Meeting Packet - Professions and Public Health Subcommittee (Tuesday, March 23, 2021)
Summary
A Meeting Packet for the Professions and Public Health Subcommittee for Tuesday, March 23, 2021, 12:45 PM to 3:45 PM in Mashburn Hall. The Committee Meeting Notice lists HB 183, HB 397, HB 631, HB 1483 and HB 1627, plus proposed committee substitutes for HB 247, HB 431 and HB 1579. The packet includes the staff analysis of HB 183, which says the bill requires the Office of Minority Health and Health Equity to develop and promote statewide implementation of policies, programs, and practices that increase health equity for racial and ethnic minority populations in Florida, with an effective date of July 1, 2021. It also includes Amendment No. 1 to HB 1627, offered by Representative Maggard, with a title amendment.
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Professions and Public Health
Subcommittee
Tuesday, March 23, 2021
12:45 PM – 3:45 PM
Mashburn Hall (306 HOB)
Meeting Packet
Chris Sprowls Will Robinson
Speaker Chair
Committee Meeting Notice
HOUSE OF REPRESENTATIVES
Professions & Public Health Subcommittee
Start Date and Time: Tuesday, March 23, 2021 12:45 pm
End Date and Time: Tuesday, March 23, 2021 03:45 pm
Location: Mashburn Hall (306 HOB)
Duration: 3.00 hrs
Consideration of the following bill(s):
HB 183 Office of Minority Health and Health Equity by Brown, Joseph
HB 397 Cardiovascular Emergency Protocols and Training by DiCeglie, McClure
HB 627 Alzheimer's Disease and Dementia-Related Disorders Education by Salzman, Plakon
HB 631 Optometry by Rizo
HB 805 Volunteer Ambulance Services by Caruso
HB 1373 Rare Disease Advisory Council by DuBose
HB 1381 Maternal Health Outcomes by Brown
HB 1483 Solicitation of Non-medical Services by Yarborough
HB 1627 Continuing Chiropractic Education by Maggard
Consideration of the following bill(s) with proposed committee substitute(s):
PCS for HB 247 -- Telehealth Practice Standards
PCS for HB 431 -- Practice of Physician Assistants
PCS for HB 1579 -- Health Care Practitioner Discipline
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 03/19/2021 4:19PM by Osborne.Erin
03/19/2021 04:19:22PM Leagis ® Page 1 of 1
HB 183
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 183 Office of Minority Health and Health Equity
SPONSOR(S): Brown
TIED BILLS: IDEN./SIM. BILLS: SB 404
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Rahming McElroy
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
In Florida, minority populations experience higher rates of illness and death from health conditions such as
heart disease, stroke, specific cancers, diabetes, HIV/AIDS, mental health, asthma, and obesity. The Office of
Minority Health and Health Equity (Office), housed within the Department of Health (DOH), is responsible for
helping to improve health and healthcare outcomes for racial and ethnic minority communities by developing or
advancing policies, programs, and practices that address health, social, economic, environmental, and other
factors which impact health. Under current law, the Office is required to be headed by a Senior Health Equity
Officer. The responsibilities of the Senior Health Equity Officer include, but are not limited to, administering the
Closing the Gap grant program in a manner that maximizes the impact of the grants in achieving health equity.
HB 183 requires the Office to develop and promote the statewide implementation of policies, programs, and
practices that increase health equity for racial and ethnic minority populations in Florida. The bill also requires
the Office to work with other state agencies, organizations, and providers to improve the health of racial and
ethnic minority populations through data analysis and the development of health policies and programs that will
help eliminate health disparities. The bill authorizes the Office to serve as a liaison to and assist the federal
Offices of Minority Health and Regional Health Operations, as appropriate, and requires the Office to maintain
and annually update specific information on its website.
The bill has significant, negative fiscal impacts on the DOH. See Fiscal Comments.
The bill has no impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
The Present Situation
Health disparities—inequities in the quality of health, health care and health outcomes experienced by
groups based on social, racial, ethnic, economic and environmental characteristics—persist
nationwide. 1
In Florida, minority populations experience higher rates of illness and death from health conditions such
as heart disease, stroke, specific cancers, diabetes, HIV/AIDS, mental health, asthma, and obesity. 2
Poor health outcomes for Blacks, Hispanic Americans, American Indians, Alaska Natives, Asian
Americans, Native Hawaiians, and Pacific Islanders are also apparent when comparing their health
indicators to Florida's general population. 3
The Office of Minority Health and Health Equity
In 2004, the Florida Legislature established the Office of Minority Health to serve as the coordinating
office within the DOH for consultative services and training in the areas of cultural and linguistic
competency, coordination, partnership building, program development and implementation, and other
related comprehensive efforts to address the health needs of Florida's minority and underrepresented
populations statewide. 4
In 2016, the Florida Legislature re-named the office the Office of Minority Health and Health Equity
(Office). 5 The Office is responsible for helping to improve health and healthcare outcomes for racial and
ethnic minority communities by developing or advancing policies, programs, and practices that address
health, social, economic, environmental, and other factors which impact health. 6
The DOH currently gathers, analyzes, and publishes data regarding disparities in health status and
access to health care services on its Florida Health Community Health Assessment Resource Tool Set
(FLHealthCHARTS) website, but not on quality of health care. 7 However, the federal Agency for
Healthcare Research and Quality does publish data on the quality of healthcare and provides a list of
measures and supporting data that can be viewed by race and ethnicity at the state level. 8
Under current law, the Office is not required to develop and promote statewide implementation of any
policies, programs, and practices that may increase health equity for racial and ethnic minority
populations in Florida. The Office is also not required to work with other state agencies, organizations,
and providers or the federal government to improve the health of racial and ethnic minority populations
through data analysis and the development of health policies and programs that will help eliminate
health disparities. Rather, the Office is statutorily required to be headed by a Senior Health Equity
Officer. 9
1 National Conference of State Legislatures (NCSL), Health Disparities Overview, https://www.ncsl.org/research/health/health-
disparities-overview.aspx (last visited Feb. 3, 2021).
2 Florida Department of Health (DOH), Health Equity Profile 2019, Health Equity Profile - State Total, Florida 2019,
http://www.flhealthcharts.com/ChartsReports/rdPage.aspx?rdReport=ChartsProfiles.HealthEquityMergeMHProfile (last visited Mar. 7,
2021).
3 Id.
4 Florida Department of Health (DOH), Minority Health and Health Equity, http://www.floridahealth.gov/programs-and-services/minority-
health/index.html (last visited Mar. 7, 2021).
5 S. 20.43(9), Florida Statutes.
6 DOH, Minority Health Liaisons, http://www.floridahealth.gov/programs-and-services/minority-health/minority-health-liaisons.html (last
visited Feb. 28, 2021).
7 DOH, Agency Legislative Bill Analysis for HB 183 (2021), at 7.
8 Agency for Healthcare Research and Quality, National Healthcare Quality and Disparities Reports: Florida,
https://nhqrnet.ahrq.gov/inhqrdr/Florida/benchmark/summary/All_Measures/All_Topics (last visited February 28, 2021).
9 S. 20.43(9), Florida Statutes.
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Minority Health Initiatives
Closing the Gap Grant Program
The Office administers multiple health promotion programs including the “Closing the Gap” (CTG) grant
program. 10 In 2000, the Legislature created the CTG grant program to improve health outcomes and
eliminate racial and ethnic health disparities in Florida by providing grants to increase community-based
health and disease prevention activities. 11
Grants are awarded for one year through a proposal process, and may be renewed annually subject to
the availability of funds and the grantee’s achievement of quality standards, objectives, and
outcomes. 12 Proposals for grants must include: 13
• The purpose and objectives of the proposed project, including the particular racial or ethnic
disparity the project will address from one or more of the following priority areas:
o Increasing adult and child immunization rates in certain racial and ethnic populations;
o Improving neighborhood social determinates of health, such as transportation, safety,
and food access, as outlined by the Centers for Disease Control and Prevention (CDC),
or
o Decreasing racial and ethnic disparities in:
Maternal and infant mortality rates;
Morbidity and mortality rates relating to cancer;
Morbidity and mortality rates relating to HIV/AIDS;
Morbidity and mortality rates relating to cardiovascular disease;
Morbidity and mortality rates relating to diabetes;
Morbidity and mortality rates relating to sickle cell disease;
Morbidity and mortality rates relating to Lupus; or
Oral health care.
• The target population and its relevance;
• Methods for obtaining baseline health status data and assessment of community health needs;
• Mechanisms for mobilizing community resources and gaining local commitment;
• Development and implementation of health promotion and disease prevention interventions;
• Mechanisms and strategies for evaluating the project’s objectives, procedures, and outcomes;
• A proposed work plan, including a timeline for implementing the project; and
• The likelihood that project activities will occur and continue in the absence of funding. 14
As the head of the Office, the Senior Health Equity Officer is required to: 15
• Administer the CTG grant program in a manner that maximizes the impact of the grants in
achieving health equity;
• Evaluate the awarded grants to assess the effectiveness and efficiency of the use of funds and
to determine best practices;
• Disseminate information on best practices to stakeholders; and
• Ensure that the assessments inform future grant award decisions.
The Office’s CTG grant program responsibilities include: 16
10 Florida Department of Health, Minority Health, http://www.floridahealth.gov/%5C/programs-and-services/minority-health/index.html
(last visited Mar. 15, 2021).
11 Ss. 381.7353–381.7356, F.S. See also, Closing the Gap Grant, http://www.floridahealth.gov/programs-and-services/minority-
health/closing-the-gap.html (last visited Feb. 28, 2021).
12 S. 381.7356(4), F.S.
13 S. 381.7355, F.S.
14 Id.
15 S. 20.43(9), F.S.
16 DOH, supra note 7, at 3.
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• Publicizing the availability of funds and establishing an application process for submitting a
grant proposal.
• Providing technical assistance and training, including a statewide meeting promoting best
practice programs, as requested, to grant recipients.
• Developing uniform data reporting requirements for the purpose of evaluating the performance
of the grant recipients and demonstrating improved health outcomes.
• Developing a monitoring process to evaluate progress toward meeting grant objectives.
• Coordinating with existing community-based programs, such as chronic disease community
intervention programs, cancer prevention and control programs, diabetes control programs, the
Healthy Start program, the Florida Kidcare Program, the HIV/AIDS program, immunization
programs, and other related programs at the state and local levels, to avoid duplication of effort
and promote consistency.
Implementation of the CTG grant program is subject to a specific appropriation provided in the General
Appropriations Act. 17
Minority Health Liaisons
The Office relies on county health departments and other programs within the DOH to achieve its
goals. 18 The Minority Health Liaisons (MHLs), comprised of a representative from each of the 67 county
health departments, are the link between local communities and the Office. 19
The objective of the Office and the MHLs is to improve the health of all residents and visitors across
Florida, primarily through increasing public awareness of the importance of minority health
and partnering initiatives focused on minority health issues statewide. 20 The Office helps to facilitate
these partnerships by coordinating with county health departments, central office divisions/bureaus,
and statewide stakeholders, and providing technical assistance to the MHLs on issues related to
minority health, health disparities, and other health issues within the state. 21
Key components of the Office-MHL partnership include: 22
• Sharing information on minority health and health disparities;
• Coordinating events, such as Take a Loved One to the Doctor Day, National Minority Health
Month, and other nationally recognized observances;
• Promoting state and local activities and events to raise awareness of programs and services
available to minorities and the underserved populations; and
• Helping meet the mission of the DOH by achieving its primary responsibilities in eliminating
health disparities.
The Office’s Website
Currently, there are no statutory requirements relating to the maintenance of the Office’s website,
including what information should be maintained on it or how often it should be updated.
Effect of Proposed Bill
HB 183 requires the Office of Minority Health and Health Equity to develop and promote the statewide
implementation of policies, programs, and practices that increase health equity for racial and ethnic
minority populations in Florida.
17 Id.
18 DOH, supra note 6.
19 Id.
20 Id.
21 Id.
22 Id.
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The bill also requires the Office to use all available resources and pursue funding opportunities to
achieve the bill’s purpose and work with other state agencies, organizations, and providers to:
• Gather and analyze data regarding disparities in health status, quality of health care, and
access to health care services for racial and ethnic minority populations in Florida;
• Develop mechanisms that support better information dissemination and education about health
disparities and improve access to and delivery of health care services to racial and ethnic
minority populations in Florida;
• Support the MHLs by facilitating access to and the exchange of information related to health
promotion, preventive health services, and education in the appropriate use of care;
• Conduct demonstration projects and evaluations to ensure the success and sustainability of
policies, programs, and practices that increase health equity in Florida;
• Promote the use of community health workers to improve the cultural competency of services
and build individual and community self-sufficiency;
• Gather and analyze data regarding the prevalence of racial and ethnic minority populations at
risk of involvement with the criminal justice system, the juvenile justice system, and the foster
care system or at risk for homelessness, and any disparities in such involvement or access to
appropriate behavioral health services by those populations when compared to other
populations in this state;
• Promote the creation of or participation in programs that divert individuals with mental health
and substance use disorders from the criminal justice system and ensure the availability of
quality behavioral health services to the populations at risk of involvement with the criminal
justice system, the juvenile justice system, and the foster care system or at risk for
homelessness; and
• Develop and implement programs that improve access to health care services for individuals
with limited proficiency in the English language by providing access to bilingual providers or
interpretive services.
HB 183 requires the Office to maintain and annually update the following information on its website:
• Current state data on health disparities and issues affecting racial and ethnic minority
populations;
• Information about and links to resources available to racial and ethnic minority populations in
Florida;
• Resources for providers who wish to improve cultural competency, understand health
disparities, and increase the quality of and access to health care services for racial and ethnic
minority populations in Florida; and
• Contact information for local minority health liaisons.
The bill requires one representative from each county health department to serve as the MHL and
requires MHLs to assist the Office in implementation of the bill. The bill also authorizes the Office to
serve as a liaison to and assist the federal Offices of Minority Health and Regional Health Operations,
as appropriate.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Creates s. 381.735, F.S., relating to the Office of Minority Health and Health Equity.
Section 2: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
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A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The DOH will experience an increase in workload and operational costs to implement this bill. 23 The
anticipated fiscal impact to implement the bill is $6,079,202, of which $5,728,124 is recurring and
$351,078 is non-recurring. 24 This includes 11 full time equivalent employees in the central office
and 67 OPS staff in the County Health Departments, one in each county to serve as the MHL.
The bill requires the DOH to “gather and analyze data regarding the prevalence of racial and ethnic
minority populations at risk of involvement with the criminal justice system, the juvenile justice
system, and the foster care system or at risk for homelessness, and any disparities in such
involvement or access to appropriate behavioral health services by those populations when
compared to other populations in this state.” This may have significant technology and fiscal
impacts to the DOH’s technology systems and staff and may also require interagency agreements
with the Florida Department of Children and Families (DCF), the Florida Department of Corrections
(FDC), and the Florida Department of Juvenile Justice (DJJ). 25 If the DCF, FDC, and/or DJJ do not
already collect and/or electronically store these data, existing DOH data systems may have to be
modified and/or new data systems created to accommodate this activity. 26
The bill has an insignificant impact on the DOH’s technology systems and staff as it relates to the
annual update and maintenance of the Office’s website; however, as it relates to the requirement
that the DOH gather, analyze, and publish data on quality of health care, the fiscal impact is
indeterminate. 27
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.
23 DOH, supra note 7, at 5.
24 DOH, supra note 7, at 8.
25 DOH, supra note 7, at 7.
26 Id.
27 Id.
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2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill provides sufficient rule-making authority to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 183 2021
1 A bill to be entitled
2 An act relating to the Office of Minority Health and
3 Health Equity; creating s. 381.735, F.S.; requiring
4 the Office of Minority Health and Health Equity to
5 develop and promote the statewide implementation of
6 certain policies, programs, and practices; requiring
7 one representative from each county health department
8 to serve as a minority health liaison for a specified
9 purpose; requiring the office to use all available
10 resources and pursue funding opportunities to achieve
11 this purpose; specifying duties for the office;
12 requiring the office to maintain on its website
13 specified information; requiring the office to serve
14 as a liaison to and assist certain federal offices;
15 authorizing the Department of Health to adopt rules;
16 providing an effective date.
17
18 Be It Enacted by the Legislature of the State of Florida:
19
20 Section 1. Section 381.735, Florida Statutes, is created
21 to read:
22 381.735 Office of Minority Health and Health Equity.—
23 (1) The Office of Minority Health and Health Equity
24 established under s. 20.43(9) shall develop and promote the
25 statewide implementation of policies, programs, and practices
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 183 2021
26 that increase health equity in this state, including, but not
27 limited to, increased access to and quality of health care
28 services for racial and ethnic minority populations. One
29 representative from each county health department shall serve as
30 a minority health liaison to assist the office in implementing
31 this section. The office shall use all available resources and
32 pursue opportunities for increased funding to achieve the
33 purpose of this section.
34 (2) The office shall coordinate with agencies,
35 organizations, and providers across this state to do all of the
36 following:
37 (a) Gather and analyze data regarding disparities in
38 health status, quality of health care, and access to health care
39 services for racial and ethnic minority populations in this
40 state.
41 (b) Develop mechanisms that support better information
42 dissemination and education about health disparities and improve
43 access to and delivery of health care services to racial and
44 ethnic minority populations in this state.
45 (c) Support minority health liaisons by facilitating
46 access to and the exchange of information related to health
47 promotion, preventive health services, and education in the
48 appropriate use of care.
49 (d) Conduct demonstration projects and evaluations to
50 ensure the success and sustainability of policies, programs, and
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 183 2021
51 practices that increase health equity in this state.
52 (e) Promote the use of community health workers to improve
53 the cultural competency of services and build individual and
54 community self-sufficiency.
55 (f) Gather and analyze data regarding the prevalence of
56 racial and ethnic minority populations at risk of involvement
57 with the criminal justice system, the juvenile justice system,
58 and the foster care system or at risk for homelessness, and any
59 disparities in such involvement or access to appropriate
60 behavioral health services by those populations when compared to
61 other populations in this state.
62 (g) Promote the creation of or participation in programs
63 that divert individuals with mental health and substance use
64 disorders from the criminal justice system and ensure the
65 availability of quality behavioral health services to the
66 populations specified in paragraph (f).
67 (h) Develop and implement programs that improve access to
68 health care services for individuals with limited proficiency in
69 the English language by providing access to bilingual providers
70 or interpretive services.
71 (3) The office shall maintain all of the following on its
72 website, updated at least annually:
73 (a) Current data on health disparities and issues
74 affecting racial and ethnic minority populations in this state.
75 (b) Information about and links to resources available to
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76 racial and ethnic minority populations in this state.
77 (c) Resources for providers who wish to improve cultural
78 competency, understand health disparities, and increase the
79 quality of and access to health care services for racial and
80 ethnic minority populations in this state. These resources must
81 include, but need not be limited to, minority health literature,
82 research, and referrals; capacity-building and technical
83 assistance services; and training materials for implementing
84 nationally recognized evidence-based practices for culturally
85 and linguistically appropriate health care services.
86 (d) Contact information for local minority health
87 liaisons.
88 (4) The office shall serve as a liaison to and assist the
89 federal Offices of Minority Health and Regional Health
90 Operations, as appropriate.
91 (5) The department may adopt rules to implement this
92 section.
93 Section 2. This act shall take effect July 1, 2021.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 183 (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 Brown offered the following:
4
5 Amendment (with title amendment)
6 Remove lines 38-71 and insert:
7 health status, health outcomes, quality of health care, and
8 access to health care services for racial and ethnic minority
9 populations in this state.
10 (b) Develop mechanisms that support better information
11 dissemination and education about health disparities which lead
12 to improved access to and delivery of health care services to
13 racial and ethnic minority populations in this state.
14 (c) Support minority health liaisons by facilitating access to
15 and the exchange of information related to health promotion,
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 183 (2021)
Amendment No. 1
16 preventive health services, and education in the appropriate use
17 of care.
18 (d) Develop and promote synergistic initiatives between
19 programs, including, but not limited to, programs related to
20 maternal and child health and human immunodeficiency virus and
21 acquired immune deficiency syndrome, to mitigate health
22 disparities for racial and ethnic minority populations in this
23 state.
24 (e) Promote evaluations of demonstration projects and
25 disseminate the evaluation findings to enhance the success and
26 sustainability of policies, programs, and practices that
27 increase health equity in this state.
28 (f) Promote the use of community health workers to improve the
29 cultural competency of services and build individual and
30 community self-sufficiency.
31 (g) Promote the development of programs that improve access to
32 health care services for individuals with limited proficiency in
33 the English language, including persons with disabilities.
34 (3) The department shall maintain all of the following on its
35 -----------------------------------------------------
36 T I T L E A M E N D M E N T
37 Remove lines 12-15 and insert:
38 requiring the Department of Health to maintain specified
39 information on its website; requiring the office to serve as a
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 183 (2021)
Amendment No. 1
40 liaison to and assist certain federal offices; authorizing the
41 department to adopt rules;
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PCS for HB 247
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 247 Telehealth Practice Standards
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 Grabowski McElroy
Subcommittee
SUMMARY ANALYSIS
Telehealth is the remote provision of health care services through the use of technology. Telehealth is not a
type of health care service but rather is a mechanism for delivery of health care services. Health care
professionals use telehealth as a platform to provide traditional health care services in a non-traditional
manner. These services include, among others, preventative medicine and the treatment of chronic conditions.
Current law defines telehealth broadly, but specifies that it does not include audio-only telephone calls, e-mail
messages, or facsimile transmission. Health care services may be provided via telehealth by a Florida-
licensed health care practitioner, a practitioner licensed under a multistate health care licensure compact of
which Florida is a member, or a registered out-of-state-health care provider.
Practitioners have the ability to prescribe drugs via telehealth, but state and federal law limits the ability of
practitioners to dispense controlled substances using telehealth. Controlled substances are drugs with an
increased potential for patient abuse. At present, Florida law prohibits a telehealth provider from using
telehealth services to prescribe a controlled substance except when treating:
• A psychiatric disorder;
• An inpatient at a hospital;
• A patient receiving hospice services; and
• A resident of a nursing home facility.
Federal law requires a practitioner to conduct at least one in-person medical evaluation prior to dispensing a
controlled substance to a patient via telehealth.
PCS for HB 247 allows practitioners to prescribe schedule III, IV, and V controlled substances using telehealth
services.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Current Situation
Telehealth
Telehealth is not a type of health care service but rather is a mechanism for delivery of health care
services. Health care professionals use telehealth as a platform to provide traditional health care
services in a non-traditional manner. These services include, among others, preventative medicine and
the treatment of chronic conditions. 1
Telehealth, in its modern form, 2 started in the 1960s in large part driven by the military and space
technology sectors. 3 Specifically, telehealth was used to remotely monitor physiological measurements
of certain military and space program personnel. As this technology became more readily available to
the civilian market, telehealth began to be used for linking physicians with patients in remote, rural
areas. As advancements were made in telecommunication technology, the use of telehealth became
more widespread to include not only rural areas but also urban communities. Due to recent technology
advancements and general accessibility, the use of telehealth has spread rapidly and is now becoming
integrated into the ongoing operations of hospitals and healthcare systems around the country. 4 In fact,
there are currently an estimated 200 telehealth networks, with 3,000 service sites in the U.S. 5
Telehealth is used to address several problems in the current health care system. Inadequate access to
care is one of the primary obstacles to obtaining quality health care. 6 This occurs in both rural areas
and urban communities. 7 Telehealth reduces the impact of this issue by providing a mechanism to
deliver quality health care, irrespective of the location of a patient or a health care professional. Cost is
another barrier to obtaining quality health care. 8 This includes the cost of travel to and from the health
care facility, as well as related loss of wages from work absences. Costs are reduced through
telehealth by decreasing the time and distance required to travel to the health care professional. Two
more issues addressed through telehealth are the reutilization of health care services and hospital
readmission. These often occur due to a lack of proper follow-up care by the patient 9 or a chronic
condition. 10 These issues however can potentially be avoided through the use of telehealth and
telemonitoring. 11
Regulation of Telehealth in Florida
1 U.S. Department of Health and Human Services, Report to Congress: E-Health and Telemedicine, (August 2016), available at
https://aspe.hhs.gov/system/files/pdf/206751/TelemedicineE-HealthReport.pdf (last visited May 6, 2019).
2 Historically, telehealth can be traced back to the mid to late 19th century with one of the first published accounts occurring in the early
20th century when electrocardiograph data were transmitted over telephone wires. See supra note Error! Bookmark not defined. at p.
9.
3 Id.
4 American Telemedicine Association, Telehealth Basics, available at https://www.americantelemed.org/resource/why-telemedicine/
(last visited May 6, 2019).
5 Id.
6 Id.
7 Id.
8 Id.
9 Post-surgical examination subsequent to a patient’s release from a hospital is a prime example. Specifically, infection can occur
without proper follow-up and ultimately leads to a readmission to the hospital.
10 For example, diabetes is a chronic condition which can benefit by treatment through telehealth.
11 Telemonitoring is the process of using audio, video, and other telecommunications and electronic information processing
technologies to monitor the health status of a patient from a distance.
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Service Providers
In 2019, the Legislature passed and the Governor signed CS/CS/HB 23, which established a
framework for telehealth services in Florida law. 12 The act broadly defines telehealth as the use of
synchronous or asynchronous telecommunications technology by a telehealth provider to provide
health care services, including, but not limited to:
• Assessment, diagnosis, consultation, treatment, and monitoring of a patient;
• Transfer of medical data;
• Patient and professional health-related education;
• Public health services; and
• Health administration.
