
3 468.203, F.S.; revising and providing definitions;
4 amending s. 468.209, F.S.; revising the fieldwork
5 experience requirement for certain persons to take the
6 examination for licensure as an occupational
7 therapist; amending s. 468.215, F.S.; authorizing
8 licensed occupational therapists to use a specified
9 title and initials in accordance with the rules of a
10 national certifying organization; amending s. 468.223,
11 F.S.; prohibiting certain persons from using a
12 specified title and initials; providing criminal
13 penalties; amending s. 468.225, F.S.; providing
14 construction; reenacting ss. 1002.385(5)(c) and
15 1002.66(2)(c), F.S., relating to the Gardiner
16 Scholarship and specialized instructional services for
17 children with disabilities, respectively, to
18 incorporate the amendments made by the act; providing
19 an effective date.
20
21 Be It Enacted by the Legislature of the State of Florida:
22
23 Section 1. Subsection (4) of section 468.203, Florida
24 Statutes, is amended to read:
25 468.203 Definitions.—As used in this act, the term:

Page 1 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

26 (4) "Occupational therapy" means the therapeutic use of
27 occupations with individuals, groups, or populations, along with
28 their families or organizations to support participation,
29 performance, and function in roles and situations in the home,
30 school, workplace, community, and other settings. Occupational
31 therapy services are provided for habilitation, rehabilitation,
32 and the promotion of health and wellness for clients with
33 disability and nondisability-related needs. These services
34 include acquisition and preservation of occupational identity
35 for clients who have or are at risk for developing an illness,
36 injury, disease, disorder, condition, impairment, disability,
37 activity limitation, or participation restriction. Through
38 engagement in everyday activities, occupational therapy supports
39 occupational performance in persons with, or at risk of
40 experiencing, a range of developmental, physical, cognitive,
41 behavioral, mental health, and other disorders and disabilities
42 purposeful activity or interventions to achieve functional
43 outcomes.
44 (a) For the purposes of this subsection:
45 1. "Activities of daily living" means functions and tasks
46 for self-care which are performed on a daily or routine basis,
47 including functional mobility, bathing, dressing, eating and
48 swallowing, personal hygiene and grooming, toileting, and other
49 similar tasks. "Achieving functional outcomes" means to maximize
50 the independence and the maintenance of health of any individual

Page 2 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

51 who is limited by a physical injury or illness, a cognitive
52 impairment, a psychosocial dysfunction, a mental illness, a
53 developmental or a learning disability, or an adverse
54 environmental condition.
55 2. "Assessment" means the use of skilled observation or
56 the administration and interpretation of standardized or
57 nonstandardized tests and measurements to identify areas for
58 occupational therapy services.
59 3. "Behavioral health services" means the promotion of
60 occupational performance and participation through services to
61 support and facilitate the prevention and treatment of, and for
62 the management and recovery from, mental health and substance
63 abuse disorders, within the scope of occupational therapy
64 practice. These include services to support positive mental
65 health, prevention of mental health disorders, and direct
66 individual and group interventions for the purpose of improving
67 occupational participation and performance.
68 4. "Health management" means activities related to
69 developing, managing, and maintaining health and wellness,
70 including self-management, with the goal of improving or
71 maintaining health to support participation in occupations.
72 5. "Instrumental activities of daily living" means daily
73 or routine activities a person must perform to live
74 independently within the home and community.
75 6. "Mental health services" means the promotion of

Page 3 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

76 occupational performance and participation related to mental
77 health, coping, resilience, and well-being. These services
78 include the treatment of mental health and substance abuse
79 disorders, by providing individual, group, and population level
80 supports and services to those who are at risk, experiencing, or
81 in recovery from these conditions, along with their families and
82 communities, within the scope of occupational therapy practice.
83 7. "Occupations" means meaningful and purposeful everyday
84 activities performed and engaged in by individuals, groups,
85 populations, families, or communities which occur in contexts
86 and over time, being broadly categorized as activities of daily
87 living, instrumental activities of daily living, health
88 management, rest and sleep, education, work, play, leisure, and
89 social participation. The term includes more specific
90 occupations and execution of multiple activities that are
91 influenced by performance patterns, performance skills, and
92 client factors, resulting in varied outcomes.
93 8. "Occupational performance" means the ability to
94 perceive, desire, recall, plan, and carry out roles, routines,
95 tasks, and subtasks for the purpose of self-maintenance, self-
96 preservation, productivity, leisure, and rest, for oneself or
97 others, in response to internal or external demands of
98 occupations and contexts.
99 (b) The practice of occupational therapy includes services
100 include, but is are not limited to:

Page 4 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

101 1. Evaluation of factors that affect activities of daily
102 living, instrumental activities of daily living, health
103 management, rest and sleep, education, work, play, leisure, and
104 social participation including context, performance patterns,
105 performance skills, and client factors The assessment,
106 treatment, and education of or consultation with the individual,
107 family, or other persons.
108 2. Methods or approaches selected to direct the process of
109 interventions including, but not limited to:
110 a. Establishment, remediation, or restoration of a skill
111 or ability that has not yet developed, is impaired, or is in
112 decline.
113 b. Compensation, modification, or adaptation of activity
114 contexts to improve or enhance performance.
115 c. Maintenance of capabilities without which performance
116 in everyday life occupations would decline.
117 d. Health promotion and wellness, including the use of
118 self-management strategies, to enable or enhance performance in
119 everyday life activities and quality of life.
120 e. Prevention of the occurrence or emergence of barriers
121 to performance and participation, including injury and
122 disability prevention, and occupational deprivation
123 Interventions directed toward developing daily living skills,
124 work readiness or work performance, play skills or leisure
125 capacities, or enhancing educational performance skills.

Page 5 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

126 3. Interventions and procedures to promote or enhance
127 safety and performance in activities of daily living,
128 instrumental activities of daily living, health management, rest
129 and sleep, education, work, play, leisure, and social
130 participation, including, but not limited to:
131 a. Therapeutic use of occupations, exercises, and
132 activities.
133 b. Training in self-care, self-management, health
134 management and maintenance, home management, community or work
135 reintegration, and school activities and work performance.
136 c. Identification, development, remediation, or
137 compensation of neuromusculoskeletal, sensory-perceptual,
138 emotional regulation, visual, mental, and cognitive functions,
139 pain tolerance and management, mental and behavioral health,
140 praxis, developmental skills, and behavioral skills.
141 d. Education and training of individuals, including family
142 members, caregivers, groups, and other populations.
143 e. Care coordination, case management, transition
144 services, and consultative services to individuals, groups, or
145 populations, along with their families and communities or
146 organizations.
147 f. Group interventions facilitating learning, skills
148 acquisition, and occupational performance of groups,
149 populations, or organizations across the life course.
150 g. Mental health services and behavioral health services

Page 6 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

151 for the promotion of occupational performance and participation.
152 h. Facilitating occupational performance of individuals,
153 groups, or populations through modification of contexts and
154 adaptation of processes, including the application of ergonomic
155 principles.
156 i. Assessment, design, fabrication, application, fitting,
157 and training in seating and positioning of assistive technology,
158 adaptive devices, orthotic devices, custom orthoses, and
159 training in the use of prosthetic devices.
160 j. Assessment, recommendation, and training in techniques
161 to enhance functional mobility, including management of
162 wheelchairs and other mobility devices.
163 k. Remediation and compensation of visual deficits
164 including low rehabilitation.
165 l. Driving skills rehabilitation and community mobility.
166 m. Management of feeding, eating, and swallowing to enable
167 eating and feeding performance.
168 n. Application of physical agent and mechanical modalities
169 and use of a range of therapeutic procedures to enhance
170 performance skills.
171 o. Efforts directed toward promoting occupational justice
172 and empowering clients to seek and obtain resources to fully
173 participate in occupations Providing for the development of:
174 sensory-motor, perceptual, or neuromuscular functioning; range
175 of motion; or emotional, motivational, cognitive, or

Page 7 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

176 psychosocial components of performance.
177
178 These services may require assessment of the need for use of
179 interventions such as the design, development, adaptation,
180 application, or training in the use of assistive technology
181 devices; the design, fabrication, or application of
182 rehabilitative technology such as selected orthotic devices;
183 training in the use of assistive technology; orthotic or
184 prosthetic devices; the application of physical agent modalities
185 as an adjunct to or in preparation for purposeful activity; the
186 use of ergonomic principles; the adaptation of environments and
187 processes to enhance functional performance; or the promotion of
188 health and wellness.
189 (c) The use of devices subject to 21 C.F.R. s. 801.109 and
190 identified by the board is expressly prohibited except by an
191 occupational therapist or occupational therapy assistant who has
192 received training as specified by the board. The board shall
193 adopt rules to carry out the purpose of this provision.
194 Section 2. Subsection (2) of section 468.209, Florida
195 Statutes, is amended to read:
196 468.209 Requirements for licensure.—
197 (2) An applicant who has practiced as a state-licensed or
198 American Occupational Therapy Association-certified occupational
199 therapy assistant for 4 years and who, before prior to January
200 24, 1988, completed a minimum of 24 weeks 6 months of supervised

Page 8 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

201 occupational-therapist-level fieldwork experience may take the
202 examination to be licensed as an occupational therapist without
203 meeting the educational requirements for occupational therapists
204 made otherwise applicable under paragraph (1)(b).
205 Section 3. Subsection (2) of section 468.215, Florida
206 Statutes, is amended to read:
207 468.215 Issuance of license.—
208 (2) Any person who is issued a license as an occupational
209 therapist under the terms of this act may use the words
210 "occupational therapist," "licensed occupational therapist,"
211 "occupational therapist doctorate," or "occupational therapist
212 registered," or he or she may use the letters "O.T.," "L.O.T.,"
213 "O.T.D.," or "O.T.R.," in connection with his or her name or
214 place of business to denote his or her registration hereunder.
215 Section 4. Section 468.223, Florida Statutes, is amended
216 to read:
217 468.223 Prohibitions; penalties.—
218 (1) A person may not:
219 (a) Practice occupational therapy unless such person is
220 licensed pursuant to ss. 468.201-468.225;
221 (b) Use, in connection with his or her name or place of
222 business, the words "occupational therapist," "licensed
223 occupational therapist," "occupational therapist doctorate,"
224 "occupational therapist registered," "occupational therapy
225 assistant," "licensed occupational therapy assistant,"

Page 9 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

226 "certified occupational therapy assistant"; the letters "O.T.,"
227 "L.O.T.," "O.T.D.," "O.T.R.," "O.T.A.," "L.O.T.A.," or
228 "C.O.T.A."; or any other words, letters, abbreviations, or
229 insignia indicating or implying that he or she is an
230 occupational therapist or an occupational therapy assistant or,
231 in any way, orally or in writing, in print or by sign, directly
232 or by implication, to represent himself or herself as an
233 occupational therapist or an occupational therapy assistant
234 unless the person is a holder of a valid license issued pursuant
235 to ss. 468.201-468.225;
236 (c) Present as his or her own the license of another;
237 (d) Knowingly give false or forged evidence to the board
238 or a member thereof;
239 (e) Use or attempt to use a license that which has been
240 suspended, revoked, or placed on inactive or delinquent status;
241 (f) Employ unlicensed persons to engage in the practice of
242 occupational therapy; or
243 (g) Conceal information relative to any violation of ss.
244 468.201-468.225.
245 (2) Any person who violates any provision of this section
246 commits a misdemeanor of the second degree, punishable as
247 provided in s. 775.082 or s. 775.083.
248 Section 5. Paragraph (e) is added to subsection (1) of
249 section 468.225, Florida Statutes, to read:
250 468.225 Exemptions.—

Page 10 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

251 (1) Nothing in this act shall be construed as preventing
252 or restricting the practice, services, or activities of:
253 (e) Any person fulfilling an occupational therapy doctoral
254 capstone experience that involves clinical practice or projects.
255 Section 6. For the purpose of incorporating the amendment
256 made by this act to section 468.203, Florida Statutes, in a
257 reference thereto, paragraph (c) of subsection (5) of section
258 1002.385, Florida Statutes, is reenacted to read:
259 1002.385 The Gardiner Scholarship.—
260 (5) AUTHORIZED USES OF PROGRAM FUNDS.—Program funds must
261 be used to meet the individual educational needs of an eligible
262 student and may be spent for the following purposes:
263 (c) Specialized services by approved providers or by a
264 hospital in this state which are selected by the parent. These
265 specialized services may include, but are not limited to:
266 1. Applied behavior analysis services as provided in ss.
267 627.6686 and 641.31098.
268 2. Services provided by speech-language pathologists as
269 defined in s. 468.1125.
270 3. Occupational therapy services as defined in s. 468.203.
271 4. Services provided by physical therapists as defined in
272 s. 486.021.
273 5. Services provided by listening and spoken language
274 specialists and an appropriate acoustical environment for a
275 child who is deaf or hard of hearing and who has received an

Page 11 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
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 543 2021

276 implant or assistive hearing device.
277
278 A provider of any services receiving payments pursuant to this
279 subsection may not share, refund, or rebate any moneys from the
280 Gardiner Scholarship with the parent or participating student in
281 any manner. A parent, student, or provider of any services may
282 not bill an insurance company, Medicaid, or any other agency for
283 the same services that are paid for using Gardiner Scholarship
284 funds.
285 Section 7. For the purpose of incorporating the amendment
286 made by this act to section 468.203, Florida Statutes, in a
287 reference thereto, paragraph (c) of subsection (2) of section
288 1002.66, Florida Statutes, is reenacted to read:
289 1002.66 Specialized instructional services for children
290 with disabilities.—
291 (2) The parent of a child who is eligible for the
292 prekindergarten program for children with disabilities may
293 select one or more specialized instructional services that are
294 consistent with the child's individual educational plan. These
295 specialized instructional services may include, but are not
296 limited to:
297 (c) Occupational therapy as defined in s. 468.203.
298 Section 8. This act shall take effect July 1, 2021.

Page 12 of 12

CODING: Words stricken are deletions; words underlined are additions.
hb0543-00
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 543 (2021)
Amendment No. 1

COMMITTEE/SUBCOMMITTEE ACTION
ADOPTED (Y/N)
ADOPTED AS AMENDED (Y/N)
ADOPTED W/O OBJECTION (Y/N)
FAILED TO ADOPT (Y/N)
WITHDRAWN (Y/N)
OTHER

1 Committee/Subcommittee hearing bill: Professions & Public
2 Health Subcommittee
3 Representative Koster offered the following:
4
5 Amendment
6 Remove lines 30-176 and insert:
7 school, workplace, community, and other settings for clients who
8 have or are at risk of developing an illness, injury, disease,
9 disorder, condition, impairment, disability, activity
10 limitation, or participation restriction purposeful activity or
11 interventions to achieve functional outcomes.
12 (a) For the purposes of this subsection:
13 1. "Activities of daily living" means functions and tasks
14 for self-care which are performed on a daily or routine basis,
15 including functional mobility, bathing, dressing, eating and
16 swallowing, personal hygiene and grooming, toileting, and other
094683 - h0543-line30.docx
Published On: 3/15/2021 5:38:01 PM
Page 1 of 5
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 543 (2021)
Amendment No. 1

17 similar tasks. "Achieving functional outcomes" means to maximize
18 the independence and the maintenance of health of any individual
19 who is limited by a physical injury or illness, a cognitive
20 impairment, a psychosocial dysfunction, a mental illness, a
21 developmental or a learning disability, or an adverse
22 environmental condition.
23 2. "Assessment" means the use of skilled observation or
24 the administration and interpretation of standardized or
25 nonstandardized tests and measurements to identify areas for
26 occupational therapy services.
27 3. "Behavioral health services" means the promotion of
28 occupational performance through services to support positive
29 mental health by providing direct individual and group
30 interventions to improve the client’s participation in daily
31 occupations.
32 4. "Health management" means activities related to
33 developing, managing, and maintaining health and wellness,
34 including self-management, with the goal of improving or
35 maintaining health to support participation in occupations.
36 5. "Instrumental activities of daily living" means daily
37 or routine activities a person must perform to live
38 independently within the home and community.
39 6. "Mental health services" means the promotion of
40 occupational performance related to mental health, coping,
41 resilience, and well-being by providing individual, group, and
094683 - h0543-line30.docx
Published On: 3/15/2021 5:38:01 PM
Page 2 of 5
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 543 (2021)
Amendment No. 1

42 population level supports and services to improve the client’s
43 participation in daily occupations for those who are at risk of,
44 experiencing, or in recovery from these conditions, along with
45 their families and communities.
46 7. "Occupations" means meaningful and purposeful everyday
47 activities performed and engaged in by individuals, groups,
48 populations, families, or communities which occur in contexts
49 and over time, such as activities of daily living, instrumental
50 activities of daily living, health management, rest and sleep,
51 education, work, play, leisure, and social participation. The
52 term includes more specific occupations and execution of
53 multiple activities that are influenced by performance patterns,
54 performance skills, and client factors, resulting in varied
55 outcomes.
56 8. "Occupational performance" means the ability to
57 perceive, desire, recall, plan, and carry out roles, routines,
58 tasks, and subtasks for the purpose of self-maintenance, self-
59 preservation, productivity, leisure, and rest, for oneself or
60 others, in response to internal or external demands of
61 occupations and contexts.
62 (b) The practice of occupational therapy includes services
63 include, but is are not limited to:
64 1. Assessment, treatment, education of, and consultation
65 with, individuals, groups, and populations whose abilities to
66 participate safely in occupations, including activities of daily
094683 - h0543-line30.docx
Published On: 3/15/2021 5:38:01 PM
Page 3 of 5
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 543 (2021)
Amendment No. 1

67 living, instrumental activities of daily living, rest and sleep,
68 education, work, play, leisure, and social participation, are
69 impaired or at risk for impairment due to issues related, but
70 not limited to, developmental deficiencies, the aging process,
71 learning disabilities, physical environment and sociocultural
72 context, physical injury or disease, cognitive impairments, and
73 psychological and social disabilities; The assessment,
74 treatment, and education of or consultation with the individual,
75 family, or other persons.
76 2. Methods or approaches to determine abilities and
77 limitations related to performance of occupations, including but
78 not limited to, the identification of physical, sensory,
79 cognitive, emotional, or social deficiencies Interventions
80 directed toward developing daily living skills, work readiness
81 or work performance, play skills or leisure capacities, or
82 enhancing educational performance skills.
83 3. Specific occupational therapy techniques used for
84 treatment that involve, but are not limited to, training in
85 activities of daily living; environmental modification;
86 assessment of the need for the use of interventions such as the
87 design, fabrication, and application of orthotics or orthotic
88 devices; selecting, applying, and training in the use of
89 assistive technology and adaptive devices; sensory, motor, and
90 cognitive activities; therapeutic exercises; manual techniques;
91 physical agent modalities; behavioral health services; and
094683 - h0543-line30.docx
Published On: 3/15/2021 5:38:01 PM
Page 4 of 5
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 543 (2021)
Amendment No. 1

92 mental health servicesProviding for the development of: sensory-
93 motor, perceptual, or neuromuscular functioning; range of
94 motion; or emotional, motivational, cognitive, or psychosocial
95 components of performance.

094683 - h0543-line30.docx
Published On: 3/15/2021 5:38:01 PM
Page 5 of 5
HB 697
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 697 Injured Police Canines
SPONSOR(S): Killebrew
TIED BILLS: IDEN./SIM. BILLS: SB 388

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

1) Professions & Public Health Subcommittee Guzzo McElroy

2) Regulatory Reform Subcommittee

3) Health & Human Services Committee

SUMMARY ANALYSIS
Emergency medical transport services, also known as ambulance services, involve urgent pre-hospital
treatment to an injured person by paramedics and emergency medical technicians (EMTs) during transport to a
hospital or similar facility. Florida law does not currently address whether an animal may be provided
emergency medical transport services; however, paramedics and EMTs are not authorized to provide
emergency medical care to animals under their respective licenses.

A veterinarian is a licensed health care practitioner who engages in the maintenance of health and treatment of
injury and disease of animals, especially domestic animals. With limited exceptions, only licensed veterinarians
may provide care to animals. The Department of Business and Professional Regulation (DBPR) may issue a
notice to cease and desist to any person it has probable cause to believe is practicing, or attempting to
practice, veterinary medicine without a license. DBPR may also impose an administrative penalty not to
exceed $5,000 per incident or may issue a citation.

Specially-trained dogs are used by various agencies and departments throughout the state in their K-9 units.
These departments employ dogs to assist with tracking and apprehending offenders, narcotics and bomb
detection, and building and article searches. Police canines are used in conjunction with high-intensity,
criminal situations and are often deployed by their handlers to chase fleeing felons. As a result, the dogs are
often caught in the line of fire while on the job.

HB 697 expressly authorizes an emergency service transport vehicle permit holder to transport a police canine
injured in the line of duty to a veterinary clinic, hospital emergency department, or similar facility if no person
requires medical attention or transport. The bill authorizes paramedics and EMTs to provide emergency
medical care to an injured police canine at the scene of an emergency or while the canine is being transported.

The bill provides civil and criminal immunity for EMTs and paramedics providing emergency care to an injured
police canine and exempts them from the application of the veterinary practice act for providing medical care to
a police canine injured in the line of duty.

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: h0697.PPH
DATE: 3/15/2021
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Background

Emergency Medical Transport Services

Prehospital life support transport services fall into two general categories – basic life support services
(BLS) and advanced life support services (ALS).