Telehealth does not include audio-only telephone calls, e-mail messages, or facsimile transmission
under Florida law. 13
Health care services may be provided via telehealth by a Florida-licensed health care practitioner, a
practitioner licensed under a multistate health care licensure compact of which Florida is a member, 14
or a registered out-of-state-health care provider. 15
Florida-licensed telehealth providers, as well as those licensed under a multistate health care licensure
compact of which Florida is a member, must be one of the following health care practitioners. 16
• Behavioral Analyst • Occupational therapist • Clinical laboratory
• Acupuncturist • Radiology technician personnel
• Allopathic physician • Electrologist • Respiratory therapist
• Osteopathic physician • Orthotist • Physical therapist
• Chiropractor • Pedorthist • Psychologist
• Podiatrist • Prosthetist • Psychotherapist
• Optometrist • Medical physicist • Dietician/Nutritionist
• Nurse • Emergency Medical • Athletic trainer
• Pharmacist Technician • Clinical social worker
• Dentist • Paramedic • Marriage and family
• Dental hygienist • Massage therapist therapist
• Midwife • Optician • Mental health counselor
• Speech therapist • Hearing aid specialist
Out-of-state telehealth providers must register biennially with DOH or the applicable board to provide
telehealth services, within the relevant scope of practice established by Florida law and rule, to patients
in this state. To register or renew registration as an out-of-state telehealth provider, the health care
professional must:
• Hold an active and unencumbered license, which is substantially similar to a license issued to a
Florida practitioner in the same profession, in a U.S. state or jurisdiction and
• Not have been subject to licensure disciplinary action during the five years before submission of
the registration application; 17
• Not be subject to a pending licensure disciplinary investigation or action;
• Not have had license revoked in any state or jurisdiction;
12 Ch. 2019-137, L.O.F.
13 S. 456.47(1), F.S.
14 Florida is a member of the Nurse Licensure Compact. See s. 464.0095, F.S.
15 Supra note 22.
16 These are professionals licensed under s. 393.17; part III, ch. 401; ch. 457; ch. 458; ch. 459; ch. 460; ch. 461; ch. 463; ch. 464; ch.
465; ch. 466; ch. 467; part I, part III, part IV, part V, part X, part XIII, and part XIV, ch. 468; ch. 478; ch. 480; part II and part III, ch. 483;
ch. 484; ch. 486; ch. 490; or ch. 491.
17 The bill requires DOH to consult the National Practitioner Data Bank to verify whether adverse information is available for the
registrant.
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• Designate a registered agent in this state for the service of process;
• Maintain professional liability coverage or financial responsibility, which covers services
provided to patients not located in the provider’s home state, in the same amount as required for
Florida-licensed practitioners; 18 and
• Prominently display a link to the DOH website, described below, which provides public
information on registered telehealth providers. 19
Standards of Practice
Current law sets the standard of care for telehealth providers at the same level as the standard of care
for health care practitioners or health care providers providing in-person health care services to patients
in this state. This ensures that a patient receives the same standard of care irrespective of the modality
used by the health care professional to deliver the services. A patient receiving telehealth services may
be in any location at the time services are rendered and a telehealth provider may be in any location
when providing telehealth services to a patient. 20
Practitioners may perform a patient evaluation using telehealth. A practitioner using telehealth is not
required to research a patient’s medical history or conduct a physical examination of the patient before
providing telehealth services to the patient if the telehealth provider is capable of conducting a patient
evaluation in a manner consistent with the applicable standard of care sufficient to diagnose and treat
the patient when using telehealth.
Controlled Substances
Florida Law
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” 21 of the
substance and whether there is a currently accepted medical use for the substance. 22
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. 23
• 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. 24
• 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. 25
• 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. 26
18 Florida law requires physicians, acupuncturists, chiropractic physicians, dentists, anesthesiologist assistants, advanced practice
registered nurses, and licensed midwives to demonstrate $100,000 per claim and an annual aggregate of $300,000 of professional
responsibility (see ss. 458.320 and 459.0085, F.S.; r. 64B1-12.001. F.A.C; r. 64B2-17.009, F.A.C.; 64B5-17.0105, F.A.C.; rr. 64B8-
31.006 and 64B15-7.006, F.A.C.; r. 64B9-4.002, F.A.C.; and r. 64B24-7.013, F.A.C.; respectively). Podiatric physicians must
demonstrate professional responsibility in the amount of $100,000 (see r. 64B18-14.0072, F.A.C.).
19 S. 456.47(4), F.S.
20 S. 456.47(2), F.S.
21 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.
22 See s. 893.03, F.S.
23 S. 893.03(1), F.S.
24 S. 893.03(2), F.S.
25 S. 893.03(3), F.S.
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• 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. 27
Federal Law
The Federal Controlled Substances Act 28 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: 29
• 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.
Telehealth Prescribing of Controlled Substances
Federal law specifically prohibits prescribing controlled substances via the Internet without an in-person
evaluation: 30
No controlled substance that is a prescription drug as determined under the Federal
Food, Drug, and Cosmetic Act may be delivered, distributed, or dispensed by means of
the Internet without a valid prescription. 31
The in-person medical evaluation requires that the patient be in the physical presence of the provider
without regard to the presence or conduct of other professionals. 32 However, the Ryan Haight Online
Pharmacy Consumer Protection Act, 33 signed into law in October 2008, created a pathway for
telehealth practitioners to dispense controlled substances via telehealth. The practitioner is still subject
to the requirement that all controlled substance prescriptions be issued for a legitimate purpose by a
practitioner acting in the usual course of professional practice. But, once an in-person evaluation of the
patient has occurred, the practitioner may provide future prescriptions for controlled substances for that
patient using telehealth services. 34
Florida law currently prohibits a telehealth provider from using telehealth services to prescribe a
controlled substance except when treating:
• A psychiatric disorder;
• An inpatient at a hospital licensed under ch. 395, F.S.;
• A patient receiving hospice services as defined under s. 400.601, F.S.;
• A resident of a nursing home facility as defined under s. 400.021(12), F.S.
Effect of Proposed Changes
26 S. 893.03(4), F.S.
27 S. 893.03(5), F.S.
28 21 U.S.C. § 812.
29 21 U.S.C. § 811(c).
30 21 CFR §829
31 A valid prescription is defined as one issued by a practitioner who has conducted at least one in-person medical evaluation of the
patient.
32 21 CFR § 829(e)(2).
33 Ryan Haight Online Consumer Protection Act of 2008, Public Law 110-425 (H.R. 6353).
34 Supra note 40.
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PCS for 247 allows practitioners to prescribe Schedule III, IV, and V controlled substances using
telehealth services and retains current law restrictions on prescribing Schedule II controlled substances
through telehealth.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 456.47, F.S.; relating to use of telehealth to provide services.
Section 2: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
DOH has sufficient rule-making authority to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
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IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
PCS for HB 247 ORIGINAL 2021
1 A bill to be entitled
2 An act relating to telehealth practice standards;
3 amending s. 456.47, F.S.; revising prohibition on
4 prescribing controlled substances through telehealth;
5 providing an effective date.
6
7 Be It Enacted by the Legislature of the State of Florida:
8
9 Section 1. Paragraph (c) of subsection (2) of section
10 456.47, Florida Statutes, is amended to read:
11 456.47 Use of telehealth to provide services.—
12 (2) PRACTICE STANDARDS.—
13 (c) A telehealth provider may not use telehealth to
14 prescribe a controlled substance listed in Schedule II of
15 section 893.03 unless the controlled substance is prescribed for
16 the following:
17 1. The treatment of a psychiatric disorder;
18 2. Inpatient treatment at a hospital licensed under
19 chapter 395;
20 3. The treatment of a patient receiving hospice services
21 as defined in s. 400.601; or
22 4. The treatment of a resident of a nursing home facility
23 as defined in s. 400.021.
24 Section 2. This act shall take effect July 1, 2021.
Page 1 of 1
PCS for HB 247.docx
CODING: Words stricken are deletions; words underlined are additions.
V
HB 397
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 397 Cardiovascular Emergency Protocols and Training
SPONSOR(S): DiCeglie
TIED BILLS: IDEN./SIM. BILLS: SB 766
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Guzzo McElroy
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
A heart attack occurs when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes
blocked. If blood flow is not restored quickly, the section of heart muscle begins to die. Heart attack treatment
is most effective if provided when symptoms first occur. Emergency assistance to a person having a heart
attack is usually provided by emergency medical technicians (EMTs), paramedics, or a bystander who
attempts to administer cardiopulmonary resuscitation (CPR).
Current law requires the medical director of an emergency medical services (EMS) provider to issue standing
orders and protocols to its EMTs and paramedics to ensure that patients are transported to facilities that offer a
type and level of care appropriate to the patient’s medical condition.
The Department of Health (DOH) is responsible for certifying 911 public safety telecommunicators (911 PSTs).
To become certified as a 911 PST an applicant is required to receive 232 hours of training, which must include
successful completion of a CPR certification class. A 911 PST must renew their certification every two years
and must receive 20 hours of continuing education prior to renewal. Current law does not require the 20-hours
of continuing education to include CPR training.
HB 397 requires DOH to annually send a list of providers of adult cardiovascular services to the medical
director of each licensed EMS provider. It further requires DOH to develop a sample heart attack triage
assessment tool to be posted on its website and distributed to each licensed EMS provider. In addition, the bill
requires EMS providers to use a substantially similar assessment tool and requires EMS medical directors to
develop and implement assessment, treatment, and transport protocols to ensure heart attack patients are
transported to the most appropriate hospital.
The bill also requires a 911 PST to receive two hours of biennial telecommunicator CPR training in order to
have their certification renewed. Further, the bill requires DOH to establish a procedure to monitor compliance
with the training requirements and authorizes DOH to adjust state revenue funds to a public safety agency
based on its employees’ compliance with the requirements.
The bill has an insignificant, negative fiscal impact on DOH which can be absorbed within current resources.
The bill has no fiscal impact on 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: h0397.PPH
DATE: 3/22/2021
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Heart Attacks
A heart attack occurs when the flow of oxygen-rich blood to a section of heart muscle suddenly
becomes blocked. 1 If blood flow is not restored quickly, the section of heart muscle begins to die. Heart
attacks most often occur as a result of ischemic heart disease – also known as coronary heart disease
or coronary artery disease, which is caused by plaque build-up inside the coronary arteries. Eventually,
an area of plaque can rupture inside of an artery causing a blood clot to form on the plaque’s surface. If
the blood clot becomes large enough, it can mostly or completely block blood flow through a coronary
artery. If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die.
Heart attack treatment is most effective if provided when symptoms first occur. 2
911 Public Safety Telecommunicators
Out-of-hospital cardiac arrest (OHCA) describes the sudden, unexpected loss of heart function,
breathing, and consciousness. 3 Every year an estimated 350,000 people have cardiac arrest in the
United States in an out-of-hospital environment and only one out of 10 victims survive. 4 911 public
safety telecommunicators (911 PSTs) along with the 911-caller are often the first responders and it is
the 911 PST’s job to transform the caller into a lay rescuer by instructing them how to perform CPR. 5
The Department of Health (DOH) is responsible for certifying 911 PSTs. 6 To become certified as a 911
PST an applicant is required to receive 232 hours of training, which must include successful completion
of a CPR certification class. 7 A 911 PST must renew their certification every two years and must
receive 20 hours of continuing education prior to renewal, which does not currently include CPR
training. 8
There are currently 8,861 certified 911 PSTs. 9
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. 10 The term includes the administration of oxygen and other techniques that have been
1 U.S. Department of Health & Human Services, National Heart, Lung, and Blood Institute, Heart Attack, available at
https://www.nhlbi.nih.gov/health-topics/heart-attack (last visited Mar. 20, 2021).
2 Id.
3 Michael Christopher, Telecommunicator Cardiopulmonary Resuscitation – A Policy Statement from the American Heart Association,
AHA Journals, Mar. 24, 2020, available at https://www.ahajournals.org/doi/10.1161/CIR.0000000000000744 (last visited Mar. 20,
2021).
4 Id.
5 Id.
6 Section 401.465(2), F.S.
7 Rule 64J-3.001, F.A.C.
8 Rule 64J-3.003, F.A.C.
9 Florida Department of Health, Agency Analysis of 2021 HB 397, (Feb. 24, 2021).
10 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 20, 2021).
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approved and are performed under specific conditions. 11 BLS services are usually performed by
EMTs. 12
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. 13 ALS services
can be performed on site and are usually provided by physicians or paramedics. 14
The medical director of an EMS provider is required to issue standing orders and protocols to its EMTs
and paramedics to ensure that patients are transported to facilities that offer a type and level of care
appropriate to the patient’s medical condition. 15 There is currently no express statutory requirement for
EMS medical directors to develop and implement transport protocols for heart attack patients.
Adult Cardiovascular Services
There are two levels of hospital program licensure for Adult Cardiovascular Services (ACS). A Level I
program is authorized to perform adult percutaneous cardiac intervention (PCI) 16 without onsite cardiac
surgery and a Level II program is authorized to perform PCI with onsite cardiac surgery. 17
For a hospital seeking a Level I ACS program license, it must demonstrate that, for the most recent 12-
month period as reported to AHCA, it has: 18
• Provided a minimum of 300 adult inpatient and outpatient diagnostic cardiac catheterizations; or
• Discharged or transferred at least 300 inpatients with the principal diagnosis of ischemic heart
disease; 19 and that it has formalized, written transfer agreement with a hospital that has a Level
II program.
A hospital seeking a Level II program license, it must demonstrate that, for the most recent 12-month
period as reported to AHCA, it has:
• Performed a minimum of 1,100 adult inpatient and outpatient cardiac catheterizations, of which
at least 400 must be therapeutic catheterizations; or
• Discharged at least 800 patients with the principal diagnosis of ischemic heart disease.
The Agency for Health Care Administration currently maintains a list on its website of hospitals with
Level I and Level II ACS programs. 20
11 Sections 401.23(7) and (8), F.S.
12 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).
13 Sections 401.23(1) and (2), F.S.
14 Ryynanen, et. al, supra note 18.
15 Rule 64J-1.004, F.A.C.
16 Percutaneous cardiac intervention (PCI), commonly known as coronary angioplasty or angioplasty, is a nonsurgical technique for
treating obstructive coronary artery disease.
17 Section 395.1055(18)(a), F.S.
18 S. 408.0361(3)(b), F.S.
19 Heart condition caused by narrowed heart arteries. This is also called “coronary artery disease” and “coronary heart disease.”
20 Agency for Health Care Administration, Hospital & Outpatient Services Unit, Reports, Cardiovascular – Level I and II ACS, available
at https://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Hospital_Outpatient/Reports.shtml (last visited Mar. 20, 2021).
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Effect of the Bill
HB 397 requires DOH to annually send a list of providers of adult cardiovascular services to the
medical director of each licensed EMS provider. It further requires DOH to develop a sample heart
attack triage assessment tool to be posted on its website and distributed to each licensed EMS
provider. In addition, the bill requires EMS providers to use a substantially similar assessment tool and
requires EMS medical directors to develop and implement assessment, treatment, and transport
protocols to ensure heart attack patients are transported to the most appropriate hospital.
The bill also requires a 911 PST to receive two hours of biennial telecommunicator CPR training in
order to have their certification renewed. Further, the bill requires DOH to establish a procedure to
monitor compliance with the training requirements and authorizes DOH to adjust state revenue funds to
a public safety agency based on its employees’ compliance with the requirements.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Creates s. 395.3042, F.S., relating to emergency medical services providers; triage and
transportation of heart attack victims to an adult cardiovascular services provider.
Section 2: Amends s. 401.465, F.S., relating to 911 public safety telecommunicator certification.
Section 3: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The bill has an insignificant, negative fiscal impact on DOH which can be absorbed within current
resources.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
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III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
DOH has sufficient rule-making authority to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
The bill requires DOH to establish a procedure to monitor adherence to the training requirements
created by the bill and authorizes DOH to adjust state grant or shared revenue funds to a public safety
agency as defined in s. 365.171(3)(d), F.S., based on its employees’ adherence or failure to adhere to
such requirements. 21 DOH does not currently have regulatory authority over public safety agencies as
defined in s. 365.171(3)(d), F.S. 22
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
21 Public safety agency means a functional division of a public agency which provides firefighting, law enforcement, medical, or other
emergency services.
22 Supra note 9.
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 397 2021
1 A bill to be entitled
2 An act relating to cardiovascular emergency protocols
3 and training; creating s. 395.3042, F.S.; requiring
4 the Department of Health to send a list of certain
5 providers of adult cardiovascular services to
6 specified persons and entities annually; requiring the
7 department to develop a sample heart attack-triage
8 assessment tool to be posted on its website and
9 distributed to licensed emergency medical services
10 providers; requiring such providers to use the
11 assessment tool; requiring medical directors of such
12 providers to develop and implement certain specified
13 protocols; requiring that such protocols include the
14 development and implementation of certain plans;
15 requiring the compliance of certain licensed emergency
16 medical services providers; amending s. 401.465, F.S.;
17 providing a definition for the term "telecommunicator
18 cardiopulmonary resuscitation training"; conforming
19 cross-references; requiring certain 911 public safety
20 telecommunicators to receive biannual telecommunicator
21 cardiopulmonary resuscitation training; requiring the
22 department to establish a procedure to monitor
23 adherence to the training requirements; authorizing
24 the department to adjust state grants or shared
25 revenue funds to certain entities based on their
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 397 2021
26 employees' adherence or failure to adhere to the
27 training requirements; providing an effective date.
28
29 Be It Enacted by the Legislature of the State of Florida:
30
31 Section 1. Section 395.3042, Florida Statutes, is created
32 to read:
33 395.3042 Emergency medical services providers; triage and
34 transportation of heart attack victims to an adult
35 cardiovascular services provider.—
36 (1) By June 1 of each year, the department shall send a
37 list of providers of Level I and Level II adult cardiovascular
38 services to the medical director of each licensed emergency
39 medical services provider in the state.
40 (2) The department shall develop a sample heart attack-
41 triage assessment tool. The department must post this sample
42 assessment tool on its website and provide a copy of the
43 assessment tool to each licensed emergency medical services
44 provider. Each licensed emergency medical services provider must
45 use a heart attack-triage assessment tool that is substantially
46 similar to the sample heart attack-triage assessment tool
47 provided by the department.
48 (3) The medical director of each licensed emergency
49 medical services provider shall develop and implement
50 assessment, treatment, and transport-destination protocols for
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HB 397 2021
51 heart attack patients with the intent to assess, treat, and
52 transport heart attack patients to the most appropriate
53 hospital. Such protocols must include the development and
54 implementation of plans for the triage and transport of patients
55 with acute heart attack symptoms.
56 (4) Each emergency medical services provider licensed
57 under chapter 401 must comply with this section.
58 Section 2. Subsections (3) and (4) of section 401.465,
59 Florida Statutes, are renumbered as subsections (4) and (5),
60 respectively, paragraphs (d) and (j) of subsection (2) of that
61 section are amended, paragraph (d) is added to subsection (1) of
62 that section, and a new subsection (3) is added to that section,
63 to read:
64 401.465 911 public safety telecommunicator certification.—
65 (1) DEFINITIONS.—As used in this section, the term:
66 (d) "Telecommunicator cardiopulmonary resuscitation
67 training" means specific training, including continuous
68 education, that is evidence based and contains nationally
69 accepted guidelines for high-quality telecommunicator
70 cardiopulmonary resuscitation with the recognition of out-of-
71 hospital cardiac arrest over the telephone and the delivery of
72 telephonic instructions for treating cardiac arrest and
73 performing compression-only cardiopulmonary resuscitation.
74 (2) PERSONNEL; STANDARDS AND CERTIFICATION.—
75 (d) The department shall determine whether the applicant
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76 meets the requirements specified in this section and in rules of
77 the department and shall issue a certificate to any person who
78 meets such requirements. Such requirements must include the
79 following:
80 1. Completion of an appropriate 911 public safety
81 telecommunication training program;
82 2. Certification under oath that the applicant is not
83 addicted to alcohol or any controlled substance;
84 3. Certification under oath that the applicant is free
85 from any physical or mental defect or disease that might impair
86 the applicant's ability to perform his or her duties;
87 4. Submission of the application fee prescribed in
88 subsection (4) (3);
89 5. Submission of a completed application to the department
90 which indicates compliance with subparagraphs 1., 2., and 3.;
91 and
92 6. Effective October 1, 2012, passage of an examination
93 approved by the department which measures the applicant's
94 competency and proficiency in the subject material of the public
95 safety telecommunication training program.
96 (j)1. The requirement for certification as a 911 public
97 safety telecommunicator is waived for a person employed as a
98 sworn state-certified law enforcement officer, provided the
99 officer:
100 a. Is selected by his or her chief executive to perform as
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101 a 911 public safety telecommunicator;
102 b. Performs as a 911 public safety telecommunicator on an
103 occasional or limited basis; and
104 c. Passes the department-approved examination that
105 measures the competency and proficiency of an applicant in the
106 subject material comprising the public safety telecommunication
107 program.
108 2. A sworn state-certified law enforcement officer who
109 fails an examination taken under subparagraph 1. must take a
110 department-approved public safety telecommunication training
111 program prior to retaking the examination.
112 3. The testing required under this paragraph is exempt
113 from the examination fee required under subsection (4) (3).
114 (3) TELECOMMUNICATOR CARDIOPULMONARY RESUSCITATION
115 TRAINING.—
116 (a) In addition to the certification and recertification
117 requirements contained in this section, 911 public safety
118 telecommunicators who take telephone calls and provide dispatch
119 functions for emergency medical conditions shall also receive
120 telecommunicator cardiopulmonary resuscitation training every 2
121 years.
122 (b) The department shall establish a procedure to monitor
123 adherence to the training requirements of this subsection and
124 may adjust state grant or shared revenue funds to a public
125 safety agency as defined in s. 365.171(3)(d) based on its
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126 employees' adherence or failure to adhere to such requirements.
127 Section 3. This act shall take effect July 1, 2021.
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PCS for HB 431
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 431 Practice of Physician Assistants
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 Rahming McElroy
Subcommittee
SUMMARY ANALYSIS
Physician Assistants (PAs) are regulated by the Florida Council on Physician Assistants (Council) in
conjunction with either the Board of Medicine for PAs licensed under ch. 458, F.S., or the Board of Osteopathic
Medicine for PAs licensed under ch. 459, F.S.
PCS for HB 431 revises the practice acts for PAs in chs. 458 and 459. The bill:
• Specifies which PA programs are approved for PA licensure and amends PA licensure and licensure
renewal requirements;
• Authorizes PAs to authenticate any document with their signature, certification, stamp, verification,
affidavit, or endorsement if the document may also be authenticated by a physician’s signature,
certification, stamp, verification, affidavit or endorsement;
• Removes the prohibition on PAs prescribing psychiatric medications for those under 18 years of age;
• Removes the restriction on the number of licensed PAs a physician may supervise at any one time;
• Removes the requirement that a PA notify a patient that he or she has the right to see a physician prior
to the PA prescribing or dispensing a prescription;
• Authorizes PAs to procure medications and medical devices, with exceptions;
• Authorizes PAs to supervise allopathic and osteopathic medical assistants;
• Authorizes PAs to directly bill and receive payment from third-party payors for the services they deliver;
• Removes obsolete language relating to prescriber numbers;
• Removes the requirement for a licensed PA to notify the DOH in writing within 30 days of employment
or after any change in his or her supervising physician; and
• Removes the requirement that PA licensure applicants seeking prescribing authority provide course
transcripts.
The bill has an insignificant, negative fiscal impact on the DOH, which can be absorbed within current
resources.
The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: pcs0431.PPH
DATE: 3/22/2021
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Current Situation
Physician Assistants
Physician Assistants (PAs) are regulated by the Florida Council on Physician Assistants (Council) in
conjunction with either the Board of Medicine for PAs licensed under ch. 458, F.S., or the Board of
Osteopathic Medicine for PAs licensed under ch. 459, F.S.
Council on Physician Assistants
The Council consists of five members including one physician who is a member of the Board of
Medicine, one physician who is a member of the Board of Osteopathic Medicine, and three licensed
PAs appointed by the Surgeon General. 1 The appointed physicians must be physicians who supervise
physician assistants in their practice. The Council is responsible for: 2
• Making recommendations to the DOH regarding the licensure of PAs;
• Developing rules for the regulation of PAs for consideration for adoption by the boards;
• Making recommendations to the boards regarding all matters relating to PAs;
• Addressing concerns and problems of practicing PAs to ensure safety in the PAs’ clinical
practices;
• Denying, restricting, or placing conditions on the license of PAs who fail to meet the licensing
requirements; and
• Establishing a formulary of medicinal drugs that PAs may not prescribe. 3
Licensure and Regulation of PAs
An applicant for a PA license must apply to the DOH, and the DOH must issue a license to a person
certified by the Council as having met all of the following requirements: 4
• Is at least 18 years old;
• Obtained a passing score an entry-level examination approved by the boards, including, but not
limited to those examinations administered by the National Commission on Certification of
Physician Assistants;
• Completed the application form and paid the applicable application fee;
• Completed the an approved PA training program accredited by a specified organization 5 or
community college that has met specified criteria; 6
• Acknowledged any prior felony convictions;
• Acknowledged any previous revocation or denial of licensure in any state;
• Provided a copy of course transcripts and a copy of the course description from a PA training
program describing the course content in pharmacotherapy, if the applicant is seeking
prescribing authority; and
• Submitted to a background screening and have no disqualifying offenses. 7
1 Ss. 458.347(9) and 459.022(9), F.S. Members of the Board of Medicine and the Board of Osteopathic Medicine are appointed by the
Governor and confirmed by the Senate. See ss. 458.307 and 459.004, F.S., respectively.
2 Id.
3 S. 458.347(4)(f), F.S.
4 Ss. 458.347(7) and 459.022(7), F.S.
5 The Commission on Accreditation of Allied Health Programs or its successor organization. Id.
6 S. 458.347(6), F.S.
7 S. 456.0135, F.S.
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The DOH may issue a temporary license to a recent approved program graduate who expects to take
the first National Commission on Certification of Physician Assistants administered examination
available for registration after the applicant’s graduation. 8 If an applicant has completed all licensure
requirements and is awaiting the next scheduled meeting of the Council, the DOH may issue up to two
temporary licenses to practice. 9 The temporary license expires 30 days after an applicant receives his
or her scores of the proficiency examination and authorizes an applicant who has passed the
examination to be granted permanent licensure. 10 Applicants who fail the examination can no longer
hold a temporary license, unless they reapply for a 1-year extension of the temporary license. 11
Within 30 days after gaining employment as a PA, licensed PAs must provide written notice with
specified information to the DOH or after any subsequent changes in the supervising physician. PAs
must renew their licenses biennially. During each biennial renewal cycle PAs must complete 100 hours
of continuing medical education (CME) or must demonstrate current certification issued by the National
Commission on Certification of Physician Assistants. 12 To maintain certification, PAs must also take a
recertification examination every 10 years. 13
PA Education
PA education programs are typically three years and award master’s degrees. 14 Many programs
require students to have health care experience as a condition for admission. 15 PA students receive
classroom training in: 16
• Anatomy;
• Physiology;
• Biochemistry;
• Pharmacology;
• Physical diagnosis;
• Pathophysiology;
• Microbiology;
• Clinical laboratory science;
• Behavioral science; and
• Medical Ethics.
A PA student must also complete approximately 2,000 hours of clinical rotations, with an emphasis on
primary care in ambulatory clinics, physician offices, and acute or long-term care facilities. 17 A PA
student’s rotation could also include family medicine, internal medicine, obstetrics and gynecology,
pediatrics, general surgery, emergency medicine, or psychiatry. 18
8 Ss. 458.347(7) and 459.002(7), F.S.
9 Id.
10 Id.
11 Id.
12 Ss. 458.347(7)(c) and 459.022(7)(c), F.S.
13 National Commission on Certification of Physician Assistants, Maintaining Certification, https://www.nccpa.net/CertificationProcess
(last visited Feb. 15, 2021).
14 American Academy of PAs, Become a PA, https://www.aapa.org/career-central/become-a-pa/ (last visited Feb. 15, 2021).
15 Id.
16 Id.
17 Id.
18 Id.
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PA Scope of Practice
PAs may only practice under the direct or indirect supervision of an allopathic or osteopathic physician
with whom they have a clinical relationship. 19 A supervising physician may only delegate tasks and
procedures to the PA that are within the supervising physician’s scope of practice. 20 The supervising
physician may not supervise more than four PAs at any time and may not be required to review and
cosign charts or medical records prepared by a PA under their supervision. 21 The supervising physician
is also responsible and liable for any acts or omissions of the PA. 22
The Boards have established by rule that “responsible supervision” of a PA means the ability of the
supervising physician to responsibly exercise control and provide direction over the services of the PA.
Whether the supervision of a PA is adequate, is dependent upon the: 23
• Complexity of the task;
• Risk to the patient;
• Background, training, and skill of the PA;
• Adequacy of the direction in terms of its form;
• Setting in which the tasks are performed;
• Availability of the supervising physician;
• Necessity for immediate attention; and
• Number of other persons that the supervising physician must supervise.
A supervising physician decides whether to permit a PA to perform a task or procedure under direct or
indirect supervision 24 based on reasonable medical judgment regarding the probability of morbidity and
mortality to the patient. 25 A supervising physician may delegate the authority for a fully licensed PA to: 26
• Prescribe or dispense any medication used in the supervising physician’s practice unless such
medication is listed in the formulary 27 established by the Council and:
o The PA notifies a patient that he or she has the right to see a physician prior to
prescribing or dispensing a prescription;
o The supervising physician notifies the DOH of his or her intention to delegate such
authority; and
o The PA completes a minimum of 10 CME hours in the specialty practice in which the PA
has prescriptive privileges with each licensure renewal. Three of the 10 CME hours that
allopathic PAs are required to take must consist of a continuing education course on the
safe and effective prescribing of specified controlled substances. Presently, osteopathic
PAs do not have this requirement. 28
• Order any medication for administration to the supervising physician’s patient in a hospital or
other facility licensed under chapter 395, F.S., or a nursing homes licensed under part II of
chapter 400, F.S.; 29 and
19 Ss. 458.347(2)(f) and 459.022(2)(f), F.S., define supervision as responsible supervision and control which requires the easy
availability or physical presence of the licensed physician for consultation and direction of the PA.
20 Rr. 64B8-30.012 and 64B15-6.010, F.A.C.
21 Ss. 458.347(3) and 459.022 (3), F.S.
22 Ss. 458.347(15) and 459.022(15), F.S.
23 Rules 64B8-30.001, F.A.C., and 64B15-6.001, F.A.C.
24 “Direct supervision” refers to the physical presence of the supervising physician so that the physician is immediately available to the
PA when needed. “Indirect supervision” refers to the easy availability of the supervising physician to the physician assistant, which
includes the ability to communicate by telecommunications. The supervising physician must be within reasonable physical proximity.
See Rr. 64B8-30.001, F.A.C., and 64B15-6.001, F.A.C.
25 Rr. 64B8-30.012(2), F.A.C., and 64B15-6.010(2), F.A.C.
26 Ss. 458.347(4)(e) and 459.022(4)(e), F.S.
27 Ss. 458.347(4)(f), F.S., and 459.022(4)(e). The formulary in rr. 64B8-30.008, F.A.C., and 64B15-6.0038, F.A.C., prohibits PAs from
prescribing general, spinal, or epidural anesthetics; radiographic contrast materials; and psychiatric mental health controlled substances
for children younger than 18 years of age. It also restricts the prescribing of Schedule II controlled substances to a 7-day supply. The
rules also authorize PAs to order medicinal drugs for a hospitalized patient of the supervising physician and administer medicinal drugs
under the direction and supervision of the physician.
28 Ss. 458.347(4)(e) and 459.022(4)(e), F.S.
29 Ss. 459.347(4)(f) and 459.022(4)(f), F.S. Chapter 395, F.S., provides for the regulation and the licensure of hospitals and trauma
centers, part II of ch. 400, F.S., provides for the regulation and licensure of nursing home facilities.
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• Perform any other service that is not expressly prohibited in ch. 458, F.S., ch. 459, F.S., or the
rules adopted thereunder.
Prescribing practitioners also required to register with the federal Drug Enforcement Administration.
The DOH may also issue a prescriber number to the PA, which grants a PA authority for prescribing
medicinal drugs authorized under current law. 30 The inclusion of the prescriber number creates a
presumption that the PA is authorized to prescribe the medicinal drug and the prescription is valid. 31
Currently, when a PA indicates they want prescribing authority and submits the requisite training, rather
than issue a “prescriber number,” the DOH places a modifier on a PA’s license so that its license
verification page (shown below) indicates they are an authorized prescribing PA: 32
Adverse Incident Reporting
A PA must report to the DOH any adverse incident occurring in an office practice setting within 15 days
after the occurrence of the adverse incident. 33 The DOH must review each report to determine if
discipline against the PA’s license is warranted. 34
An adverse incident in an office setting is defined as an event over which the PA could exercise control
and which is associated with a medical intervention and results in one of the following patient injuries: 35
• The death of a patient;
• Brain or spinal damage to a patient;
• The performance of a surgical procedure on the wrong patient;
• If the procedure results in death; brain or spinal damage; permanent disfigurement; the fracture
or dislocation of bones or joints; a limitation of neurological, physical, or sensory functions; or
any condition that required the transfer of a patient, the performance of:
o A wrong-site surgical procedure;
o A wrong surgical procedure; or
o A surgical repair of damage to a patient resulting from a planned surgical procedure
where the damage is not a recognized specific risk as disclosed to the patient and
documented through the informed consent process;
• A procedure to remove unplanned foreign objects remaining from a surgical procedure; or
• Any condition that required the transfer of a patient to a hospital from an ambulatory surgical
center or any facility or any office maintained by a physician for the practice of medicine which
is not licensed under ch. 395, F.S.
Effect of Proposed Changes
PCS for HB 413 authorizes a PA to authenticate any document with their signature, certification, stamp,
verification, affidavit, or endorsement if it may be so authenticated by a physician’s signature,
certification, stamp, verification, affidavit, or endorsement, including, but not limited to:
• Baker Act commitments;
• Do-not-resuscitate (DNR) orders or physician orders for the administration of life-sustaining
procedures;
• Death certificates;
• School physicals;
• Medical evaluations for workers’ compensation claims; and
30 Ss. 459.347 (4)(e) and 459.022 (4)(e), F.S.
31 Id.
32 Email from Andrew Love, Director of Legislative Affairs, Florida Department of Health, RE: HB 431 Data Request, regarding issuance
of prescriber numbers (Mar. 19, 2014).
33 Ss. 458.351 and 459.026, F.S.
34 Ss. 458.351(5) and 459.026(5), F.S.
35 Ss. 458.351(4) and 459.026(4), F.S.
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• Physical, occupational, speech therapy, home health services, or durable medical equipment
orders.
The bill removes from current law:
• The prohibition on PAs prescribing psychiatric medications for those under 18 years of age;
• The restriction on the number of licensed PAs a physician may supervise at any one time;
• The requirement that a PA notify a patient that he or she has the right to see a physician prior to
the PA prescribing or dispensing a prescription;
• The requirement for a licensed PA to notify the DOH in writing within 30 days of employment or
after any change in his or her supervising physician; and
• Obsolete language relating to prescriber numbers.
The bill also authorizes PAs to:
• Procure drugs and medical devices, unless the medication is listed on the formulary;
• Supervise allopathic and osteopathic medical assistants; and
• Directly bill and receive payment from third-party payors for the services they deliver.
The bill maintains the requirement that the Council recommend PA education and training programs to
the Board of Medicine or the Board of Osteopathic Medicine for approval, but specifies that the board
may only approve PA programs accredited by the Accreditation Review Commission on Education for
the Physician Assistant, Inc. The bill also amends the examination type that a PA is required to pass to
obtain licensure, moving from an entry-level examination approved by the boards to the PANCE
examination administered by the National Commission on Certification of Physician assistants or its
successor entity.
The bill maintains the current age requirement for a PA applicant and adds additional licensure
requirements including:
• Graduating from an approved program;
o Specified graduation requirements must be met; and
• Obtaining a passing score on the Physician Assistant National Certifying Examination (PANCE)
administered by the National Commission on Certification of Physician Assistants or its
successor organization.
The bill removes the allopathic PA only requirement for 10 CME hours in the specialty practice in which
the PA has prescriptive privileges and requires three of the 100 CME hours required biennially for all
PA licensure renewal consist of a course on the safe and effective prescribing of specified controlled
substances.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 458.347, F.S., relating to physician assistants.
Section 2: Amends s. 459.022, F.S., relating to physician assistants.
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:
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The bill has an insignificant, negative fiscal impact on the DOH, which can be absorbed within
current resources.
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. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill provides sufficient rule-making authority to implement its provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
PCS for HB 431 ORIGINAL 2021
1 A bill to be entitled
2 An act relating to the practice of physician
3 assistants; amending ss. 458.347 and 459.022, F.S.;
4 F.S.; providing legislative intent; revising and
5 providing definitions; authorizing a licensed
6 physician assistant to provide a signature,
7 certification, stamp, verification, affidavit, or
8 endorsement for specified reasons; providing
9 applicability; deleting a provision relating to the
10 performance of medical services by a trainee; revising
11 an accreditation requirement to come from the
12 Accreditation Review Commission on Education for the
13 Physician Assistant, Inc., or its successor
14 organization, or, if before 2001, its predecessor
15 organization; authorizing a trainee to perform medical
16 services within the scope of an approved program;
17 revising physician assistant licensure requirements
18 for each applicant recommended by the Council on
19 Physician Assistants; providing direct billing and
20 reimbursement requirements for a physician assistant;
21 providing an effective date.
22
23 Be It Enacted by the Legislature of the State of Florida:
24
25 Section 1. Section 458.347, Florida Statutes, is amended
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26 to read:
27 458.347 Physician assistants.—
28 (1) LEGISLATIVE INTENT.—
29 (a) The purpose of this section is to authorize physician
30 assistants, with their education, training and experience in the
31 field of medicine, to practice medicine in collaboration with
32 physicians and other health practitioners to provide increased
33 efficiency and to ensure high-quality medical services are
34 available at a reasonable cost encourage more effective
35 utilization of the skills of physicians or groups of physicians
36 by enabling them to delegate health care tasks to qualified
37 assistants when such delegation is consistent with the patient's
38 health and welfare.
39 (b) In order that maximum skills may be obtained within a
40 minimum time period of education, a physician assistant shall be
41 specialized to the extent that he or she can operate efficiently
42 and effectively in the specialty areas in which he or she has
43 been trained or is experienced.
44 (c) The purpose of this section is to encourage the
45 utilization of physician assistants by physicians and to allow
46 for innovative development of programs for the education of
47 physician assistants.
48 (2) DEFINITIONS.—As used in this section:
49 (a) "Approved program" means a physician assistant program
50 in the United States, or any possession or territory thereof,
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51 accredited by the Accreditation Review Commission on Education
52 for the Physician Assistant, Inc., or its successor
53 organization, or, if before 2001, its predecessor organization.
54 formally approved by the boards, for the education of physician
55 assistants.
56 (b) "Boards" means the Board of Medicine and the Board of
57 Osteopathic Medicine.
58 (c) "Council" means the Council on Physician Assistants.
59 (d) "Trainee" means a person who is currently enrolled in
60 an approved program.
61 (e) "Physician assistant" means a healthcare professional
62 who meets qualifications defined in this chapter or chapter 459
63 and is licensed to practice medicine as provided in this chapter
64 or chapter 459 person who is a graduate of an approved program
65 or its equivalent or meets standards approved by the boards and
66 is licensed to perform medical services delegated by the
67 supervising physician.
68 (f) "Supervision" means responsible supervision and
69 control. Except in cases of emergency, supervision requires the
70 easy availability or physical presence of the licensed physician
71 for consultation and direction of the actions of the physician
72 assistant. For the purposes of this definition, the term "easy
73 availability" includes the ability to communicate by way of
74 telecommunication. The boards shall establish rules as to what
75 constitutes responsible supervision of the physician assistant.
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76 (g) "Physician assistant national certifying examination"
77 means the Physician Assistant National Certifying Examination
78 (PANCE) administered by the National Commission on Certification
79 of Physician Assistants or its successor agency "Proficiency
80 examination" means an entry-level examination approved by the
81 boards, including, but not limited to, those examinations
82 administered by the National Commission on Certification of
83 Physician Assistants.
84 (h) "Continuing medical education" means courses
85 recognized and approved by the boards, the American Academy of
86 Physician Assistants, the American Medical Association, the
87 American Osteopathic Association, or the Accreditation Council
88 on Continuing Medical Education.
89 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician
90 or group of physicians supervising a licensed physician
91 assistant must be qualified in the medical areas in which the
92 physician assistant is to perform and shall be individually or
93 collectively responsible and liable for the performance and the
94 acts and omissions of the physician assistant. A physician may
95 not supervise more than four currently licensed physician
96 assistants at any one time. A physician supervising a physician
97 assistant pursuant to this section may not be required to review
98 and cosign charts or medical records prepared by such physician
99 assistant.
100 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
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101 (a) The boards shall adopt, by rule, the general
102 principles that supervising physicians must use in developing
103 the scope of practice of a physician assistant under direct
104 supervision and under indirect supervision. These principles
105 shall recognize the diversity of both specialty and practice
106 settings in which physician assistants are used.
107 (b) This chapter authorizes third-party payors to
108 reimburse employers of physician assistants for covered services
109 rendered by licensed physician assistants. Payment for services
110 within the physician assistant’s scope of practice shall be made
111 when ordered or performed by a physician assistant if the same
112 service would have been covered if ordered or performed by a
113 physician. Physician assistants are authorized to bill for and
114 receive direct payment for the services they deliver. This
115 chapter does not prevent third-party payors from reimbursing
116 employers of physician assistants for covered services rendered
117 by licensed physician assistants.
118 (c) Licensed physician assistants may not be denied
119 clinical hospital privileges, except for cause, so long as the
120 supervising physician is a staff member in good standing.
121 (d) A supervisory physician may delegate to a licensed
122 physician assistant, pursuant to a written protocol, the
123 authority to act according to s. 154.04(1)(c). Such delegated
124 authority is limited to the supervising physician's practice in
125 connection with a county health department as defined and
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126 established pursuant to chapter 154. The boards shall adopt
127 rules governing the supervision of physician assistants by
128 physicians in county health departments.
129 (e) A supervising physician may delegate to a fully
130 licensed physician assistant the authority to prescribe or
131 dispense any medication used in the supervising physician's
132 practice unless such medication is listed on the formulary
133 created pursuant to paragraph (f). A fully licensed physician
134 assistant may only prescribe or dispense such medication under
135 the following circumstances:
136 1. A physician assistant must clearly identify to the
137 patient that he or she is a physician assistant and inform the
138 patient that the patient has the right to see the physician
139 before a prescription is prescribed or dispensed by the
140 physician assistant.
141 2. The supervising physician must notify the department of
142 his or her intent to delegate, on a department-approved form,
143 before delegating such authority and of any change in
144 prescriptive privileges of the physician assistant. Authority to
145 dispense may be delegated only by a supervising physician who is
146 registered as a dispensing practitioner in compliance with s.
147 465.0276.
148 3. A fully licensed physician may procure drugs and
149 medical devise unless the medication is listed on the formulary
150 created pursuant to this paragraph The physician assistant must
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151 complete a minimum of 10 continuing medical education hours in
152 the specialty practice in which the physician assistant has
153 prescriptive privileges with each licensure renewal. Three of
154 the 10 hours must consist of a continuing education course on
155 the safe and effective prescribing of controlled substance
156 medications which is offered by a statewide professional
157 association of physicians in this state accredited to provide
158 educational activities designated for the American Medical
159 Association Physician's Recognition Award Category 1 credit or
160 designated by the American Academy of Physician Assistants as a
161 Category 1 credit.
162 4. The department may issue a prescriber number to the
163 physician assistant granting authority for the prescribing of
164 medicinal drugs authorized within this paragraph upon completion
165 of the requirements of this paragraph. The physician assistant
166 is not required to independently register pursuant to s.
167 465.0276.
168 5. The prescription may be in paper or electronic form but
169 must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
170 and must contain, in addition to the supervising physician's
171 name, address, and telephone number, of the physician
172 assistant's prescriber number. Unless it is a drug or drug
173 sample dispensed by the physician assistant, the prescription
174 must be filled in a pharmacy permitted under chapter 465 and
175 must be dispensed in that pharmacy by a pharmacist licensed
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176 under chapter 465. The inclusion of the prescriber number
177 creates a presumption that the physician assistant is authorized
178 to prescribe the medicinal drug and the prescription is valid.
179 6. The physician assistant must note the prescription or
180 dispensing of medication in the appropriate medical record.
181 (f)1. The council shall establish a formulary of medicinal
182 drugs that a fully licensed physician assistant having
183 prescribing authority under this section or s. 459.022 may not
184 prescribe. The formulary must include general anesthetics and
185 radiographic contrast materials and must limit the prescription
186 of Schedule II controlled substances as listed in s. 893.03 to a
187 7-day supply. The formulary must also restrict the prescribing
188 of psychiatric mental health controlled substances for children
189 younger than 18 years of age.
190 2. In establishing the formulary, the council shall
191 consult with a pharmacist licensed under chapter 465, but not
192 licensed under this chapter or chapter 459, who shall be
193 selected by the State Surgeon General.
194 3. Only the council shall add to, delete from, or modify
195 the formulary. Any person who requests an addition, a deletion,
196 or a modification of a medicinal drug listed on such formulary
197 has the burden of proof to show cause why such addition,
198 deletion, or modification should be made.
199 4. The boards shall adopt the formulary required by this
200 paragraph, and each addition, deletion, or modification to the
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201 formulary, by rule. Notwithstanding any provision of chapter 120
202 to the contrary, the formulary rule shall be effective 60 days
203 after the date it is filed with the Secretary of State. Upon
204 adoption of the formulary, the department shall mail a copy of
205 such formulary to each fully licensed physician assistant having
206 prescribing authority under this section or s. 459.022, and to
207 each pharmacy licensed by the state. The boards shall establish,
208 by rule, a fee not to exceed $200 to fund the provisions of this
209 paragraph and paragraph (e).
210 (g) A supervisory physician may delegate to a licensed
211 physician assistant the authority to, and the licensed physician
212 assistant acting under the direction of the supervisory
213 physician may, order any medication for administration to the
214 supervisory physician's patient in a facility licensed under
215 chapter 395 or part II of chapter 400, notwithstanding any
216 provisions in chapter 465 or chapter 893 which may prohibit this
217 delegation.
218 (h) A licensed physician assistant may perform services
219 delegated by the supervising physician in the physician
220 assistant's practice in accordance with his or her education and
221 training unless expressly prohibited under this chapter, chapter
222 459, or rules adopted under this chapter or chapter 459.
223 (i) A physician assistant may authenticate any document
224 with their signature, certification, stamp, verification,
225 affidavit or endorsement if it may be so authenticated by the
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226 signature, certification, stamp, verification, affidavit or
227 endorsement of a physician, including but not limited to, any of
228 the following:
229 1. Initiation of an involuntary examination pursuant to s.
230 394.463 (Baker Act);
231 2. Do-not-resuscitate orders or physician orders for the
232 administration of life-sustaining treatment;
233 3. Death certificates;
234 4. School physical examinations;
235 5. Medical evaluations for workers’ compensation claims,
236 including date of maximum medical improvement as defined in s.
237 440.02; and
238 6. Orders for physical therapy, occupational therapy,
239 speech-language therapy, home health services or durable medical
240 equipment.
241 (j) A physician assistant may supervise medical assistants
242 as defined in this chapter and chapter 459.
243 (5) PERFORMANCE BY TRAINEES.—Notwithstanding any other
244 law, a trainee may perform medical services when such services
245 are rendered within the scope of an approved program.
246 (6) PROGRAM APPROVAL.—
247 (a) The boards shall approve programs, based on
248 recommendations by the council, for the education and training
249 of physician assistants which meet standards established by rule
250 of the boards. The council may recommend only those physician
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251 assistant programs that hold full accreditation or provisional
252 accreditation from the Accreditation Review Commission on
253 Education for the Physician Assistant, Inc., Commission on
254 Accreditation of Allied Health Programs or its successor
255 organization or, if before 2001, its predecessor organization.
256 Any educational institution offering a physician assistant
257 program approved by the boards pursuant to this paragraph may
258 also offer the physician assistant program authorized in
259 paragraph (c) for unlicensed physicians.
260 (b) Notwithstanding any other provision of law, a trainee
261 may perform medical services when such services are rendered
262 within the scope of an approved program The boards shall adopt
263 and publish standards to ensure that such programs operate in a
264 manner that does not endanger the health or welfare of the
265 patients who receive services within the scope of the programs.
266 The boards shall review the quality of the curricula, faculties,
267 and facilities of such programs and take whatever other action
268 is necessary to determine that the purposes of this section are
269 being met.
270 (c) Any community college with the approval of the State
271 Board of Education may conduct a physician assistant program
272 which shall apply for national accreditation through the
273 American Medical Association's Committee on Allied Health,
274 Education, and Accreditation, or its successor organization, and
275 which may admit unlicensed physicians, as authorized in
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276 subsection (7), who are graduates of foreign medical schools
277 listed with the World Health Organization. The unlicensed
278 physician must have been a resident of this state for a minimum
279 of 12 months immediately prior to admission to the program. An
280 evaluation of knowledge base by examination shall be required to
281 grant advanced academic credit and to fulfill the necessary
282 requirements to graduate. A minimum of one 16-week semester of
283 supervised clinical and didactic education, which may be
284 completed simultaneously, shall be required before graduation
285 from the program. All other provisions of this section shall
286 remain in effect.
287 (7) PHYSICIAN ASSISTANT LICENSURE.—
288 (a) Any person desiring to be licensed as a physician
289 assistant must apply to the department. The department shall
290 issue a license to any person certified by the council as having
291 met the following requirements:
292 1. Is at least 18 years of age.
293 2. Has graduated from an approved program.
294 a. For an applicant who graduated after December 31, 2020,
295 has received a master's degree in accordance with the
296 Accreditation Review Commission on Education for the Physician
297 Assistant, Inc., or its successor organization.
298 b. For an applicant who graduated before December 31, 2020,
299 has received a baccalaureate or master's degree from an approved
300 program.
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301 c. For an applicant who graduated before July 1, 1994, has
302 graduated from an approved program of instruction in primary
303 health care or surgery.