BLS services include the assessment or treatment by a person qualified under part III of ch. 401, F.S.,
through the use of techniques described in the EMT-Basic National Standard Curriculum or the
National Emergency Medical Services (EMS) Education Standards of the U.S. Department of
Transportation. 1 The term includes the administration of oxygen and other techniques that have been
approved and are performed under specific conditions. 2 BLS services are usually performed by EMTs. 3

ALS services include patient assessment or treatment including the implementation of advanced
medical skills such as endotracheal intubation, the administration of drugs or intravenous fluids,
telemetry, cardiac monitoring, cardiac defibrillation, and other techniques described in the EMT-
Paramedic National Standard Curriculum or the National EMS Education Standards. 4 ALS services can
be performed on site and are usually provided by physicians or paramedics. 5

To obtain a transport vehicle permit to provide BLS or ALS services, an applicant must provide to the
Department of Health the following:

• An application and required fees; and
• Documentation that the vehicle qualifies as follows:
o Is furnished with essential medical supplies and equipment which is in good working
order;
o Meets appropriate standards for design and construction;
o Is equipped with an appropriate communication system;
o Meets appropriate safety standards;
o Meets sanitation and maintenance standards;
o Is insured for a minimum of $100,000/$300,000 against injuries to or the death of any
person arising out of an accident; and
o Has been awarded a Certificate of Public Convenience and Necessity (COPCN). 6

Emergency Medical Technicians and Paramedics

An emergency medical technician (EMT) must be certified by the Department of Health (DOH) to
perform basic life support. 7 A paramedic must also be certified by DOH, but in addition to basic life
support, a certified paramedic may also perform advanced life support. 8 Applicants for certification as
1 United States Department of Transportation, National Highway Traffic Safety Administration, National Emergency Medical Services

Education Standards, (January 2009), available at https://www.ems.gov/pdf/National-EMS-Education-Standards-FINAL-Jan-2009.pdf
(last visited March 11, 2021).
2 Sections 401.23(7) and (8), F.S.
3 Ryynanen, et. al, Is advanced life support better than basic life support in prehospital care? A systematic review, Scand J Trauma

Resusc. Emerg. Med. 2010; 18: 62, (November 23, 2010), available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001418/ (last
visited March 11, 2021).
4 Sections 401.23(1) and (2), F.S.
5 Ryynanen, et. al, supra note 18.
6 Section 401.26(2), F.S., and Fla. Admin. Code R. 64J-1.002 and 64J-1.003 (2019).
7 Section 401.23(11), F.S.
8 Section 401.23(17), F.S.

STORAGE NAME: h0697.PPH PAGE: 2
DATE: 3/15/2021
an EMT or paramedic are required to complete a training program approved by DOH, which must be
equivalent to the most recent EMT-Basic National Standard Curriculum or the National EMS Education
Standards of the United States Department of Transportation. 9 They are also required to:

• Certify under oath that he or she is not addicted to alcohol or any controlled substance;
• Certify under oath that he or she is free from any physical or mental defect or disease that might
impair the applicant’s ability to perform his or her duties; and
• Pass an exam within 2 years after completion of a training program. 10

An EMT is required to hold a current American Heart Association cardiopulmonary resuscitation course
card or an American Red Cross cardiopulmonary resuscitation course card or its equivalent as defined
by department rule. Paramedics must hold a certificate of successful course completion in advanced
cardiac life support from the American Heart Association or its equivalent.

Current law does not authorize an EMT or a paramedic to provide emergency medical services to
animals, including canines.

Veterinary Medical Care and Treatment for Canines

The practice of veterinary medicine is licensed and regulated by the Department of Business and
Professional Regulation (DBPR), Board of Veterinary Medicine. 11 A veterinarian is a licensed health
care practitioner who engages in the practice of veterinary medicine which the Legislature has
determined can be potentially dangerous to the public health and safety if conducted by incompetent
and unlicensed practitioners. 12 The practice of veterinary medicine consists of: 13

• The diagnosis of medical conditions of animals;
• Prescribing, dispensing, or administering drugs, medicine, appliances, and applications for
animals;
• The treatment of animals for the prevention, cure, or relief of a wound, fracture, bodily injury, or
disease;
• The performance of any manual procedure for the diagnosis of or treatment for pregnancy or
fertility or infertility of animals; and
• The determination of the health, fitness, or soundness of an animal.

Veterinary medicine includes: 14

• Surgery;
• Acupuncture;
• Obstetrics;
• Dentistry;
• Physical therapy;
• Radiology;
• Theriogenology; and
• Any other veterinary medicine specialty.

9 Section 401.27(4)(a), F.S.
10 Section 401.27(4)(b)(c) and (d), F.S.
11 Chapter 474, F.S.; and see s. 20.165, F.S.
12 Ss. 474.201 and 407.202(11), F.S.
13 S. 474.202(9), F.S.
14 S. 474.202(13), F.S.

STORAGE NAME: h0697.PPH PAGE: 3
DATE: 3/15/2021
Section 474.202, F.S., defines an animal as a wild or domestic, dead or alive, bird, amphibian, fish,
reptile, or mammal, other than a human being. A dog, or canine, is a mammal. 15 It is the responsibility
of every veterinarian licensed and practicing in Florida to provide, either personally or through another
licensed veterinarian, 24-hour emergency services for all animals under his or her continuing care. 16

DBPR may issue a notice to cease and desist to any person it has probable cause to believe is
practicing, or attempting to practice, veterinary medicine without a license, or aiding and abetting a
person to practice veterinary medicine without a license. If the person fails to comply with the notice,
DBPR may file a proceeding seeking an injunction or a writ of mandamus. Additionally, DBPR may
impose an administrative penalty not to exceed $5,000 per incident or may issue a citation. 17

Section 474.203, F.S., provides exemptions from veterinary licensure for certain individuals and
entities, including: 18

• Any faculty member who is a graduate of a school or college of veterinary medicine and is
practicing only in conjunction with teaching duties at a school or college of veterinary medicine
located in this state and accredited by the American Veterinary Medical Association Council on
Education;
• A person practicing as an intern or resident veterinarian who is a graduate of a school or college
of veterinary medicine;
• A student in a school or college of veterinary medicine while in the performance of duties
assigned by her or his instructor or when working as a preceptor under the immediate
supervision of a licensee, if such preceptorship is required for graduation from an accredited
school or college of veterinary medicine;
• Any doctor of veterinary medicine in the employ of a state agency or the United States
Government while actually engaged in the performance of her or his official duties, however,
this exemption does not apply to such person when the person is not engaged in carrying out
her or his official duties or is not working at the installations for which her or his services were
engaged;
• Any person, or the person’s regular employee, administering to the ills or injuries of her or his
own animals, including, but not limited to, castration, spaying, and dehorning of herd animals;
• A person hired on a part-time or temporary basis, or as an independent contractor, by an owner
to assist with herd management and animal husbandry tasks for herd and flock animals,
including castration, dehorning, parasite control, and debeaking, or a person hired on a part-
time or temporary basis, or as an independent contractor, by an owner to provide farriery and
manual hand floating of teeth on equines;
• State agencies, accredited schools, institutions, foundations, business corporations or
associations, physicians licensed to practice medicine and surgery in all its branches, graduate
doctors of veterinary medicine, or persons under the direct supervision thereof, which or who
conduct experiments and scientific research on animals in the development of pharmaceuticals,
biologicals, serums, or methods of treatment, or techniques for the diagnosis or treatment of
human ailments, or when engaged in the study and development of methods and techniques
directly or indirectly applicable to the problems of the practice of veterinary medicine;
• Any veterinary aide, nurse, laboratory technician, preceptor, or other employee of a licensed
veterinarian who administers medication or who renders auxiliary or supporting assistance
under the responsible supervision of a licensed veterinarian, including those tasks identified by
rule of the board requiring immediate supervision;
• A veterinarian, licensed by and actively practicing veterinary medicine in another state, who is
board certified in a specialty recognized by the board and who responds to a request of a

15 Merriam-Webster On-line Dictionary, Dog or Canine is a highly variable domestic mammal (Canis familiaris) closely related to the

gray wolf, available at https://www.merriam-webster.com/dictionary/dog (last visited March 11, 2021).
16 Fla. Admin. Code R. 61G18-19.001 (2019).
17 S. 455.228, F.S.
18 Section 474.203, F.S.

STORAGE NAME: h0697.PPH PAGE: 4
DATE: 3/15/2021
veterinarian licensed in this state to assist with the treatment on a specific case of a specific
animal or with the treatment on a specific case of the animals of a single owner, as long as the
veterinarian licensed in this state requests the other veterinarian’s presence; and
• An employee, an agent, or a contractor of a public or private animal shelter, humane
organization, or animal control agency operated by a humane organization or by a county, a
municipality, or another incorporated political subdivision whose work is confined solely to the
implantation of a radio frequency identification device microchip for dogs and cats.

Special K-9 Units

Specially-trained dogs are used by various agencies and departments throughout the state in their K-9
units. These departments employ dogs to assist with tracking and apprehending offenders, narcotics
and bomb detection, 19 and building and article searches. 20 Additionally, some fire departments use
dogs as part of arson detection programs. 21 Various non-profit organizations also use dogs for the
purpose of search and rescue, such as the Community Emergency Response Team, which provides
support to the federal Emergency Management Agency. 22

Police Canines

Section 843.19, F.S., defines the term “police canine” for law enforcement purposes as any canine that
is owned, or the service of which is employed, by a law enforcement agency or a correctional agency
for the principal purpose of aiding in the detection of criminal activity, enforcement of laws, or
apprehension of offenders.

Police dogs are frequently used in conjunction with high-intensity, criminal situations and are often
deployed by their handlers to chase fleeing felons. As a result, the dogs can be caught in the line of fire
while on the job. In September 2018, 3-year-old Fang, a member of Jacksonville Sheriff’s Office canine
unit, was shot and killed by a teenager who was fleeing a scene after carjacking two women at a gas
station minutes earlier. 23 Similarly, in December 2018, 3-year-old Cigo with the Palm Beach County
Sheriff’s Office was shot and killed by an attempted murder suspect outside of a shopping mall. 24 In
2020, 48 police canines were killed in the line of duty in Florida. 25 In 2019, the Legislature, recognizing
the ongoing danger to and violence against police canines, increased the penalty for causing harm to
or using a deadly weapon against a police canine from a third degree felony to a second degree
felony. 26, 27

Effect of the Bill

The bill creates s. 401.254, F.S., to authorize an emergency service transport vehicle permit holder to
transport a police canine injured in the line of duty to a veterinary clinic, hospital emergency

19 City of Orlando, K-9 Unit, available at http://www.cityoforlando.net/police/k-9-unit/ (last visited March 11, 2021).
20 St. Petersburg Police Department, K-9 Unit, available at http://police.stpete.org/k-9 (last visited March 11, 2021).
21 City of Orlando, Accelerant Detection Canines, available at http://www.cityoforlando.net/fire/accelerant-detection-canines/ (last visited

March 11, 2021).
22 Boondocks K9 SAR-CERT Unit, Community Emergency Response Team (CERT), available at https://www.boondocksk9.org/ (last

visited March 11, 2021).
23 Tarik Mino and Colette DuChanois, Audio, video evidence released in case of teen held in K-9’s death, NEWS4JAX (November 12,

2018), available at https://www.news4jax.com/news/2018/11/13/audio-video-evidence-released-in-case-of-teen-held-in-k-9s-death/ (last
visited March 11, 2021).
24 Mark Osborne and Jason M. Volack, Suspect kills police dog in shootout outside mall on Christmas Eve, police say, ABC NEWS

(December 25, 2018), available at https://abcnews.go.com/US/suspect-kills-police-dog-shootout-mall-christmas-eve/story?id=60007552
(last visited March 11, 2021).
25 Officer Down Memorial Page, Florida Line of Duty Deaths, available at https://www.odmp.org/search/browse/florida (last visited

March 11, 2021).
26 Chapter 2019-9, Laws of Fla. (2019).
27 A third degree felony is punishable by up to five years imprisonment and up to a $5,000 fine. Sections 775.082, 775.083, and

775.084, F.S. A second degree felony is punishable by up to 15 years imprisonment and up to a $10,000 fine. Sections 775.082 and
775.083, F.S.
STORAGE NAME: h0697.PPH PAGE: 5
DATE: 3/15/2021
department, or similar facility if no person requires medical attention or transport when the canine
needs it.

The bill defines the term “police canine” as any canine that is owned, or the service of which is
employed, by a state or local law enforcement agency, a correctional agency, a fire department, a
special fire district, or the State Fire Marshal for the principal purpose of aiding in the detection of
criminal activity, flammable materials, or missing persons; enforcement of laws; investigation of fires; or
apprehension of offenders.

The bill authorizes EMTs and paramedics to provide emergency medical care to an injured police
canine at the scene of the emergency or while being transported. The bill provides civil and criminal
immunity for EMTs and paramedics who act in good faith to provide emergency care to an injured
police canine and exempts them from the application of the veterinary practice act for providing medical
care to a police canine injured in the line of duty.

The bill provides an effective date of July 1, 2021.

B. SECTION DIRECTORY:
Section 1: Creates s. 401.254, F.S., related to treatment of injured police canines.
Section 2: Amends s. 474.203, F.S., related to exemptions.
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:
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:

STORAGE NAME: h0697.PPH PAGE: 6
DATE: 3/15/2021
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:
No additional rule-making authority is needed to implement the provisions of the bill.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: h0697.PPH PAGE: 7
DATE: 3/15/2021
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 697 2021

1 A bill to be entitled
2 An act relating to injured police canines; creating s.
3 401.254, F.S.; defining the term "police canine";
4 authorizing licensed life support services to
5 transport injured police canines under certain
6 circumstances; authorizing a paramedic or an emergency
7 medical technician to provide emergency medical care
8 to injured police canines under certain circumstances;
9 providing for immunity from criminal and civil
10 liability under certain circumstances; amending s.
11 474.203, F.S.; providing applicability; providing an
12 effective date.
13
14 Be It Enacted by the Legislature of the State of Florida:
15
16 Section 1. Section 401.254, Florida Statutes, is created
17 to read:
18 401.254 Treatment of injured police canines.—
19 (1) As used in this section, the term "police canine"
20 means any canine that is owned, or the service of which is
21 employed, by a state or local law enforcement agency, a
22 correctional agency, a fire department, a special fire district,
23 or the State Fire Marshal for the principal purpose of aiding in
24 the detection of criminal activity, flammable materials, or
25 missing persons; the enforcement of laws; the investigation of

Page 1 of 3

CODING: Words stricken are deletions; words underlined are additions.
hb0697-00
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 697 2021

26 fires; or the apprehension of offenders.
27 (2) A licensee with a valid permit for the transport
28 vehicle may transport a police canine injured in the line of
29 duty to a veterinary clinic, hospital emergency department, or
30 similar facility if there is no individual requiring medical
31 attention or transport at that time.
32 (3) Notwithstanding s. 474.213, a paramedic or an
33 emergency medical technician may provide emergency medical care
34 to a police canine injured in the line of duty while at the
35 scene of the emergency or while the police canine is being
36 transported to a veterinary clinic, hospital emergency
37 department, or similar facility. A paramedic or an emergency
38 medical technician who acts in good faith to provide emergency
39 medical care to an injured police canine is immune from criminal
40 or civil liability.
41 Section 2. Subsection (10) is added to section 474.203,
42 Florida Statutes, to read:
43 474.203 Exemptions.—This chapter does not apply to:
44 (10) A paramedic or an emergency medical technician
45 providing emergency medical care to a police canine injured in
46 the line of duty as authorized under s. 401.254.
47
48 For the purposes of chapters 465 and 893, persons exempt
49 pursuant to subsection (1), subsection (2), or subsection (4)
50 are deemed to be duly licensed practitioners authorized by the

Page 2 of 3

CODING: Words stricken are deletions; words underlined are additions.
hb0697-00
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 697 2021

51 laws of this state to prescribe drugs or medicinal supplies.
52 Section 3. This act shall take effect July 1, 2021.

Page 3 of 3

CODING: Words stricken are deletions; words underlined are additions.
hb0697-00
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 697 (2021)
Amendment No.1

COMMITTEE/SUBCOMMITTEE ACTION
ADOPTED (Y/N)
ADOPTED AS AMENDED (Y/N)
ADOPTED W/O OBJECTION (Y/N)
FAILED TO ADOPT (Y/N)
WITHDRAWN (Y/N)
OTHER

1 Committee/Subcommittee hearing bill: Professions & Public
2 Health Subcommittee
3 Representative Killebrew offered the following:
4
5 Amendment
6 Remove lines 27-40 and insert:
7 (2) A licensee with a valid permit for the transport
8 vehicle may transport a police canine injured in the line of
9 duty to a veterinary clinic or similar facility if there is no
10 individual requiring medical attention or transport at that
11 time.
12 (3) Notwithstanding s. 474.213, a paramedic or an
13 emergency medical technician may provide emergency medical care
14 to a police canine injured in the line of duty while at the
15 scene of the emergency or while the police canine is being
16 transported to a veterinary clinic or similar facility. A
152043 - h0697-line27.docx
Published On: 3/15/2021 5:36:54 PM
Page 1 of 2
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 697 (2021)
Amendment No.1

17 paramedic or an emergency medical technician who acts in good
18 faith to provide emergency medical care to an injured police
19 canine is immune from criminal or civil liability.

152043 - h0697-line27.docx
Published On: 3/15/2021 5:36:54 PM
Page 2 of 2
HB 1097
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1097 Health Care Licensure Requirements
SPONSOR(S): Learned
TIED BILLS: IDEN./SIM. BILLS: SB 780

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

1) Professions & Public Health Subcommittee Rahming McElroy

2) Health & Human Services Committee

SUMMARY ANALYSIS
Florida is home to one of the largest veteran populations in the United States. The United States Veterans
Affairs (VA) provides health care services to veterans through a large health care system of hospitals and
clinics throughout the state. To work at a VA health care facility, a health care practitioner must hold an active
license to practice his or her healthcare profession from any state in the nation. However, if a VA health care
practitioner wants to provide health care services to a veteran in a setting outside of a VA health care facility in
this state, he or she must hold the appropriate Florida health care practitioner license.

HB 1097 requires the Department of Health (DOH) to exempt certain VA physicians from licensure
requirements. To qualify for the exemption, a VA physician must submit to the DOH:

• Proof that he or she holds an active, unencumbered license to practice medicine from another state or
territory of the United States;
• Proof of current employment with the VA; and
• An attestation that he or she will only provide medical services to veterans in Florida-licensed hospitals
and that such services are pursuant to his or her employment with the VA.

The DOH must notify the physician within 15 business of receipt of the documentation that the physician is
exempt from Florida licensure requirements.

The bill has an indeterminate, 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.

FULL ANALYSIS
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1097.PPH
DATE: 3/15/2021
I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Physician Licensure in Florida

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 with the Department of Health (DOH). The chapter imposes
requirements for licensure examination and licensure by endorsement.

An individual seeking to be licensed by examination as an allopathic physician must, among other
things: 1

• Complete two years of preprofessional postsecondary education, which includes, at a minimum,
anatomy, biology, and chemistry courses prior to entering medical school;
• Not have committed an act or offense that would constitute a basis for disciplining a physician
under Florida law;
• Meet one of the following medical education and postgraduate training requirements:
o Be a graduate of 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 have completed at
least one year of approved residency training;
o Be a graduate of 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 have completed at least one year of approved
residency training; or
o Be a graduate of an allopathic foreign medical school that has not been certified
pursuant to statute; have an active, valid certificate issued by the Educational
Commission for Foreign Medical Graduates (ECFMG), 2 pass the commission’s
examination; and complete an approved residency or fellowship of at least two years in
one specialty area;
• Obtain 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; and
• Successfully complete a background screening.

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.

1 S. 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 a

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 of the foreign medical school, has completed an
academic year of supervised clinical training and upon completion has passed part II of the National Board Medical Examiners licensing
examination or the ECFMG equivalent examination. S. 458.311(3), F.S.
3 S. 458.313, F.S.

STORAGE NAME: h1097.PPH PAGE: 2
DATE: 3/15/2021
If the allopathic board determines that an applicant has failed to meet the requirements for licensure by
endorsement, it may: 4

• Refuse to certify the application for licensure to the DOH;
• Certify the application for licensure to the DOH with restrictions on the scope of practice of the
licensee; or
• Certify the application for licensure to the DOH, 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.

Osteopathic Physicians

Chapter 459, F.S., provides for the licensure and regulation of the practice of medicine by the Florida
Board of Osteopathic Medicine (osteopathic board) in conjunction with the DOH. The chapter imposes
requirements for licensure.

An individual seeking to be licensed as an osteopathic physician must, among other things: 5

• Have completed at least three years of preprofessional postsecondary education;
• Have not committed an act that would constitute a basis for disciplining a physician under
Florida law, unless the osteopathic board determines that such act does not adversely affect the
applicant’s ability and fitness to practice osteopathic medicine.
• Graduate from a medical college recognized and approved by the American Osteopathic
Association;
• Successfully complete a residency or internship of at least 12 months in a program accredited
by the American Osteopathic Association or the Accreditation Council for Graduate Medical
Education;
• Obtain 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; 6 and
• Successfully complete a background screening.

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. If it has been more than two years since the applicant actively practiced osteopathic
medicine, the osteopathic board may: 7

• Deny the application;
• Issue a license with reasonable restrictions or conditions, which may include, but is not limited
to, a requirement that the applicant practice under the supervision of a physician approved by
the osteopathic board; or
• Issue a license upon receipt of documentation confirming the applicant has met any reasonable
conditions of the osteopathic board, which may include, but is not limited to, completing
continuing education or undergoing an assessment of skills and training.

Unlicensed Practice of a Health Care Profession

An individual must meet minimum education and training requirements to become licensed and practice
a health care profession. 8 Licensure is available by examination or, in many instances, by endorsement

4 S. 458.313(7), F.S.
5 S. 459.0055(1), F.S.
6 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.
7 S. 459.0055(2), F.S.
8 S. 456.065(1), F.S.

STORAGE NAME: h1097.PPH PAGE: 3
DATE: 3/15/2021
if the practitioner is licensed in another jurisdiction. Florida law prohibits an individual from practicing a
regulated health care profession without a license.