304 d. For an applicant who graduated before July 1, 1983, has
305 received a certification from the boards as a physician
306 assistant.
307 e. The board may also grant a license to an applicant who
308 does not meet the educational requirement specified in
309 subparagraph(a)2., but who passed the Physician Assistant
310 National Certifying Examination administered by the National
311 Commission on Certification of Physician Assistants prior to
312 1986.
313 3.2. Has obtained satisfactorily passed a passing
314 proficiency examination by an acceptable score as established by
315 the National Commission on Certification of Physician Assistants
316 or its successor and has been nationally certified. If an
317 applicant does not hold a current certificate issued by the
318 National Commission on Certification of Physician Assistants or
319 its successor organization and has not actively practiced as a
320 physician assistant within the immediately preceding 4 years,
321 the applicant must retake and successfully complete the entry-
322 level examination of the National Commission on Certification of
323 Physician Assistants or its successor organization to be
324 eligible for licensure.
325 4.3. Has completed the application form and remitted an
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326 application fee not to exceed $300 as set by the boards. An
327 application for licensure made by a physician assistant must
328 include:
329 a. A diploma from an approved certificate of completion of
330 a physician assistant training program specified in subsection
331 (6).
332 b. Acknowledgment of any prior felony convictions.
333 c. Acknowledgment of any previous revocation or denial of
334 licensure or certification in any state.
335 d. A copy of course transcripts and a copy of the course
336 description from a physician assistant training program
337 describing course content in pharmacotherapy, if the applicant
338 wishes to apply for prescribing authority. These documents must
339 meet the evidence requirements for prescribing authority.
340 (b)1. The license must be renewed biennially. Each renewal
341 must include:
342 a. A renewal fee not to exceed $500 as set by the boards.
343 b. Acknowledgment of no felony convictions in the previous
344 2 years.
345 c. A completed physician assistant workforce survey, which
346 shall be administered in the same manner as the physician survey
347 established in s. 458.3191 and must contain the same information
348 required in s. 458.3191(1) and (2).
349 2. Beginning July 1, 2018, and every 2 years thereafter,
350 the department shall report the data collected from the
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351 physician assistant workforce surveys to the boards.
352 3. The department shall adopt rules to implement this
353 paragraph.
354 (c) Each licensed physician assistant shall biennially
355 complete 100 hours of continuing medical education or shall hold
356 a current certificate issued by the National Commission on
357 Certification of Physician Assistants or its successor
358 organization. Three hours of the continuing medical education
359 must consist of the safe and effective prescribing of controlled
360 substances designated by the Florida Academy of Physician
361 Assistants category I credit.
362 (d) Upon employment as a physician assistant, a licensed
363 physician assistant must notify the department in writing within
364 30 days after such employment or after any subsequent changes in
365 the supervising physician. The notification must include the
366 full name, Florida medical license number, specialty, and
367 address of the supervising physician.
368 (d)(e) Notwithstanding subparagraph (a)2., the department
369 may grant to a recent graduate of an approved program, as
370 specified in subsection (6), who expects to take the first
371 examination administered by the National Commission on
372 Certification of Physician Assistants available for registration
373 after the applicant's graduation, a temporary license. The
374 temporary license shall expire 30 days after receipt of scores
375 of the proficiency examination administered by the National
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376 Commission on Certification of Physician Assistants. Between
377 meetings of the council, the department may grant a temporary
378 license to practice based on the completion of all temporary
379 licensure requirements. All such administratively issued
380 licenses shall be reviewed and acted on at the next regular
381 meeting of the council. The recent graduate may be licensed
382 before employment but must comply with paragraph (d). An
383 applicant who has passed the proficiency examination may be
384 granted permanent licensure. An applicant failing the
385 proficiency examination is no longer temporarily licensed but
386 may reapply for a 1-year extension of temporary licensure. An
387 applicant may not be granted more than two temporary licenses
388 and may not be licensed as a physician assistant until he or she
389 passes the examination administered by the National Commission
390 on Certification of Physician Assistants. As prescribed by board
391 rule, the council may require an applicant who does not pass the
392 licensing examination after five or more attempts to complete
393 additional remedial education or training. The council shall
394 prescribe the additional requirements in a manner that permits
395 the applicant to complete the requirements and be reexamined
396 within 2 years after the date the applicant petitions the
397 council to retake the examination a sixth or subsequent time.
398 (e)(f) The Board of Medicine may impose any of the
399 penalties authorized under ss. 456.072 and 458.331(2) upon a
400 physician assistant if the physician assistant or the
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401 supervising physician has been found guilty of or is being
402 investigated for any act that constitutes a violation of this
403 chapter or chapter 456.
404 (f)(g) An application or other documentation required to
405 be submitted to the department under this subsection may be
406 submitted electronically.
407 (8) DELEGATION OF POWERS AND DUTIES.—The boards may
408 delegate such powers and duties to the council as they may deem
409 proper.
410 (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
411 Physician Assistants is created within the department.
412 (a) The council shall consist of five members appointed as
413 follows:
414 1. The chairperson of the Board of Medicine shall appoint
415 one member who is a physician and member of the Board of
416 Medicine who supervises a physician assistant in the physician's
417 practice.
418 2. The chairperson of the Board of Osteopathic Medicine
419 shall appoint one member who is a physician and member of the
420 Board of Osteopathic Medicine who supervises a physician
421 assistant in the physician's practice.
422 3. The State Surgeon General or his or her designee shall
423 appoint three fully licensed physician assistants licensed under
424 this chapter or chapter 459.
425 (b) Members shall be appointed to terms of 4 years, except
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426 that of the initial appointments, two members shall be appointed
427 to terms of 2 years, two members shall be appointed to terms of
428 3 years, and one member shall be appointed to a term of 4 years,
429 as established by rule of the boards. Council members may not
430 serve more than two consecutive terms. The council shall
431 annually elect a chairperson from among its members.
432 (c) The council shall:
433 1. Recommend to the department the licensure of physician
434 assistants.
435 2. Develop all rules regulating the use of physician
436 assistants by physicians under this chapter and chapter 459,
437 except for rules relating to the formulary developed under
438 paragraph (4)(f). The council shall also develop rules to ensure
439 that the continuity of supervision is maintained in each
440 practice setting. The boards shall consider adopting a proposed
441 rule developed by the council at the regularly scheduled meeting
442 immediately following the submission of the proposed rule by the
443 council. A proposed rule submitted by the council may not be
444 adopted by either board unless both boards have accepted and
445 approved the identical language contained in the proposed rule.
446 The language of all proposed rules submitted by the council must
447 be approved by both boards pursuant to each respective board's
448 guidelines and standards regarding the adoption of proposed
449 rules. If either board rejects the council's proposed rule, that
450 board must specify its objection to the council with
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451 particularity and include any recommendations it may have for
452 the modification of the proposed rule.
453 3. Make recommendations to the boards regarding all
454 matters relating to physician assistants.
455 4. Address concerns and problems of practicing physician
456 assistants in order to improve safety in the clinical practices
457 of licensed physician assistants.
458 (d) When the council finds that an applicant for licensure
459 has failed to meet, to the council's satisfaction, each of the
460 requirements for licensure set forth in this section, the
461 council may enter an order to:
462 1. Refuse to certify the applicant for licensure;
463 2. Approve the applicant for licensure with restrictions
464 on the scope of practice or license; or
465 3. Approve the applicant for conditional licensure. Such
466 conditions may include placement of the licensee on probation
467 for a period of time and subject to such conditions as the
468 council may specify, including but not limited to, requiring the
469 licensee to undergo treatment, to attend continuing education
470 courses, to work under the direct supervision of a physician
471 licensed in this state, or to take corrective action.
472 (10) INACTIVE AND DELINQUENT STATUS.—A license on inactive
473 or delinquent status may be reactivated only as provided in s.
474 456.036.
475 (11) PENALTY.—Any person who has not been licensed by the
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476 council and approved by the department and who holds himself or
477 herself out as a physician assistant or who uses any other term
478 in indicating or implying that he or she is a physician
479 assistant commits a felony of the third degree, punishable as
480 provided in s. 775.082 or s. 775.084 or by a fine not exceeding
481 $5,000.
482 (12) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.—The
483 boards may deny, suspend, or revoke a physician assistant
484 license if a board determines that the physician assistant has
485 violated this chapter.
486 (13) RULES.—The boards shall adopt rules to implement this
487 section, including rules detailing the contents of the
488 application for licensure and notification pursuant to
489 subsection (7) and rules to ensure both the continued competency
490 of physician assistants and the proper utilization of them by
491 physicians or groups of physicians.
492 (14) EXISTING PROGRAMS.—This section does not eliminate or
493 supersede existing laws relating to other paramedical
494 professions or services and is supplemental to all such existing
495 laws relating to the licensure and practice of paramedical
496 professions.
497 (15) LIABILITY.—Each supervising physician using a
498 physician assistant is liable for any acts or omissions of the
499 physician assistant acting under the physician's supervision and
500 control.
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501 (16) LEGAL SERVICES.—Legal services shall be provided to
502 the council pursuant to s. 456.009(1).
503 (17) FEES.—The department shall allocate the fees
504 collected under this section to the council.
505 Section 2. Section 459.022, Florida Statutes, is amended
506 to read:
507 459.022 Physician assistants.—
508 (1) LEGISLATIVE INTENT.—
509 (a) The purpose of this section is to authorize physician
510 assistants, with their education, training and experience in the
511 field of medicine, to practice medicine in collaboration with
512 physicians and other health practitioners to provide increased
513 efficiency and to ensure high-quality medical services are
514 available at a reasonable cost encourage more effective
515 utilization of the skills of osteopathic physicians or groups of
516 osteopathic physicians by enabling them to delegate health care
517 tasks to qualified assistants when such delegation is consistent
518 with the patient's health and welfare.
519 (b) In order that maximum skills may be obtained within a
520 minimum time period of education, a physician assistant shall be
521 specialized to the extent that she or he can operate efficiently
522 and effectively in the specialty areas in which she or he has
523 been trained or is experienced.
524 (c) The purpose of this section is to encourage the
525 utilization of physician assistants by osteopathic physicians
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526 and to allow for innovative development of programs for the
527 education of physician assistants.
528 (2) DEFINITIONS.—As used in this section:
529 (a) "Approved program" means a physician assistant program
530 in the United States, or any possession or territory thereof,
531 accredited by the Accreditation Review Commission on Education
532 for the Physician Assistant, Inc., or its successor
533 organization, or, if before 2001, its predecessor organization.
534 formally approved by the boards, for the education of physician
535 assistants.
536 (b) "Boards" means the Board of Medicine and the Board of
537 Osteopathic Medicine.
538 (c) "Council" means the Council on Physician Assistants.
539 (d) "Trainee" means a person who is currently enrolled in
540 an approved program.
541 (e) "Physician assistant" means a healthcare professional
542 who meets qualifications defined in this chapter or chapter 458
543 and is licensed to practice medicine as provided in this chapter
544 or chapter 458 person who is a graduate of an approved program
545 or its equivalent or meets standards approved by the boards and
546 is licensed to perform medical services delegated by the
547 supervising physician.
548 (f) "Supervision" means responsible supervision and
549 control. Except in cases of emergency, supervision requires the
550 easy availability or physical presence of the licensed physician
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551 for consultation and direction of the actions of the physician
552 assistant. For the purposes of this definition, the term "easy
553 availability" includes the ability to communicate by way of
554 telecommunication. The boards shall establish rules as to what
555 constitutes responsible supervision of the physician assistant.
556 (g) "Physician assistant national certifying examination"
557 means the Physician Assistant National Certifying Examination
558 (PANCE) administered by the National Commission on Certification
559 of Physician Assistants or its successor agency "Proficiency
560 examination" means an entry-level examination approved by the
561 boards, including, but not limited to, those examinations
562 administered by the National Commission on Certification of
563 Physician Assistants.
564 (h) "Continuing medical education" means courses
565 recognized and approved by the boards, the American Academy of
566 Physician Assistants, the American Medical Association, the
567 American Osteopathic Association, or the Accreditation Council
568 on Continuing Medical Education.
569 (3) PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician
570 or group of physicians supervising a licensed physician
571 assistant must be qualified in the medical areas in which the
572 physician assistant is to perform and shall be individually or
573 collectively responsible and liable for the performance and the
574 acts and omissions of the physician assistant. A physician may
575 not supervise more than four currently licensed physician
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576 assistants at any one time. A physician supervising a physician
577 assistant pursuant to this section may not be required to review
578 and cosign charts or medical records prepared by such physician
579 assistant.
580 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—
581 (a) The boards shall adopt, by rule, the general
582 principles that supervising physicians must use in developing
583 the scope of practice of a physician assistant under direct
584 supervision and under indirect supervision. These principles
585 shall recognize the diversity of both specialty and practice
586 settings in which physician assistants are used.
587 (b) This chapter authorizes third-party payors to
588 reimburse employers of physician assistants for covered services
589 rendered by licensed physician assistants. Payment for services
590 within the physician assistant’s scope of practice shall be made
591 when ordered or performed by a physician assistant if the same
592 service would have been covered if ordered or performed by a
593 physician. Physician assistants are authorized to bill for and
594 receive direct payment for the services they deliver. This
595 chapter does not prevent third-party payors from reimbursing
596 employers of physician assistants for covered services rendered
597 by licensed physician assistants.
598 (c) Licensed physician assistants may not be denied
599 clinical hospital privileges, except for cause, so long as the
600 supervising physician is a staff member in good standing.
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601 (d) A supervisory physician may delegate to a licensed
602 physician assistant, pursuant to a written protocol, the
603 authority to act according to s. 154.04(1)(c). Such delegated
604 authority is limited to the supervising physician's practice in
605 connection with a county health department as defined and
606 established pursuant to chapter 154. The boards shall adopt
607 rules governing the supervision of physician assistants by
608 physicians in county health departments.
609 (e) A supervising physician may delegate to a fully
610 licensed physician assistant the authority to prescribe or
611 dispense any medication used in the supervising physician's
612 practice unless such medication is listed on the formulary
613 created pursuant to s. 458.347. A fully licensed physician
614 assistant may only prescribe or dispense such medication under
615 the following circumstances:
616 1. A physician assistant must clearly identify to the
617 patient that she or he is a physician assistant and must inform
618 the patient that the patient has the right to see the physician
619 before a prescription is prescribed or dispensed by the
620 physician assistant.
621 2. The supervising physician must notify the department of
622 her or his intent to delegate, on a department-approved form,
623 before delegating such authority and of any change in
624 prescriptive privileges of the physician assistant. Authority to
625 dispense may be delegated only by a supervising physician who is
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626 registered as a dispensing practitioner in compliance with s.
627 465.0276.
628 3. A fully licensed physician may procure drugs and
629 medical devise unless the medication is listed on the formulary
630 created pursuant to this paragraph The physician assistant must
631 complete a minimum of 10 continuing medical education hours in
632 the specialty practice in which the physician assistant has
633 prescriptive privileges with each licensure renewal.
634 4. The department may issue a prescriber number to the
635 physician assistant granting authority for the prescribing of
636 medicinal drugs authorized within this paragraph upon completion
637 of the requirements of this paragraph. The physician assistant
638 is not required to independently register pursuant to s.
639 465.0276.
640 5. The prescription may be in paper or electronic form but
641 must comply with ss. 456.0392(1) and 456.42(1) and chapter 499
642 and must contain, in addition to the supervising physician's
643 name, address, and telephone number, of the physician
644 assistant's prescriber number. Unless it is a drug or drug
645 sample dispensed by the physician assistant, the prescription
646 must be filled in a pharmacy permitted under chapter 465, and
647 must be dispensed in that pharmacy by a pharmacist licensed
648 under chapter 465. The inclusion of the prescriber number
649 creates a presumption that the physician assistant is authorized
650 to prescribe the medicinal drug and the prescription is valid.
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651 6. The physician assistant must note the prescription or
652 dispensing of medication in the appropriate medical record.
653 (f)1. The council shall establish a formulary of medicinal
654 drugs that a fully licensed physician assistant having
655 prescribing authority under this section or s. 459.022 may not
656 prescribe. The formulary must include general anesthetics and
657 radiographic contrast materials and must limit the prescription
658 of Schedule II controlled substances as listed in s. 893.03 to a
659 7-day supply.
660 2. In establishing the formulary, the council shall
661 consult with a pharmacist licensed under chapter 465, but not
662 licensed under this chapter or chapter 458, who shall be
663 selected by the State Surgeon General.
664 3. Only the council shall add to, delete from, or modify
665 the formulary. Any person who requests an addition, a deletion,
666 or a modification of a medicinal drug listed on such formulary
667 has the burden of proof to show cause why such addition,
668 deletion, or modification should be made.
669 4. The boards shall adopt the formulary required by this
670 paragraph, and each addition, deletion, or modification to the
671 formulary, by rule. Notwithstanding any provision of chapter 120
672 to the contrary, the formulary rule shall be effective 60 days
673 after the date it is filed with the Secretary of State. Upon
674 adoption of the formulary, the department shall mail a copy of
675 such formulary to each fully licensed physician assistant having
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676 prescribing authority under this section or s. 458.437, and to
677 each pharmacy licensed by the state. The boards shall establish,
678 by rule, a fee not to exceed $200 to fund the provisions of this
679 paragraph and paragraph (e).
680 (g)(f) A supervisory physician may delegate to a licensed
681 physician assistant the authority to, and the licensed physician
682 assistant acting under the direction of the supervisory
683 physician may, order any medication for administration to the
684 supervisory physician's patient in a facility licensed under
685 chapter 395 or part II of chapter 400, notwithstanding any
686 provisions in chapter 465 or chapter 893 which may prohibit this
687 delegation.
688 (h)(g) A licensed physician assistant may perform services
689 delegated by the supervising physician in the physician
690 assistant's practice in accordance with his or her education and
691 training unless expressly prohibited under this chapter, chapter
692 458, or rules adopted under this chapter or chapter 458.
693 (i) A physician assistant may authenticate any document
694 with their signature, certification, stamp, verification,
695 affidavit or endorsement if it may be so authenticated by the
696 signature, certification, stamp, verification, affidavit or
697 endorsement of a physician, including but not limited to, any of
698 the following:
699 1. Initiation of an involuntary examination pursuant to s.
700 394.463 (Baker Act);
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701 2. Do-not-resuscitate orders or physician orders for the
702 administration of life-sustaining treatment;
703 3. Death certificates;
704 4. School physical examinations;
705 5. Medical evaluations for workers’ compensation claims,
706 including date of maximum medical improvement as defined in s.
707 440.02; and
708 6. Orders for physical therapy, occupational therapy,
709 speech-language therapy, home health services or durable medical
710 equipment.
711 (j) A physician assistant may supervise medical assistants
712 as defined in this chapter and chapter 458.
713 (5) PERFORMANCE BY TRAINEES.—Notwithstanding any other
714 law, a trainee may perform medical services when such services
715 are rendered within the scope of an approved program.
716 (6) PROGRAM APPROVAL.—
717 (a) The boards shall approve programs, based on
718 recommendations by the council, for the education and training
719 of physician assistants which meet standards established by rule
720 of the boards. The council may recommend only those physician
721 assistant programs that hold full accreditation or provisional
722 accreditation from the Accreditation Review Commission on
723 Education for the Physician Assistant, Inc., Commission on
724 Accreditation of Allied Health Programs or its successor
725 organization or, if before 2001, its predecessor organization.
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726 (b) Notwithstanding any other provision of law, a trainee
727 may perform medical services when such services are rendered
728 within the scope of an approved program The boards shall adopt
729 and publish standards to ensure that such programs operate in a
730 manner that does not endanger the health or welfare of the
731 patients who receive services within the scope of the programs.
732 The boards shall review the quality of the curricula, faculties,
733 and facilities of such programs and take whatever other action
734 is necessary to determine that the purposes of this section are
735 being met.
736 (7) PHYSICIAN ASSISTANT LICENSURE.—
737 (a) Any person desiring to be licensed as a physician
738 assistant must apply to the department. The department shall
739 issue a license to any person certified by the council as having
740 met the following requirements:
741 1. Is at least 18 years of age.
742 2. Has graduated from an approved program.
743 a. For an applicant who graduated after December 31, 2020,
744 has received a master's degree in accordance with the
745 Accreditation Review Commission on Education for the Physician
746 Assistant, Inc., or its successor organization.
747 b. For an applicant who graduated before December 31, 2020,
748 has received a baccalaureate or master's degree from an approved
749 program.
750 c. For an applicant who graduated before July 1, 1994, has
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751 graduated from an approved program of instruction in primary
752 health care or surgery.
753 d. For an applicant who graduated before July 1, 1983, has
754 received a certification from the boards as a physician
755 assistant.
756 e. The board may also grant a license to an applicant who
757 does not meet the educational requirement specified in
758 subparagraph(a)2., but who passed the Physician Assistant
759 National Certifying Examination administered by the National
760 Commission on Certification of Physician Assistants prior to
761 1986.
762 3.2. Has obtained satisfactorily passed a passing
763 proficiency examination by an acceptable score as established by
764 the National Commission on Certification of Physician Assistants
765 or its successor and has been nationally certified. If an
766 applicant does not hold a current certificate issued by the
767 National Commission on Certification of Physician Assistants or
768 its successor organization and has not actively practiced as a
769 physician assistant within the immediately preceding 4 years,
770 the applicant must retake and successfully complete the entry-
771 level examination of the National Commission on Certification of
772 Physician Assistants or its successor organization to be
773 eligible for licensure.
774 4.3. Has completed the application form and remitted an
775 application fee not to exceed $300 as set by the boards. An
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776 application for licensure made by a physician assistant must
777 include:
778 a. A diploma from an approved certificate of completion of
779 a physician assistant training program specified in subsection
780 (6).
781 b. Acknowledgment of any prior felony convictions.
782 c. Acknowledgment of any previous revocation or denial of
783 licensure or certification in any state.
784 d. A copy of course transcripts and a copy of the course
785 description from a physician assistant training program
786 describing course content in pharmacotherapy, if the applicant
787 wishes to apply for prescribing authority. These documents must
788 meet the evidence requirements for prescribing authority.
789 (b)1. The licensure must be renewed biennially. Each
790 renewal must include:
791 a. A renewal fee not to exceed $500 as set by the boards.
792 b. Acknowledgment of no felony convictions in the previous
793 2 years.
794 c. A completed physician assistant workforce survey, which
795 shall be administered in the same manner as the physician survey
796 established in s. 459.0081 and must contain the same information
797 required under s. 459.0081(1) and (2).
798 2. Beginning July 1, 2018, and every 2 years thereafter,
799 the department shall report the data collected from the
800 physician assistant workforce surveys to the boards.
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801 3. The department shall adopt rules to implement this
802 paragraph.
803 (c) Each licensed physician assistant shall biennially
804 complete 100 hours of continuing medical education or shall hold
805 a current certificate issued by the National Commission on
806 Certification of Physician Assistants or its successor
807 organization. Three hours of the continuing medical education
808 must consist of the safe and effective prescribing of controlled
809 substances designated by the Florida Academy of Physician
810 Assistants category I credit.
811 (d) Upon employment as a physician assistant, a licensed
812 physician assistant must notify the department in writing within
813 30 days after such employment or after any subsequent changes in
814 the supervising physician. The notification must include the
815 full name, Florida medical license number, specialty, and
816 address of the supervising physician.
817 (d)(e) Notwithstanding subparagraph (a)2., the department
818 may grant to a recent graduate of an approved program, as
819 specified in subsection (6), a temporary license to expire upon
820 receipt of scores of the proficiency examination administered by
821 the National Commission on Certification of Physician
822 Assistants. Between meetings of the council, the department may
823 grant a temporary license to practice to physician assistant
824 applicants based on the completion of all temporary licensure
825 requirements. All such administratively issued licenses shall be
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826 reviewed and acted on at the next regular meeting of the
827 council. The recent graduate may be licensed prior to
828 employment, but must comply with paragraph (d). An applicant who
829 has passed the proficiency examination may be granted permanent
830 licensure. An applicant failing the proficiency examination is
831 no longer temporarily licensed, but may reapply for a 1-year
832 extension of temporary licensure. An applicant may not be
833 granted more than two temporary licenses and may not be licensed
834 as a physician assistant until she or he passes the examination
835 administered by the National Commission on Certification of
836 Physician Assistants. As prescribed by board rule, the council
837 may require an applicant who does not pass the licensing
838 examination after five or more attempts to complete additional
839 remedial education or training. The council shall prescribe the
840 additional requirements in a manner that permits the applicant
841 to complete the requirements and be reexamined within 2 years
842 after the date the applicant petitions the council to retake the
843 examination a sixth or subsequent time.
844 (e)(f) The Board of Osteopathic Medicine may impose any of
845 the penalties authorized under ss. 456.072 and 459.015(2) upon a
846 physician assistant if the physician assistant or the
847 supervising physician has been found guilty of or is being
848 investigated for any act that constitutes a violation of this
849 chapter or chapter 456.
850 (f)(g) An application or other documentation required to
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851 be submitted to the department under this subsection may be
852 submitted electronically.
853 (8) DELEGATION OF POWERS AND DUTIES.—The boards may
854 delegate such powers and duties to the council as they may deem
855 proper.
856 (9) COUNCIL ON PHYSICIAN ASSISTANTS.—The Council on
857 Physician Assistants is created within the department.
858 (a) The council shall consist of five members appointed as
859 follows:
860 1. The chairperson of the Board of Medicine shall appoint
861 one member who is a physician and member of the Board of
862 Medicine who supervises a physician assistant in the physician's
863 practice.
864 2. The chairperson of the Board of Osteopathic Medicine
865 shall appoint one member who is a physician and member of the
866 Board of Osteopathic Medicine who supervises a physician
867 assistant in the physician's practice.
868 3. The State Surgeon General or her or his designee shall
869 appoint three fully licensed physician assistants licensed under
870 chapter 458 or this chapter.
871 (b) Members shall be appointed to terms of 4 years, except
872 that of the initial appointments, two members shall be appointed
873 to terms of 2 years, two members shall be appointed to terms of
874 3 years, and one member shall be appointed to a term of 4 years,
875 as established by rule of the boards. Council members may not
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876 serve more than two consecutive terms. The council shall
877 annually elect a chairperson from among its members.
878 (c) The council shall:
879 1. Recommend to the department the licensure of physician
880 assistants.
881 2. Develop all rules regulating the use of physician
882 assistants by physicians under chapter 458 and this chapter,
883 except for rules relating to the formulary developed under s.
884 458.347. The council shall also develop rules to ensure that the
885 continuity of supervision is maintained in each practice
886 setting. The boards shall consider adopting a proposed rule
887 developed by the council at the regularly scheduled meeting
888 immediately following the submission of the proposed rule by the
889 council. A proposed rule submitted by the council may not be
890 adopted by either board unless both boards have accepted and
891 approved the identical language contained in the proposed rule.
892 The language of all proposed rules submitted by the council must
893 be approved by both boards pursuant to each respective board's
894 guidelines and standards regarding the adoption of proposed
895 rules. If either board rejects the council's proposed rule, that
896 board must specify its objection to the council with
897 particularity and include any recommendations it may have for
898 the modification of the proposed rule.
899 3. Make recommendations to the boards regarding all
900 matters relating to physician assistants.
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901 4. Address concerns and problems of practicing physician
902 assistants in order to improve safety in the clinical practices
903 of licensed physician assistants.
904 (d) When the council finds that an applicant for licensure
905 has failed to meet, to the council's satisfaction, each of the
906 requirements for licensure set forth in this section, the
907 council may enter an order to:
908 1. Refuse to certify the applicant for licensure;
909 2. Approve the applicant for licensure with restrictions
910 on the scope of practice or license; or
911 3. Approve the applicant for conditional licensure. Such
912 conditions may include placement of the licensee on probation
913 for a period of time and subject to such conditions as the
914 council may specify, including but not limited to, requiring the
915 licensee to undergo treatment, to attend continuing education
916 courses, to work under the direct supervision of a physician
917 licensed in this state, or to take corrective action.
918 (10) INACTIVE AND DELINQUENT STATUS.—A license on inactive
919 or delinquent status may be reactivated only as provided in s.
920 456.036.
921 (11) PENALTY.—Any person who has not been licensed by the
922 council and approved by the department and who holds herself or
923 himself out as a physician assistant or who uses any other term
924 in indicating or implying that she or he is a physician
925 assistant commits a felony of the third degree, punishable as
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926 provided in s. 775.082 or s. 775.084 or by a fine not exceeding
927 $5,000.
928 (12) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.—The
929 boards may deny, suspend, or revoke a physician assistant
930 license if a board determines that the physician assistant has
931 violated this chapter.
932 (13) RULES.—The boards shall adopt rules to implement this
933 section, including rules detailing the contents of the
934 application for licensure and notification pursuant to
935 subsection (7) and rules to ensure both the continued competency
936 of physician assistants and the proper utilization of them by
937 physicians or groups of physicians.
938 (14) EXISTING PROGRAMS.—This section does not eliminate or
939 supersede existing laws relating to other paramedical
940 professions or services and is supplemental to all such existing
941 laws relating to the licensure and practice of paramedical
942 professions.
943 (15) LIABILITY.—Each supervising physician using a
944 physician assistant is liable for any acts or omissions of the
945 physician assistant acting under the physician's supervision and
946 control.
947 (16) LEGAL SERVICES.—Legal services shall be provided to
948 the council pursuant to s. 456.009(1).
949 (17) FEES.—The department shall allocate the fees
950 collected under this section to the council.
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951 Section 3. This act shall take effect July 1, 2021.
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HB 627
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 627 Alzheimer's Disease and Dementia-Related Disorders Education
SPONSOR(S): Salzman
TIED BILLS: IDEN./SIM. BILLS: SB 874
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Grabowski McElroy
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
Alzheimer’s disease is the most prevalent form of dementia, a general term for memory loss. It is a progressive
brain disorder that damages and eventually destroys brain cells, leading to memory loss and changes in the
functions of the brain. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases. There are an
estimated 5.8 million people in the United States with Alzheimer’s disease, including 5.6 million people aged 65
and older and 200,000 individuals under age 65 who have younger-onset Alzheimer’s disease.
Florida has several programs and initiatives under the oversight of the Department of Elder Affairs (DOEA) that
provide resources and support for individuals suffering from Alzheimer’s disease and other dementia-related
disorders. These include:
• The Alzheimer’s Disease Initiative;
• The Purple Ribbon Task Force and Alzheimer’s Disease State Plan;
• The Alzheimer’s Disease Advisory Committee; and
• The Dementia Care and Cure Initiative.
The Florida Department of Health (DOH) licenses physicians, osteopathic physicians, and nursing
professionals who provide care, among others, to patients with Alzheimer’s disease and other dementia-
related disorders.
The bill requires DOH, in partnership with DOEA and the Alzheimer’s Association, to provide information to
educate physicians and nursing professionals about Alzheimer’s disease and dementia-related disorders. This
effort will occur through existing public health and community outreach programs and include education on:
• The importance of early detection and timely diagnosis of cognitive impairment;
• Utilization of a validated cognitive assessment tool;
• The value of Medicare annual wellness visits for cognitive health;
• The use of the Medicare billing code for care planning for individuals with cognitive impairment;
• Methods to detect early warning signs of Alzheimer’s disease and other types of dementia; and,
• Methods to reduce the risk of cognitive decline, particularly among individuals in diverse
communities who are at greater risk of developing Alzheimer’s disease and other types of
dementia.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Alzheimer’s Disease
Alzheimer’s disease is a form of dementia, a general term for memory loss. It is a progressive brain
disorder that damages and eventually destroys brain cells, leading to memory loss and changes in the
functions of the brain. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases.
Alzheimer's disease is a progressive disease in which dementia symptoms worsen gradually over time.
In the early stages of Alzheimer’s disease, memory loss is mild; in late-stage, individuals lose the ability
to carry on a conversation and respond to their environment. Currently, the disease has no cure, but
treatment can temporarily slow the worsening of symptoms. 1
There are an estimated 5.8 million people in the United States with Alzheimer’s disease, including 5.6
million people aged 65 and older and 200,000 individuals under age 65 who have younger-onset
Alzheimer’s disease. 2 By 2050, the number of people age 65 and older with Alzheimer’s disease in the
U.S. is expected to nearly triple to a projected 13.8 million people. 3
Florida has an increasing number of individuals with Alzheimer’s disease. An estimated 560,000
Floridians have Alzheimer’s disease. 4 The projected number of Floridians with Alzheimer’s disease is
estimated to increase by 28.6% to 720,000 individuals by 2025. 5
Alzheimer’s Disease Initiative
Section 430.503, F.S., creates the Alzheimer’s Disease Initiative (ADI) within the Department of Elder
Affairs (DOEA). 6 The Alzheimer’s Disease Initiative is a statewide program that provides services to
individuals and families affected by Alzheimer’s disease. The ADI includes the following programs: 7
• Respite care and other support services for caregivers;
• Memory Disorder Clinics;
• Specialized Alzheimer’s Adult Day Care Centers; and
• The Florida Alzheimer’s Brain Bank, which is a service- and research-oriented network of
regional sites which collect and study the brains of deceased dementia patients. 8
1 Alzheimer’s Association, What is Alzheimer’s?, http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp (last accessed March
17, 2021).
2 Alzheimer’s Association, 2019 Alzheimer’s Disease Facts and Figures, https://www.alz.org/media/Documents/alzheimers-facts-and-
figures-2019-r.pdf (last accessed March 17, 2021).
3 Id.
4 Alzheimer’s Association, Alzheimer’s Statistics: Florida, https://alz.org/getmedia/4d0840b6-0baa-4b97-8a0e-
1775cfbf44a4/statesheet_florida (last accessed March 17, 2021).
5 Id.
6 S. 430.503(1), F.S.
7 Florida Department of Elder Affairs, Alzheimer’s Disease Initiative, http://elderaffairs.state.fl.us/doea/alz.php (last accessed March 17,
2021).
8 Florida Department of Elder Affairs, The Florida Brain Bank, http://elderaffairs.state.fl.us/doea/BrainBank/docs/BrainBank-
brochure.pdf (last accessed March 17, 2021).
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Memory Disorder Clinics
Section 430.502(1), F.S., designates 17 memory disorder clinics (MDCs) 9 that provide comprehensive
assessments, diagnostic services, and treatment to individuals who exhibit symptoms of Alzheimer's
disease and related memory disorders. The MDCs operate in 13 distinct service areas. 10
MDC Service Areas and Locations 11
MDCs also develop training programs and materials and conduct training for caregivers, respite service
providers, and health care professionals in the care of persons with Alzheimer's disease and related
memory disorders. 12 In addition, MDCs conduct service-related research projects through model day
9 S. 430.502(1), F.S.
10 Florida Department of Elder Affairs, Summary of Programs and Services 2019, available at
http://elderaffairs.state.fl.us/doea/pubs/pubs/sops2019/2019_SOPS_A.pdf (last accessed March 17, 2021).
11 Id.
12 Supra note 7.
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care programs and respite care programs. 13 MDCs are established at medical schools, teaching
hospitals, and public and private not-for-profit hospitals throughout the state in accordance with s.
430.502, F.S. MDCs served 9,753 clients in 2017-2018. 14
Purple Ribbon Task Force and Alzheimer’s Disease State Plan
Chapter 2012-172, Laws of Florida, created the Purple Ribbon Task Force. The task force was
composed of 18 members with 6 members appointed by the Governor, 6 members appointed by the
Speaker of the House of Representatives, and 6 members appointed by the President of the Senate. 15
The law required the task force to conduct an interim study regarding Alzheimer’s disease in the state
and directed the Task Force to: 16
• Assess the current and future impact of Alzheimer’s disease on the state;
• Examine existing industries, services, and resources that address the needs of persons with
Alzheimer’s disease;
• Develop a strategy to mobilize a state response to Alzheimer’s disease; and
• Gather information on state trends and policy regarding Alzheimer’s disease.
Additionally, the law required the task force to submit a report in the form of an Alzheimer’s disease
state plan. 17 The 2013 completed report by the task force is the State Plan on Alzheimer’s Disease and
Related Forms of Dementia. 18 The state report included the task force’s findings and recommendations.
Upon submission of this report, pursuant to law, the Purple Ribbon Task Force terminated.
Current law requires DOEA to review and update the Alzheimer’s disease state plan every three years.
The state plan must include an assessment of the current and future impact of Alzheimer’s disease, an
examination of existing resources available to persons living with Alzheimer’s disease, and other
information regarding Alzheimer’s disease trends and policies in the state. 19
Alzheimer’s Disease Advisory Committee
Section 430.501, F.S., establishes the Alzheimer’s Disease Advisory Committee (Committee) to advise
DOEA on legislative, programmatic, and administrative matters regarding individuals with Alzheimer’s
disease and their caretakers. The committee is established within DOEA and composed of 11
members appointed by the Governor, 2 members appointed by the Senate President (one of which
must be a sitting Senator), and 2 members appointed by the Speaker of the House of Representatives
(one of which must be a sitting Representative). 20 The Governor’s appointments must reflect the
following representation: 21
• At least four members must be persons licensed pursuant to ch. 458 or 459, F.S., or hold a
Ph.D. degree and be currently involved in research on Alzheimer’s disease;
• At least four persons who have been caregivers of victims of Alzheimer’s disease; and
• Whenever possible, a gerontologist, a geriatric psychiatrist, a geriatrician, a neurologist, a
social worker, and a registered nurse.
Committee members are appointed to four-year staggered terms. The chair is elected by the
Committee and serves a one-year term. The Committee may establish subcommittees as necessary to
carry out the functions of the Committee. Currently, the Committee has four standing subcommittees
13 Id.
14 Supra note 10.
15 Ch. 2012-172, Laws of Fla.
16 Id.
17 Id.
18 Florida Department of Elder Affairs, Purple Ribbon Task Force State Plan on Alzheimer’s Disease and Related Forms of Dementia,
https://www.alz.org/media/Documents/florida-state-plan-august-2013.pdf (last accessed March 17, 2021).
19 S. 430.501, F.S.
20 Id.
21 Id.
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DATE: 3/22/2021
regarding clinical services, home- and community-based care, education and research, and legislative
advocacy. 22
The Committee is required to submit an annual report to the Governor, the President of the Senate, the
Speaker of the House of Representatives, and the Secretary of Elder Affairs by September 1 of each
year. The report must include recommendations on Alzheimer’s disease policy, all state-funded
Alzheimer’s disease efforts, and proposed updates to the Alzheimer’s disease state plan.
DOEA must use the report submitted by the Committee and collaborate with other organizations and
professionals when updating the state plan. DOEA must submit the updated state plan every three
years, beginning November 1, 2020, to the Governor, the President of the Senate, and the Speaker of
the House of Representatives.
Dementia Care and Cure Initiative
The DOEA announced the Dementia Care and Cure Initiative (DCCI) in 2015 to engage communities
across the state to be more dementia-caring, promote better care for Floridians affected by dementia,
and support research efforts to find a cure. In collaboration with Florida’s 11 Area Agencies on Aging
and 17 memory disorder clinics, participating DCCI communities organize task forces consisting of
community professionals and stakeholders who work to bring about education, awareness of, and
sensitivity regarding the needs of those affected by dementia. 23
Health Care Licensure in Florida
Chapter 458, F.S., governs licensure and regulation of the practice of medicine by the Florida Board of
Medicine in conjunction with Florida Department of Health (DOH). Physicians holding a Doctor of
Medicine (M.D.) degree are licensed under this chapter.
Chapter 459, F.S., provides for the licensure and regulation of the practice of medicine by the Florida
Board of Osteopathic Medicine in conjunction with DOH. Osteopathic Physicians holding a Doctor of
Osteopathic Medicine (D.O.) are licensed under this chapter.
Chapter 464, F.S., provides for the licensure and regulations of the practice of nursing by the Florida
Board of Nursing in conjunction with DOH. Individuals licensed under this chapter include registered
nurses (RN), advanced practice registered nurses (APRN), licensed practical nurses (LPN), and
certified nursing assistants (CNA).
Medicare Program
Medicare is a federal health insurance program for people 65 or older, people under 65 with certain
disabilities, and people of any age with end-stage renal disease (permanent kidney failure requiring
dialysis or a kidney transplant). 24 The program is administered by the Centers for Medicare and
Medicaid Services in the U.S. Department of Health and Human Services.
Medicare will pay for some services during every stage of Alzheimer’s disease and dementia care,
such as: 25
• Cognitive assessments;
• Home safety evaluations
22 Alzheimer’s Disease Advisory Committee, 2009-2016 Summary of Accomplishments,
http://elderaffairs.state.fl.us/doea/alz/ADI_Accomplishments.pdf (last accessed March 18, 2021).
23 Department of Elder Affairs, Dementia Care and Cure Initiative, http://elderaffairs.state.fl.us/doea/dcci.php (last accessed March 18,
2021).
24 Medicare.gov, What’s Medicare, https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare
(last accessed March 3, 2021).
25 Centers for Medicare and Medicaid Services, Medicare and Medicaid Benefits for People with Dementia, August 2017,
https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Downloads/Medicare-and-Medicaid-Benefits-for-
People-with-Dementia.pdf (last accessed March 18, 2021).
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DATE: 3/22/2021
• Planning for care;
• Hospital stays; and,
• Prescription drugs — Medicare Part D pays a portion of drug costs for individuals diagnosed
with dementia.
Effect of Proposed Changes
The bill requires the DOH, in collaboration with the DOEA and the Alzheimer’s Association, to use
existing resources to educate physicians and nursing professionals on a range of topics related to the
diagnosis and treatment of Alzheimer’s disease and dementia-related disorders. The information
provided to practitioners must include education on:
• The importance of early detection and timely diagnosis of cognitive impairment;
• Utilization of a validated cognitive assessment tool;
• The value of Medicare annual wellness visits for cognitive health;
• The use of the Medicare billing code for care planning for individuals with cognitive
impairment;
• Methods to detect early warning signs of Alzheimer’s disease and other types of dementia;
and,
• Methods to reduce the risk of cognitive decline, particularly among individuals in diverse
communities who are at greater risk of developing Alzheimer’s disease and other types of
dementia.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Creates s. 381.825, F.S.; relating to Alzheimer’s disease and dementia-related disorders
education.
Section 2: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
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DATE: 3/22/2021
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:
No rule-making authority is necessary to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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DATE: 3/22/2021
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 627 2021
1 A bill to be entitled
2 An act relating to Alzheimer's disease and dementia-
3 related disorders education; creating s. 381.825,
4 F.S.; requiring the Department of Health, in
5 partnership with the Department of Elderly Affairs and
6 the Alzheimer's Association, to provide specified
7 information relating to creating awareness about
8 Alzheimer's disease and dementia-related disorders to
9 certain licensed health care providers; providing an
10 effective date.
11
12 Be It Enacted by the Legislature of the State of Florida:
13
14 Section 1. Section 381.825, Florida Statutes, is created
15 to read:
16 381.825 Alzheimer's disease and dementia-related disorders
17 education.—The Department of Health, in partnership with the
18 Department of Elderly Affairs and the Alzheimer's Association,
19 shall provide, through existing, relevant public health and
20 community outreach programs, information to educate health care
21 providers licensed under chapter 458, chapter 459, or chapter
22 464 on the following:
23 (1) The importance of early detection and timely diagnosis
24 of cognitive impairment.
25 (2) Use of a validated cognitive assessment tool.
Page 1 of 2
CODING: Words stricken are deletions; words underlined are additions.
hb0627-00
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 627 2021
26 (3) The value of a Medicare annual wellness visit for
27 cognitive health.
28 (4) Use of the Medicare advance care planning billing code
29 for persons with cognitive impairment.
30 (5) An increased understanding and awareness of early
31 warning signs of Alzheimer's disease and dementia-related
32 disorders.
33 (6) Reducing the risk of cognitive decline, particularly
34 among persons in diverse communities who are at greater risk of
35 developing Alzheimer's disease and dementia-related disorders.
36 Section 2. This act shall take effect July 1, 2021.
Page 2 of 2
CODING: Words stricken are deletions; words underlined are additions.
hb0627-00
HB 631
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 631 Optometry
SPONSOR(S): Rizo
TIED BILLS: IDEN./SIM. BILLS: SB 876
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Morris McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
Optometrists examine, diagnose, treat, and manage diseases and injuries of the visual system as well as
identify systemic conditions which affect visual health. Optometrists are regulated under ch. 463, F.S., by the
Board of Optometry (Board) within the Department of Health (DOH). Optometrists may prescribe certain ocular
medications listed in law or established in a formulary by the Board, but may not perform certain surgical
procedures using an instrument, including a laser, scalpel, or needle.
HB 613 creates a new category for certification of licensed optometrists, “optometrist certified in ophthalmic
procedures,” which authorizes the performance of board-approved laser and non-laser ophthalmic procedures
and therapy.
The bill repeals the statutory formulary that specifies the oral ocular pharmaceutical agents a certified
optometrist may administer or prescribe and the prohibition on administering or prescribing certain drugs for
more than 72 hours, expanding the types of drugs certified optometrist may administer or prescribe. Instead,
the Board is required to create a negative formulary consisting of ocular pharmaceutical agents that a certified
optometrist may not administer or prescribe. The bill also repeals the requirement that certified optometrists
complete a board-approved course and examination in order to administer and prescribe oral ocular
pharmaceutical agents.
The bill prohibits a certified optometrist from administering or prescribing Schedule II controlled substances
except for oral analgesics for pain relief of the eye and its appendages. Current law allows this exception for
Schedule III, IV, and V controlled substances.
The bill requires the Board to adopt rules relating to the performance of laser and non-laser ophthalmic
procedures and therapies, the scope of the practice of optometry, and the required content, grading criteria,
and passing scores for the optometry licensure examination.
The bill has an insignificant, negative fiscal impact to DOH which can be absorbed within current resources.
The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0631.PPH
DATE: 3/22/2021
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Optometrists and Ophthalmologists
Optometrists examine, diagnose, treat, and manage diseases and injuries of the visual system as well
as identify systemic conditions which affect visual health. Optometrists are regulated under ch. 463,
F.S., by the Board of Optometry (Board) within DOH. The Board is composed of seven members
appointed by the Governor and confirmed by the Senate. Five members must be licensed practitioners
actively participating in this state and the two reaming members must be citizens of the state that are
not and have never been licensed practitioners. 1
Optometrist training involves an undergraduate degree and completion of a 4-year program at a college
of optometry. Some optometrists complete residencies to gain more specialized knowledge, but
residency training is not required for licensure or practice. 2
Ophthalmologists are medical doctors who specialize in diseases of the eye. Ophthalmologists provide
a full spectrum of eye care, from prescribing corrective lenses and medications to performing eye
surgery. Ophthalmologists also care for patients with more advanced and complicated diseases than
optometrists. Ophthalmologists are regulated under ch. 458 and 459, F.S., by the Board of Medicine
and the Board of Osteopathic Medicine within DOH. Ophthalmologist training involves an
undergraduate degree, 4 years of medical school, and completion of at least 4 years of residency
training in ophthalmology. 3
The American Council for Graduate Medical Education (ACGME) 4 requires each opthamologist
resident to perform a minimum number of certain surgeries before he or she may graduate from the
program. Residents must perform the following minimum number of surgeries: 5
Cataract 86
Laser Surgery- YAG Capsulotomy 5
Laser Surgery - Laser Trabeculoplasty 5
Laser Surgery – Laser Iridotomy 4
Laser Surgery – Panretinal Laser Photocoagulation 10
Keratoplasty 5
Pterygium/Conjunctival and other cornea 3
Keratorefractive Surgery 6
Strabismus 10
Glaucoma – Filtering/Shunting Procedures 5
Retinal Vitreous 10
Intravitreal Injection 10
Oculoplastic and orbit– Total 28
Oculoplastic and orbit – Eyelid Laceration 3
Oculoplastic and orbit – Chalazia Excision 3
Oculoplastic and orbit – Ptosis/Blepharoplasty 3
1 Section 463.003, F.S.
2 American Optometric Association, What is a Doctor of Optometry?, http://www.aoa.org/about-the-aoa/what-is-a-doctor-of-
optometry?sso=y (last visited March 17, 2021).
3 American Academy of Ophthalmology, What is an Ophthalmologist?, https://www.aao.org/eye-health/tips-prevention/what-is-
ophthalmologist (last visited March 17, 2021).
4 ACGME sets standards for and accredits US graduate medical education (residency and fellowship) programs. Available at:
http://www.acgme.org/What-We-Do/Overview (last visited March 17, 2021).
5 ACGME Review Committee for Ophthalmology, Frequently Asked Questions,
https://www.acgme.org/Portals/0/PDFs/FAQ/240_ophthalmology_FAQs.pdf (last visited March 17, 2021).
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DATE: 3/22/2021
Globe Trauma – Total 4
ACGME resident case logs between 2015 and 2016 showed that the average resident performed 183
cataract surgeries, 13.4 glaucoma surgeries, and 107.6 laser surgeries.
Florida law requires optometrists diagnosing a patient with certain diseases to refer such patients to
“physician skilled in the diseases of the eye” (ophthalmologists) for further treatment. 6 Additionally, an
optometrist must promptly advise a patient to seek an evaluation by an ophthalmologist for diagnosis
and possible treatment whenever the optometrist is informed by the patient of the sudden onset of
spots or “floaters” with loss of all or part of the visual field. 7 Optometrists must maintain the names of at
least three physicians, clinics, or hospitals to which they may refer patients who experience adverse
drug reactions. 8
Five states, Alaska, Arkansas, Kentucky, Louisiana, and Oklahoma allow optometrists to perform
surgical procedures. 9 Oklahoma has allowed optometrists to perform surgical procedures since 1988. 10
Oklahoma requires passage of the Laser Therapy for the Anterior Segment Course offered by
Northeastern State University to become a licensed optometrist. 11 The course consists of 9 hours of
lectures and 4 hours of laboratory sessions with hands-on training. 12
Between 1988 and 1998, 5,000 laser surgeries were performed by optometrists in Oklahoma. 13 A
review by the Oklahoma Board of Examiners in Optometry of the outcomes of those surgeries found
that negative outcome rates ranged between 0.5%-1.5% and were the same as those of surgeries
performed by ophthalmologists in Oklahoma. 14 Since 1998, 25,000 anterior laser surgeries have been
performed by optometrists in Oklahoma and the Oklahoma Board of Examiners in Optometry has not
received any complaints regarding those surgeries. 15
A 2016 peer-reviewed study that analyzed the outcomes for laser glaucoma surgeries between 2008
and 2013 in Oklahoma found that patients were nearly twice as likely to need additional treatment when
the procedure was performed by an optometrist as compared to an ophthalmologist. 16 The study also
found there was a 189% increased risk of needing additional treatment in the eye that had been treated
when the procedure was performed by an optometrist as compared to an ophthalmologist.17
6 Diagnoses which mandate a referral to an ophthalmologist include angle closure glaucoma, congenital or infantile glaucoma, and
infectious corneal diseases that are unresponsive to standard treatment. Section 463.0135, F.S.