An unlicensed individual providing healthcare services is subject to administrative and criminal
penalties. The DOH may issue a cease and desist letter to such a person and impose, by citation, an
administrative penalty of up to $5,000 per offense. 9 The DOH may also seek a civil penalty of up to
$5,000 for each offense through the circuit court in addition to, or in lieu of, the administrative penalty. 10

An individual practicing, attempting to practice, or offering to practice a health care profession without
an active, valid Florida license is subject to criminal penalties: 11

• A first degree misdemeanor punishable by up to one year imprisonment and a fine of up to
$1,000 if the license has been inactive or delinquent for any period of time up to 12 months,
with a minimum sentence of 30 days imprisonment and a $500 fine.
• A third degree felony punishable by up to five years imprisonment and a fine of up to $5,000 if
the license has been inactive or delinquent for a period of time exceeding 12 months, with a
minimum sentence of 30 days imprisonment and a $500 fine.
• A third degree felony punishable by up to five years imprisonment and a fine of up to $5,000,
with a minimum mandatory sentence of one year imprisonment and a $1,000 fine.
• A second degree felony punishable by up to 15 years imprisonment and a fine of up to $15,000
if such practice results in serious bodily injury, with a minimum mandatory sentence of one year
imprisonment and a $1,000 fine.

These penalties are in addition to any administrative and civil penalties incurred by the unlicensed
individual.

U.S. Department of Veteran Affairs Practitioners

The Veterans Health Administration within the United States Department of Veterans Affairs (VA)
operates the nation’s largest integrated health care systems, providing care at 1,255 health care
facilities. 12 The U.S. is divided into 18 Veterans Integrated Service Networks, or VISNs. 13 Each service
network is comprised of medical centers or hospitals, which oversees the clinics in its region. Florida is
a part of the VA Sunshine Health Network (VISN 8), which is comprised of eight medical centers and
over 60 community clinics, the largest VISN in the U.S. in terms of patients served. 14 In 2020, the VISN
8 employed 33,457 and treated more than 764,000 veterans. 15

9 S. 456.065(2)(b), F.S. Each day that the unlicensed practice continues after issuance of a notice to cease and desist constitutes a

separate offense.
10 S. 456.065(2)(c), F.S.
11 S. 456.065(2)(d), F.S.
12 U.S. Department of Veterans Affairs, Veterans Health Administration, About VHA, https://www.va.gov/health/aboutvha.asp (last

visited Mar. 7, 2021).
13 Id.
14 U.S. Department of Veterans Affairs, Veterans Health Administration, VA Sunshine Healthcare Network (VISN 8), 2020 Annual

Report, available at https://www.visn8.va.gov/VISN8/news/documents/V-508CLEAN_V082020_AnnualReport.pdf (last visited Mar. 7,
2021).
15 Id. at p. 4.

STORAGE NAME: h1097.PPH PAGE: 4
DATE: 3/15/2021
The health care practitioners practicing in VA facilities in Florida are not required to be licensed in
Florida. The VA requires that a health care practitioner have an active, unrestricted license to practice
from any state to practice at any one of its facilities nationwide. 16 A VA health care practitioner may
treat any veteran in a VA facility located in Florida, regardless of the state of licensure. However, a VA
health care practitioner may not provide medical services to one of his or her veteran patients outside
the VA facility unless he or she holds a Florida license. If the health care practitioner is not licensed in
Florida and provides such services, the health care practitioner could be prosecuted for the unlicensed
practice of a health care practitioner.

Effect of Proposed Changes

16 U.S. Department of Veterans Affairs, Physicians at VA, available at https://www.vacareers.va.gov/Careers/Physicians/#live-work-

anywhere (last visited Mar. 7, 2021).
STORAGE NAME: h1097.PPH PAGE: 5
DATE: 3/15/2021
HB 1097 requires DOH to exempt a VA physician from Florida licensure requirements if the VA
physician:

• Holds an active, unencumbered license to practice medicine in another state, the District of
Columbia, or a possession, commonwealth, or territory of the United States;
• Is currently employed with the VA;
• Attests that he or she will only provide medical services to veterans at Florida-licensed
hospitals pursuant to his or her employment with the VA.

DOH must notify the physician that he or she is exempt from licensure within 15 business days of
receiving documentation that a VA physician meets the requirements for an exemption. An exempt
physician remains subject to prosecution for the unlicensed practice of a health care profession if the
physician treats a patient who is not a veteran.

The bill authorizes DOH to adopt rules to implement its provisions.

The bill provides an effective date of July 1, 2021.

B. SECTION DIRECTORY:
Section 1: Creates s. 456.0231, F.S., relating to exemption from health care license requirements
for the treatment of veterans.
Section 2: Provides an effective date of July 1, 2021.

II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT

A. FISCAL IMPACT ON STATE GOVERNMENT:

1. Revenues:
DOH may experience a decrease in licensure revenue if a physician who works for the VA and is
licensed in another state, the District of Columbia, or a possession, commonwealth, or territory of
the United States is exempt from Florida licensure and licensure fees to treat veterans in a licensed
hospital. The fiscal impact is indeterminate.

2. Expenditures:
The DOH will experience an increase in workload associated with reviewing documentation
submitted by physicians seeking exemption from licensure. The fiscal impact is indeterminate.

The DOH will incur recurring costs associated with updating the existing data exchange services
with its vendor to support printing and mailing approval notification to physicians approved for
exemption, which current resources are anticipated to be adequate to absorb.

The DOH will incur nonrecurring costs relating to rulemaking and updating the Licensing and
Enforcement Information Database System (LEIDS), Online Service Portal (Versa Online), Axiom
Pro Document Management System and board websites to implement the bill, which current
resources are adequate to absorb.

B. FISCAL IMPACT ON LOCAL GOVERNMENTS:

1. Revenues:
None.

2. Expenditures:
None.

STORAGE NAME: h1097.PPH PAGE: 6
DATE: 3/15/2021
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
A physician who works for the VA and is licensed in another state will no longer have to pay the fees
associated with obtaining a Florida license to treat Florida veterans in licensed hospitals.

D. FISCAL COMMENTS:
None.

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:
The bill provides the DOH sufficient rulemaking authority to implement the bill.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: h1097.PPH PAGE: 7
DATE: 3/15/2021
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 1097 2021

1 A bill to be entitled
2 An act relating to health care licensure requirements;
3 creating s. 456.0231, F.S.; defining the term
4 "physician"; requiring certain physicians to submit
5 specified information to the Department of Health to
6 be exempt from specified licensure requirements;
7 requiring the department to notify such health care
8 practitioners of their exemption within a specified
9 timeframe; authorizing the department to adopt rules;
10 providing an effective date.
11
12 Be It Enacted by the Legislature of the State of Florida:
13
14 Section 1. Section 456.0231, Florida Statutes, is created
15 to read:
16 456.0231 Exemption from health care licensure requirements
17 for the treatment of veterans.—
18 (1) As used in this section, the term "physician" means a
19 person who holds an active, unencumbered license to practice
20 allopathic medicine or osteopathic medicine issued by another
21 state, the District of Columbia, or a possession, commonwealth,
22 or territory of the United States.
23 (2) A physician must submit to the department all of the
24 following to be exempt from the licensure requirements of
25 chapters 458 and 459:

Page 1 of 2

CODING: Words stricken are deletions; words underlined are additions.
hb1097-00
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 1097 2021

26 (a) Proof that he or she holds an active, unencumbered
27 license to practice allopathic medicine or osteopathic medicine
28 issued by another state, the District of Columbia, or a
29 possession, commonwealth, or territory of the United States.
30 (b) Proof of current employment with the United States
31 Department of Veterans Affairs.
32 (c) An attestation that he or she will only provide
33 medical services:
34 1. To veterans.
35 2. Pursuant to his or her employment with the United
36 States Department of Veterans Affairs.
37 3. In hospitals licensed under chapter 395.
38 (3) The department shall notify the physician within 15
39 business days after receipt of the documentation required by
40 subsection (2) that the physician is exempt from the licensure
41 requirements of chapters 458 and 459.
42 (4) The department may adopt rules to administer this
43 section.
44 Section 2. This act shall take effect July 1, 2021.

Page 2 of 2

CODING: Words stricken are deletions; words underlined are additions.
hb1097-00
HB 6095
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 6095 Scheduling of Drug Products Containing Cannabidiol
SPONSOR(S): Fischer
TIED BILLS: IDEN./SIM. BILLS: SB 1476

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

1) Professions & Public Health Subcommittee Morris McElroy

2) Criminal Justice & Public Safety Subcommittee

3) Health & Human Services Committee

SUMMARY ANALYSIS
Federal and state law both classify controlled substances into five schedules. The scheduling determination for
a controlled substance is based on a substance’s potential for abuse, accepted medical use, and potential for
addiction. The classifications range from a Schedule I substance, which has a high potential for abuse, with no
accepted medical use, and high potential for addiction; to a Schedule V substance, which has a low potential
for abuse, an accepted medical use, and a mild potential for addiction. Cannabis and compounds derived from
cannabis are listed in Schedule I of both federal and Florida law.

Epidiolex is a prescription cannabidiol, a non-psychoactive compound derived from the cannabis plant, which
is used to treat seizures associated with Lennox-Gastaut syndrome or Dravet syndrome. On June 25, 2018,
the U.S. Food and Drug Administration approved Epidiolex for use by patients two years of age or older. The
federal Drug Enforcement Administration (DEA) rescheduled Epidiolex in Schedule V of the federal Controlled
Substances Act effective September 27, 2018. On October 31, 2018, the Florida Attorney General rescheduled
Epidiolex as a Schedule V controlled substance under an emergency rule. On April 6, 2020 the manufacturer
of Epidiolex, announced it had received notification from the DEA confirming that Epidiolex is no longer subject
to the federal Controlled Substances Act.

The bill repeals Epidiolex as a Schedule V controlled substance, mirroring federal law, and makes conforming
changes.

The bill does not have a fiscal impact on state or local governments.

The bill is effective upon becoming law.

This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h6095.PPH
DATE: 3/15/2021
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Background

Florida Law

Controlled Substances

Chapter 893, F.S., the Florida Comprehensive Drug Abuse Prevention and Control Act, classifies
controlled substances into five categories, called schedules. These schedules regulate the
manufacture, distribution, preparation, and dispensing of the substances listed therein. The
distinguishing factors between the different drug schedules are the “potential for abuse” 1 of the
substance and whether there is a currently accepted medical use for the substance. 2

The controlled substance schedules are as follows:

• Schedule I substances have a high potential for abuse and currently have no accepted medical
use in the United States, including substances such as cannabis and heroin. 3
• Schedule II substances have a high potential for abuse and have a currently accepted but
severely restricted medical use in the United States, including substances such as raw opium,
fentanyl, and codeine. 4
• Schedule III substances have a potential for abuse less than the substances contained in
Schedules I and II and have a currently accepted medical use in the United States, including
substances such as stimulants and anabolic steroids. 5
• Schedule IV substances have a low potential for abuse relative to substances in Schedule III
and have a currently accepted medical use in the United States, including substances such as
benzodiazepines and barbiturates. 6
• Schedule V substances have a low potential for abuse relative to the substances in Schedule IV
and have a currently accepted medical use in the United States, including substances such as
mixtures that contain small quantities of opiates, narcotics, or stimulants. 7

For each controlled substance schedule I-V dispensed to a patient in this state, the dispenser must
report by the close of the next business day to E-FORCSE, Florida’s prescription drug monitoring
program. 8

Attorney General

The Legislature delegated to the Florida Attorney General the authority to adopt rules rescheduling or
deleting controlled substances from a schedule if reduced control of a substance is in the best interest
of the public. 9 To determine whether rescheduling a controlled substance is in the public interest, the
Attorney General must consider: 10

1 S. 893.035(3)(a), F.S., defines “potential for abuse” to mean that a substance has properties as a central nervous system stimulant or

depressant or a hallucinogen that create a substantial likelihood of its being: 1) used in amounts that create a hazard to the user’s
health or safety of the community; 2) diverted from legal channels and distributed through illegal channels; or 3) taken on the user’s
own initiative rather than on the basis of professional medical advice.
2 See s. 893.03, F.S.
3 S. 893.03(1), F.S.
4 S. 893.03(2), F.S.
5 S. 893.03(3), F.S.
6 S. 893.03(4), F.S.
7 S. 893.03(5), F.S.
8 S. 893.055, F.S. A dispenser means a pharmacy, a dispensing pharmacist, or a dispensing health care practitioner.
9 S. 893.0355, F.S.
10 S. 893.0355(2)(a)–(h), F.S.

STORAGE NAME: h6095.PPH PAGE: 2
DATE: 3/15/2021
• Whether the controlled substance has been rescheduled under federal law;
• The substance’s potential for abuse;
• Scientific evidence of the substance’s pharmacological effect;
• The state of current scientific knowledge regarding the substance;
• The substance’s history and current pattern of abuse;
• The scope, duration, and significance of abuse;
• The public health risk; and
• The substance’s psychic or psychological dependency.

Federal Law

The Federal Controlled Substances Act 11 also classifies controlled substances into schedules based on
the potential for abuse and whether there is a currently accepted medical use for the substance. The
Drug Enforcement Administration (DEA) is required to consider the following when determining where
to schedule a substance: 12

• The substance’s actual or relative potential for abuse;
• Scientific evidence of the substance’s pharmacological effect, if known;
• The state of current scientific knowledge regarding the substance;
• The substance’s history and current pattern of abuse;
• The scope, duration, and significance of abuse;
• What, if any, risk there is to public health;
• The substance’s psychic or physiological dependence liability; and
• Whether the substance is an immediate precursor of a substance already controlled.

Epidiolex

Because Epidiolex was not scheduled under Florida law, there was concern the substance would be
treated in the same manner as cannabis, which is classified as a Schedule I substance. In response, on
October 31, 2018, the Florida Attorney General filed an emergency rule with the Secretary of State
rescheduling Epidiolex as a schedule V controlled substance. As of that date, there were approximately
64 patients in Florida taking Epidiolex pursuant to clinical drug trial programs, which were nearing an
end. 16 A delay in rescheduling Epidiolex would likely have disrupted the supply of the drug to Florida
patients. 17 The emergency rule will remain in effect until the effective date of legislation that provides a
different schedule for the substance. 18

11 21 U.S.C. § 812.
12 21 U.S.C. § 811(c).
13 Greenwich Biosciences, The Epidiolex Story, https://www.epidiolex.com/about-epidiolex/story (last visited March 10, 2021).
14 U.S. Food and Drug Administration, FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare,

severe forms of epilepsy, https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm (last visited March 10,
2021).
15 United State Drug Enforcement Administration, FDA-approved drug Epidiolex placed in schedule V of Controlled Substance Act,

https://www.dea.gov/press-releases/2018/09/27/fda-approved-drug-epidiolex-placed-schedule-v-controlled-substance-act (last visited
March 10, 2021).
16 Office of the Attorney General, Findings of the Attorney General in Support of Emergency Rule 2ER18-1, F.A.C. (Oct. 31, 2018).
17 Id.
18 S. 893.0355(6), F.S.

STORAGE NAME: h6095.PPH PAGE: 3
DATE: 3/15/2021
On April 6, 2020, Greenwich Biosciences, the manufacturer of Epidiolex, announced it had received
notification from the DEA confirming that Epidiolex is no longer subject to the federal Controlled
Substances Act, effective immediately. 19

Effect of the Bill

HB 6095 repeals Epidiolex as a Schedule V controlled substance, mirroring federal law. Descheduling
enables practitioners to prescribe Epidiolex free of schedule V reporting requirements.

The bill makes conforming changes.

B. SECTION DIRECTORY:

Section 1 Amends s. 893.03, F.S., relating to standards and schedules.
Section 2 Amends s. 893.02, F.S., relating to definitions.
Section 3 Provides the bill shall take effect upon becoming a law.

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.

19 GW Pharmaceuticals, GW Pharmaceuticals plc and Its U.S. Subsidiary Greenwich Biosciences, Inc. Announce That EPIDIOLEX®

(cannabidiol) Oral Solution Has Been Descheduled And Is No Longer A Controlled Substance, https://www.gwpharm.com/ir/press-
releases/gw-pharmaceuticals-plc-and-its-us-subsidiary-greenwich-biosciences-inc-announce (last visited March 10, 2021).
STORAGE NAME: h6095.PPH PAGE: 4
DATE: 3/15/2021
2. Other:
None.

B. RULE-MAKING AUTHORITY:
Rulemaking authority is not required to implement the provisions of the bill.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: h6095.PPH PAGE: 5
DATE: 3/15/2021
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 6095 2021

1 A bill to be entitled
2 An act relating to scheduling of drug products
3 containing cannabidiol; amending s. 893.03, F.S.;
4 removing provisions concerning the scheduling of
5 certain drug products containing cannabidiol; amending
6 s. 893.02, F.S.; conforming provisions to changes made
7 by the act; providing an effective date.
8
9 Be It Enacted by the Legislature of the State of Florida:
10
11 Section 1. Paragraph (d) of subsection (5) of section
12 893.03, Florida Statutes, is amended to read:
13 893.03 Standards and schedules.—The substances enumerated
14 in this section are controlled by this chapter. The controlled
15 substances listed or to be listed in Schedules I, II, III, IV,
16 and V are included by whatever official, common, usual,
17 chemical, trade name, or class designated. The provisions of
18 this section shall not be construed to include within any of the
19 schedules contained in this section any excluded drugs listed
20 within the purview of 21 C.F.R. s. 1308.22, styled "Excluded
21 Substances"; 21 C.F.R. s. 1308.24, styled "Exempt Chemical
22 Preparations"; 21 C.F.R. s. 1308.32, styled "Exempted
23 Prescription Products"; or 21 C.F.R. s. 1308.34, styled "Exempt
24 Anabolic Steroid Products."
25 (5) SCHEDULE V.—A substance, compound, mixture, or

Page 1 of 3

CODING: Words stricken are deletions; words underlined are additions.
hb6095-00
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 6095 2021

26 preparation of a substance in Schedule V has a low potential for
27 abuse relative to the substances in Schedule IV and has a
28 currently accepted medical use in treatment in the United
29 States, and abuse of such compound, mixture, or preparation may
30 lead to limited physical or psychological dependence relative to
31 the substances in Schedule IV.
32 (d) A drug product in finished dosage formulation that has
33 been approved by the United States Food and Drug Administration
34 that contains cannabidiol (2-[1R-3-methyl-6R-(1-methylethenyl)-
35 2-cyclohexen-1-yl]-5-pentyl-1,3-benzenediol) derived from
36 cannabis and no more than 0.1 percent (w/w) residual
37 tetrahydrocannabinols.
38 Section 2. Subsection (3) of section 893.02, Florida
39 Statutes, is amended to read:
40 893.02 Definitions.—The following words and phrases as
41 used in this chapter shall have the following meanings, unless
42 the context otherwise requires:
43 (3) "Cannabis" means all parts of any plant of the genus
44 Cannabis, whether growing or not; the seeds thereof; the resin
45 extracted from any part of the plant; and every compound,
46 manufacture, salt, derivative, mixture, or preparation of the
47 plant or its seeds or resin. The term does not include
48 "marijuana," as defined in s. 381.986, if manufactured,
49 possessed, sold, purchased, delivered, distributed, or
50 dispensed, in conformance with s. 381.986. The term does not

Page 2 of 3

CODING: Words stricken are deletions; words underlined are additions.
hb6095-00
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 6095 2021

51 include hemp as defined in s. 581.217 or industrial hemp as
52 defined in s. 1004.4473. The term does not include a drug
53 product described in s. 893.03(5)(d).
54 Section 3. This act shall take effect upon becoming a law.

Page 3 of 3

CODING: Words stricken are deletions; words underlined are additions.
hb6095-00
PCS for HB 1063
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 1063 Administration of Vaccines
SPONSOR(S): Professions & Public Health Subcommittee
TIED BILLS: IDEN./SIM. BILLS:

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

Orig. Comm.: Professions & Public Health Morris McElroy
Subcommittee

SUMMARY ANALYSIS
Current law authorizes pharmacists and registered interns who meet certain educational requirements to
administer vaccines to adults within an established protocol with a supervising physician. A pharmacist may
administer:

• Immunizations or vaccines listed on the U.S. Centers for Disease Control and Prevention (CDC) Adult
Immunization Schedule as of February 1, 2015;
• Vaccines recommended by the CDC for international travel as of July 1, 2015;
• Immunizations or vaccines approved by the Board of Pharmacy in rule; and
• Immunizations or vaccines approved by the Board of Pharmacy in response to a state of emergency
declared by the Governor.

PCS/HB 1063 authorizes qualified Florida-licensed pharmacists or registered pharmacy interns to administer
any CDC-recommended vaccine or vaccine licensed for use in the United States by the U.S. Food and Drug
Administration (FDA) to an adult. The PCS allows the Board of Pharmacy to authorize by rule additional
immunizations or vaccines, as they are recommended by the CDC or licensed by the FDA, that a qualified
pharmacist or registered pharmacy intern may administer. The PCS also authorizes pharmacists to provide
influenza vaccines to individuals age 7 and older.

The PCS also repeals the specific statutory limitation to the 2015 CDC-recommended vaccines.

The PCS has an insignificant, negative fiscal impact on the Department of Health, which can be absorbed
within existing resources. The PCS has no fiscal impact on local governments.