7 Section 463.0135(4), F.S.
8 Section 463.0135(8), F.S.
9 National Conference of State Legislatures, Optometrist Scope of Practice, https://www.ncsl.org/research/health/optometrist-scope-of-
practice.aspx (last visited on March 17, 2021). In September 2020, the Arkansas Supreme Court ruled to disqualify Arkansas Issue 6,
the Practice of Optometry Referendum, from the 2020 general election ballot, allowing optometrists to continue to perform a range of
surgeries. See Arkansas Democrat Gazette, Ruling Keeps Question on Eye Surgery off State Ballot,
https://www.arkansasonline.com/news/2020/sep/18/ruling-keeps-question-on-eye-surgery-off-ballot/ (last visited March 17, 2021).
10 Testimony of Dr. April Jasper, former President of the Florida Optometric Association, on file with Professions and Public Health
Subcommittee staff.
11 Oklahoma Board of Examiners, Licensing, https://optometry.ok.gov/licensing.htm (last visited March 17, 2021).
12 Stein, J.D., et. al. Comparison of Outcomes of Laser Trabeculoplasty Performed by Optometrists vs. Ophthalmologists in Oklahoma.
JAMA Ophthalmol. 2016;134(10):1095-1101.
13 Supra, note 10.
14 Id.
15 Id.
16 Supra, note 12.
17 Id.
18 Id.
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DATE: 3/22/2021
Laser Glaucoma Surgery Outcomes in Oklahoma18
Probability of 1 or more Probability of 1 or
Number of
Number of eyes that additional surgeries more additional
eyes that
Provider received 1 or more performed during 10 surgeries performed
received laser
additional surgeries days after initial 11-30 days after initial
surgery
surgery surgery
Ophthalmologist 1150 174 (15%) 0 1.1%
Optometrist 234 84 (35.9%) 0.4% 10.3%
Optometrist Prescribing Authority in Florida
Currently, Florida law allows licensed optometrists to administer and prescribe drugs under limited
circumstances. Licensed optometrists may only use topical anesthetics for glaucoma examinations,
unless the licensed optometrist is also a certified optometrist. 19 Certified optometrists may administer
and prescribe topical or oral ocular pharmaceutical agents for the diagnosis and treatment of ocular
conditions of the human eye and its appendages without the use of surgery or other invasive
techniques. 20
To be certified by the board to administer and prescribe topical ocular pharmaceuticals, a licensed
optometrist must be complete at least 110 hours of board approved coursework and training and one
year of supervised experience in differential diagnosis of eye diseases or disorders. 21 Certified
optometrists that also wish to administer and prescribe oral ocular pharmaceutical agents must also
complete a board-approved 20-hour course and examination on general and ocular pharmaceutical
agents and their side effects. 22 If a certified optometrist does not complete the course and examination,
he or she may only administer or prescribe topical ocular pharmaceutical agents as established by
board rule. 23
The oral ocular pharmaceutical agents a certified optometrist may administer or prescribe are specified
in a statutory formulary. 24 The agents include seven antibiotics and three antivirals: 25
• Amoxicillin with or without clavulanic acid;
• Azithromycin;
• Erythromycin;
• Dicloxacillin;
• Doxycycline/Tetracycline;
• Keflex; and
• Minocycline.
• Acyclovir;
• Famciclovir; and
• Valacyclovir.
Current law prohibits a certified optometrist from administering or prescribing certain drugs for more
than 72 hours, including two analgesics and two anti-glaucoma agents: 26
• Tramadol hydrochloride; and
19 Section 453.0055(1)(a), F.S.; Chapter No. 2013-26,L.O.F.
20 Ss. 463.0055(1)(a) and 463.002(4), F.S.
21 Rule 64B13-10.001, F.A.C.
22 Section 463.0055, F.S.
23 Rule 64B13-18.002, F.A.C.
24 Section 463.0055(3), F.S.
25 Section 463.0055(3)(b), F.S.
26 Section 463.0055(3)(a), (c), (d) F.S.
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• Acetaminophen 300 mg with No. 3 codeine phosphate 30 mg.
• Acetazolamide; and
• Methazolamide.
Any oral ocular pharmaceutical agent listed in the statutory formulary which is subsequently determined
by the U.S. Food and Drug Administration to be unsafe for the administration or prescription is
considered to have been deleted from the statutory formulary. 27
The statutory formulary prohibits the administration or prescription of a controlled substance listed in
Schedule III 28, Schedule IV 29, or Schedule V30 of s. 893.03, F.S., except for the oral analgesics
specified in the statutory formulary for the relief of pain due to ocular conditions of the eye and its
appendages, or a controlled substance for the treatment of chronic nonmalignant pain. 31
As of February 2021, there are 3,855 licensed certified optometrists and 91 non-certified optometrists in
this state. 32 Since July 1, 1993, graduates of accredited schools of optometry have been considered
certified optometrists as the curriculum changed to include specific training on administering and
prescribing ocular pharmaceutical agents. 33 There are currently 51 optometrists in this state licensed
before July 1, 1993 that are not certified. 34
Optometrist Scope of Practice in Florida
Optometrists may prescribe certain medications, vision therapy, and corrective lenses, but may not
perform surgical procedures in Florida. 35 Florida law defines surgery as a procedure using an
instrument, including a laser, scalpel, or needle, in which human tissue is cut, burned, scraped, or
vaporized by incision, injection, ultrasound, laser, infusion, cryotherapy, or radiation and also includes a
procedure using an instrument which requires the closure of human tissue by suture, clamp, or a
similar device. 36 However, certified optometrists that are authorized to administer or prescribe certain
medication, may perform the following optometric practices 37:
• Performing an eye examination, including a dilated examination, if required or authorized under
laws related to pugilistic exhibitions; 38
• Removing an eyelash by epilation;
• Probing an uninflamed tear duct in a patient 18 years of age or older;
• Blocking the puncta by plug;
• Performing a superficial scraping to remove damaged epithelial tissue or superficial foreign
bodies or take a culture of the surface of the cornea or conjunctiva; and
• Using commonly accepted means or methods to immediately address incidents of anaphylaxis.
Effect of Proposed Changes
27 Id.
28 Section 893.03(3), F.S. defines a Schedule II substance as a substance that has a potential for abuse less than the substances
contained in Schedules I and II and has a currently accepted medical use in treatment in the United States, and abuse of the substance
may lead to moderate or low physical dependence or high psychological dependence or, in the case of anabolic steroids, may lead to
physical damage.
29 Section 893.03(4) defines a Schedule IV substance as a substance that has a low potential for abuse relative to the substances in
Schedule III and has a currently accepted medical use in treatment in the United States, and abuse of the substance may lead to
limited physical or psychological dependence relative to the substances in Schedule III.
30 Section 893.03(5), F.S. defines a Schedule V substance, compound, mixture or preparation that has a low potential for abuse relative
to the substances in Schedule IV and has a currently accepted medical use in treatment in the United States, and abuse of such
compound, mixture, or preparation may lead to limited physical or psychological dependence relative to the substances in Schedule IV.
31 Chronic nonmalignant pain is defined in section 456.44, F.S., as pain unrelated to cancer which persists beyond the usual course of
disease or the injury that is the cause of the pain or more than 90 day after surgery.
32 Department of Health, Agency Analysis of 2021 House Bill 631, p. 2 (March 5, 2021).
33 Id at p. 2.
34 Id.
35 Section 463.014(4), F.S.
36 Section 463.002(6), F.S.
37 Section 463.014(4), F.S.
38 Ch. 548, F.S.
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HB 613 repeals the prohibition on performing surgery, authorizes certified optometrists to perform laser
and non-laser ophthalmic procedures, and expands the prescriptive authority of certified optometrists.
The bill creates a new category for certification of licensed optometrists, “optometrist certified in
ophthalmic procedures,” which authorizes the performance of board-approved laser and non-laser
ophthalmic procedures and therapy.
Optometrist Prescribing Authority
The bill repeals the requirement that certified optometrists complete a board-approved 20-hour course
and examination on general and ocular pharmaceutical agents and their side effects in order to
administer and prescribe oral ocular pharmaceutical agents, allowing certified optometrists to
administer and prescribe such agents without completing board-approved courses.
The bill prohibits a certified optometrist from administering or prescribing Schedule II controlled
substances except for oral analgesics for pain relief of the eye and its appendages. The bill also
repeals the statutory formulary that specifies the oral ocular pharmaceutical agents a certified
optometrist may administer or prescribe and the prohibition on administering or prescribing certain
drugs for more than 72 hours. Instead, the bill requires the Board to create a negative formulary
consisting of ocular pharmaceutical agents that a certified optometrist may not administer or prescribe.
This expands the types of drugs certified optometrist may administer or prescribe.
Optometrist Scope of Practice
The bill repeals the prohibition on performing surgery, allowing optometrists to perform surgical
procedures.
The bill creates a new certification category for licensed optometrists, “optometrist in ophthalmic
procedures.” The bill requires a licensed optometrist successfully complete a board-approved course
and examination to become an optometrist certified in ophthalmic procedures. The bill allows
optometrists certified in ophthalmic procedures to perform board-authorized laser and non-laser
ophthalmic procedures. The bill prohibits such optometrists from performing ophthalmic procedures or
therapy that requires preoperative medication or drug-induced alteration of consciousness. However,
an optometrist certified in ophthalmic procedures may use medication for minimal tranquilization of the
patient and local or topical anesthesia if the chances of complications requiring hospitalization of the
patient are remote.
The bill also specifies certain ophthalmic procedures that optometrists certified in ophthalmic
procedures are prohibited from performing, including:
• Laser vision correction, penetrating keratoplasty, and corneal or lamellar keratoplasty;
• Laser of the vitreous chamber or retina of the eye to treat any vitreomacular or retinal disease;
• Surgery of the eyelid for suspected eyelid malignancies or for incisional cosmetic or mechanical
repair of blepharochalasis, ptosis, or tarsorrhaphy;
• Surgery of the boney orbit, including, but not limited to, orbital implants or removal of the human
eye;
• Incisional or excisional surgery of the lacrimal system other than lacrimal probing or related
procedures;
• Surgery requiring full thickness incision or excision of the cornea or sclera other than
paracentesis in an emergency situation requiring immediate reduction of elevated pressure
inside the eye;
• Surgery requiring incision or excision by scalpel of the iris and ciliary body, including, but not
limited to, iris diathermy or cryotherapy;
• Surgery requiring incision or excision of the vitreous or retina;
• Surgery requiring incision or excision of the crystalline lens or an intraocular prosthetic implant;
• Surgery involving incision or excision of the extraocular muscles;
• Surgery requiring full thickness conjunctivoplasty with graft or flap;
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• Pterygium surgery; and
• Any other procedure or therapy the board deems appropriate.
Board Authority
The bill requires the Board of Optometry to adopt rules relating to:
• Laser and non-laser ophthalmic procedures and therapies an optometrist certified in ophthalmic
procedures may perform;
• The scope of the practice of optometry consistent with its practice act; and
• The required content, grading criteria, and passing scores for the optometry licensure
examination.
The bill requires five members of the Board to be certified optometrists or optometrists certified in
ophthalmic procedures. This may require new appointments to the Board if the current members do not
meet such requirements.
The bill makes conforming changes.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 463.002, F.S., relating to definitions.
Section 2: Amends s. 463.003, F.S., relating to board of optometry.
Section 3: Amends s. 463.005, F.S., relating to authority of the board.
Section 4: Amends s. 463.0055, F.S., relating to administration and prescription of ocular
pharmaceutical agents.
Section 5: Creates s. 463.0056, F.S., relating to ophthalmic procedures.
Section 6: Amends s. 463.0057, F.S., relating to optometric faculty certificate.
Section 7: Amends s. 463.006, F.S., relating to licensure and certification by examination.
Section 8: Amends s. 463.0135, F.S., relating to standards of practice.
Section 9: Amends s. 463.014, F.S., relating to certain acts prohibited.
Section 10: Amends s. 463.009, F.S., relating to supporting personnel.
Section 11: Amends s. 641.31, F.S., relating to health maintenance contracts.
Section 12: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
DOH will experience an increase in workload relating to rulemaking and technology updates to
implement the bill, which current resources are adequate to absorb. 39
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
39 Supra, note 32 at p. 6.
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DATE: 3/22/2021
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
An optometrist may experience an increase in expenditures if he or she enrolls in the required board-
approved course and sits for the examination in order to become certified in ophthalmic procedures.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
The bill requires the Board of Optometry to adopt rules relating to the scope of practice of optometry
consistent with ch. 463, F.S., which is potentially an unlawful delegation of legislative authority.
B. RULE-MAKING AUTHORITY:
The bill provides sufficient rulemaking to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
STORAGE NAME: h0631.PPH PAGE: 8
DATE: 3/22/2021
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1 A bill to be entitled
2 An act relating to optometry; reordering and amending
3 s. 463.002, F.S.; revising and defining terms;
4 amending s. 463.003, F.S.; revising the member
5 composition requirements for the Board of Optometry;
6 revising applicability; amending s. 463.005, F.S.;
7 revising specified rules the board must adopt;
8 amending s. 463.0055, F.S.; revising circumstances
9 under which a certified optometrist may administer or
10 prescribe ocular pharmaceutical agents; deleting
11 requirements a certified optometrist must satisfy to
12 administer or prescribe ocular pharmaceutical agents;
13 requiring the board to adopt a negative formulary of
14 ocular pharmaceutical agents certified optometrists
15 are prohibited from administering or prescribing;
16 deleting provisions relating to the topical and oral
17 ocular pharmaceutical agent formularies established by
18 the board; requiring the board to mail a copy of the
19 negative formulary to all certified optometrists and
20 licensed pharmacies under certain circumstances;
21 revising the controlled substances that certified
22 optometrists are prohibited from administering or
23 prescribing; creating s. 463.0056, F.S.; authorizing
24 certain certified optometrists to perform laser and
25 non-laser ophthalmic procedures and therapies under
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26 certain circumstances; providing certification
27 requirements certified optometrists must satisfy to
28 perform such procedures and therapies; requiring the
29 board to approve the courses and examinations to be
30 used for certification if certain conditions are met;
31 requiring the board to review and approve the
32 examination annually if certain conditions are met;
33 authorizing certified optometrists to use the board-
34 approved course and examination to satisfy their
35 continuing education requirements under certain
36 circumstances; prohibiting a certified optometrist who
37 does not complete such course and examination from
38 performing certain ophthalmic procedures; specifying
39 ophthalmic procedures that are excluded from the scope
40 of practice of optometry, with an exception; amending
41 s. 463.0057, F.S.; conforming a provision to changes
42 made by the act; amending s. 463.006, F.S.; conforming
43 provisions to changes made by the act; requiring the
44 board to determine the required content, grading
45 criteria, and passing score for the licensure
46 examination for certified optometrists; making
47 technical changes; amending s. 463.0135, F.S.;
48 authorizing certified optometrists to remove
49 superficial foreign bodies; defining the term
50 "superficial foreign bodies"; specifying circumstances
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51 under which optometrists may perform procedures within
52 the practice of optometry which may otherwise be
53 considered surgery; requiring licensed practitioners
54 who are not certified optometrists to display in their
55 practices a sign containing specified information;
56 amending s. 463.014, F.S.; deleting a prohibition on
57 surgery performed by certified optometrists to conform
58 to changes made by the act; amending ss. 463.009 and
59 641.31, F.S.; conforming cross-references; providing
60 an effective date.
61
62 Be It Enacted by the Legislature of the State of Florida:
63
64 Section 1. Section 463.002, Florida Statutes, is reordered
65 and amended to read:
66 463.002 Definitions.—As used in this chapter, the term:
67 (2)(1) "Board" means the Board of Optometry.
68 (5)(2) "Department" means the Department of Health.
69 (8)(3)(a) "Licensed practitioner" means a person who is a
70 primary health care provider licensed to engage in the practice
71 of optometry under the authority of this chapter. With respect
72 to persons initially licensed under this chapter after July 1,
73 1993, the term includes only certified optometrists.
74 (b) A licensed practitioner who is not a certified
75 optometrist shall be required to display at her or his place of
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76 practice a sign which states, "I am a Licensed Practitioner, not
77 a Certified Optometrist, and I am not able to prescribe ocular
78 pharmaceutical agents."
79 (c) All practitioners initially licensed after July 1,
80 1993, must be certified optometrists.
81 (3)(4) "Certified optometrist" or "certified optometric
82 physician" means a licensed practitioner authorized by the board
83 to administer and prescribe ocular pharmaceutical agents.
84 (9)(5) "Ocular pharmaceutical agent" means a
85 pharmaceutical agent that is administered or prescribed
86 topically or orally for the diagnosis or treatment of ocular
87 conditions of the human eye and its appendages without the use
88 of surgery or other invasive techniques.
89 (13)(6) "Surgery" means a procedure using an instrument,
90 including a laser, scalpel, or needle, in which human tissue is
91 cut, burned, scraped except as provided in s. 463.0135(12) s.
92 463.014(4), or vaporized, by incision, injection, ultrasound,
93 laser, infusion, cryotherapy, or radiation. The term includes a
94 procedure using an instrument which requires the closure of
95 human tissue by suture, clamp, or other such device.
96 (11)(7) "Optometry" means the diagnosis, evaluation,
97 treatment, and management of conditions of the human eye and its
98 appendages, including any visual, muscular, neurological, or
99 anatomical anomalies and chronic systemic conditions relating to
100 the eye; the determination of the refractive powers of the human
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101 eye; and the prescribing and employment of any objective or
102 subjective means or methods, including the administration of
103 ocular pharmaceutical agents, contact lenses, spectacle lenses,
104 magnification lenses, vision therapy, low vision rehabilitation
105 devices, and ophthalmic procedures and therapy, for the
106 diagnosis, evaluation, correction, remedy, treatment,
107 management, or relief of any insufficiency, anomaly,
108 abnormality, or disease condition relating to the human eye or
109 its appendages for the purpose of determining the refractive
110 powers of the human eyes, or any visual, muscular, neurological,
111 or anatomic anomalies of the human eyes and their appendages;
112 and the prescribing and employment of lenses, prisms, frames,
113 mountings, contact lenses, orthoptic exercises, light
114 frequencies, and any other means or methods, including ocular
115 pharmaceutical agents, for the correction, remedy, or relief of
116 any insufficiencies or abnormal conditions of the human eyes and
117 their appendages.
118 (6)(8) "Direct supervision" means supervision to an extent
119 that the licensee remains on the premises while all procedures
120 are being done and gives final approval to any procedures
121 performed by an employee.
122 (7)(9) "General supervision" means the responsible
123 supervision of supportive personnel by a licensee who need not
124 be present when such procedures are performed, but who assumes
125 legal liability therefor. Except in cases of emergency, "general
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126 supervision" shall require the easy availability or physical
127 presence of the licensee for consultation with and direction of
128 the supportive personnel.
129 (1)(10) "Appendages" means the eyelids, the eyebrows, the
130 conjunctiva, and the lacrimal apparatus.
131 (14)(11) "Transcript-quality" means a course that which is
132 in conjunction with or sponsored by a school or college of
133 optometry or equivalent educational entity, which course is
134 approved by the board and requires a test and passing grade.
135 (4)(12) "Clock hours" means the actual time engaged in
136 approved coursework and clinical training.
137 (10) "Optometrist certified in ophthalmic procedures"
138 means a certified optometrist who is authorized under s.
139 463.0056 to perform board-approved laser and non-laser
140 ophthalmic procedures and therapy in accordance with that
141 section.
142 (12) "Refraction" means the use of lenses and ocular
143 pharmaceutical agents during the course of a comprehensive
144 medical eye examination to determine a patient's visual,
145 neurological, and physical requirements to attain optimal visual
146 and perceptual performance.
147 Section 2. Subsections (2) and (4) of section 463.003,
148 Florida Statutes, are amended to read:
149 463.003 Board of Optometry.—
150 (2) Five members of the board must be certified
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151 optometrists or optometrists certified in ophthalmic procedures
152 licensed practitioners actively practicing in this state. The
153 remaining two members must be citizens of this the state who are
154 not, and have never been, licensed practitioners and who are in
155 no way connected with the practice of optometry or with any
156 vision-oriented profession or business. At least one member of
157 the board must be 60 years of age or older.
158 (4) All applicable provisions of chapter 456 relating to
159 activities of regulatory boards which do not conflict with this
160 chapter shall apply.
161 Section 3. Subsection (1) of section 463.005, Florida
162 Statutes, is amended to read:
163 463.005 Authority of the board.—
164 (1) The Board of Optometry shall has authority to adopt
165 rules pursuant to ss. 120.536(1) and 120.54 to implement the
166 provisions of this chapter conferring duties upon it. Such rules
167 must shall include, but need not be limited to, rules relating
168 to all of the following:
169 (a) Standards of practice, including, but not limited to,
170 those provided for in s. 463.0135.
171 (b) Minimum equipment that which a licensed practitioner
172 must shall at all times possess to engage in the practice of
173 optometry.
174 (c) Minimum procedures that which shall constitute a
175 visual examination.
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176 (d) Procedures for the safekeeping and transfer of
177 prescription files or case records upon the discontinuance of
178 practice.
179 (e) Supervision of supportive personnel.
180 (f) Courses and procedures for continuing education.
181 (g) Practices and procedures for the administration and
182 prescription of ocular pharmaceutical agents.
183 (h) Laser and non-laser ophthalmic procedures and
184 therapies an optometrist certified in ophthalmic procedures may
185 perform, including, but not limited to, the standards of
186 practice for such ophthalmic procedures and therapies.
187 (i) The scope of practice of optometry consistent with
188 this chapter.
189 (j) Required content, grading criteria, and passing scores
190 for the licensure examinations set forth in s. 463.006.
191 Section 4. Section 463.0055, Florida Statutes, is amended
192 to read:
193 463.0055 Administration and prescription of ocular
194 pharmaceutical agents.—
195 (1)(a) Certified optometrists may administer and prescribe
196 ocular pharmaceutical agents as provided in this section for the
197 diagnosis and treatment of ocular conditions of the human eye
198 and its appendages without the use of surgery or other invasive
199 techniques. However, a licensed practitioner who is not
200 certified may use topically applied anesthetics solely for the
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201 purpose of glaucoma examinations, but is otherwise prohibited
202 from administering or prescribing ocular pharmaceutical agents.
203 (b) Before a certified optometrist may administer or
204 prescribe oral ocular pharmaceutical agents, the certified
205 optometrist must provide proof to the department of successful
206 completion of a course and subsequent examination, approved by
207 the board, on general and ocular pharmaceutical agents and the
208 side effects of those agents. The course shall consist of 20
209 contact hours, all of which may be web-based. The first course
210 and examination shall be presented by October 1, 2013, and shall
211 be administered at least annually thereafter. The course and
212 examination shall be developed and offered jointly by a
213 statewide professional association of physicians in this state
214 accredited to provide educational activities designated for the
215 American Medical Association Physician's Recognition Award (AMA
216 PRA) Category 1 credit and a statewide professional association
217 of licensed practitioners which provides board-approved
218 continuing education on an annual basis. The board shall review
219 and approve the content of the initial course and examination if
220 the board determines that the course and examination adequately
221 and reliably satisfy the criteria set forth in this section. The
222 board shall thereafter annually review and approve the course
223 and examination if the board determines that the content
224 continues to adequately and reliably satisfy the criteria set
225 forth in this section. Successful completion of the board-
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226 approved course and examination may be used by a certified
227 optometrist to satisfy 20 hours of the continuing education
228 requirements in s. 463.007(3), only for the biennial period in
229 which the board-approved course and examination are taken. If a
230 certified optometrist does not complete a board-approved course
231 and examination under this section, the certified optometrist is
232 only authorized to administer and prescribe topical ocular
233 pharmaceutical agents.
234 (2)(a) The board shall establish a negative formulary of
235 topical ocular pharmaceutical agents that a certified
236 optometrist may not administer or prescribe be prescribed and
237 administered by a certified optometrist. The formulary shall
238 consist of those topical ocular pharmaceutical agents that are
239 appropriate to treat or diagnose ocular diseases and disorders
240 and that the certified optometrist is qualified to use in the
241 practice of optometry. The board shall establish, add to, delete
242 from, or modify the topical formulary by rule. Notwithstanding
243 any provision of chapter 120 to the contrary, the topical
244 formulary rule becomes effective 60 days from the date it is
245 filed with the Secretary of State.
246 (b) The formulary may be added to, deleted from, or
247 modified according to the procedure described in paragraph (a).
248 Any person who requests an addition, deletion, or modification
249 of an authorized topical ocular pharmaceutical agent shall have
250 the burden of proof to show cause why such addition, deletion,
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251 or modification should be made.
252 (c) The State Surgeon General shall have standing to
253 challenge any rule or proposed rule of the board pursuant to s.
254 120.56. In addition to challenges for any invalid exercise of
255 delegated legislative authority, the administrative law judge,
256 upon such a challenge by the State Surgeon General, may declare
257 all or part of a rule or proposed rule invalid if it:
258 1. Does not protect the public from any significant and
259 discernible harm or damages;
260 2. Unreasonably restricts competition or the availability
261 of professional services in the state or in a significant part
262 of the state; or
263 3. Unnecessarily increases the cost of professional
264 services without a corresponding or equivalent public benefit.
265
266 However, there shall not be created a presumption of the
267 existence of any of the conditions cited in this subsection in
268 the event that the rule or proposed rule is challenged.
269 (d) Upon adoption of the negative formulary required by
270 this section, and upon each addition, deletion, or modification
271 to the formulary, the board shall mail a copy of the amended
272 formulary to each certified optometrist and to each pharmacy
273 licensed by the state.
274 (3) In addition to the formulary of topical ocular
275 pharmaceutical agents established by rule of the board, there is
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276 created a statutory formulary of oral ocular pharmaceutical
277 agents, which includes the following agents:
278 (a) The following analgesics or their generic or
279 therapeutic equivalents, which may not be administered or
280 prescribed for more than 72 hours without consultation with a
281 physician licensed under chapter 458 or chapter 459 who is
282 skilled in diseases of the eye:
283 1. Tramadol hydrochloride.
284 2. Acetaminophen 300 mg with No. 3 codeine phosphate 30
285 mg.
286 (b) The following antibiotics or their generic or
287 therapeutic equivalents:
288 1. Amoxicillin with or without clavulanic acid.
289 2. Azithromycin.
290 3. Erythromycin.
291 4. Dicloxacillin.
292 5. Doxycycline/Tetracycline.
293 6. Keflex.
294 7. Minocycline.
295 (c) The following antivirals or their generic or
296 therapeutic equivalents:
297 1. Acyclovir.
298 2. Famciclovir.
299 3. Valacyclovir.
300 (d) The following oral anti-glaucoma agents or their
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301 generic or therapeutic equivalents, which may not be
302 administered or prescribed for more than 72 hours:
303 1. Acetazolamide.
304 2. Methazolamide.
305
306 Any oral ocular pharmaceutical agent that is listed in the
307 statutory formulary set forth in this subsection and that is
308 subsequently determined by the United States Food and Drug
309 Administration to be unsafe for administration or prescription
310 shall be considered to have been deleted from the formulary of
311 oral ocular pharmaceutical agents. The oral ocular
312 pharmaceutical agents on the statutory formulary set forth in
313 this subsection may not otherwise be deleted by the board, the
314 department, or the State Surgeon General.
315 (3)(4) A certified optometrist shall be issued a
316 prescriber number by the board. Any prescription written by a
317 certified optometrist for an ocular pharmaceutical agent
318 pursuant to this section shall have the prescriber number
319 printed thereon. A certified optometrist may not administer or
320 prescribe any of the following:
321 (a) A controlled substance listed in Schedule II, Schedule
322 III, Schedule IV, or Schedule V of s. 893.03, except for an oral
323 analgesic placed on the formulary pursuant to this section for
324 the relief of pain due to ocular conditions of the eye and its
325 appendages.
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326 (b) A controlled substance for the treatment of chronic
327 nonmalignant pain as defined in s. 456.44(1)(f).
328 Section 5. Section 463.0056, Florida Statutes, is created
329 to read:
330 463.0056 Ophthalmic Procedures.—
331 (1)(a) An optometrist certified in ophthalmic procedures
332 may perform laser and non-laser ophthalmic procedures and
333 therapies as authorized by the board but may not perform an
334 ophthalmic procedure or therapy that requires preoperative
335 medications or drug-induced alteration of consciousness.
336 However, an optometrist certified in ophthalmic procedures may
337 use medication for minimal tranquilization of the patient and
338 local or topical anesthesia if the chances of complications
339 requiring hospitalization of the patient as a result are remote.
340 (b) To be certified to perform ophthalmic procedures, a
341 certified optometrist must first provide proof to the department
342 of successful completion of a course and subsequent examination,
343 approved by the board, on laser and non-laser ophthalmic
344 procedures and therapy. The course and examination shall be
345 developed and offered jointly by a statewide professional
346 association of physicians in this state accredited to provide
347 educational activities designated for the American Medical
348 Association Physician's Recognition Award Category 1 credit and
349 a statewide professional association of licensed practitioners
350 which provides board-approved continuing education on an annual
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351 basis. The board shall review and approve the content of the
352 initial course and examination if the board determines that the
353 course and examination adequately and reliably satisfy the
354 criteria set forth in this section. The board shall thereafter
355 annually review and approve the examination if the board
356 determines that the content continues to adequately and reliably
357 satisfy the criteria set forth in this section. Successful
358 completion of the board-approved course and examination may be
359 used by a certified optometrist to satisfy the continuing
360 education requirements in s. 463.007(3) only for the biennial
361 period in which the board-approved course and examination are
362 taken. If a certified optometrist does not complete a board-
363 approved course and examination under this section, the
364 certified optometrist may not perform ophthalmic procedures
365 described in paragraph (a).
366 (2) The following ophthalmic procedures are excluded from
367 the scope of practice of optometry, except for the preoperative
368 and postoperative care of these procedures:
369 (a) Laser vision correction, penetrating keratoplasty, and
370 corneal or lamellar keratoplasty.
371 (b) Laser of the vitreous chamber or retina of the eye to
372 treat any vitreomacular or retinal disease.
373 (c) Surgery of the eyelid for suspected eyelid
374 malignancies or for incisional cosmetic or mechanical repair of
375 blepharochalasis, ptosis, or tarsorrhaphy.
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376 (d) Surgery of the boney orbit, including, but not limited
377 to, orbital implants or removal of the human eye.
378 (e) Incisional or excisional surgery of the lacrimal
379 system other than lacrimal probing or related procedures.
380 (f) Surgery requiring full thickness incision or excision
381 of the cornea or sclera other than paracentesis in an emergency
382 situation requiring immediate reduction of elevated pressure
383 inside the eye.
384 (g) Surgery requiring incision or excision by scalpel of
385 the iris and ciliary body, including, but not limited to, iris
386 diathermy or cryotherapy.
387 (h) Surgery requiring incision or excision of the vitreous
388 or retina.
389 (i) Surgery requiring incision or excision of the
390 crystalline lens or an intraocular prosthetic implant.
391 (j) Surgery involving incision or excision of the
392 extraocular muscles.
393 (k) Surgery requiring full thickness conjunctivoplasty
394 with graft or flap.
395 (l) Pterygium surgery.
396 (m) Any other procedure or therapy the board deems
397 appropriate.
398 Section 6. Subsection (3) of section 463.0057, Florida
399 Statutes, is amended to read:
400 463.0057 Optometric faculty certificate.—
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401 (3) The holder of a faculty certificate may engage in the
402 practice of optometry as permitted by this section but may not
403 administer or prescribe topical ocular pharmaceutical agents
404 unless the certificateholder has satisfied the requirements of
405 s. 463.006(1)(e) and (f). If a certificateholder wishes to
406 administer or prescribe oral ocular pharmaceutical agents, the
407 certificateholder must also satisfy the requirements of s.
408 463.0055(1)(b).
409 Section 7. Section 463.006, Florida Statutes, is amended
410 to read:
411 463.006 Licensure and certification by examination.—
412 (1) Any person desiring to be a certified optometrist
413 licensed practitioner pursuant to this chapter must apply to the
414 department and must submit proof to the department that she or
415 he:
416 (a) Has completed the application forms as required by the
417 board, remitted an application fee for certification not to
418 exceed $250, remitted an examination fee for certification not
419 to exceed $250, and remitted an examination fee for licensure
420 not to exceed $325, all as set by the board.
421 (b) Is at least 18 years of age.
422 (c) Has graduated from an accredited school or college of
423 optometry approved by rule of the board.
424 (d) Is of good moral character.
425 (e) Has successfully completed at least 110 hours of
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426 transcript-quality coursework and clinical training in general
427 and ocular pharmacology as determined by the board, at an
428 institution that:
429 1. Has facilities for both didactic and clinical
430 instructions in pharmacology; and
431 2. Is accredited by a regional or professional accrediting
432 organization that is recognized and approved by the Commission
433 on Recognition of Postsecondary Accreditation or the United
434 States Department of Education.
435 (f) Has completed at least 1 year of supervised experience
436 in differential diagnosis of eye disease or disorders as part of
437 the optometric training or in a clinical setting as part of the
438 optometric experience.
439 (2) The board shall approve a licensure examination
440 consisting of the appropriate subjects and including applicable
441 state laws and rules and general and ocular pharmacology with
442 emphasis on the use and side effects of ocular pharmaceutical
443 agents. The board may by rule substitute a national examination
444 as part or all of the examination and, notwithstanding chapter
445 456, may by rule offer a practical examination in addition to a
446 written examination. The board shall determine the required
447 content, grading criteria, and passing score for the licensure
448 examination.
449 (3) Each applicant who submits proof satisfactory to the
450 board that he or she has met the requirements of subsection (1),
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451 who successfully passes the licensure examination within 3 years
452 before the date of application or within 3 years after the
453 submission of an application, and who otherwise meets the
454 requirements of this chapter is entitled to be licensed as a
455 certified optometrist practitioner and to be certified to
456 administer and prescribe ocular pharmaceutical agents in the
457 diagnosis and treatment of ocular conditions.
458 Section 8. Subsections (12) and (13) are added to section
459 463.0135, Florida Statutes, to read:
460 463.0135 Standards of practice.—
461 (12) Certified optometrists may remove superficial foreign
462 bodies. For the purpose of this subsection, the term
463 "superficial foreign bodies" means any foreign matter that is
464 embedded in the conjunctiva or cornea but that has not
465 penetrated the globe. Notwithstanding the definition of surgery
466 in s. 463.002, a certified optometrist may provide any
467 optometric care within the practice of optometry as defined in
468 s. 463.002, including, but not limited to, removing an eyelash
469 by epilation, probing an uninflamed tear duct in a patient 18
470 years of age or older, blocking the puncta by plug, or
471 superficial scraping for the purpose of removing damaged
472 epithelial tissue or superficial foreign bodies or taking a
473 culture of the surface of the cornea or conjunctiva.
474 (13) A licensed practitioner who is not a certified
475 optometrist is required to display at her or his place of
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476 practice a sign that states, "I am a Licensed Practitioner, not
477 a Certified Optometrist, and I am not able to prescribe ocular
478 pharmaceutical agents or perform ophthalmic procedures."
479 Section 9. Subsection (4) of section 463.014, Florida
480 Statutes, is amended to read:
481 463.014 Certain acts prohibited.—
482 (4) Surgery of any kind is expressly prohibited. Certified
483 optometrists may remove superficial foreign bodies. For the
484 purposes of this subsection, the term "superficial foreign
485 bodies" means any foreign matter that is embedded in the
486 conjunctiva or cornea but that has not penetrated the globe.
487 Notwithstanding the definition of surgery as provided in s.
488 463.002(6), a certified optometrist is not prohibited from
489 providing any optometric care within the practice of optometry
490 as defined in s. 463.002(7), such as removing an eyelash by
491 epilation, probing an uninflamed tear duct in a patient 18 years
492 of age or older, blocking the puncta by plug, or superficial
493 scraping for the purpose of removing damaged epithelial tissue
494 or superficial foreign bodies or taking a culture of the surface
495 of the cornea or conjunctiva.
496 Section 10. Section 463.009, Florida Statutes, is amended
497 to read:
498 463.009 Supportive personnel.—No person other than a
499 licensed practitioner may engage in the practice of optometry as
500 defined in s. 463.002 s. 463.002(7). Except as provided in this
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 631 2021
501 section, under no circumstances shall nonlicensed supportive
502 personnel be delegated diagnosis or treatment duties; however,
503 such personnel may perform data gathering, preliminary testing,
504 prescribed visual therapy, and related duties under the direct
505 supervision of the licensed practitioner. Nonlicensed personnel,
506 who need not be employees of the licensed practitioner, may
507 perform ministerial duties, tasks, and functions assigned to
508 them by and performed under the general supervision of a
509 licensed practitioner, including obtaining information from
510 consumers for the purpose of making appointments for the
511 licensed practitioner. The licensed practitioner shall be
512 responsible for all delegated acts performed by persons under
513 her or his direct and general supervision.
514 Section 11. Subsection (19) of section 641.31, Florida
515 Statutes, is amended to read:
516 641.31 Health maintenance contracts.—
517 (19) Notwithstanding any other provision of law, health
518 maintenance policies or contracts which provide coverage,
519 benefits, or services as described in s. 463.002 s. 463.002(7),
520 shall offer to the subscriber the services of an optometrist
521 licensed pursuant to chapter 463.
522 Section 12. This act shall take effect July 1, 2021.
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hb0631-00
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 631 (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 Rizo offered the following:
4
5 Amendment (with title amendment)
6 Remove lines 315-495 and insert:
7 (3) Controlled substances for acute pain shall not be
8 administered or prescribed for more than 72 hours without
9 consultation with a physician licensed under chapter 458 or
10 chapter 459 who is skilled in diseases of the eye.
11 (3)(4) A certified optometrist shall be issued a
12 prescriber number by the board. Any prescription written by a
13 certified optometrist for an ocular pharmaceutical agent
14 pursuant to this section shall have the prescriber number
15 printed thereon. A certified optometrist may not administer or
16 prescribe any of the following:
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 631 (2021)
Amendment No. 1
17 (a) A controlled substance listed in Schedule II, Schedule
18 III, Schedule IV, or Schedule V of s. 893.03, except for an oral
19 analgesic placed on the formulary pursuant to this section for
20 the relief of pain due to ocular conditions of the eye and its
21 appendages.
22 (b) A controlled substance for the treatment of chronic
23 nonmalignant pain as defined in s. 456.44(1)(f).
24 Section 5. Section 463.0056, Florida Statutes, is created
25 to read:
26 463.0056 Ophthalmic Procedures.—
27 (1)(a) An optometrist certified in ophthalmic procedures
28 may perform laser and non-laser ophthalmic procedures and
29 therapies as authorized by the board but may not perform an
30 ophthalmic procedure or therapy that requires drug-induced
31 alteration of consciousness or that burns, cuts, or incises the
32 globe of the eye. However, an optometrist certified in
33 ophthalmic procedures may use medication for minimal
34 tranquilization of the patient and local or topical anesthesia
35 if the chances of complications requiring hospitalization of the
36 patient as a result are remote.
37 (b) To be certified to perform ophthalmic procedures, a
38 certified optometrist must first provide proof to the department
39 of successful completion of a course and subsequent examination,
40 approved by the board, on laser and non-laser ophthalmic
41 procedures and therapy. The course and examination shall be
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 631 (2021)
Amendment No. 1
42 developed and offered jointly by a statewide professional
43 association of physicians in this state accredited to provide
44 educational activities designated for the American Medical
45 Association Physician's Recognition Award Category 1 credit and
46 a statewide professional association of licensed practitioners
47 which provides board-approved continuing education on an annual
48 basis. The board shall review and approve the content of the
49 initial course and examination if the board determines that the
50 course and examination adequately and reliably satisfy the
51 criteria set forth in this section. The board shall thereafter
52 annually review and approve the examination if the board
53 determines that the content continues to adequately and reliably
54 satisfy the criteria set forth in this section. Successful
55 completion of the board-approved course and examination may be
56 used by a certified optometrist to satisfy the continuing
57 education requirements in s. 463.007(3) only for the biennial
58 period in which the board-approved course and examination are
59 taken. If a certified optometrist does not complete a board-
60 approved course and examination under this section, the
61 certified optometrist may not perform ophthalmic procedures
62 described in paragraph (a).
63 (2) The following ophthalmic procedures are excluded from
64 the scope of practice of optometry, except for the preoperative
65 and postoperative care of these procedures:
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 631 (2021)
Amendment No. 1
66 (a) Any procedure that burns, cuts, or incises the globe
67 of the eye.
68 (b) Laser vision correction, penetrating keratoplasty, and
69 corneal or lamellar keratoplasty.
70 (c) Laser of the vitreous chamber or retina of the eye to
71 treat any vitreomacular or retinal disease.
72 (d) Surgery of the eyelid for suspected eyelid
73 malignancies or for incisional cosmetic or mechanical repair of
74 blepharochalasis, ptosis, or tarsorrhaphy.
75 (e) Surgery of the boney orbit, including, but not limited
76 to, orbital implants or removal of the human eye.
77 (f) Incisional or excisional surgery of the lacrimal
78 system other than lacrimal probing or related procedures.
79 (g) Surgery requiring full thickness incision or excision
80 of the cornea or sclera other than paracentesis in an emergency
81 situation requiring immediate reduction of elevated pressure
82 inside the eye.
83 (h) Surgery requiring incision or excision by scalpel of
84 the iris and ciliary body, including, but not limited to, iris
85 diathermy or cryotherapy.
86 (i) Surgery requiring incision or excision of the vitreous
87 or retina.
88 (j) Surgery requiring incision or excision of the
89 crystalline lens or an intraocular prosthetic implant.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 631 (2021)
Amendment No. 1
90 (k) Surgery involving incision or excision of the
91 extraocular muscles.
92 (l) Surgery requiring full thickness conjunctivoplasty
93 with graft or flap.
94 (m) Pterygium surgery.
95 (n) Any other procedure or therapy the board deems
96 appropriate.
97 Section 6. Subsection (3) of section 463.0057, Florida
98 Statutes, is amended to read:
99 463.0057 Optometric faculty certificate.—
100 (3) The holder of a faculty certificate may engage in the
101 practice of optometry as permitted by this section but may not
102 administer or prescribe topical ocular pharmaceutical agents
103 unless the certificateholder has satisfied the requirements of
104 s. 463.006(1)(e) and (f). If a certificateholder wishes to
105 administer or prescribe oral ocular pharmaceutical agents, the
106 certificateholder must also satisfy the requirements of s.
107 463.0055(1)(b).
108 Section 7. Section 463.006, Florida Statutes, is amended
109 to read:
110 463.006 Licensure and certification by examination.—
111 (1) Any person desiring to be a certified optometrist
112 licensed practitioner pursuant to this chapter must apply to the
113 department and must submit proof to the department that she or
114 he:
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 631 (2021)
Amendment No. 1
115 (a) Has completed the application forms as required by the
116 board, remitted an application fee for certification not to
117 exceed $250, remitted an examination fee for certification not
118 to exceed $250, and remitted an examination fee for licensure
119 not to exceed $325, all as set by the board.
120 (b) Is at least 18 years of age.
121 (c) Has graduated from an accredited school or college of
122 optometry approved by rule of the board.
123 (d) Is of good moral character.
124 (e) Has successfully completed at least 110 hours of
125 transcript-quality coursework and clinical training in general
126 and ocular pharmacology as determined by the board, at an
127 institution that:
128 1. Has facilities for both didactic and clinical
129 instructions in pharmacology; and
130 2. Is accredited by a regional or professional accrediting
131 organization that is recognized and approved by the Commission
132 on Recognition of Postsecondary Accreditation or the United
133 States Department of Education.
134 (f) Has completed at least 1 year of supervised experience
135 in differential diagnosis of eye disease or disorders as part of
136 the optometric training or in a clinical setting as part of the
137 optometric experience.
138 (2) The board shall approve a licensure examination
139 consisting of the appropriate subjects and including applicable
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 631 (2021)
Amendment No. 1
140 state laws and rules and general and ocular pharmacology with
141 emphasis on the use and side effects of ocular pharmaceutical
142 agents. The board may by rule substitute a national examination
143 as part or all of the examination and, notwithstanding chapter
144 456, may by rule offer a practical examination in addition to a
145 written examination. The board shall determine the required
146 content, grading criteria, and passing score for the licensure
147 examination.
148 (3) Each applicant who submits proof satisfactory to the
149 board that he or she has met the requirements of subsection (1),
150 who successfully passes the licensure examination within 3 years
151 before the date of application or within 3 years after the
152 submission of an application, and who otherwise meets the
153 requirements of this chapter is entitled to be licensed as a
154 certified optometrist practitioner and to be certified to
155 administer and prescribe ocular pharmaceutical agents in the
156 diagnosis and treatment of ocular conditions.
157 Section 8. Subsection (12) is added to section 463.0135,
158 Florida Statutes, to read:
159 463.0135 Standards of practice.—
160 (12) A licensed practitioner who is not a certified
161 optometrist is required to display at her or his place of
162 practice a sign that states, "I am a Licensed Practitioner, not
163 a Certified Optometrist, and I am not able to prescribe ocular
164 pharmaceutical agents or perform ophthalmic procedures."
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 631 (2021)
Amendment No. 1
165 Section 9. Subsection (4) of section 463.014, Florida
166 Statutes, is amended to read:
167 463.014 Certain acts prohibited.—
168 (4) Surgery, except as otherwise provided in this chapter,
169 is of any kind is expressly prohibited. Certified optometrists
170 may remove superficial foreign bodies. For the purposes of this
171 subsection, the term "superficial foreign bodies" means any
172 foreign matter that is embedded in the conjunctiva or cornea but
173 that has not penetrated the globe. Notwithstanding the
174 definition of surgery as provided in s. 463.002(6), a certified
175 optometrist may provide is not prohibited from providing any
176 optometric care within the practice of optometry as defined in
177 s. 463.002(7), including, but not limited to, such as removing
178 an eyelash by epilation, probing an uninflamed tear duct in a
179 patient 18 years of age or older, blocking the puncta by plug,
180 or superficial scraping for the purpose of removing damaged
181 epithelial tissue or superficial foreign bodies or taking a
182 culture of the surface of the cornea or conjunctiva.
183
184 -----------------------------------------------------
185 T I T L E A M E N D M E N T
186 Remove lines 48-56 and insert:
187 requiring licensed practitioners who are not certified
188 optometrists to display in their practices a sign containing
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 631 (2021)
Amendment No. 1
189 specified information; amending s. 463.014, F.S.; revising a
190 prohibition on
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HB 805
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 805 Volunteer Ambulance Services
SPONSOR(S): Caruso and others
TIED BILLS: IDEN./SIM. BILLS: SB 1084
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Guzzo McElroy
2) Local Administration & Veterans Affairs
Subcommittee
3) Tourism, Infrastructure & Energy Subcommittee
4) Health & Human Services Committee
SUMMARY ANALYSIS
Prehospital life support transport services fall into two general categories – basic life support services (BLS)
and advanced life support services (ALS). The Department of Health (DOH) licenses basic life support (BLS)
service providers, advanced life support (ALS) service providers and air ambulances. To obtain a transport
vehicle permit to provide BLS or ALS services, an applicant must meet the minimum standards regarding
equipment, vehicles, personnel, services, and insurance established by the DOH. However, BLS and ALS
service providers must also obtain a Certificate of Public Convenience and Necessity (COPCN) from the
governing board of each county in which the provider plans to operate.
The “Florida Uniform Traffic Control Law” permits the drivers of certain authorized emergency vehicles to
disregard specified traffic laws and ordinances and use emergency lights and sirens while responding to an
emergency. The authorized emergency vehicles include vehicles of a fire department, police department, and
ambulance and emergency vehicles of municipal and county departments, public service corporations
operated by private corporations, and certain state agencies. Current law does not recognize an ambulance
providing volunteer ambulance services as an authorized emergency vehicle.
HB 805 exempts certain faith-based volunteer first responder agencies that have operated for at least 10
consecutive years from the certificate of public convenience and necessity requirements. The bill prohibits a
county or municipal government from limiting, prohibiting, or preventing a volunteer ambulance service from
responding to an emergency or providing emergency medical services or transport within its jurisdiction. The
bill also prohibits a county or municipal government from requiring a volunteer ambulance service to obtain a
license or certificate or pay a fee to provide ambulance or air ambulance services within its jurisdiction.
The bill allows a volunteer ambulance services vehicle that qualifies as an authorized emergency vehicle to
disregard specified traffic laws and ordinances and use emergency lights and sirens while responding to an
emergency. The bill also allows a medical staff physician or technician of a volunteer ambulance service to
disregard specified traffic laws and ordinances and use red lights in their privately owned vehicles when
responding to an emergency in the line of duty.
The bill declares that it is in the public interest to foster the development of emergency medical services that
address religious sensitivities and to recognize the value of augmenting existing county and municipal
emergency medical services with those provided by volunteer service organizations.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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DATE: 3/22/2021
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
Certificate of Public Convenience and Necessity
A Certificate of Public Convenience and Necessity (COPCN) is a written statement, issued by the
governing board of a county, granting permission for an emergency medical service provider to provide
authorized services for the benefit of the population of that county or the benefit of the population of
some geographic area of that county. 7 At the time of licensure, each provider of life support
transportation services must have a COPCN from each county in which the provider intends to
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 Rule 64J-1.001(2), F.A.C.
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operate. 8 Section 401.25(6), F.S., authorizes, but does not require, counties to adopt ordinances
establishing standards for issuing a COPCN.
Emergency Vehicles
Chapter 316, F.S., provides uniform traffic laws and ordinances applicable throughout the state and is
titled the “Florida Uniform Traffic Control Law”. The law permits the drivers of certain authorized
emergency vehicles to disregard specified traffic laws and ordinances and use emergency lights and
sirens while responding to an emergency. The authorized emergency vehicles include vehicles of a fire
department, police department, and ambulance and emergency vehicles of: 9
• Municipal and county departments;
• Public service corporations operated by private corporations;
• The Fish and Wildlife Conservation Commission;
• The Department of Environmental Protection;
• The Department of Health;
• The Department of Transportation; and
• The Department of Corrections.