The PCS 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: pcs1063.PPH
DATE: 3/15/2021
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Present Situation

Vaccinations

CDC Immunizations Recommendations

The Advisory Committee on Immunization Practices (ACIP) is comprised of medical and public health
experts who develop recommendations on the use of vaccines in the United States. 1 The ACIP works
with professional organizations, such as the American Academy of Pediatrics, the American Academy
of Family Physicians, the American College of Obstetricians and Gynecologists, and the American
College of Physicians to develop annual childhood and adult immunization schedules. 2 The Centers for
Disease Control and Prevention (CDC) reviews the ACIP’s recommendations; and once approved, they
are published as the CDC’s official recommendations for immunizations of the U.S. population. 3 The
current recommended immunization schedule for those ages 18 and under includes: 4

• Hepatitis B • Rotavirus
• Diphtheria, tetanus, & acellular pertussis • Haemophilus influenza type b
• Pneumococcal conjugate • Inactivated poliovirus
• Influenza • Measles, mumps, rubella (MMR)
• Varicella • Hepatitis A
• Meningococcal • Human papillomavirus
• Meningococcal B • Pneumococcal polysaccharide
• Tetanus, diphtheria, and acellular pertussis

The current recommended immunization schedule for adults includes: 5

• Influenza (annually) • Varicella (if born in 1980 or later)
• Measles, mumps, rubella (if born in 1957 or • Tetanus, diphtheria, pertussis (booster
later) every 10 years)
• Zoster • Human papillomavirus
• Pneumococcal polysaccharide • Pneumococcal conjugate
• Haemophilus influenza type b • Hepatitis A
• Hepatitis B • Meningococcal A, C, W, Y
• Meningococcal B

New vaccines are considered for addition to the schedule after licensure by the United States Food and
Drug Administration. 6 Not all newly licensed vaccines are added to the schedule. Some licensed
vaccines are only recommended for people who are traveling to areas where other vaccine preventable

1 Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices (ACIP), General Committee-Related

Information, available at https://www.cdc.gov/vaccines/acip/committee/index.html (last visited March 8, 2021).
2 Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices (ACIP), ACIP Recommendations,

available at https://www.cdc.gov/vaccines/acip/recommendations.html (last visited March 8, 2021).
3 Id.
4 Centers for Disease Control and Prevention, Recommended Child and Adolescent Immunization Schedule for Ages 18 Years and

Younger, United States, 2021, available at https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html (last visited March 8,
2021). The schedule provides the recommended age, as well as the administration intervals for vaccines that require multiple doses.
Some vaccines are recommended only for populations with special situations that put these individuals at higher risk.
5 Centers for Disease Control and Prevention, Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States,

2021, available at https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html (last visited March 8, 2021). The schedule provides the
recommended age, as well as the administration intervals for vaccines that require multiple doses. Some vaccines are recommended
only for populations with special situations that put these individuals at higher risk.
6 College of Physicians of Philadelphia, The History of Vaccines: The Development of the Immunization Schedule, available at

http://www.historyofvaccines.org/content/articles/development-immunization-schedule (last visited March 8, 2021).
STORAGE NAME: pcs1063.PPH PAGE: 2
DATE: 3/15/2021
diseases occur, such as yellow fever, cholera, dengue, Japanese encephalitis, plague, rabies,
smallpox, and typhoid. 7

CDC Health Information for International Travel

CDC’s Health Information for International Travel, commonly called the Yellow Book (Book), is
published biannually by the CDC as a reference for those who advise international travelers about
health risks. 8 The Book includes the CDC’s most current travel health guidelines, including pre-travel
vaccine recommendations and destination-specific health advice. The Book is authored by subject-
matter experts both within and outside the CDC and the guidelines in the Book are evidence-based and
supported by best practices. 9

Vaccinations are recommended by the CDC to protect international travelers from illness and prevent
the importation of infectious diseases across international borders. The Book recommends that persons
traveling internationally should be up to date on all CDC-recommended vaccines. 10 Additionally, the
Book may recommend additional vaccinations based on traveler’s destination and other factors.
Examples of additional vaccines required for travelers based on the country of entry is yellow fever,
meningococcal, and polio. 11 An example of a vaccine the CDC recommends travelers obtain to protect
their health, even if they aren’t required for entry into the country, is the typhoid vaccine. 12

Practice of Pharmacy

Licensure

Pharmacy is the third largest health profession behind nursing and medicine. 13 The Board of Pharmacy
(Board), in conjunction with the Department of Health (DOH), regulates the practice of pharmacists
pursuant to ch. 465, F.S. 14 To be licensed as a pharmacist, a person must: 15

• Complete an application and remit an examination fee;
• Be at least 18 years of age;
• Hold a degree from an accredited and approved school or college of pharmacy; 16
• Have completed a Board-approved internship; and
• Successfully complete the Board-approved examination.

A pharmacist must complete at least 30 hours of Board-approved continuing education during each
biennial renewal period. 17 Pharmacists who are certified to administer vaccines or epinephrine
autoinjections must complete a 3-hour continuing education course on the safe and effective
administration of vaccines and epinephrine injections as a part of the biennial licensure renewal. 18

7 Id. For a complete list of FDA-licensed vaccines, see U.S. Food & Drug Administration, Vaccines Licensed for Use in the United

States, (last rev. Jan. 16, 2020), available at https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-
states (last visited February 4, 2020).
8 Centers for Disease Control and Prevention. CDC Yellow Book 2020: Health Information for International Travel, available at

https://wwwnc.cdc.gov/travel/page/yellowbook-home (last visited March 8, 2021).
9 Id.
10 Id.
11 Centers for Disease Control and Prevention, Travelers’ Health Most Frequently Asked Questions, available at

https://wwwnc.cdc.gov/travel/page/faq (last visited March 8, 2021).
12 Id.
13 American Association of Colleges of Pharmacy, About AACP, available at https://www.aacp.org/about-aacp (last visited March 8,

2021).
14 Sections 465.004 and 465.005, F.S.
15 Section 465.007, F.S. DOH may also issue a license by endorsement to a pharmacist who is licensed in another state upon meeting

the applicable requirements set forth in law and rule. See s. 465.0075, F.S.
16 If the applicant has graduated from a 4-year undergraduate pharmacy program of a school or college of pharmacy located outside

the United States, the applicant must demonstrate proficiency in English, pass the board-approved Foreign Pharmacy Graduate
Equivalency Examination, and complete a minimum of 500 hours in a supervised work activity program within Florida under the
supervision of a DOH-licensed pharmacist
17 Section 465.009, F.S.
18 Section 465.009(6), F.S.

STORAGE NAME: pcs1063.PPH PAGE: 3
DATE: 3/15/2021
Pharmacists who administer long-acting antipsychotic medications must complete an approved 8-hour
continuing education course as a part of the continuing education for biennial licensure renewal. 19

Scope of Practice

In Florida, the practice of the profession of pharmacy includes: 20

• Compounding, dispensing, and consulting concerning contents, therapeutic values, and uses of
a medicinal drug;
• Consulting concerning therapeutic values and interactions of patent or proprietary preparations;
• Monitoring a patient’s drug therapy and assisting the patient in the management of his or her
drug therapy, including the review of the patient’s drug therapy and communication with the
patient’s prescribing health care provider or other persons specifically authorized by the patient,
regarding the drug therapy;
• Transmitting information from prescribers to their patients;
• Administering vaccines to adults; 21
• Administering epinephrine injections; 22 and
• Administering antipsychotic medications by injection. 23

Pharmacy Interns

To become a pharmacy intern, a person must be certified by the Board as enrolled in an intern program
at an accredited school or college of pharmacy or as a graduate of an accredited school or college of
pharmacy and not yet licensed as a pharmacist in Florida. 24 The Board’s rules outline the registration
process for pharmacy interns and the internship program requirements for U.S. pharmacy students or
graduates and foreign pharmacy graduates. 25

A pharmacist is responsible for any delegated act performed by a registered pharmacy intern employed
or supervised by the pharmacist. 26

Pharmacist Vaccine Administration

A pharmacist, or registered pharmacy intern under the supervision of a certified pharmacist, may
administer immunizations and vaccines to adults within an established protocol under a licensed
supervising physician. 27 The protocol between the pharmacist and the supervising physician dictates
which types of patients to whom the pharmacist may administer allowable vaccines. 28 The terms,
scope, and conditions set forth in the protocol must be appropriate to the pharmacist’s training and
certification. A supervising physician must review the administration of vaccines by the pharmacist. 29

To be certified to administer vaccines, a pharmacist or registered pharmacy intern must successfully
complete a Board-approved vaccine administration certification program. The certification program
requires a pharmacist or registered intern to complete 20 hours of Board-approved continuing
education that addresses: 30

• Mechanisms of action for vaccines, contraindications, drug interactions, and monitoring after
vaccine administration;

19 Section 465.1893, F.S.
20 Section 465.003(13), F.S.
21 See s. 465.189, F.S.
22 Id.
23 Section 465.1893, F.S.
24 Section 465.013, F.S.
25 Rule 64B16-26.2032, F.A.C. (U.S. pharmacy students/graduates); Rule 64B16-26.2033, F.A.C. (foreign pharmacy graduates).
26 Rule 64B16-27.430, F.A.C.
27 Section 468.189(1), F.S.
28 Section 465.189(7), F.S.
29 Id.
30 Rule 64B16-26.1031, F.A.C.

STORAGE NAME: pcs1063.PPH PAGE: 4
DATE: 3/15/2021
• Immunization schedules;
• Immunization screening questions, provision of risk/benefit information, informed consent,
recordkeeping, and electronic reporting into the statewide immunization registry maintained by
DOH;
• Vaccine storage and handling;
• Bio-hazardous waste disposal and sterile technique;
• Entering, negotiating, and performing pursuant to physician oversight protocols;
• Community immunization resources and programs;
• Identifying, managing and responding to adverse incidents including but not limited to potential
allergic reactions associated with vaccine administration;
• Procedures and policies for reporting adverse incidents to the Vaccine Adverse Event Reporting
System;
• Reimbursement procedures and vaccine coverage by federal, state, and local governmental
jurisdictions and private third party payers;
• Administration techniques;
• Administration of epinephrine using an autoinjector delivery system;
• The February 1, 2015, CDC Recommended Adult Immunization Schedule;
• The immunizations or vaccines recommended for international travel as of July 1, 2015, found in
the CDC Health Information for International Travel (2014 Edition);
• State of emergency administration of immunizations or vaccines;
• Review of the current law permitting a pharmacist to administer vaccinations and epinephrine;
and
• CPR training.

A pharmacist must also pass an examination and demonstrate vaccine administration technique.31
Pharmacists who are certified to administer vaccines must maintain at least $200,000 of professional
liability insurance. 32 A pharmacist is permitted to administer epinephrine to treat any allergic reaction
resulting from a vaccine.

Current law restricts the vaccines a pharmacist may administer to adults to those vaccines listed in the
February 1, 2015, CDC Recommended Adult Immunization Schedule, which is the same as the 2021
list of recommended vaccines (see pg. 3), except that the CDC has added the Meningococcal B
vaccine to the list. 33

The Board may authorize, by rule, additional vaccines a pharmacist may administer. 34 The Board may
authorize pharmacists to administer vaccines in response to a declared state of emergency. 35 There
are 14,579 Florida-licensed pharmacists and 3,579 pharmacy interns who are certified to administer
vaccines. 36

Pharmacist Vaccination and Age Restrictions

In August of 2020, the U.S. Department of Health and Human Services amended the Declaration under
the Public Readiness and Emergency Preparedness Act to authorize pharmacists and registered or
licensed pharmacy interns acting under the supervision of a pharmacist to administer vaccines to
individuals aged three to 18 years. 37

31 Id.
32 Section 465.189(3), F.S.
33 Centers for Disease Control and Prevention, Recommended Adult Immunization Schedule, United States - 2015, available at

https://www.cdc.gov/vaccines/schedules/downloads/past/2015-adult.pdf (last visited March 8, 2021). The schedule provides the
recommended age, as well as the administration intervals for vaccines that require multiple doses. Some vaccines are recommended
only for populations with special situations that put these individuals at higher risk. See also supra note 5.
34 Section 465.189, F.S..
35 Section 465.189(1)(c), F.S.
36 E-mail correspondence with DOH, dated March 8, 2021 on file with the Professions and Public Health Subcommittee.
37 U.S. Department of Health and Human Services, Third Amendment to Declaration Under the Public Readiness and Emergency

Preparedness Act for Medical Countermeasures Against COVID-19, https://www.hhs.gov/sites/default/files/third-amendment-
declaration.pdf (last visited March 8, 2021).
STORAGE NAME: pcs1063.PPH PAGE: 5
DATE: 3/15/2021
Currently, all 50 states authorize pharmacists to administer vaccinations; however, that authority may
vary by, among other things, the age of the patients that a pharmacist may vaccinate. 38 Four states,
including Florida, limit pharmacist vaccinations to adult patients. 39 Twenty six states allow pharmacists
to administer vaccines to individuals of any age. 40 The remaining states have minimum age restrictions
that range from 12 years to 2 years. 41

Authority to administer influenza vaccines to minors differ by state. For example, some states, such as
Arizona, allow pharmacists to administer influenza vaccines to children age 3 and over, while other
states, such as West Virginia, only allow pharmacists to administer influenza vaccines to those age 11
and older. Three states, including Florida, do not authorize pharmacists to administer influenza
vaccines to minors, 19 states have age restrictions, and 28 others allow pharmacists to give influenza
vaccines to children of any age. Sixteen states require a prescription for an influenza vaccine. 42

Effect of Proposed Changes

PCS/HB 1063 revises the list of immunizations that qualified pharmacists and registered pharmacy
interns can provide to adults. Currently, pharmacists may only administer those vaccines listed in 2015
CDC-recommended immunization for adults and the 2015 CDC-recommended immunizations for
international travels. The PCS authorizes pharmacists to administer those vaccines or immunizations
listed in the 2021 CDC Recommended Immunization Schedule for adults and the CDC’s Health
Information for International Travel. Therefore, pharmacists may administer the Meningococcal B
vaccine, which is on the current recommended immunization schedule but was not on the 2015
recommended schedule.

The PCS also authorizes a pharmacist to administer any vaccine that has been licensed for use in the
United States by the U.S. Food and Drug Administration (FDA) and allows the Board to authorize by
rule additional vaccines that may be administered as they are recommended by the CDC or licensed by
the FDA. This allows a pharmacist to administer vaccines for yellow fever, cholera, dengue, Japanese
encephalitis, plague, rabies, smallpox, and typhoid, which are not in the CDC-recommended schedule
but have been approved by the FDA. The PCS expands the authority of qualified pharmacists and
pharmacy interns to administer the influenza vaccines to allow them to administer the vaccine to
individuals age 7 and older.

The PCS provides an effective date of July 1, 2021.

B. SECTION DIRECTORY:
Section 1 Amends s. 465.189, F.S., relating to administration of vaccines and epinephrine
autoinjection.

38 Yvette C. Terrie, BSPharm, RPH, Vaccinations: The Expanding Role of Pharmacists, PHARMACY TIMES, Jan. 15, 2010, available at

https://www.pharmacytimes.com/publications/issue/2010/january2010/featurefocusvaccinations-0110 (last visited March 8, 2021).
39 National Alliance of State Pharmacy Associations, Pharmacist Administered Vaccines (Sept. 18, 2020), https://naspa.us/wp-

content/uploads/2020/08/IZ-Authority-9_2020.pdf (last visited March 8, 2021). The states that limit pharmacist vaccinations to adults are
Connecticut, Delaware, Florida, and Vermont.
40 Id. The twenty six states that allow pharmacists to vaccinate individuals of any age are: Alabama, Alaska, California, Colorado,

Georgia, Idaho, Indiana, Iowa, Louisiana, Michigan, Mississippi, Missouri, Nebraska, New Hampshire, Nevada, New Mexico,
Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, and Wisconsin.
41 Id. Minimum age limits: Hawaii and West Virginia is 11 years; Illinois is 10 years; Massachusetts, Maryland, Pennsylvania, and

Rhode Island is 9 years; Arkansas, Maine, Montana, New Jersey, Ohio, and Wyoming is 7 years; Kansas, Minnesota, and North
Carolina is 6 years; North Dakota is 5 years; Arizona is 3 years; and New York is 2 years.
42 Id at p. 11. The three states that do not allow pharmacists to administer influenza vaccines to minors are Connecticut, Florida, and

Vermont. The states with age limits re: Hawaii and West Virginia is 11 years; Illinois is 10 years; Massachusetts, Maryland,
Pennsylvania, and Rhode Island is 9 years; Arkansas, Maine, Montana, New Jersey, Ohio, and Wyoming is 7 years; Kansas,
Minnesota, and North Carolina is 6 years; North Dakota is 5 years; Arizona is 3 years; and New York is 2 years. The twenty eight states
that allow pharmacists to give influenza vaccines to children of any age are: Alabama, Alaska, California, Colorado, Delaware (with an
adult dose), Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Nebraska, New Hampshire, New
Mexico, Nevada, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, and Wisconsin.
The sixteen states that require a prescription for an influenza vaccine are: California, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky,
Louisiana, Missouri, Oregon, South Carolina, Texas, Virginia, West Virginia, and Wisconsin.
STORAGE NAME: pcs1063.PPH PAGE: 6
DATE: 3/15/2021
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:
The PCS may have an insignificant, negative fiscal impact on DOH, as the Board of Pharmacy will
need to amend its rules.

B. FISCAL IMPACT ON LOCAL GOVERNMENTS:

1. Revenues:
None.

2. Expenditures:
None.

C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Those between the ages of 7 and 18 may obtain influenza vaccinations from a qualified pharmacist,
which may reduce costs associated with travel and physician office visits.

D. FISCAL COMMENTS:
None.

III. COMMENTS

A. CONSTITUTIONAL ISSUES:

1. Applicability of Municipality/County Mandates Provision:
Not applicable. The PCS does not appear to affect county or municipal governments.

2. Other:
None.

B. RULE-MAKING AUTHORITY:
Rule-making authority is not needed to implement the provisions of the PCS.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: pcs1063.PPH PAGE: 7
DATE: 3/15/2021
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

PCS for HB 1063 ORIGINAL 2021

1 A bill to be entitled
2 An act relating to administration of vaccines;
3 amending s. 465.189, F.S.; revising the recommended
4 immunizations or vaccines a pharmacist, or a
5 registered intern under certain conditions, may
6 administer; authorizing a certified pharmacist to
7 administer the influenza vaccine to specified
8 individuals; providing an effective date.
9
10 Be It Enacted by the Legislature of the State of Florida:
11
12 Section 1. Subsections (2) through (8) of section 465.189,
13 Florida Statutes, are renumbered as sections (3) through (9),
14 respectively, subsection (1) and present subsection (6) are
15 amended, and a new subsection (2) is added to that section, to
16 read:
17 465.189 Administration of vaccines and epinephrine
18 autoinjection.—
19 (1) In accordance with guidelines of the Centers for
20 Disease Control and Prevention for each recommended immunization
21 or vaccine, a pharmacist, or a registered intern under the
22 supervision of a pharmacist who is certified under subsection
23 (7) (6), may administer the following vaccines to an adult
24 within the framework of an established protocol under a
25 supervising physician licensed under chapter 458 or chapter 459:

Page 1 of 3
PCS for HB 1063.docx
CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1063 ORIGINAL 2021

26 (a) Immunizations or vaccines listed in the Adult
27 Immunization Schedule as of February 1, 2015, by the United
28 States Centers for Disease Control and Prevention’s Recommended
29 Immunization Schedule, the United States Centers for Disease
30 Control and Prevention’s Health Information for International
31 Travel, or the United States Food and Drug Administration’s
32 Vaccines Licensed for Use in the United States. The board may
33 authorize, by rule, additional immunizations or vaccines as they
34 are added to the United States Centers for Disease Control and
35 Prevention’s Recommended Immunization Schedule, recommended by
36 the United States Centers for Disease Control and Prevention for
37 international travel, or licensed by the United States Food and
38 Drug Administration’s Vaccines Licensed for Use in the United
39 States added to the Adult Immunization Schedule.
40 (b) Immunizations or vaccines recommended by the United
41 States Centers for Disease Control and Prevention for
42 international travel as of July 1, 2015. The board may
43 authorize, by rule, additional immunizations or vaccines as they
44 are recommended by the United States Centers for Disease Control
45 and Prevention for international travel.
46 (b)(c) Immunizations or vaccines approved by the board in
47 response to a state of emergency declared by the Governor
48 pursuant to s. 252.36.
49
50 A registered intern who administers an immunization or vaccine

Page 2 of 3
PCS for HB 1063.docx
CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1063 ORIGINAL 2021

51 under this subsection must be supervised by a certified
52 pharmacist at a ratio of one pharmacist to one registered
53 intern.
54 (2) A pharmacist who is certified under subsection (7) may
55 administer influenza vaccines to individuals 7 years of age and
56 older within the framework of an established protocol under a
57 supervising physician licensed under chapter 458 or chapter 459.
58 (7)(6) Any pharmacist or registered intern seeking to
59 administer vaccines to adults under this section must be
60 certified to administer such vaccines pursuant to a
61 certification program approved by the Board of Pharmacy in
62 consultation with the Board of Medicine and the Board of
63 Osteopathic Medicine. The certification program shall, at a
64 minimum, require that the pharmacist attend at least 20 hours of
65 continuing education classes approved by the board and the
66 registered intern complete at least 20 hours of coursework
67 approved by the board. The program shall have a curriculum of
68 instruction concerning the safe and effective administration of
69 such vaccines, including, but not limited to, potential allergic
70 reactions to such vaccines.
71 Section 2. This act shall take effect July 1, 2021.

Page 3 of 3
PCS for HB 1063.docx
CODING: Words stricken are deletions; words underlined are additions.
V
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. PCS for HB 1063 (2021)
Amendment No.1

COMMITTEE/SUBCOMMITTEE ACTION
ADOPTED (Y/N)
ADOPTED AS AMENDED (Y/N)
ADOPTED W/O OBJECTION (Y/N)
FAILED TO ADOPT (Y/N)
WITHDRAWN (Y/N)
OTHER

1 Committee/Subcommittee hearing bill: Professions & Public
2 Health Subcommittee
3 Representative Fernandez-Barquin offered the following:
4
5 Amendment
6 Remove lines 26-39 and insert:
7 (a) Immunizations or vaccines listed in the Adult
8 Immunization Schedule as of February 1, 2015, by the United
9 States Centers for Disease Control and Prevention’s Recommended
10 Immunization Schedule, the United States Centers for Disease
11 Control and Prevention’s Health Information for International
12 Travel, the United States Food and Drug Administration’s
13 Vaccines Licensed for Use in the United States, or vaccines
14 authorized for emergency use by the United States Food and Drug
15 Administration. The board may authorize, by rule, additional
16 immunizations or vaccines as they are added to the United States
PCS for HB 1063 a1
Published On: 3/15/2021 6:30:05 PM
Page 1 of 2
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. PCS for HB 1063 (2021)
Amendment No.1

17 Centers for Disease Control and Prevention’s Recommended
18 Immunization Schedule, recommended by the United States Centers
19 for Disease Control and Prevention for international travel,
20 licensed by the United States Food and Drug Administration’s
21 Vaccines Licensed for Use in the United States, or vaccines
22 authorized for emergency use by the United States Food and Drug
23 Administration added to the Adult Immunization Schedule.

PCS for HB 1063 a1
Published On: 3/15/2021 6:30:05 PM
Page 2 of 2
PCS for HB 1565
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 1565 Department of Health
SPONSOR(S): Professions & Public Health Subcommittee
TIED BILLS: IDEN./SIM. BILLS:

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

Orig. Comm.: Professions & Public Health Morris McElroy
Subcommittee

SUMMARY ANALYSIS
PCS for HB 1565 makes numerous changes to programs under the Department of Health (DOH) and health
care professions regulated by Medical Quality Assurance (MQA) within DOH.

DOH administers the Targeted Outreach for Pregnant Women Act (TOPWA) which supports high risk pregnant
women that aim to prevent heath issues for themselves and their newborns. The PCS updates the TOPWA to
account for current medication options, information on HIV, and mental health issues that may lead to a
pregnancy being high risk.

MQA regulates health care practitioners in this state. MQA works in conjunction with 22 boards and 4 councils
to license and regulate 7 types of health facilities and 40 health care professions. Each profession is regulated
by an individual practice act and by ch. 456, F.S., which provides general regulatory authority and licensure
authority for MQA. The PCS:

• Updates institutional accreditation references for chiropractic medicine, clinical laboratory personnel,
and mental clinical social workers and marriage and family therapists;
• Clarifies DOH’s ability to prosecute nurses licensed under ch. 464, F.S.;
• Removes obsolete references to DOH issued licensure examinations for clinical social workers and
marriage and family therapists;
• Clarifies education, training, and temporary certification requirement for midwives;
• Removes obsolete form and fee requirements for fingerprinting of orthotists and prosthetists;
• Clarifies educational requirements for psychologists applying for licensure by endorsement; and
• Allows DOH to continue to issue licenses to marriage and family therapy graduates until July 1, 2026,
while such programs seek accreditation.

The PCS has an insignificant, negative fiscal impact on DOH, which current resources are adequate to absorb.
The PCS has no fiscal impact on local governments.

The PCS 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: pcs1565.PPH
DATE: 3/15/2021
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Targeted Outreach for Pregnant Women

Current Situation

The Targeted Outreach for Pregnant Women Act (TOPWA) supports targeted outreach programs that
aim to prevent vertical HIV transmission and other health issues by linking high-risk pregnant women
with services that can help them have healthier pregnancies and deliveries and can aid them in
ensuring their newborn gets a healthy start. 1 In 2019, there were 453 HIV-exposed births in Florida. 2

TOPWA programs aim to provide outreach and linkage services to pregnant women who may not seek
proper prenatal care, who suffer from substance-use disorders, or who are living with HIV or are at
increased risk for HIV acquisition. 3 Many of the women targeted by TOPWA programs would not
otherwise receive prenatal care or know their HIV status. In 2019, there were seven funded TOPWA
programs in Florida. 4 TOPWA programs provided services to 7,703 women from January 2016 to July
2020. Black women represented 48 percent of enrollees, Hispanic women represented 39 percent, and
white women represented 10 percent. 5 Women living with HIV made up just under 10 percent of TOPW
enrollments. 6

If a pregnant woman tests positive for HIV, medical interventions, like antiretroviral (ARV) medication
and delivery by caesarian section, can greatly reduce her risk of transmitting the virus to her baby
during childbirth. 7 Prevention methods, like avoiding breastfeeding, can reduce her risk of transmitting
the virus to her child post childbirth. Providing ARV medication to the newborn also decreases the
chances of seroconversion in the event of an HIV-exposed birth. 8 DOH has developed a program, Baby
Rxpress, which provides a six-week course of ARV medication to HIV-exposed newborns at no cost to
the mother. 9 In 2019, this program filled 304 prescriptions to 264 HIV-exposed newborns. 10

TOPWA programs aim to engage women into care who very likely do not already have knowledge of or
access to these interventions. Without these types of interventions, a mother’s chances of transmitting
HIV to her newborn can be up to 45 percent. 11 With these interventions, the chances of transmission
are less than 2 percent. 12

There were no known perinatal HIV transmissions in 2019; however, DOH does not have a definitive
status on roughly 25 percent of the 453 HIV-exposed births. 13

Effect of Proposed Changes – Targeted Outreach for Pregnant Women

1 Department of Health, Targeted Outreach for Pregnant Women Act, http://stlucie.floridahealth.gov/programs-and-services/infectious-

disease-services/hiv-aids/topwa.html (last visited March 10, 2021).
2 E-mail correspondence with DOH, dated Jan. 28, 2021 on file with the Professions and Public Health Subcommittee.
3 Id.
4 Id.
5 Id.
6 Id.
7 Id.
8 Id.
9 Department of Health, Baby Rxpress, http://www.floridahealth.gov/diseases-and-conditions/aids/Prevention/_documents/topwa/baby-

rxpress-program-description-2018.pdf (last visited March 10, 2021).
10 Supra, note 2.
11 Id.
12 Id.
13 Id.

STORAGE NAME: pcs1565.PPH PAGE: 2
DATE: 3/15/2021
The PCS adds pregnant women who are suffering from mental health problems to the list of outreach
targets. It also includes mental health services as a linkage option.

The PCS revises the duties of DOH’s administration of the TOPWA and the information and services
DOH provides to the women it serves. The PCS requires DOH to encourage high-risk pregnant women
to be tested for other sexually transmitted diseases, in addition to HIV, as specified by rule. The PCS
requires DOH to provide pregnant women to have HIV with information on the need for ARV medication
for their newborn, their medication options, and how to access medication after hospital discharge. The
PCS removes a reference to a specific type of ARV medication DOH may provide information on and
incorporates more general information on ARV medications, allowing for additional options. The PCS
requires DOH to educate pregnant women who have HIV on the importance or engaging in and
continuing HIV care. Lastly, the PCS requires DOH to conduct additional follow up for HIV-exposed
newborns to ensure final HIV status is known and necessary linkages to care are made.

Institutional Accreditation

Current Situation

Accreditation is the recognition from an accrediting agency that an institution maintains a certain level
of educational standards. Institutional accreditation normally applies to an entire institution and
indicates that each entity of a school contributes to the achievement of the school’s objectives. This
does not necessarily mean that all parts of the school have the same quality level of education. 14

Accrediting agencies issue accreditations. 15 Institutions or programs that request an agency’s
evaluation and that meet an agency’s criteria are then accredited by that agency. 16 Accrediting
agencies are organizations made up of educational professionals that: 17

• Establish the operating standards for educational or professional institutions and programs;
• Determine if a school meets those standards; and
• Publically announce their findings through the issuance of accreditations.

While the United States Department of Education (DOE) does not issue accreditations, it does hold
agencies accountable by ensuring that such agencies enforce their accreditation standards effectively.
As part of DOE oversight, the Secretary of Education is required by law to publish a list of nationally
recognized accrediting agencies that the Secretary determines to be reliable authorities as to the
quality of education or training provided by the institutions of higher education and the higher education
programs they accredit. 18

The DOE issued finalized regulations in the Federal Register in October 2019 relating to institutional
accrediting agencies. 19 DOE issued a letter of guidance on February 26, 2020, specifying that final
regulations omit references to “regional” and “national” accreditation. 20 The letter specifies, “[b]ecause
the Department holds all accrediting agencies to the same standards, distinctions between regional and
national accrediting agencies are unfounded.” Provisions implemented in 34 C.F.R. § 602.32(d),
relating to the recognition of accrediting agencies, became effective January 1, 2021.

14 U.S. Department of Homeland Security – Study in the States, The Basics of School Accreditation,

https://studyinthestates.dhs.gov/the-basics-of-school-accreditation (last visited March 10, 2021).
15 Id. See also U.S. Department of Education, Database of Accredited Postsecondary Institutions and Programs,

https://ope.ed.gov/dapip/#/home (last visited March 10, 2021).
16 U.S. Department of Education, Database of Accredited Postsecondary Institutions and Programs, https://ope.ed.gov/dapip/#/home

(last visited March 10, 2021).
17 Supra, note 14.
18 Supra, note 16.
19 84 C.F.R § 58834 (2020). The new regulations delayed implementation of changes to DOE staff’s review of accrediting agency

applications for initial or renewal of recognition under 34 C.R.R. § 602.32(d) until January 1, 2021. The new regulations also delayed
implementation of changes to DOE staff’s process for responding to accrediting agency applications and allowing agency responses
within 180 days under 34 C.F.R. § 602.32(h) until July 1, 2021.
20 U.S. Department of Education, Re: Final Accreditation and State Authorization Regulations (February 26, 2021)

https://sacscoc.org/app/uploads/2020/03/State-Authorization-Letter-w-Diane-Signature-2.26.19.pdf (last visited March 10, 2021).
STORAGE NAME: pcs1565.PPH PAGE: 3
DATE: 3/15/2021
Chiropractic Medicine

Chapter 460, F.S., is the practice act for chiropractic medicine that sets the minimum requirements for
safe practice in the state. The Board of Chiropractic Medicine under DOH enforces the practice act,
including licensure, monitoring, and ensuring safe practice of chiropractic professionals. 21

A chiropractic physician is authorized to adjust, manipulate, and treat the human body by manual,
mechanical, electrical, or natural methods. 22 Chiropractic physicians may not prescribe or administer
legend drugs, perform surgery, or practice obstetrics. 23 Licensure requirements for chiropractic
physicians include: 24

• Graduation from a chiropractic college accredited by the Council on Chiropractic Education;
• Passage of the National Board of Chiropractic Examiners; and
• Passage of a background screening.

Clinical Laboratory Directors

A clinical laboratory is the physical location in which services are performed to provide information or
materials for use in the diagnosis, prevention, or treatment of a disease or the identification or
assessment of a medical or physical condition. 25 Services performed in clinical labs include:

• The examination of fluids or other materials taken from the human body; 26
• The examination of tissue taken from the human body; 27 and
• The examination of cells from individual tissues or fluid taken from the human body. 28

Clinical laboratories are regulated under part I of ch. 483, F.S. Clinical laboratories must meet
appropriate standards to maintain compliance with federal laws and regulations. 29 Such standards
include overall standards of performance that comply with the federal Clinical Laboratory Improvement
Amendments of 1988 (CLIA), and the federal rules adopted thereunder, for a comprehensive quality
assurance program 30 and standards of performance in the examination of specimens for clinical
laboratory proficiency testing programs using external quality control procedures. 31

The Board of Clinical Laboratory Personnel (Board) oversees the licensure and regulation of clinical
laboratory personnel, including supervisors, technologists, technicians, directors, and public health
laboratory personnel. Generally, licensure requirements for clinical laboratory personnel include
passage of an exam designated by the Board, completion of a medical technology training program,
and completion of applicable education requirements. 32

To qualify as a clinical laboratory director, an individual must: 33

• Have four years of clinical laboratory experience, with two years of experience or national
certification in the specialty to be directed
• Be a physician licensed under chs. 458 or 459, F.S.;

21 Florida Department of Health, Board of Chiropractic Medicine, https://floridaschiropracticmedicine.gov/ (last visited March 10, 2021).
22 Section 460.403(9)(c), F.S.
23 Id. However, there are limited exceptions for ordering, storing, and administering legend drugs and performing surgeries.
24 Section 460.406, F.S.
25 Section 483.041, F.S.
26 Section 483.041(2)(a), F.S.
27 Section 483.041(2)(b), F.S.
28 Section 483.041(2)(c), F.S.
29 Section 483.021, F.S.
30 Section 483.051(2)(a), F.S.
31 Section 483.051(2)(b), F.S.
32 Section 483.809, F.S. and ch. 64B3-5, F.A.C.
33 Section 483.824, F.S.

STORAGE NAME: pcs1565.PPH PAGE: 4
DATE: 3/15/2021
• Hold a doctoral degree in a chemical, physical, or biological science from a regionally accredited
institution and maintain national certification requirements equal to those required by the federal
Health Care Financing Administration; or
• For the subspecialty of oral pathology, be a physician licensed under chs. 458 or 459, F.S., or a
dentist licensed under ch. 466, F.S.

Effect of Proposed Changes – Institutional Accreditation

The PCS removes all references to “regional” accreditation replacing such references with “institutional”
accreditation for chiropractic medicine and clinical laboratory directors.

Nursing

Current Situation

The Board of Nursing (Board) within DOH, oversees the licensure and regulation of certified nursing
assistants, licensed practical nurses, registered nurses, and advanced registered nurse practitioners.
The Board has the authority to adopt rules to implement ch. 464, F.S., which regulates the practice of
nursing in this state. 34

Certified Nursing Assistants

Certified Nursing Assistants (CNAs) provide care and assist individuals with tasks relating to the
activities of daily living, such as those associated with personal care, nutrition and hydration,
maintaining mobility, toileting, safety and cleaning, end-of-life care, cardiopulmonary resuscitation and
emergency care. 35 An applicant for certification as a CNA must complete an approved training
program, pass a competency examination, and pass a background screening. 36 A CNA who is certified
in another state or territory of the U.S. or in the District of Columbia, is listed on that state’s CNA
registry 37 and has not been found to have committed abuse, neglect, or exploitation in that state, is
eligible for certification by endorsement in Florida. 38

Licensed Practical Nurses

A licensed practical nurse (LPN) is licensed to practice “practical nursing,” which is the performance of
selected acts, including the administration of treatments and medications, under the direction of a
registered nurse, licensed physician, or a licensed dentist, and responsibility for making decisions
based on the individual’s educational preparation and experience in nursing. 39 To be licensed as an
LPN, among other things, an individual must complete a board-approved education program consisting
of 50 percent clinical training. 40

Registered Nurses

A registered nurse (RN) is licensed to practice “professional nursing,” which is the performance of
those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied
principles of psychological, biological, physical, and social sciences. 41 To be licensed as an RN, among
other things, an individual must complete an associate’s degree consisting of 50 percent clinical

34 Section 464.006, F.S.
35 Section 464.201(5), F.S.
36 Section 464.203, F.S. See also Department of Health, Board of Nursing, Certified Nursing Assistant (CNA) by Examination, available

at http://floridasnursing.gov/licensing/certified-nursing-assistant-examination/ (last visited November 25, 2019). An applicant who fails
the competency examination 3 times, may not take the exam again until he or she completes an approved training program.
37 A CNA Registry is a listing of CNAs who received certification and maintain an active certification. (r. 64B9-15.004, F.A.C.)
38 Section 464.203(1)(c), F.S.
39
Section 464.003(18), F.S.
40
Section 464.019(1)(b), F.S., and r. 64B9-2.021, F.A.C.
41
Section 464.003(19), F.S.
STORAGE NAME: pcs1565.PPH PAGE: 5
DATE: 3/15/2021
training or a bachelor’s degree consisting of 40 percent clinical training from a board-approved
education program. 42

Advanced Practice Registered Nurses

In Florida, an advanced practice registered nurse (APRN) 43 is licensed in one of four roles: a certified
nurse practitioner, certified nurse midwife, clinical nurse specialist, or certified registered nurse
anesthetist. 44

The Board provides by rule the eligibility criteria for applicants to be licensed as APRNs and the
applicable regulatory standards for APRN nursing practices. Additionally, the Board is responsible for
administratively disciplining an APRN who commits an act prohibited under ss. 464.018 or 456.072,
F.S.

Section 464.003(2), F.S., defines the term “advanced or specialized nursing practice” to include, in
addition to practices of professional nursing that registered nurses are authorized to perform,
advanced-level nursing acts approved by the Board as appropriate for APRNs to perform by virtue of
their post-basic specialized education, training, and experience. Advanced or specialized nursing acts
may only be performed if authorized under a supervising physician’s protocol. 45 In addition to advanced
or specialized nursing practices, APRNs are authorized to practice certain medical acts, as opposed to
nursing acts, as authorized within the framework of an established supervisory physician’s protocol. 46

To be eligible to be licensed as an APRN, an applicant must be licensed as a registered nurse, have a
master’s degree in a nursing clinical specialty area with preparation in specialized practitioner skills,
and submit proof that the applicant holds a current national advanced practice certification from a
board-approved nursing specialty board. 47 A nursing specialty board must: 48

• Attest to the competency of nurses in a clinical specialty area;
• Require a written examination prior to certification;
• Require nurses to complete a formal program prior to eligibility for examination;
• Maintain program accreditation or review mechanism that adheres to criteria which are
substantially equivalent to requirements in Florida; and
• Identify standards or scope of practice statements appropriate for each nursing specialty.

Effect of Proposed Changes – Nursing

The PCS clarifies DOH’s ability to prosecute licensees under ch. 464, F.S., who had adjudication
withheld in their court cases after having entered a plea of nolo contender or guilty to an offense
prohibited in ch. 435, F.S., or domestic violence under s. 741.20, F.S.

Midwifery

Current Situation

Chapter 467, F.S., is the practice act for midwifery (Act). DOH licenses and regulates the practice of
midwifery in this state. Midwifery is the practice of supervising a normal labor and childbirth, with the
informed consent of the parent, advising the parents as to the progress of childbirth, and rendering
prenatal and postpartal care. 49 The Council of Licensed Midwifery assists and advises DOH on
midwifery, including the development of rules relating to regulatory requirements. These regulations

42
Section 464.019(1)(b), F.S., and Rule 64B9-2.021, F.A.C.
43 Section 464.003(3), F.S.
44 Section 464.012(4), F.S. In 2018, the Florida Legislature changed the occupational title from “Advanced Registered Nurse

Practitioner” to “Advanced Practice Registered Nurse,” and reclassified a CNS as a type of APRN (see ch. 2018-106, Laws of Fla.).
45 Section 464.012(3)-(4), F.S.
46 Section 464.003, F.S., and s. 464.012, F.S.
47 Section 464.012(1), F.S., and Rule 64B9-4.002, F.A.C.
48 Rule 64B9-4.002(3), F.A.C.
49 Section 467.003(8), F.S.

STORAGE NAME: pcs1565.PPH PAGE: 6
DATE: 3/15/2021
include training requirements, the licensure examination, responsibilities of midwives, emergency care
plans, and reports and records to be filed by licensed midwives. 50

Licensure

An individual must graduate from an approved midwifery program and pass a licensure examination to
be eligible for licensure as a midwife. 51 A licensed midwife must submit a general emergency care plan
to DOH, which addresses consultation with other health care providers, emergency transfer protocols,
and access to neonatal intensive care units and obstetrical units or other patient care areas with his or
her application for licensure and licensure renewal. 52 A licensed midwife must also submit proof of
professional liability coverage of at least $100,000, with an annual aggregate of at least $300,000. 53

DOH may issue a license by endorsement for midwifery applicants who: 54

• Holds a valid certificate or diploma from a foreign institution of medicine or from midwifery
program in another state provided the requirements for licensure or certification in another
country or another state are equivalent to or exceed that which is required for licensing in
Florida; or
• Holds a valid certificate or license to practice midwifery in another state provided the
requirements for licensure or certification in another state are equivalent to or exceed that which
is required for licensing in Florida; and
• Has completed a 4-month prelicensure course conducted by an approved program; and
• Has successfully passed the licensed midwifery examination.

DOH may also issue a temporary certificate to a midwife who qualifies for licensure by endorsement to
practice in areas of critical need. 55 The fee for a temporary certificate is $50 in addition to the fee
required for licensure. 56

Midwifery Students

The Act uses the terms “applicant” and “student midwife” interchangeably. It also sets standards for
admission, education, and clinical training in the context of student requirements, which, according to
DOH, may cause confusion. As an example, a student must have a high school diploma or the
equivalent to enroll in a program, but the statutes do not clearly state that a high school diploma is a
requirement for licensure. 57

The use of the undefined term “midwifery student” has led to unlicensed persons attempting to work
with clients and complete clinical requirements without enrolling in or being educated by an approved
midwifery program, as well as midwives attempting to serve as preceptors who are not affiliated with an
approved midwifery program. 58

The Act does not include any provisions explicitly allowing a new midwifery program to be provisionally
approved nor does it provide clear guidance to schools regarding the circumstances under which DOH
may rescind the approval of a program.

50 Section 467.004, F.S.
51 Section 467.011, F.S. Section 467.0125, F.S. DOH no longer administers licensure examinations.
52 Section 467.017, F.S.
53 Rule 64B24-7.013, F.A.C. An applicant does not have to submit proof of professional liability insurance if the applicant practices

exclusively as an officer, employee, or agent of the federal government, practices only in conjunction with teaching duties at an
approved midwifery school that provides such coverage on the applicant’s behalf, or who does not practice midwifery in this state and
provides proof of such.
54 Section 467.0125(1), F.S.
55 Section 467.0125(2), F.S.
56 Section 467.0125(2)(f), F.S.
57 Supra, note 2.
58 Id. In general, health care practitioners do not start seeing clients in a clinical setting until they have completed prerequisite portions

of a course of study and are near the end of their educational program.
STORAGE NAME: pcs1565.PPH PAGE: 7
DATE: 3/15/2021
Effect of Proposed Changes – Midwifery

The PCS makes numerous clarifying changes to the midwifery practice act.

The PCS clarifies that a preceptor may not supervise a midwifery student unless the student has been
enrolled in an approved midwifery program. This clarifies that an individual cannot begin their clinical
practice before enrolling in an approved midwifery program and will explicitly conform midwifery training
with the requirements of other medical professions, with students having to complete the majority of
their classroom training before working with patients in a clinical setting.

The PCS clarifies licensing requirements and updates licensing methods. The PCS prohibits
endorsement without a license or certification in another state, territory or jurisdiction and creates a
pathway to licensure by examination for applicants who have completed education equivalent to or
exceeds that which is required for licensing in Florida in a state, territory, or jurisdiction that does not
license midwives. These revisions do not change what is actually required to qualify for a midwifery
license, but instead clarify licensure requirements allowing applicants to better understand those
requirements. 59

The PCS clarifies education and training requirements for approved midwifery programs. The PCS
allows midwifery programs to be provisionally approved for five years. This change conforms to the
five-year period that such programs can be provisionally licensed by the U.S. Department of
Education’s Commission for Independent Education when seeking accreditation status. DOH will be
able to give provisional approval to a new program who has meet all requirements except for showing
their students have an 80% passage rate on the national exam. Programs provisionally approved will
have five years to demonstrate the required exam approval rate after they are preliminary approved.
This time period allows completion of the three-year education program for at least one cohort of
students, and for those students to take the exam before the Department tries to determine the passing
rate. 60

The PCS clarifies the requirements for temporary certification of a midwife to practice in an area of
critical need. The PCS allows a midwife certified to practice in an area of critical need to report a new
area of critical need or relinquish the certificate within a specified timeframe following a change in an
areas designated status, rather than being immediately subject to disciplinary action, while retaining the
DOH’s ability to revoke a certificate for non-compliance. 61

The PCS removes obsolete references to the DOH issued exam for midwifery licensure as DOH no
longer administers licensure examinations.

Lastly, the PCS clarifies the circumstances under which DOH may rescind the approval of a midwifery
program.

Orthotists and Prosthetists

Current Situation

The Board of Orthotists and Prosthetists oversees the licensure and regulation of orthotists 62 and
prosthetists. 63 A person applying for licensure must first apply to DOH to take the appropriate licensure
examination. The board may accept the exam results of a national orthotic or prosthetic, standards

59 Id.
60 Id.
61 Id.
62 An orthotist is a health care professional who evaluates, formulates treatment, measures, designs, fabricates, assembles, fits,

adjusts, services, or provides necessary training to accomplish the fitting of an orthosis or a pedorthic device (s. 468.80(9)-(10), F.S.)
63 An prosthetist is a health care professional who evaluates, formulates treatment, measures, designs, fabricates, assembles, fits,

adjusts, services, or provides necessary training to accomplish the fitting of a prosthesis (s. 468.80(15)-(16), F.S.)
STORAGE NAME: pcs1565.PPH PAGE: 8
DATE: 3/15/2021
organization in lieu of administering the state exam. 64 The board must verify that an applicant for
licensure examination meets the following requirements: 65

• Has completed the application form and paid all applicable fees;
• Is of good moral character;
• Is 18 years of age or older;
• Has completed the appropriate educational preparation, including practical training
requirements; and
• Has successfully completed an appropriate clinical internship in the professional area for which
the license is sought.

In addition to the requirements listed above, an applicant must meet the following requirements for
each license sought: 66

• A Bachelor of Science degree in Orthotics and Prosthetics from a regionally accredited college
or university from an accredited college or university recognized by the Commission on
Accreditation of Allied Health Education Programs, or a bachelor’s degree with a certificate in
orthotics or prosthetics from a program recognized by the Commission on Accreditation of Allied
Health Education Programs, or its equivalent;
• An internship of one year of qualified experience or a residency program recognized by the
board;
• Completion of the mandatory classes; 67 and
• Passage of the state orthotic examination or board-approved orthotic examination if applying for
an orthotist license, or the state prosthetic examination or board-approved examination if
applying for a prosthetist license.

Background Screening

Chapter 435, F.S., establishes standard procedures and requirements for criminal history background
screening of prospective employees. There are two levels of background screening: level 1 and level 2.
Level 1 screening includes, at a minimum, employment history checks and statewide criminal
correspondence checks through the Florida Department of Law Enforcement (FDLE) and a check of
the Dru Sjodin National Sex Offender Public Website, 68 and may include criminal records checks
through local law enforcement agencies. A level 2 background screening includes, but, is not limited to,
fingerprinting for statewide criminal history records checks through FDLE and national criminal history
checks through the Federal Bureau of Investigation (FBI), and may include local criminal records
checks through local law enforcement agencies. 69

Every person required by law to be screened pursuant to ch. 435, F.S., must submit a complete set of
information necessary to conduct a screening to his or her employer. 70 Such information for a level 2
screening includes fingerprints, which are taken by a vendor that submits them electronically to
FDLE. 71

For both level 1 and 2 screenings, the employer must submit the information necessary for screening to
FDLE within five working days after receiving it. 72 Additionally, for both levels of screening, FDLE must

64 Section 468.803(4), F.S. The Board has approved the American Board for Certification in Orthotics, Prosthetics, and Pedorthics

(ABC) exam for orthotist and prosthetist applicants (r. 64B14-4.001, F.A.C.)
65 Section 468.803(2), F.S.
66 Section 468.803(5), F.S. Licenses must be renewed biennially.
67 Pursuant to r. 64B14-5.005, F.A.C., mandatory courses include two hours on Florida laws and rules, two hours on the prevention of

medical errors, one hour on infection disease control, and a CPR certification course.
68 The Dru Sjodin National Sex Offender Public Website is a U.S. government website that links public state, territorial, and tribal sex

offender registries in one national search site. The website is available at https://www.nsopw.gov/ (last visited March 10, 2021).
69 Section 435.04, F.S.
70 Section 435.05(1)(a), F.S.
71 Sections 435.03(1) and 435.04(1)(a), F.S.
72 Section 435.05(1)(b)-(c), F.S.

STORAGE NAME: pcs1565.PPH PAGE: 9
DATE: 3/15/2021
perform a criminal history record check of its records. 73 For a level 1 screening, this is the only
information searched, and once complete, FDLE responds to the employer or agency, who must then
inform the employee whether screening has revealed any disqualifying information. 74 For level 2
screening, FDLE also requests the FBI to conduct a national criminal history record check of its records
for each employee for whom the request is made. 75 As with a level 1 screening, FDLE responds to the
employer or agency, and the employer or agency must inform the employee whether screening has
revealed disqualifying information. If the employer or agency finds that an individual has a history
containing one of these offenses, it must disqualify that individual from employment.

The person whose background is being checked must supply any missing criminal or other necessary
information upon request to the requesting employer or agency within 30 days after receiving the
request for the information. 76

Disqualifying Offenses

Regardless of whether the screening is level 1 or level 2, the screening employer or agency must make
sure that the applicant has good moral character by ensuring that the employee has not been arrested
for and is awaiting final disposition of, been found guilty of, regardless of adjudication, or entered a plea
of nolo contendere or guilty to, or been adjudicated delinquent and the record has not been sealed or
expunged for, certain offenses under Florida law, or similar law of another jurisdiction. 77

Health Care Practitioner Background Screening Under Ch. 456, F.S.

Section 456.0135, F.S., requires physicians, physician assistants, chiropractic physicians, podiatric
physicians, nurses, certified nursing assistants, pharmacy owners, athletic trainers, massage
therapists, and massage establishment owners to undergo a Level 2 background screening as a part of
the licensure process. The appropriate regulatory board reviews the background screening results of
an applicant or licensee to determine if there is a disqualifying offense. The only automatic disqualifying
offenses for licensure are the following offenses under federal law or Florida law, or similar law in
another jurisdiction: 78

• A felony under:
o Chapter 409, related to social and economic assistance;
o Chapter 817, relating to fraudulently practices; and
o Chapter 893, relating to drug abuse prevention and control.
• A felony under 21 U.S.C. ss. 801-970, relating to controlled substances, or 42 U.S.C. ss. 1395-
1396, relating to health insurance for the aged and disabled, if the sentence and any
subsequent probation ended less than 15 years before the date of application.

Exemption from Disqualification

If an individual is disqualified due to a pending arrest, conviction, plea of nolo contendere, or
adjudication of delinquency to one or more of the disqualifying offenses, s. 435.07, F.S., allows the
Secretary of the appropriate agency (in the case of substance abuse treatment, DCF) to exempt
applicants from that disqualification under certain circumstances: 79

• Three years have elapsed since the individual has completed or been lawfully released from
confinement, supervision, or nonmonetary condition imposed by a court for a disqualifying
felony; or

73 Id.
74 Section 435.05(1)(b), F.S.
75 Section 435.05(1)(c), F.S.
76 Section 435.05(1)(d), F.S.
77 Section 435.04(2), F.S.
78 Section 456.0635, F.S.
79 Section 435.07(1), F.S.

STORAGE NAME: pcs1565.PPH PAGE: 10
DATE: 3/15/2021
• The applicant has completed or been lawfully released from confinement, supervision, or
nonmonetary condition imposed by a court for a misdemeanor or an offense that was a felony at
the time of commission but is now a misdemeanor.

Receiving an exemption allows that individual to work despite the disqualifying crime in that person’s
past. However, an individual who is considered a sexual predator, 80 career offender, 81 or sexual
offender (unless not required to register) 82 cannot ever be exempted from disqualification. 83

Effect of Proposed Changes – Orthotists and Prosthetists

The PCS removes obsolete references to form and fee requirements for background screening of the
practice of orthotics, prosthetics, and pedorthics which are no longer required to be collected by DOH.

The PCS removes all references to “regional” accreditation replacing such references with “institutional”
accreditation for Orthotists and Prosthetists.

Psychologists

Current Situation

The Board of Psychology oversees the licensure and regulation of psychologists. 84 To receive a license
to practice psychology, an individual must: 85

• Meet one of the following educational requirements:
o Received a doctoral-level psychological education from an institution that had
institutional accreditation from an agency recognized by the United States Department of
Education or was recognized as a member in good standing with the Association of
Universities and Colleges of Canada, and had programmatic accreditation from the
American Psychological Association; 86 or
o Received the equivalent of a doctoral-level education from a program at a school or
university located outside of the United States, which is officially recognized by the
government of the country in which it is located as a program or institution to train
students to practice professional psychology.
• Complete 2 years or 4,000 hours of supervised experience;
• Pass the Examination for Professional Practice in Psychology; 87 and
• Pass an examination on Florida laws and rules.

The American Psychological Association (APA) is recognized by the U.S. Department of Education and
the Council for Higher Education Accreditation as the national accrediting authority for professional
education and training in psychology. 88

Applicants for licensure by endorsement must: 89

• Be a diplomate in good standing with the American Board of Professional Psychology;
• Hold a doctoral degree in psychology with at least 10 years of experience as a licensed
psychologist in any jurisdiction or territory of the U.S. within the 25 years preceding the date of
application.

80 Section 775.261, F.S.
81 Section 775.261, F.S.
82 Section 943.0435, F.S.
83 Section 435.07(4)(b), F.S.
84 Section 490.004, F.S.
85 Section 490.005(1), F.S.
86 Section 490.003(3), F.S., defines doctoral-level education as a Psy.D, an Ed.D., or a Ph.D in psychology.
87 Rule 64B19-11.001, F.A.C.
88 American Psychological Association, Understanding APA Accreditation, available at

http://www.apa.org/ed/accreditation/about/index.aspx (last visited March 10, 2021).
89 Section 490.006, F.S.

STORAGE NAME: pcs1565.PPH PAGE: 11
DATE: 3/15/2021
Effect of Proposed Changes – Psychologists

The PCS allows a psychologist applying by endorsement, who has 10 years licensed experience, to
obtain licensure regardless of whether the doctoral program was APA accredited. This will streamline
licensure by endorsement while maintaining the needed accreditation and educational standards for
licensure by examination. 90

Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling

Current Situation

Licensed Clinical Social Workers

Licensed clinical social work uses scientific and applied knowledge, theories, and methods for the
purpose of describing, preventing, evaluating, and treating individual, couple, marital, family, or group
behavior, based on the person-in-situation perspective of psychosocial development, normal and
abnormal behavior, psychopathology, unconscious motivation, interpersonal relationships,
environmental stress, differential assessment, differential planning, and data gathering to prevent and
treat undesired behavior and enhance of mental health. 91 An applicant seeking licensure as a clinical
social worker must: 92

• Possess a master’s or doctoral degree from an accredited program;
• Have a least two years’ experience in clinical social work;
• Pass a theory and practice examination approved by DOH; and
• Demonstrate knowledge of laws and rules governing the practice.

Licensed Clinical Social Workers must pass an examination offered by the American Association of
State Social Worker Boards. 93 In 1999, the American Association of State Social Worker Boards
changed its name to the Association of Social Work Boards. 94

Marriage and Family Therapists

Marriage and family therapy incorporates marriage and family therapy, psychotherapy, hypnotherapy,
sex therapy, counseling, behavior modification, consultation, client-centered advocacy, crisis
intervention, and the provision of needed information and education to clients. 95 An applicant seeking
licensure as a mental health counselor must: 96

• Possess a master’s degree from an a program accredited by the Commission on Accreditation
for Marriage and Family Therapy Education or from a Florida university program accredited by
the Council for Accreditation of Counseling and Related Educational Programs and board-
approved graduate courses; 97
• Complete two years of post-master’s supervised experience under the supervision of a licensed
marriage and family therapist with five years of experience or the equivalent who is a qualified
supervisor as determined by the board;
• Pass a board-approved examination; and

90 Department of Health, Agency Analysis of 2021 House Bill 1565 (March 12, 2021).
91 Section 491.003(7), F.S.
92 Section 491.005(1), F.S.
93 Id.
94 Association of Social Work Boards, History, available at https://www.aswb.org/about/history/ (last visited March 10, 2021).
95 Id.
96 Section 491.005(3), F.S. An individual may qualify for a dual license in marriage and family therapy if he or she passes an

examination in marriage and family therapy and has held an active license for at least three years as a psychologist, clinical social
worker, mental health counselor, or advanced registered nurse practitioner who is determined by the Board of Nursing to be a specialist
in psychiatric mental health (s. 491.0057, F.S.)
97 Ch. 2020-133, Laws of Fla, required applicants for licensure as a marriage and family therapist to graduate from an accredited

program or an accredited Florida university program.
STORAGE NAME: pcs1565.PPH PAGE: 12
DATE: 3/15/2021
• Demonstrate knowledge of laws and rules governing the practice.

DOH must verify that an applicant’s education matches the specified courses and hours as outlined in
statute. However, there are organizations that accredit marriage and family therapy education
programs, including the Commission on Accreditation for Marriage and Family Therapy Education and
the Council for the Accreditation of Counseling and Related Educational Programs that establish the
minimum standards to meet the requirements to practice the profession. 98

Mental Health Counselors

A mental health counselor is an individual who uses scientific and applied behavioral science theories,
methods, and techniques to describe, prevent, and treat undesired behavior and enhance mental
health and human development and is based on research and theory in personality, family, group, and
organizational dynamics and development, career planning, cultural diversity, human growth and
development, human sexuality, normal and abnormal behavior, psychopathology, psychotherapy, and
rehabilitation. 99 To qualify for licensure as a mental health counselor, an individual must: 100

• Have a master’s degree from a mental health counseling program accredited by the Council of
the Accreditation of Counseling and Related Educational Programs, or a program related to the
practice of mental health counseling that includes coursework and a 700-hour practicum,
internship, or fieldwork of which at least 280 hours must be in direct client services;
• Have at least two years of post-master’s supervised clinical experience in mental health
counseling;
• Pass an examination from the Professional Examination Service for the National Academy of
Certified Clinical Mental Health Counselors; and
• Pass an eight-hour course on Florida laws and rules approved by the Board of Clinical Social
Work, Marriage and Family Therapy, and Mental Health Counseling. 101

After July 1, 2025, applicants for licensure as a mental health counselor must hold a master’s degree
from a program accredited by the Council for Accreditation of Counseling and Related Education
Programs. 102

Effect of Proposed Changes – Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling

The bill removes all references to “regional” accreditation replacing such references with “institutional”
accreditation for clinical social workers and marriage and family therapists.

The PCS allows DOH to continue to license marriage and family therapy students or graduates who
have graduated from an unaccredited program until July 1, 2026. This will eliminate a barrier to
licensure for such students. 103

The PCS also removes obsolete references to DOH issued licensure examinations.

B. SECTION DIRECTORY:
Section 1 Amends s. 381.0045, F.S., relating to targeted outreach for pregnant women.
Section 2 Amends s. 460.406, F.S., relating to licensure by examination.
Section 3 Amends s. 464.018, F.S., relating to disciplinary actions.

98 See Commission on Accreditation for Marriage and Family Therapy Education, What Are the Benefits of COAMFTE Accreditation,

available at https://www.coamfte.org/COAMFTE/Accreditation/About_Accreditation.aspx (last visited March 10, 2021), and Council for
the Accreditation of Counseling and Related Educational Programs, About CACREP, available at https://www.cacrep.org/about-cacrep/
(last visited March 10, 2021).
99 Sections 491.003(6) and (9), F.S.
100 Section 491.005(4), F.S.
101 Section 491.005(4), F.S., and r. 64B4-3.0035, F.A.C.
102 Ch. 2020-133, Laws of Fla.
103 Supra, note 2.

STORAGE NAME: pcs1565.PPH PAGE: 13
DATE: 3/15/2021
Section 4 Amends s. 467.003, F.S., relating to definitions.
Section 5 Amends s. 467.009, F.S., relating to midwifery programs; education and training
requirements.
Section 6 Amends s. 467.011, F.S., relating to licensure by examination.
Section 7 Amends s. 467.0125, F.S., relating to licensure by endorsement.
Section 8 Amends s. 467.205, F.S., relating to approval of midwifery programs.
Section 9 Amends s. 468.803, F.S., relating to license, registration, and examination requirements.
Section 10 Amends s. 483.824, F.S., relating to qualifications of clinical laboratory director.
Section 11 Amends s. 490.003, F.S., relating to definitions.
Section 12 Amends s. 490.005, F.S., relating to licensure by examination.
Section 13 Amends s. 490.0051, F.S., relating to provisional licensure; requirements.
Section 14 Amends s. 491.005, F.S., relating to licensure by examination.
Section 15 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 may experience an increase in workload to conduct rulemaking and updating online
application websites to implement the provisions of the PCS, the impact of which can be absorbed
within current resources. 104

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 PCS does not appear to affect county or municipal governments.

2. Other:
None.

104 Supra, note 90.
STORAGE NAME: pcs1565.PPH PAGE: 14
DATE: 3/15/2021
B. RULE-MAKING AUTHORITY:
DOH has sufficient rulemaking authority to implement the PCS.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: pcs1565.PPH PAGE: 15
DATE: 3/15/2021
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

PCS for HB 1565 2021

1 A bill to be entitled
2 An act relating to the Department of Health; amending
3 s. 381.0045, F.S.; revising the purpose of the
4 department's targeted outreach program for certain
5 pregnant women; requiring the department to encourage
6 high-risk pregnant women of unknown status to be
7 tested for sexually transmissible diseases; requiring
8 the department to provide specified information to
9 pregnant women who have human immunodeficiency virus
10 (HIV); requiring the department to link women with
11 mental health services when available; requiring the
12 department to educate pregnant women who have HIV on
13 certain information; requiring the department to
14 provide, for a specified purpose, continued oversight
15 of newborns exposed to HIV; amending s. 460.406, F.S.;
16 revising provisions related to chiropractic physician
17 licensing; amending s. 464.018, F.S.; revising grounds
18 for disciplinary action against licensed nurses;
19 amending s. 467.003, F.S.; revising and defining
20 terms; amending s. 467.009, F.S.; revising provisions
21 related to approved midwifery programs; amending s.
22 467.011, F.S.; revising provisions relating to
23 licensure of midwives; amending s. 467.0125, F.S.;
24 revising provisions relating to licensure by
25 endorsement of midwives; revising requirements for

Page 1 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

26 temporary certificates to practice midwifery in this
27 state; amending s. 467.205, F.S.; revising provisions
28 relating to approval, continued monitoring,
29 probationary status, provisional approval, and
30 approval rescission of midwifery programs; amending s.
31 468.803, F.S.; revising provisions related to
32 orthotist and prosthetist registration, examination,
33 and licensing; amending 483.824, F.S.; revising
34 educational requirements for clinical laboratory
35 directors; amending s. 490.003, F.S.; defining the
36 terms "doctoral degree from an American Psychological
37 Association accredited program" and "doctoral degree
38 in psychology"; amending ss. 490.005 and 490.0051,
39 F.S.; revising education requirements for psychologist
40 licensing and provisional licensing, respectively;
41 amending s. 491.005, F.S.; revising licensing
42 requirements for clinical social workers, marriage and
43 family therapists, and mental health counselors;
44 providing an effective date.
45
46 Be It Enacted by the Legislature of the State of Florida:
47
48 Section 1. Subsections (2) and (3) of section 381.0045,
49 Florida Statutes, are amended to read:
50 381.0045 Targeted outreach for pregnant women.—

Page 2 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

51 (2) It is the purpose of this section to establish a
52 targeted outreach program for high-risk pregnant women who may
53 not seek proper prenatal care, who suffer from substance abuse
54 or mental health problems, or who have are infected with human
55 immunodeficiency virus (HIV), and to provide these women with
56 links to much needed services and information.
57 (3) The department shall:
58 (a) Conduct outreach programs through contracts with,
59 grants to, or other working relationships with persons or
60 entities where the target population is likely to be found.
61 (b) Provide outreach that is peer-based, culturally
62 sensitive, and performed in a nonjudgmental manner.
63 (c) Encourage high-risk pregnant women of unknown status
64 to be tested for HIV and other sexually transmissible diseases
65 as specified by department rule.
66 (d) Educate women not receiving prenatal care as to the
67 benefits of such care.
68 (e) Provide HIV-infected pregnant women who have HIV with
69 information on the need for antiretroviral medication for their
70 newborn, their medication options, and how they can access the
71 medication after their discharge from the hospital so they can
72 make an informed decision about the use of Zidovudine (AZT).
73 (f) Link women with substance abuse treatment and mental
74 health services, when available, and act as a liaison with
75 Healthy Start coalitions, children's medical services, Ryan

Page 3 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

76 White-funded providers, and other services of the Department of
77 Health.
78 (g) Educate pregnant women who have HIV on the importance
79 of engaging in and continuing HIV care.
80 (h) Provide continued oversight of to HIV-exposed newborns
81 exposed to HIV to determine the newborn's final HIV status and
82 ensure continued linkage to care if the newborn is diagnosed
83 with HIV.
84 Section 2. Subsection (1) of section 460.406, Florida
85 Statutes, is amended to read:
86 460.406 Licensure by examination.—
87 (1) Any person desiring to be licensed as a chiropractic
88 physician must apply to the department to take the licensure
89 examination. There shall be an application fee set by the board
90 not to exceed $100 which shall be nonrefundable. There shall
91 also be an examination fee not to exceed $500 plus the actual
92 per applicant cost to the department for purchase of portions of
93 the examination from the National Board of Chiropractic
94 Examiners or a similar national organization, which may be
95 refundable if the applicant is found ineligible to take the
96 examination. The department shall examine each applicant who the
97 board certifies has met all of the following criteria:
98 (a) Completed the application form and remitted the
99 appropriate fee.
100 (b) Submitted proof satisfactory to the department that he

Page 4 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

101 or she is not less than 18 years of age.
102 (c) Submitted proof satisfactory to the department that he
103 or she is a graduate of a chiropractic college which is
104 accredited by or has status with the Council on Chiropractic
105 Education or its predecessor agency. However, any applicant who
106 is a graduate of a chiropractic college that was initially
107 accredited by the Council on Chiropractic Education in 1995, who
108 graduated from such college within the 4 years immediately
109 preceding such accreditation, and who is otherwise qualified is
110 shall be eligible to take the examination. An No application for
111 a license to practice chiropractic medicine may not shall be
112 denied solely because the applicant is a graduate of a
113 chiropractic college that subscribes to one philosophy of
114 chiropractic medicine as distinguished from another.
115 (d)1. For an applicant who has matriculated in a
116 chiropractic college before prior to July 2, 1990, completed at
117 least 2 years of residence college work, consisting of a minimum
118 of one-half the work acceptable for a bachelor's degree granted
119 on the basis of a 4-year period of study, in a college or
120 university accredited by an institutional accrediting agency
121 recognized and approved by the United States Department of
122 Education. However, before prior to being certified by the board
123 to sit for the examination, each applicant who has matriculated
124 in a chiropractic college after July 1, 1990, must shall have
125 been granted a bachelor's degree, based upon 4 academic years of

Page 5 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

126 study, by a college or university accredited by an institutional
127 a regional accrediting agency which is a member of the
128 Commission on Recognition of Postsecondary Accreditation.
129 2. Effective July 1, 2000, completed, before prior to
130 matriculation in a chiropractic college, at least 3 years of
131 residence college work, consisting of a minimum of 90 semester
132 hours leading to a bachelor's degree in a liberal arts college
133 or university accredited by an institutional accrediting agency
134 recognized and approved by the United States Department of
135 Education. However, before prior to being certified by the board
136 to sit for the examination, each applicant who has matriculated
137 in a chiropractic college after July 1, 2000, must shall have
138 been granted a bachelor's degree from an institution holding
139 accreditation for that degree from an institutional a regional
140 accrediting agency which is recognized by the United States
141 Department of Education. The applicant's chiropractic degree
142 must consist of credits earned in the chiropractic program and
143 may not include academic credit for courses from the bachelor's
144 degree.
145 (e) Successfully completed the National Board of
146 Chiropractic Examiners certification examination in parts I, II,
147 III, and IV, and the physiotherapy examination of the National
148 Board of Chiropractic Examiners, with a score approved by the
149 board.
150 (f) Submitted to the department a set of fingerprints on a

Page 6 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

151 form and under procedures specified by the department, along
152 with payment in an amount equal to the costs incurred by the
153 Department of Health for the criminal background check of the
154 applicant.
155
156 The board may require an applicant who graduated from an
157 institution accredited by the Council on Chiropractic Education
158 more than 10 years before the date of application to the board
159 to take the National Board of Chiropractic Examiners Special
160 Purposes Examination for Chiropractic, or its equivalent, as
161 determined by the board. The board shall establish by rule a
162 passing score.
163 Section 3. Paragraph (e) of subsection (1) of section
164 464.018, Florida Statutes, is amended to read:
165 464.018 Disciplinary actions.—
166 (1) The following acts constitute grounds for denial of a
167 license or disciplinary action, as specified in ss. 456.072(2)
168 and 464.0095:
169 (e) Having been found guilty of, regardless of
170 adjudication, or entered a plea of nolo contendere or guilty to,
171 regardless of adjudication, any offense prohibited under s.
172 435.04 or similar statute of another jurisdiction; or having
173 committed an act which constitutes domestic violence as defined
174 in s. 741.28.
175 Section 4. Present subsections (13) and (14) of section

Page 7 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

176 467.003, Florida Statutes, are redesignated as subsections (14)
177 and (15), respectively, a new subsection (13) is added to that
178 section, and subsections (1) and (12) of that section are
179 amended, to read:
180 467.003 Definitions.—As used in this chapter, unless the
181 context otherwise requires:
182 (1) "Approved midwifery program" means a midwifery school
183 or a midwifery training program that which is approved by the
184 department pursuant to s. 467.205.
185 (12) "Preceptor" means a physician licensed under chapter
186 458 or chapter 459, a licensed midwife licensed under this
187 chapter, or a certified nurse midwife licensed under chapter
188 464, who has a minimum of 3 years' professional experience, and
189 who directs, teaches, supervises, and evaluates the learning
190 experiences of a the student midwife as part of an approved
191 midwifery program.
192 (13) "Prelicensure course" means a course of study,
193 offered by an approved midwifery program and approved by the
194 department, which an applicant for licensure must complete
195 before a license may be issued and which provides instruction in
196 the laws and rules of this state and demonstrates the student's
197 competency to practice midwifery under this chapter.
198 Section 5. Section 467.009, Florida Statutes, is amended
199 to read:
200 467.009 Approved midwifery programs; education and

Page 8 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

201 training requirements.—
202 (1) The department shall adopt standards for approved
203 midwifery programs which must include, but need not be limited
204 to, standards for all of the following:
205 (a) . The standards shall encompass Clinical and classroom
206 instruction in all aspects of prenatal, intrapartal, and
207 postpartal care, including all of the following:
208 1. Obstetrics.;
209 2. Neonatal pediatrics.;
210 3. Basic sciences.;
211 4. Female reproductive anatomy and physiology.;
212 5. Behavioral sciences.;
213 6. Childbirth education.;
214 7. Community care.;
215 8. Epidemiology.;
216 9. Genetics.;
217 10. Embryology.;
218 11. Neonatology.;
219 12. Applied pharmacology.;
220 13. The medical and legal aspects of midwifery.;
221 14. Gynecology and women's health.;
222 15. Family planning.;
223 16. Nutrition during pregnancy and lactation.;
224 17. Breastfeeding.; and
225 18. Basic nursing skills; and any other instruction

Page 9 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

226 determined by the department and council to be necessary.
227 (b) The standards shall incorporate the Core competencies,
228 incorporating those established by the American College of Nurse
229 Midwives and the Midwives Alliance of North America, including
230 knowledge, skills, and professional behavior in all of the
231 following areas:
232 1. Primary management, collaborative management, referral,
233 and medical consultation.;
234 2. Antepartal, intrapartal, postpartal, and neonatal
235 care.;
236 3. Family planning and gynecological care.;
237 4. Common complications.; and
238 5. Professional responsibilities.
239 (c) Noncurricular The standards shall include
240 noncurriculum matters under this section, including, but not
241 limited to, staffing and teacher qualifications.
242 (2) An approved midwifery program must offer shall include
243 a course of study and clinical training for a minimum of 3 years
244 which incorporates all of the standards, curriculum guidelines,
245 and educational objectives provided in this section and the
246 rules adopted hereunder.
247 (3) An approved midwifery program may reduce If the
248 applicant is a registered nurse or a licensed practical nurse or
249 has previous nursing or midwifery education, the required period
250 of training may be reduced to the extent of the student's

Page 10 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

251 applicant's qualifications as a registered nurse or licensed
252 practical nurse or based on prior completion of equivalent
253 nursing or midwifery education, as determined under rules
254 adopted by the department rule. In no case shall the training be
255 reduced to a period of less than 2 years.
256 (4)(3) An approved midwifery program may accept students
257 who To be accepted into an approved midwifery program, an
258 applicant shall have both:
259 (a) A high school diploma or its equivalent.
260 (b) Taken three college-level credits each of math and
261 English or demonstrated competencies in communication and
262 computation.
263 (5)(4) As part of its course of study, an approved
264 midwifery program must require clinical training that includes
265 all of the following:
266 (a) A student midwife, during training, shall undertake,
267 under the supervision of a preceptor, The care of 50 women in
268 each of the prenatal, intrapartal, and postpartal periods under
269 the supervision of a preceptor., but The same women need not be
270 seen through all three periods.
271 (b)(5) Observation of The student midwife shall observe an
272 additional 25 women in the intrapartal period before qualifying
273 for a license.
274 (6) Clinical The training required under this section must
275 include all of the following:

Page 11 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

276 (a) shall include Training in either hospitals, or
277 alternative birth settings, or both.
278 (b) A requirement that students demonstrate competency in
279 the assessment of and differentiation, with particular emphasis
280 on learning the ability to differentiate between low-risk
281 pregnancies and high-risk pregnancies.
282 (7) A hospital or birthing center receiving public funds
283 shall be required to provide student midwives access to observe
284 labor, delivery, and postpartal procedures, provided the woman
285 in labor has given informed consent. The Department of Health
286 shall assist in facilitating access to hospital training for
287 approved midwifery programs.
288 (8)(7) The Department of Education shall adopt curricular
289 frameworks for midwifery programs conducted within public
290 educational institutions under pursuant to this section.
291 (8) Nonpublic educational institutions that conduct
292 approved midwifery programs shall be accredited by a member of
293 the Commission on Recognition of Postsecondary Accreditation and
294 shall be licensed by the Commission for Independent Education.
295 Section 6. Section 467.011, Florida Statutes, is amended
296 to read:
297 467.011 Licensed midwives; qualifications; examination
298 Licensure by examination.—
299 (1) The department shall administer an examination to test
300 the proficiency of applicants in the core competencies required

Page 12 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

301 to practice midwifery as specified in s. 467.009.
302 (2) The department shall develop, publish, and make
303 available to interested parties at a reasonable cost a
304 bibliography and guide for the examination.
305 (3) The department shall issue a license to practice
306 midwifery to an applicant who meets all of the following
307 criteria:
308 (1) Demonstrates that he or she has graduated from one of
309 the following:
310 (a) An approved midwifery program.
311 (b) A medical or midwifery program offered in another
312 state, jurisdiction, territory, or country whose graduation
313 requirements were equivalent to or exceeded those required by s.
314 467.009 and the rules adopted thereunder at the time of
315 graduation.
316 (2) Demonstrates that he or she has and successfully
317 completed a prelicensure course offered by an approved midwifery
318 program. Students graduating from an approved midwifery program
319 may meet this requirement by showing that the content
320 requirements for the prelicensure course were covered as part of
321 their course of study.
322 (3) Submits an application for licensure on a form
323 approved by the department and pays the appropriate fee.
324 (4) Demonstrates that he or she has received a passing
325 score on an the examination specified by the department, upon

Page 13 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

326 payment of the required licensure fee.
327 Section 7. Section 467.0125, Florida Statutes, is amended
328 to read:
329 467.0125 Licensed midwives; qualifications; Licensure by
330 endorsement; temporary certificates.—
331 (1) The department shall issue a license by endorsement to
332 practice midwifery to an applicant who, upon applying to the
333 department, demonstrates to the department that she or he meets
334 all of the following criteria:
335 (a)1. Holds a valid certificate or diploma from a foreign
336 institution of medicine or midwifery or from a midwifery program
337 offered in another state, bearing the seal of the institution or
338 otherwise authenticated, which renders the individual eligible
339 to practice midwifery in the country or state in which it was
340 issued, provided the requirements therefor are deemed by the
341 department to be substantially equivalent to, or to exceed,
342 those established under this chapter and rules adopted under
343 this chapter, and submits therewith a certified translation of
344 the foreign certificate or diploma; or
345 2. Holds an active, unencumbered a valid certificate or
346 license to practice midwifery in another state, jurisdiction, or
347 territory issued by that state, provided the licensing
348 requirements of that state, jurisdiction, or territory at the
349 time the license was issued were therefor are deemed by the
350 department to be substantially equivalent to, or exceeded to

Page 14 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

351 exceed, those established under this chapter and the rules
352 adopted thereunder under this chapter.
353 (b) Has successfully completed a 4-month prelicensure
354 course conducted by an approved midwifery program and has
355 submitted documentation to the department of successful
356 completion.
357 (c) Submits an application for licensure on a form
358 approved by the department and pays the appropriate fee Has
359 successfully passed the licensed midwifery examination.
360 (2) The department may issue a temporary certificate to
361 practice in areas of critical need to an applicant any midwife
362 who is qualifying for a midwifery license licensure by
363 endorsement under subsection (1) who meets all of the following
364 criteria, with the following restrictions:
365 (a) Submits an application for a temporary certificate on
366 a form approved by the department and pays the appropriate fee,
367 which may not exceed $50 and is in addition to the fee required
368 for licensure by endorsement under subsection (1);
369 (b) Specifies on the application that he or she will The
370 Department of Health shall determine the areas of critical need,
371 and the midwife so certified shall practice only in one or more
372 of the following locations:
373 1. A county health department;
374 2. A correctional facility;
375 3. A Department of Veterans' Affairs clinic;

Page 15 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

376 4. A community health center funded by s. 329, s. 330, or
377 s. 340 of the United States Public Health Service Act; or
378 5. Any other agency or institution that is approved by the
379 State Surgeon General and provides health care to meet the needs
380 of an underserved population in this state; and those specific
381 areas,
382 (c) Will practice only under the supervision auspices of a
383 physician licensed under pursuant to chapter 458 or chapter 459,
384 a certified nurse midwife licensed under pursuant to part I of
385 chapter 464, or a midwife licensed under this chapter, who has a
386 minimum of 3 years' professional experience.
387 (3) The department may issue a temporary certificate under
388 this section with the following restrictions:
389 (a) A requirement that a temporary certificateholder
390 practice only in areas of critical need. The State Surgeon
391 General shall determine the areas of critical need, which Such
392 areas shall include, but are not be limited to, health
393 professional shortage areas designated by the United States
394 Department of Health and Human Services.
395 (b) A requirement that if a temporary certificateholder's
396 practice area ceases to be an area of critical need, within 30
397 days after such change the certificateholder must either:
398 1. Report a new practice area of critical need to the
399 department; or
400 2. Voluntarily relinquish the temporary certificate.

Page 16 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

401 (c) The department shall review a temporary
402 certificateholder's practice at least annually to determine
403 whether the certificateholder is meeting the requirements of
404 subsections (2) and (3) and the rules adopted thereunder. If the
405 department determines that a certificateholder is not meeting
406 these requirements, the department must revoke the temporary
407 certificate.
408 (d) A temporary certificate issued under this section is
409 shall be valid only as long as an area for which it is issued
410 remains an area of critical need, but no longer than 2 years,
411 and is shall not be renewable.
412 (c) The department may administer an abbreviated oral
413 examination to determine the midwife's competency, but no
414 written regular examination shall be necessary.
415 (d) The department shall not issue a temporary certificate
416 to any midwife who is under investigation in another state for
417 an act which would constitute a violation of this chapter until
418 such time as the investigation is complete, at which time the
419 provisions of this section shall apply.
420 (e) The department shall review the practice under a
421 temporary certificate at least annually to ascertain that the
422 minimum requirements of the midwifery rules promulgated under
423 this chapter are being met. If it is determined that the minimum
424 requirements are not being met, the department shall immediately
425 revoke the temporary certificate.

Page 17 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

426 (f) The fee for a temporary certificate shall not exceed
427 $50 and shall be in addition to the fee required for licensure.
428 Section 8. Section 467.205, Florida Statutes, is amended
429 to read:
430 467.205 Approval of midwifery programs.—
431 (1) The department shall approve an accredited or state-
432 licensed public or private institution seeking to provide
433 midwifery education and training as an approved midwifery
434 program in this state if the institution meets all of the
435 following criteria:
436 (a) Submits an application for approval on a form approved
437 by the department.
438 (b) Demonstrates to the department's satisfaction that the
439 proposed midwifery program complies with s. 467.009 and the
440 rules adopted thereunder.
441 (c) For a private institution, demonstrates its
442 accreditation by a member of the Council for Higher Education
443 Accreditation and its licensing or provisional licensing by the
444 Commission for Independent Education An organization desiring to
445 conduct an approved program for the education of midwives shall
446 apply to the department and submit such evidence as may be
447 required to show that it complies with s. 467.009 and with the
448 rules of the department. Any accredited or state-licensed
449 institution of higher learning, public or private, may provide
450 midwifery education and training.

Page 18 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

451 (2) The department shall adopt rules regarding educational
452 objectives, faculty qualifications, curriculum guidelines,
453 administrative procedures, and other training requirements as
454 are necessary to ensure that approved programs graduate midwives
455 competent to practice under this chapter.
456 (3) The department shall survey each organization applying
457 for approval. If the department is satisfied that the program
458 meets the requirements of s. 467.009 and rules adopted pursuant
459 to that section, it shall approve the program.
460 (2)(4) The department shall, at least once every 3 years,
461 certify whether each approved midwifery program is currently
462 compliant, and has maintained compliance, complies with the
463 requirements of standards developed under s. 467.009 and the
464 rules adopted thereunder.
465 (3)(5) If the department finds that an approved midwifery
466 program is not in compliance with the requirements of s. 467.009
467 or the rules adopted thereunder, or has lost its accreditation
468 status, the department must provide its finding to the program
469 in writing and no longer meets the required standards, it may
470 place the program on probationary status for a specified period
471 of time, which may not exceed 3 years until such time as the
472 standards are restored.
473 (4) If a program on probationary status does not come into
474 compliance with the requirements of s. 467.009 or the rules
475 adopted thereunder, or regain its accreditation status, as

Page 19 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

476 applicable, within the period specified by the department fails
477 to correct these conditions within a specified period of time,
478 the department may rescind the program's approval.
479 (5) A Any program that has having its approval rescinded
480 has shall have the right to reapply for approval.
481 (6) The department may grant provisional approval of a new
482 program seeking accreditation status, for a period not to exceed
483 5 years, provided that all other requirements of this section
484 are met.
485 (7) The department may rescind provisional approval of a
486 program that fails to the meet the requirements of s. 467.009,
487 this section, or the rules adopted thereunder, in accordance
488 with procedures provided in subsections (3) and (4) may be
489 granted pending the licensure results of the first graduating
490 class.
491 Section 9. Subsections (2), (3), and (4) and paragraphs
492 (a) and (b) of subsection (5) of section 468.803, Florida
493 Statutes, are amended to read:
494 468.803 License, registration, and examination
495 requirements.—
496 (2) An applicant for registration, examination, or
497 licensure must apply to the department on a form prescribed by
498 the board for consideration of board approval. Each initial
499 applicant shall submit a set of fingerprints to the department
500 on a form and under procedures specified by the department,

Page 20 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

501 along with payment in an amount equal to the costs incurred by
502 the department for state and national criminal history checks of
503 the applicant. The department shall submit the fingerprints
504 provided by an applicant to the Department of Law Enforcement
505 for a statewide criminal history check, and the Department of
506 Law Enforcement shall forward the fingerprints to the Federal
507 Bureau of Investigation for a national criminal history check of
508 the applicant. The board shall screen the results to determine
509 if an applicant meets licensure requirements. The board shall
510 consider for examination, registration, or licensure each
511 applicant who the board verifies:
512 (a) Has submitted the completed application and completed
513 the fingerprinting requirements fingerprint forms and has paid
514 the applicable application fee, not to exceed $500, and the cost
515 of the state and national criminal history checks. The
516 application fee is and cost of the criminal history checks shall
517 be nonrefundable;
518 (b) Is of good moral character;
519 (c) Is 18 years of age or older; and
520 (d) Has completed the appropriate educational preparation.
521 (3) A person seeking to attain the orthotics or
522 prosthetics experience required for licensure in this state must
523 be approved by the board and registered as a resident by the
524 department. Although a registration may be held in both
525 disciplines, for independent registrations the board may not

Page 21 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

526 approve a second registration until at least 1 year after the
527 issuance of the first registration. Notwithstanding subsection
528 (2), a person who has been approved by the board and registered
529 by the department in one discipline may apply for registration
530 in the second discipline without an additional state or national
531 criminal history check during the period in which the first
532 registration is valid. Each independent registration or dual
533 registration is valid for 2 years after the date of issuance
534 unless otherwise revoked by the department upon recommendation
535 of the board. The board shall set a registration fee not to
536 exceed $500 to be paid by the applicant. A registration may be
537 renewed once by the department upon recommendation of the board
538 for a period no longer than 1 year, as such renewal is defined
539 by the board by rule. The renewal fee may not exceed one-half
540 the current registration fee. To be considered by the board for
541 approval of registration as a resident, the applicant must have
542 one of the following:
543 (a) A Bachelor of Science or higher-level postgraduate
544 degree in orthotics and prosthetics from an a regionally
545 accredited college or university recognized by the Commission on
546 Accreditation of Allied Health Education Programs.
547 (b) A minimum of a bachelor's degree from an
548 institutionally a regionally accredited college or university
549 and a certificate in orthotics or prosthetics from a program
550 recognized by the Commission on Accreditation of Allied Health

Page 22 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

551 Education Programs, or its equivalent, as determined by the
552 board.
553 (c) A minimum of a bachelor's degree from an
554 institutionally a regionally accredited college or university
555 and a dual certificate in both orthotics and prosthetics from
556 programs recognized by the Commission on Accreditation of Allied
557 Health Education Programs, or its equivalent, as determined by
558 the board.
559 (4) The department may develop and administer a state
560 examination for an orthotist or a prosthetist license, or the
561 board may approve the existing examination of a national
562 standards organization. The examination must be predicated on a
563 minimum of a baccalaureate-level education and formalized
564 specialized training in the appropriate field. Each examination
565 must demonstrate a minimum level of competence in basic
566 scientific knowledge, written problem solving, and practical
567 clinical patient management. The board shall require an
568 examination fee not to exceed the actual cost to the board in
569 developing, administering, and approving the examination, which
570 fee must be paid by the applicant. To be considered by the board
571 for examination, the applicant must have:
572 (a) For an examination in orthotics:
573 1. A Bachelor of Science or higher-level postgraduate
574 degree in orthotics and prosthetics from an institutionally a
575 regionally accredited college or university recognized by the

Page 23 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

576 Commission on Accreditation of Allied Health Education Programs
577 or, at a minimum, a bachelor's degree from an institutionally a
578 regionally accredited college or university and a certificate in
579 orthotics from a program recognized by the Commission on
580 Accreditation of Allied Health Education Programs, or its
581 equivalent, as determined by the board; and
582 2. An approved orthotics internship of 1 year of qualified
583 experience, as determined by the board, or an orthotic residency
584 or dual residency program recognized by the board.
585 (b) For an examination in prosthetics:
586 1. A Bachelor of Science or higher-level postgraduate
587 degree in orthotics and prosthetics from an institutionally a
588 regionally accredited college or university recognized by the
589 Commission on Accreditation of Allied Health Education Programs
590 or, at a minimum, a bachelor's degree from an institutionally a
591 regionally accredited college or university and a certificate in
592 prosthetics from a program recognized by the Commission on
593 Accreditation of Allied Health Education Programs, or its
594 equivalent, as determined by the board; and
595 2. An approved prosthetics internship of 1 year of
596 qualified experience, as determined by the board, or a
597 prosthetic residency or dual residency program recognized by the
598 board.
599 (5) In addition to the requirements in subsection (2), to
600 be licensed as:

Page 24 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

601 (a) An orthotist, the applicant must pay a license fee not
602 to exceed $500 and must have:
603 1. A Bachelor of Science or higher-level postgraduate
604 degree in Orthotics and Prosthetics from an institutionally a
605 regionally accredited college or university recognized by the
606 Commission on Accreditation of Allied Health Education Programs,
607 or a bachelor's degree from an institutionally accredited
608 college or university and with a certificate in orthotics from a
609 program recognized by the Commission on Accreditation of Allied
610 Health Education Programs, or its equivalent, as determined by
611 the board;
612 2. An approved appropriate internship of 1 year of
613 qualified experience, as determined by the board, or a residency
614 program recognized by the board;
615 3. Completed the mandatory courses; and
616 4. Passed the state orthotics examination or the board-
617 approved orthotics examination.
618 (b) A prosthetist, the applicant must pay a license fee
619 not to exceed $500 and must have:
620 1. A Bachelor of Science or higher-level postgraduate
621 degree in Orthotics and Prosthetics from an institutionally a
622 regionally accredited college or university recognized by the
623 Commission on Accreditation of Allied Health Education Programs,
624 or a bachelor's degree from an institutionally accredited
625 college or university and with a certificate in prosthetics from

Page 25 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

626 a program recognized by the Commission on Accreditation of
627 Allied Health Education Programs, or its equivalent, as
628 determined by the board;
629 2. An internship of 1 year of qualified experience, as
630 determined by the board, or a residency program recognized by
631 the board;
632 3. Completed the mandatory courses; and
633 4. Passed the state prosthetics examination or the board-
634 approved prosthetics examination.
635 Section 10. Section 483.824, Florida Statutes, is amended
636 to read:
637 483.824 Qualifications of clinical laboratory director.—A
638 clinical laboratory director must have 4 years of clinical
639 laboratory experience with 2 years of experience in the
640 specialty to be directed or be nationally board certified in the
641 specialty to be directed, and must meet one of the following
642 requirements:
643 (1) Be a physician licensed under chapter 458 or chapter
644 459;
645 (2) Hold an earned doctoral degree in a chemical,
646 physical, or biological science from an a regionally accredited
647 institution and maintain national certification requirements
648 equal to those required by the federal Health Care Financing
649 Administration; or
650 (3) For the subspecialty of oral pathology, be a physician

Page 26 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

651 licensed under chapter 458 or chapter 459 or a dentist licensed
652 under chapter 466.
653 Section 11. Subsection (3) of section 490.003, Florida
654 Statutes, is amended to read:
655 490.003 Definitions.—As used in this chapter:
656 (3)(a) "Doctoral degree from an American Psychological
657 Association accredited program" means Effective July 1, 1999,
658 "doctoral-level psychological education" and "doctoral degree in
659 psychology" mean a Psy.D., an Ed.D. in psychology, or a Ph.D. in
660 psychology from a psychology program at an educational
661 institution that, at the time the applicant was enrolled and
662 graduated:
663 1.(a) Had institutional accreditation from an agency
664 recognized and approved by the United States Department of
665 Education or was recognized as a member in good standing with
666 the Association of Universities and Colleges of Canada; and
667 2.(b) Had programmatic accreditation from the American
668 Psychological Association.
669 (b) "Doctoral degree in psychology" means a Psy.D., an
670 Ed.D. in psychology, or a Ph.D. in psychology from a psychology
671 program at an educational institution that, at the time the
672 applicant was enrolled and graduated, had institutional
673 accreditation from an agency recognized and approved by the
674 United States Department of Education or was recognized as a
675 member in good standing with the Association of Universities and

Page 27 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

676 Colleges of Canada.
677 Section 12. Subsection (1) of section 490.005, Florida
678 Statutes, is amended to read:
679 490.005 Licensure by examination.—
680 (1) Any person desiring to be licensed as a psychologist
681 shall apply to the department to take the licensure examination.
682 The department shall license each applicant who the board
683 certifies has met all of the following requirements:
684 (a) Completed the application form and remitted a
685 nonrefundable application fee not to exceed $500 and an
686 examination fee set by the board sufficient to cover the actual
687 per applicant cost to the department for development, purchase,
688 and administration of the examination, but not to exceed $500.
689 (b) Submitted proof satisfactory to the board that the
690 applicant has received:
691 1. A doctoral degree from an American Psychological
692 Association accredited program Doctoral-level psychological
693 education; or
694 2. The equivalent of a doctoral degree from an American
695 Psychological Association accredited program doctoral-level
696 psychological education, as defined in s. 490.003(3), from a
697 program at a school or university located outside the United
698 States of America which was officially recognized by the
699 government of the country in which it is located as an
700 institution or program to train students to practice

Page 28 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

701 professional psychology. The applicant has the burden of
702 establishing that this requirement has been met.
703 (c) Had at least 2 years or 4,000 hours of experience in
704 the field of psychology in association with or under the
705 supervision of a licensed psychologist meeting the academic and
706 experience requirements of this chapter or the equivalent as
707 determined by the board. The experience requirement may be met
708 by work performed on or off the premises of the supervising
709 psychologist if the off-premises work is not the independent,
710 private practice rendering of psychological services that does
711 not have a psychologist as a member of the group actually
712 rendering psychological services on the premises.
713 (d) Passed the examination. However, an applicant who has
714 obtained a passing score, as established by the board by rule,
715 on the psychology licensure examination designated by the board
716 as the national licensure examination need only pass the Florida
717 law and rules portion of the examination.
718 Section 13. Subsection (1) of section 490.0051, Florida
719 Statutes, is amended to read:
720 490.0051 Provisional licensure; requirements.—
721 (1) The department shall issue a provisional psychology
722 license to each applicant who the board certifies has:
723 (a) Completed the application form and remitted a
724 nonrefundable application fee not to exceed $250, as set by
725 board rule.

Page 29 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

726 (b) Earned a doctoral degree from an American
727 Psychological Association accredited program in psychology as
728 defined in s. 490.003(3).
729 (c) Met any additional requirements established by board
730 rule.
731 Section 14. Subsections (1), (3), and (4) of section
732 491.005, Florida Statutes, are amended to read:
733 491.005 Licensure by examination.—
734 (1) CLINICAL SOCIAL WORK.—Upon verification of
735 documentation and payment of a fee not to exceed $200, as set by
736 board rule, plus the actual per applicant cost to the department
737 for purchase of the examination from the American Association of
738 State Social Worker's Boards or a similar national organization,
739 the department shall issue a license as a clinical social worker
740 to an applicant who the board certifies has met all of the
741 following criteria:
742 (a) Has Submitted an application and paid the appropriate
743 fee.
744 (b)1. Has Received a doctoral degree in social work from a
745 graduate school of social work which at the time the applicant
746 graduated was accredited by an accrediting agency recognized by
747 the United States Department of Education or has received a
748 master's degree in social work from a graduate school of social
749 work which at the time the applicant graduated:
750 a. Was accredited by the Council on Social Work Education;

Page 30 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

751 b. Was accredited by the Canadian Association of Schools
752 of Social Work; or
753 c. Has been determined to have been a program equivalent
754 to programs approved by the Council on Social Work Education by
755 the Foreign Equivalency Determination Service of the Council on
756 Social Work Education. An applicant who graduated from a program
757 at a university or college outside of the United States or
758 Canada must present documentation of the equivalency
759 determination from the council in order to qualify.
760 2. The applicant's graduate program must have emphasized
761 direct clinical patient or client health care services,
762 including, but not limited to, coursework in clinical social
763 work, psychiatric social work, medical social work, social
764 casework, psychotherapy, or group therapy. The applicant's
765 graduate program must have included all of the following
766 coursework:
767 a. A supervised field placement which was part of the
768 applicant's advanced concentration in direct practice, during
769 which the applicant provided clinical services directly to
770 clients.
771 b. Completion of 24 semester hours or 32 quarter hours in
772 theory of human behavior and practice methods as courses in
773 clinically oriented services, including a minimum of one course
774 in psychopathology, and no more than one course in research,
775 taken in a school of social work accredited or approved pursuant

Page 31 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

776 to subparagraph 1.
777 3. If the course title which appears on the applicant's
778 transcript does not clearly identify the content of the
779 coursework, the applicant shall be required to provide
780 additional documentation, including, but not limited to, a
781 syllabus or catalog description published for the course.
782 (c) Has Had at least 2 years of clinical social work
783 experience, which took place subsequent to completion of a
784 graduate degree in social work at an institution meeting the
785 accreditation requirements of this section, under the
786 supervision of a licensed clinical social worker or the
787 equivalent who is a qualified supervisor as determined by the
788 board. An individual who intends to practice in Florida to
789 satisfy clinical experience requirements must register pursuant
790 to s. 491.0045 before commencing practice. If the applicant's
791 graduate program was not a program which emphasized direct
792 clinical patient or client health care services as described in
793 subparagraph (b)2., the supervised experience requirement must
794 take place after the applicant has completed a minimum of 15
795 semester hours or 22 quarter hours of the coursework required. A
796 doctoral internship may be applied toward the clinical social
797 work experience requirement. A licensed mental health
798 professional must be on the premises when clinical services are
799 provided by a registered intern in a private practice setting.
800 (d) Has Passed a theory and practice examination

Page 32 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

801 designated by board rule provided by the department for this
802 purpose.
803 (e) Has Demonstrated, in a manner designated by rule of
804 the board, knowledge of the laws and rules governing the
805 practice of clinical social work, marriage and family therapy,
806 and mental health counseling.
807 (3) MARRIAGE AND FAMILY THERAPY.—Upon verification of
808 documentation and payment of a fee not to exceed $200, as set by
809 board rule, plus the actual cost of the purchase of the
810 examination from the Association of Marital and Family Therapy
811 Regulatory Board, or similar national organization, the
812 department shall issue a license as a marriage and family
813 therapist to an applicant who the board certifies has met all of
814 the following criteria:
815 (a) Has Submitted an application and paid the appropriate
816 fee.
817 (b)1. Obtained one of the following:
818 a. Has A minimum of a master's degree with major emphasis
819 in marriage and family therapy or a closely related field from a
820 program accredited by the Commission on Accreditation for
821 Marriage and Family Therapy Education or from a Florida
822 university program accredited by the Council for Accreditation
823 of Counseling and Related Educational Programs.
824 b. A minimum of a master's degree with an emphasis in
825 marriage and family therapy with a degree conferred date before

Page 33 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

826 July 1, 2026, from an institutionally accredited college or
827 university that is not yet accredited by the Commission on
828 Accreditation for Marriage and Family Therapy Education or the
829 Council for Accreditation of Counseling and Related Educational
830 Programs.
831 2. Completed and graduate courses approved by the Board of
832 Clinical Social Work, Marriage and Family Therapy, and Mental
833 Health Counseling.
834
835 If the course title that appears on the applicant's transcript
836 does not clearly identify the content of the coursework, the
837 applicant shall provide additional documentation, including, but
838 not limited to, a syllabus or catalog description published for
839 the course. The required master's degree must have been received
840 in an institution of higher education that, at the time the
841 applicant graduated, was fully accredited by an institutional a
842 regional accrediting body recognized by the Commission on
843 Recognition of Postsecondary Accreditation or publicly
844 recognized as a member in good standing with the Association of
845 Universities and Colleges of Canada, or an institution of higher
846 education located outside the United States and Canada which, at
847 the time the applicant was enrolled and at the time the
848 applicant graduated, maintained a standard of training
849 substantially equivalent to the standards of training of those
850 institutions in the United States which are accredited by an

Page 34 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

851 institutional a regional accrediting body recognized by the
852 Commission on Recognition of Postsecondary Accreditation. Such
853 foreign education and training must have been received in an
854 institution or program of higher education officially recognized
855 by the government of the country in which it is located as an
856 institution or program to train students to practice as
857 professional marriage and family therapists or psychotherapists.
858 The applicant has the burden of establishing that the
859 requirements of this provision have been met, and the board
860 shall require documentation, such as an evaluation by a foreign
861 equivalency determination service, as evidence that the
862 applicant's graduate degree program and education were
863 equivalent to an accredited program in this country. An
864 applicant with a master's degree from a program that did not
865 emphasize marriage and family therapy may complete the
866 coursework requirement in a training institution fully
867 accredited by the Commission on Accreditation for Marriage and
868 Family Therapy Education recognized by the United States
869 Department of Education.
870 (c) Has Had at least 2 years of clinical experience during
871 which 50 percent of the applicant's clients were receiving
872 marriage and family therapy services, which must have been be at
873 the post-master's level under the supervision of a licensed
874 marriage and family therapist with at least 5 years of
875 experience, or the equivalent, who is a qualified supervisor as

Page 35 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

876 determined by the board. An individual who intends to practice
877 in Florida to satisfy the clinical experience requirements must
878 register pursuant to s. 491.0045 before commencing practice. If
879 a graduate has a master's degree with a major emphasis in
880 marriage and family therapy or a closely related field which did
881 not include all of the coursework required by paragraph (b),
882 credit for the post-master's level clinical experience may not
883 commence until the applicant has completed a minimum of 10 of
884 the courses required by paragraph (b), as determined by the
885 board, and at least 6 semester hours or 9 quarter hours of the
886 course credits must have been completed in the area of marriage
887 and family systems, theories, or techniques. Within the 2 years
888 of required experience, the applicant must shall provide direct
889 individual, group, or family therapy and counseling to cases
890 including those involving unmarried dyads, married couples,
891 separating and divorcing couples, and family groups that include
892 children. A doctoral internship may be applied toward the
893 clinical experience requirement. A licensed mental health
894 professional must be on the premises when clinical services are
895 provided by a registered intern in a private practice setting.
896 (d) Has Passed a theory and practice examination
897 designated by board rule provided by the department.
898 (e) Has Demonstrated, in a manner designated by board
899 rule, knowledge of the laws and rules governing the practice of
900 clinical social work, marriage and family therapy, and mental

Page 36 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

901 health counseling.
902
903 For the purposes of dual licensure, the department shall license
904 as a marriage and family therapist any person who meets the
905 requirements of s. 491.0057. Fees for dual licensure may not
906 exceed those stated in this subsection.
907 (4) MENTAL HEALTH COUNSELING.—Upon verification of
908 documentation and payment of a fee not to exceed $200, as set by
909 board rule, plus the actual per applicant cost of purchase of
910 the examination from the National Board for Certified Counselors
911 or its successor organization, the department shall issue a
912 license as a mental health counselor to an applicant who the
913 board certifies has met all of the following criteria:
914 (a) Has Submitted an application and paid the appropriate
915 fee.
916 (b)1. Obtained Has a minimum of an earned master's degree
917 from a mental health counseling program accredited by the
918 Council for the Accreditation of Counseling and Related
919 Educational Programs which consists of at least 60 semester
920 hours or 80 quarter hours of clinical and didactic instruction,
921 including a course in human sexuality and a course in substance
922 abuse. If the master's degree is earned from a program related
923 to the practice of mental health counseling which is not
924 accredited by the Council for the Accreditation of Counseling
925 and Related Educational Programs, then the coursework and

Page 37 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

926 practicum, internship, or fieldwork must consist of at least 60
927 semester hours or 80 quarter hours and meet all of the following
928 requirements:
929 a. Thirty-three semester hours or 44 quarter hours of
930 graduate coursework, which must include a minimum of 3 semester
931 hours or 4 quarter hours of graduate-level coursework in each of
932 the following 11 content areas: counseling theories and
933 practice; human growth and development; diagnosis and treatment
934 of psychopathology; human sexuality; group theories and
935 practice; individual evaluation and assessment; career and
936 lifestyle assessment; research and program evaluation; social
937 and cultural foundations; substance abuse; and legal, ethical,
938 and professional standards issues in the practice of mental
939 health counseling. Courses in research, thesis or dissertation
940 work, practicums, internships, or fieldwork may not be applied
941 toward this requirement.
942 b. A minimum of 3 semester hours or 4 quarter hours of
943 graduate-level coursework addressing diagnostic processes,
944 including differential diagnosis and the use of the current
945 diagnostic tools, such as the current edition of the American
946 Psychiatric Association's Diagnostic and Statistical Manual of
947 Mental Disorders. The graduate program must have emphasized the
948 common core curricular experience.
949 c. The equivalent, as determined by the board, of at least
950 700 hours of university-sponsored supervised clinical practicum,

Page 38 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

951 internship, or field experience that includes at least 280 hours
952 of direct client services, as required in the accrediting
953 standards of the Council for Accreditation of Counseling and
954 Related Educational Programs for mental health counseling
955 programs. This experience may not be used to satisfy the post-
956 master's clinical experience requirement.
957 2. Has Provided additional documentation if a course title
958 that appears on the applicant's transcript does not clearly
959 identify the content of the coursework. The documentation must
960 include, but is not limited to, a syllabus or catalog
961 description published for the course.
962
963 Education and training in mental health counseling must have
964 been received in an institution of higher education that, at the
965 time the applicant graduated, was fully accredited by an
966 institutional a regional accrediting body recognized by the
967 Council for Higher Education Accreditation or its successor
968 organization or publicly recognized as a member in good standing
969 with the Association of Universities and Colleges of Canada, or
970 an institution of higher education located outside the United
971 States and Canada which, at the time the applicant was enrolled
972 and at the time the applicant graduated, maintained a standard
973 of training substantially equivalent to the standards of
974 training of those institutions in the United States which are
975 accredited by an institutional a regional accrediting body

Page 39 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

976 recognized by the Council for Higher Education Accreditation or
977 its successor organization. Such foreign education and training
978 must have been received in an institution or program of higher
979 education officially recognized by the government of the country
980 in which it is located as an institution or program to train
981 students to practice as mental health counselors. The applicant
982 has the burden of establishing that the requirements of this
983 provision have been met, and the board shall require
984 documentation, such as an evaluation by a foreign equivalency
985 determination service, as evidence that the applicant's graduate
986 degree program and education were equivalent to an accredited
987 program in this country. Beginning July 1, 2025, an applicant
988 must have a master's degree from a program that is accredited by
989 the Council for Accreditation of Counseling and Related
990 Educational Programs or the Master’s in Psychology and
991 Counseling Accreditation Council which consists of at least 60
992 semester hours or 80 quarter hours to apply for licensure under
993 this paragraph.
994 (c) Has Had at least 2 years of clinical experience in
995 mental health counseling, which must be at the post-master's
996 level under the supervision of a licensed mental health
997 counselor or the equivalent who is a qualified supervisor as
998 determined by the board. An individual who intends to practice
999 in Florida to satisfy the clinical experience requirements must
1000 register pursuant to s. 491.0045 before commencing practice. If

Page 40 of 41

CODING: Words stricken are deletions; words underlined are additions.
V
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

PCS for HB 1565 2021

1001 a graduate has a master's degree with a major related to the
1002 practice of mental health counseling which did not include all
1003 the coursework required under sub-subparagraphs (b)1.a. and b.,
1004 credit for the post-master's level clinical experience may not
1005 commence until the applicant has completed a minimum of seven of
1006 the courses required under sub-subparagraphs (b)1.a. and b., as
1007 determined by the board, one of which must be a course in
1008 psychopathology or abnormal psychology. A doctoral internship
1009 may be applied toward the clinical experience requirement. A
1010 licensed mental health professional must be on the premises when
1011 clinical services are provided by a registered intern in a
1012 private practice setting.
1013 (d) Has Passed a theory and practice examination
1014 designated by department rule provided by the department for
1015 this purpose.
1016 (e) Has Demonstrated, in a manner designated by board
1017 rule, knowledge of the laws and rules governing the practice of
1018 clinical social work, marriage and family therapy, and mental
1019 health counseling.
1020 Section 15. This act shall take effect July 1, 2021.

Page 41 of 41

CODING: Words stricken are deletions; words underlined are additions.
V

File and source

File: 2021-03-16_3093_professions-public-health-subcommittee_meeting-packets_mtg12909.pdf
Size: 1,408,559 bytes
SHA-256: a49c125460800d3cd11288473c45d726beefa1b9f2014d230a331cb2c8315bd5
Our copy: 2021-03-16_3093_professions-public-health-subcommittee_meeting-packets_mtg12909.pdf
Original: No public link identified.