Red or red and white lights may be shown or displayed by vehicles of the fire department and fire
patrol, and by a privately owned vehicle belonging to a member of a regularly organized volunteer
firefighting company or association, while on their way to the scene of a fire or other emergency in the
line of duty. 10
Red lights may be shown or displayed by privately owned vehicles of medical staff physicians or
technicians of medical facilities licensed by the state while responding to an emergency in the line of
duty, certain ambulances, and certain buses and taxicabs. 11
Section 316.072(5), F.S., permits the drivers of certain vehicles to disregard specified traffic laws and
ordinances while responding to an emergency, including:
• The driver of an authorized emergency vehicle when responding to an emergency call, when in
the pursuit of an actual or suspected violator of the law, or when responding to a fire alarm, but
not upon returning from a fire;
• A medical staff physician or technician of a licensed medical facility when responding to an
emergency in the line of duty in his or her privately owned vehicle, using red lights;
• The driver of an authorized law enforcement vehicle, when conducting a nonemergency escort,
to warn the public of an approaching motorcade.
The driver of a vehicle described above, unless otherwise directed by a police officer may:
• Park or stand, regardless of traffic laws and ordinances;
• Proceed past a red light or stop sign, but only after slowing down as may be necessary for safe
operation;
• Exceed the maximum speed limits so long as the driver does not endanger life or property; and
• Disregard regulations governing direction or movement or turning in specified directions, as long
as the driver does not endanger life or property.
Current law does not recognize an ambulance providing volunteer ambulance services as an
authorized emergency vehicle.
Effect of the Bill
8 Section 401.25(2)(d), F.S.
9 Section 316.003(1), F.S.
10 Section 316.2398(1), F.S.
11 Id.
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HB 805 exempts certain faith-based volunteer first responder agencies that have operated for at least
10 consecutive years from the certificate of public convenience and necessity requirements. The bill
prohibits a county or municipal government from limiting, prohibiting, or preventing a volunteer
ambulance service from responding to an emergency or providing emergency medical services or
transport within its jurisdiction. The bill also prohibits a county or municipal government from requiring a
volunteer ambulance service to obtain a license or certificate or pay a fee to provide ambulance or air
ambulance services within its jurisdiction.
The bill allows a volunteer ambulance services vehicle that qualifies as an authorized emergency
vehicle to disregard specified traffic laws and ordinances and use emergency lights and sirens while
responding to an emergency. The bill also allows a medical staff physician or technician of a volunteer
ambulance service to disregard specified traffic laws and ordinances and use red lights in their privately
owned vehicles when responding to an emergency in the line of duty.
The bill declares that it is in the public interest to foster the development of emergency medical services
that address religious sensitivities and to recognize the value of augmenting existing county and
municipal emergency medical services with those provided by volunteer service organizations.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 316.003, F.S., relating to definitions.
Section 2: Amends s. 316.072, F.S., relating to obedience to and effect of traffic laws.
Section 3: Amends s. 316.2397, F.S., relating to certain lights prohibited; exceptions.
Section 4: Amends s. 316.2398, F.S., relating to display or use of red or red and white warning
signals; motor vehicles of volunteer firefighters or medical staff.
Section 5: Amends s. 401.211, F.S., relating to legislative intent.
Section 6: Amends s. 401.23, F.S., relating to definitions.
Section 7: Amends s. 401.25, F.S., relating to licensure as a basic life support or an advanced life
support service.
Section 8: Amends s. 316.306, F.S., relating to school and work zones; prohibition on the use of a
wireless communications device in a handheld manner.
Section 9: 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.
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B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
No additional rule-making authority is necessary to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
The bill may present challenges for a county or municipal government (especially during a disaster or
mass casualty event) because a volunteer ambulance service is not required to report to or
communicate with the county or municipal government. The county or municipal government would
have no ability to respond or control the scene in terms of traffic management and staging areas.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 805 2021
1 A bill to be entitled
2 An act relating to volunteer ambulance services;
3 amending s. 316.003, F.S.; revising the definition of
4 the term "authorized emergency vehicles" and defining
5 the term "volunteer ambulance service"; amending s.
6 316.072, F.S.; authorizing certain medical staff of a
7 volunteer ambulance service to use red lights on a
8 privately owned vehicle under certain circumstances;
9 amending s. 316.2397, F.S.; authorizing vehicles of
10 volunteer ambulance services to show or display red
11 lights and operate emergency lights and sirens under
12 certain circumstances; amending s. 316.2398, F.S.;
13 authorizing privately owned vehicles belonging to
14 certain medical staff of a volunteer ambulance service
15 to display or use red warning signals under certain
16 circumstances; conforming a provision to changes made
17 by the act; prohibiting certain medical staff of
18 volunteer ambulance services from operating red
19 warning signals when not responding to an emergency in
20 the line of duty; amending s. 401.211, F.S.; revising
21 legislative intent; amending s. 401.23, F.S.; defining
22 the terms "volunteer ambulance service" and "volunteer
23 first responder agency"; amending s. 401.25, F.S.;
24 exempting volunteer first responder agencies from
25 certificate of public convenience and necessity
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HB 805 2021
26 requirements; providing that county and municipal
27 governments may not limit, prohibit, or prevent
28 volunteer ambulance services from responding to
29 emergencies or providing emergency medical services or
30 transport within their respective jurisdictions;
31 prohibiting county and municipal governments from
32 requiring volunteer ambulance services to obtain a
33 license or certificate or pay a fee to provide
34 ambulance or air ambulance services within their
35 respective jurisdictions, with an exception; amending
36 s. 316.306, F.S.; conforming a cross-reference;
37 providing an effective date.
38
39 Be It Enacted by the Legislature of the State of Florida:
40
41 Section 1. Present subsection (105) of section 316.003,
42 Florida Statutes, is redesignated as subsection (106), a new
43 subsection (105) is added to that section, and subsection (1) of
44 that section is amended, to read:
45 316.003 Definitions.—The following words and phrases, when
46 used in this chapter, shall have the meanings respectively
47 ascribed to them in this section, except where the context
48 otherwise requires:
49 (1) AUTHORIZED EMERGENCY VEHICLES.—Vehicles of the fire
50 department (fire patrol), police vehicles, and such ambulances
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HB 805 2021
51 and emergency vehicles of municipal departments, volunteer
52 ambulance services, public service corporations operated by
53 private corporations, the Fish and Wildlife Conservation
54 Commission, the Department of Environmental Protection, the
55 Department of Health, the Department of Transportation, and the
56 Department of Corrections as are designated or authorized by
57 their respective departments department or the chief of police
58 of an incorporated city or any sheriff of any of the various
59 counties.
60 (105) VOLUNTEER AMBULANCE SERVICE.—A faith-based, not-for-
61 profit corporation registered under chapter 617 which is
62 licensed by the department as a basic life support service or an
63 advanced life support service and which has no for-profit
64 subsidiaries, uses volunteers to provide services, is not
65 operating for pecuniary profit or financial gain, and does not
66 distribute to or inure to the benefit of its directors, members,
67 or officers any part of its assets or income.
68 Section 2. Paragraph (a) of subsection (5) of section
69 316.072, Florida Statutes, is amended to read:
70 316.072 Obedience to and effect of traffic laws.—
71 (5) AUTHORIZED EMERGENCY VEHICLES.—
72 (a)1. The driver of an authorized emergency vehicle, when
73 responding to an emergency call, when in the pursuit of an
74 actual or suspected violator of the law, or when responding to a
75 fire alarm, but not upon returning from a fire;
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76 2. A medical staff physician or technician of a medical
77 facility or a volunteer ambulance service licensed by the state
78 when responding to an emergency in the line of duty in his or
79 her privately owned vehicle, using red lights as authorized in
80 s. 316.2398; or
81 3. The driver of an authorized law enforcement vehicle,
82 when conducting a nonemergency escort, to warn the public of an
83 approaching motorcade;
84
85 may exercise the privileges set forth in this section, but
86 subject to the conditions herein stated.
87 Section 3. Subsection (3) of section 316.2397, Florida
88 Statutes, is amended to read:
89 316.2397 Certain lights prohibited; exceptions.—
90 (3) Vehicles of the fire department and fire patrol,
91 including vehicles of volunteer firefighters as permitted under
92 s. 316.2398, may show or display red or red and white lights.
93 Vehicles of medical staff physicians or technicians of medical
94 facilities or volunteer ambulance services licensed by the state
95 as authorized under s. 316.2398, ambulances as authorized under
96 this chapter, and buses and taxicabs as authorized under s.
97 316.2399 may show or display red lights. Vehicles of the fire
98 department, fire patrol, police vehicles, and such ambulances
99 and emergency vehicles of municipal and county departments,
100 volunteer ambulance services, public service corporations
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101 operated by private corporations, the Fish and Wildlife
102 Conservation Commission, the Department of Environmental
103 Protection, the Department of Transportation, the Department of
104 Agriculture and Consumer Services, and the Department of
105 Corrections as are designated or authorized by their respective
106 department or the chief of police of an incorporated city or any
107 sheriff of any county may operate emergency lights and sirens in
108 an emergency. Wreckers, mosquito control fog and spray vehicles,
109 and emergency vehicles of governmental departments or public
110 service corporations may show or display amber lights when in
111 actual operation or when a hazard exists provided they are not
112 used going to and from the scene of operation or hazard without
113 specific authorization of a law enforcement officer or law
114 enforcement agency. Wreckers must use amber rotating or flashing
115 lights while performing recoveries and loading on the roadside
116 day or night, and may use such lights while towing a vehicle on
117 wheel lifts, slings, or under reach if the operator of the
118 wrecker deems such lights necessary. A flatbed, car carrier, or
119 rollback may not use amber rotating or flashing lights when
120 hauling a vehicle on the bed unless it creates a hazard to other
121 motorists because of protruding objects. Further, escort
122 vehicles may show or display amber lights when in the actual
123 process of escorting overdimensioned equipment, material, or
124 buildings as authorized by law. Vehicles owned or leased by
125 private security agencies may show or display green and amber
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126 lights, with either color being no greater than 50 percent of
127 the lights displayed, while the security personnel are engaged
128 in security duties on private or public property.
129 Section 4. Subsections (1), (2), and (4) of section
130 316.2398, Florida Statutes, are amended to read:
131 316.2398 Display or use of red or red and white warning
132 signals; motor vehicles of volunteer firefighters or medical
133 staff.—
134 (1) A privately owned vehicle belonging to an active
135 firefighter member of a regularly organized volunteer
136 firefighting company or association, while en route to the fire
137 station for the purpose of proceeding to the scene of a fire or
138 other emergency or while en route to the scene of a fire or
139 other emergency in the line of duty as an active firefighter
140 member of a regularly organized firefighting company or
141 association, may display or use red or red and white warning
142 signals. A privately owned vehicle belonging to a medical staff
143 physician or technician of a medical facility or a volunteer
144 ambulance service licensed by the state, while responding to an
145 emergency in the line of duty, may display or use red warning
146 signals. Warning signals must be visible from the front and from
147 the rear of such vehicle, subject to the following restrictions
148 and conditions:
149 (a) No more than two red or red and white warning signals
150 may be displayed.
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151 (b) No inscription of any kind may appear across the face
152 of the lens of the red or red and white warning signal.
153 (c) In order for an active volunteer firefighter to
154 display such red or red and white warning signals on his or her
155 vehicle, the volunteer firefighter must first secure a written
156 permit from the chief executive officers of the firefighting
157 organization to use the red or red and white warning signals,
158 and this permit must be carried by the volunteer firefighter at
159 all times while the red or red and white warning signals are
160 displayed.
161 (2) A person who is not an active firefighter member of a
162 regularly organized volunteer firefighting company or
163 association or a physician or technician of the medical staff of
164 a medical facility or a volunteer ambulance service licensed by
165 the state may not display on any motor vehicle owned by him or
166 her, at any time, any red or red and white warning signals as
167 described in subsection (1).
168 (4) A physician or technician of the medical staff of a
169 medical facility or a volunteer ambulance service may not
170 operate any red warning signals as authorized in subsection (1),
171 except when responding to an emergency in the line of duty.
172 Section 5. Section 401.211, Florida Statutes, is amended
173 to read:
174 401.211 Legislative intent.—The Legislature recognizes
175 that the systematic provision of emergency medical services
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176 saves lives and reduces disability associated with illness and
177 injury. In addition, that system of care must be equally capable
178 of assessing, treating, and transporting children, adults, and
179 frail elderly persons. Further, it is the intent of the
180 Legislature to encourage the development and maintenance of
181 emergency medical services because such services are essential
182 to the health and well-being of all citizens of the state. The
183 Legislature finds that it is in the public interest to foster
184 the development of emergency medical services that address
185 religious sensitivities. In accordance with the Florida
186 Volunteer and Community Service Act of 2001, the Legislature
187 further recognizes the value of augmenting existing county and
188 municipal emergency medical services with those provided by
189 volunteer service organizations. The Legislature also recognizes
190 that the establishment of a comprehensive statewide injury-
191 prevention program supports state and community health systems
192 by further enhancing the total delivery system of emergency
193 medical services and reduces injuries for all persons. The
194 purpose of this part is to protect and enhance the public
195 health, welfare, and safety through the establishment of an
196 emergency medical services state plan, an advisory council, a
197 comprehensive statewide injury-prevention program, minimum
198 standards for emergency medical services personnel, vehicles,
199 services and medical direction, and the establishment of a
200 statewide inspection program created to monitor the quality of
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201 patient care delivered by each licensed service and
202 appropriately certified personnel.
203 Section 6. Subsections (22) and (23) are added to section
204 401.23, Florida Statutes, to read:
205 401.23 Definitions.—As used in this part, the term:
206 (22) "Volunteer ambulance service" means a faith-based,
207 not-for-profit corporation registered under chapter 617 which is
208 licensed by the department as a basic life support service or an
209 advanced life support service and which has no for-profit
210 subsidiaries, uses volunteers to provide services, is not
211 operating for pecuniary profit or financial gain, and does not
212 distribute to or inure to the benefit of its directors, members,
213 or officers any part of its assets or income.
214 (23) "Volunteer first responder agency" means a first
215 responder agency as defined in s. 401.435(2) which is a faith-
216 based, not-for-profit corporation registered under chapter 617,
217 has been operating in this state for at least 10 consecutive
218 years, has no for-profit subsidiaries, uses volunteers to
219 provide services, is not operating for pecuniary profit or
220 financial gain, and does not distribute to or inure to the
221 benefit of its directors, members, or officers any part of its
222 assets or income.
223 Section 7. Paragraph (d) of subsection (2) and subsection
224 (6) of section 401.25, Florida Statutes, are amended to read:
225 401.25 Licensure as a basic life support or an advanced
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226 life support service.—
227 (2) The department shall issue a license for operation to
228 any applicant who complies with the following requirements:
229 (d) The applicant has obtained a certificate of public
230 convenience and necessity from each county in which the
231 applicant will operate. In issuing the certificate of public
232 convenience and necessity, the governing body of each county
233 shall consider the recommendations of municipalities within its
234 jurisdiction. An applicant that is a volunteer first responder
235 agency is exempt from this requirement.
236 (6)(a) The governing body of each county may adopt
237 ordinances that provide reasonable standards for certificates of
238 public convenience and necessity for basic or advanced life
239 support services and air ambulance services. In developing
240 standards for certificates of public convenience and necessity,
241 the governing body of each county must consider state
242 guidelines, recommendations of the local or regional trauma
243 agency created under chapter 395, and the recommendations of
244 municipalities within its jurisdiction.
245 (b) A county or municipal government may not limit,
246 prohibit, or prevent a volunteer ambulance service from
247 responding to an emergency or from providing emergency medical
248 services or transport within its jurisdiction.
249 (c) A county or municipal government may not require a
250 volunteer ambulance service to obtain a license or certificate
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251 or pay a fee to provide ambulance or air ambulance services
252 within its jurisdiction, except that a county or municipal
253 government may impose, collect, or enforce payment of any
254 occupational license tax authorized by law.
255 Section 8. Paragraph (a) of subsection (3) of section
256 316.306, Florida Statutes, is amended to read:
257 316.306 School and work zones; prohibition on the use of a
258 wireless communications device in a handheld manner.—
259 (3)(a)1. A person may not operate a motor vehicle while
260 using a wireless communications device in a handheld manner in a
261 designated school crossing, school zone, or work zone area as
262 defined in s. 316.003(106) s. 316.003(105). This subparagraph
263 shall only be applicable to work zone areas if construction
264 personnel are present or are operating equipment on the road or
265 immediately adjacent to the work zone area. For the purposes of
266 this paragraph, a motor vehicle that is stationary is not being
267 operated and is not subject to the prohibition in this
268 paragraph.
269 2.a. During the period from October 1, 2019, through
270 December 31, 2019, a law enforcement officer may stop motor
271 vehicles to issue verbal or written warnings to persons who are
272 in violation of subparagraph 1. for the purposes of informing
273 and educating such persons of this section. This sub-
274 subparagraph shall stand repealed on October 1, 2020.
275 b. Effective January 1, 2020, a law enforcement officer
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276 may stop motor vehicles and issue citations to persons who are
277 driving while using a wireless communications device in a
278 handheld manner in violation of subparagraph 1.
279 Section 9. This act shall take effect July 1, 2021.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 805 (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 Caruso offered the following:
4
5 Amendment
6 Remove lines 62-235 and insert:
7 licensed under part III of chapter 401 as a basic life support
8 service or an advanced life support service and which has no
9 for-profit subsidiaries, uses volunteers to provide services, is
10 not operating for pecuniary profit or financial gain, and does
11 not distribute to or inure to the benefit of its directors,
12 members, or officers any part of its assets or income.
13 Section 2. Paragraph (a) of subsection (5) of section
14 316.072, Florida Statutes, is amended to read:
15 316.072 Obedience to and effect of traffic laws.—
16 (5) AUTHORIZED EMERGENCY VEHICLES.—
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 805 (2021)
Amendment No. 1
17 (a)1. The driver of an authorized emergency vehicle, when
18 responding to an emergency call, when in the pursuit of an
19 actual or suspected violator of the law, or when responding to a
20 fire alarm, but not upon returning from a fire;
21 2. A medical staff physician or technician of a medical
22 facility licensed by the state or of a volunteer ambulance
23 service when responding to an emergency in the line of duty in
24 his or her privately owned vehicle, using red lights as
25 authorized in s. 316.2398; or
26 3. The driver of an authorized law enforcement vehicle,
27 when conducting a nonemergency escort, to warn the public of an
28 approaching motorcade;
29
30 may exercise the privileges set forth in this section, but
31 subject to the conditions herein stated.
32 Section 3. Subsection (3) of section 316.2397, Florida
33 Statutes, is amended to read:
34 316.2397 Certain lights prohibited; exceptions.—
35 (3) Vehicles of the fire department and fire patrol,
36 including vehicles of volunteer firefighters as permitted under
37 s. 316.2398, may show or display red or red and white lights.
38 Vehicles of medical staff physicians or technicians of medical
39 facilities licensed by the state or of volunteer ambulance
40 services as authorized under s. 316.2398, ambulances as
41 authorized under this chapter, and buses and taxicabs as
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 805 (2021)
Amendment No. 1
42 authorized under s. 316.2399 may show or display red lights.
43 Vehicles of the fire department, fire patrol, police vehicles,
44 and such ambulances and emergency vehicles of municipal and
45 county departments, volunteer ambulance services, public service
46 corporations operated by private corporations, the Fish and
47 Wildlife Conservation Commission, the Department of
48 Environmental Protection, the Department of Transportation, the
49 Department of Agriculture and Consumer Services, and the
50 Department of Corrections as are designated or authorized by
51 their respective department or the chief of police of an
52 incorporated city or any sheriff of any county may operate
53 emergency lights and sirens in an emergency. Wreckers, mosquito
54 control fog and spray vehicles, and emergency vehicles of
55 governmental departments or public service corporations may show
56 or display amber lights when in actual operation or when a
57 hazard exists provided they are not used going to and from the
58 scene of operation or hazard without specific authorization of a
59 law enforcement officer or law enforcement agency. Wreckers must
60 use amber rotating or flashing lights while performing
61 recoveries and loading on the roadside day or night, and may use
62 such lights while towing a vehicle on wheel lifts, slings, or
63 under reach if the operator of the wrecker deems such lights
64 necessary. A flatbed, car carrier, or rollback may not use amber
65 rotating or flashing lights when hauling a vehicle on the bed
66 unless it creates a hazard to other motorists because of
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Bill No. HB 805 (2021)
Amendment No. 1
67 protruding objects. Further, escort vehicles may show or display
68 amber lights when in the actual process of escorting
69 overdimensioned equipment, material, or buildings as authorized
70 by law. Vehicles owned or leased by private security agencies
71 may show or display green and amber lights, with either color
72 being no greater than 50 percent of the lights displayed, while
73 the security personnel are engaged in security duties on private
74 or public property.
75 Section 4. Subsections (1), (2), and (4) of section
76 316.2398, Florida Statutes, are amended to read:
77 316.2398 Display or use of red or red and white warning
78 signals; motor vehicles of volunteer firefighters or medical
79 staff.—
80 (1) A privately owned vehicle belonging to an active
81 firefighter member of a regularly organized volunteer
82 firefighting company or association, while en route to the fire
83 station for the purpose of proceeding to the scene of a fire or
84 other emergency or while en route to the scene of a fire or
85 other emergency in the line of duty as an active firefighter
86 member of a regularly organized firefighting company or
87 association, may display or use red or red and white warning
88 signals. A privately owned vehicle belonging to a medical staff
89 physician or technician of a medical facility licensed by the
90 state or of a volunteer ambulance service, while responding to
91 an emergency in the line of duty, may display or use red warning
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Bill No. HB 805 (2021)
Amendment No. 1
92 signals. Warning signals must be visible from the front and from
93 the rear of such vehicle, subject to the following restrictions
94 and conditions:
95 (a) No more than two red or red and white warning signals
96 may be displayed.
97 (b) No inscription of any kind may appear across the face
98 of the lens of the red or red and white warning signal.
99 (c) In order for an active volunteer firefighter to
100 display such red or red and white warning signals on his or her
101 vehicle, the volunteer firefighter must first secure a written
102 permit from the chief executive officers of the firefighting
103 organization to use the red or red and white warning signals,
104 and this permit must be carried by the volunteer firefighter at
105 all times while the red or red and white warning signals are
106 displayed.
107 (2) A person who is not an active firefighter member of a
108 regularly organized volunteer firefighting company or
109 association or a physician or technician of the medical staff of
110 a medical facility licensed by the state or of a volunteer
111 ambulance service may not display on any motor vehicle owned by
112 him or her, at any time, any red or red and white warning
113 signals as described in subsection (1).
114 (4) A physician or technician of the medical staff of a
115 medical facility licensed by the state or of a volunteer
116 ambulance service may not operate any red warning signals as
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Bill No. HB 805 (2021)
Amendment No. 1
117 authorized in subsection (1), except when responding to an
118 emergency in the line of duty.
119 Section 5. Section 401.211, Florida Statutes, is amended
120 to read:
121 401.211 Legislative intent.—The Legislature recognizes
122 that the systematic provision of emergency medical services
123 saves lives and reduces disability associated with illness and
124 injury. In addition, that system of care must be equally capable
125 of assessing, treating, and transporting children, adults, and
126 frail elderly persons. Further, it is the intent of the
127 Legislature to encourage the development and maintenance of
128 emergency medical services because such services are essential
129 to the health and well-being of all citizens of the state. The
130 Legislature finds that it is in the public interest to foster
131 the development of emergency medical services that address
132 religious sensitivities. In accordance with the Florida
133 Volunteer and Community Service Act of 2001, the Legislature
134 further recognizes the value of augmenting existing county and
135 municipal emergency medical services with those provided by
136 volunteer service organizations. The Legislature also recognizes
137 that the establishment of a comprehensive statewide injury-
138 prevention program supports state and community health systems
139 by further enhancing the total delivery system of emergency
140 medical services and reduces injuries for all persons. The
141 purpose of this part is to protect and enhance the public
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Bill No. HB 805 (2021)
Amendment No. 1
142 health, welfare, and safety through the establishment of an
143 emergency medical services state plan, an advisory council, a
144 comprehensive statewide injury-prevention program, minimum
145 standards for emergency medical services personnel, vehicles,
146 services and medical direction, and the establishment of a
147 statewide inspection program created to monitor the quality of
148 patient care delivered by each licensed service and
149 appropriately certified personnel.
150 Section 6. Subsection (22) is added to section 401.23,
151 Florida Statutes, to read:
152 401.23 Definitions.—As used in this part, the term:
153 (22) "Volunteer ambulance service" means a faith-based,
154 not-for-profit corporation registered under chapter 617 which is
155 licensed by the department as a basic life support service or an
156 advanced life support service, is not a parent, subsidiary or
157 affiliate of, or related to any for-profit entity, and which
158 uses only unpaid volunteers to provide services, is not
159 operating for pecuniary profit or financial gain, and does not
160 distribute to or inure to the benefit of its directors,
161 volunteers, members, or officers, any part of its assets or
162 income.
163 Section 7. Paragraph (d) of subsection (2) and subsection
164 (6) of section 401.25, Florida Statutes, are amended to read:
165 401.25 Licensure as a basic life support or an advanced
166 life support service.—
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Bill No. HB 805 (2021)
Amendment No. 1
167 (2) The department shall issue a license for operation to
168 any applicant who complies with the following requirements:
169 (d) The applicant has obtained a certificate of public
170 convenience and necessity from each county in which the
171 applicant will operate. In issuing the certificate of public
172 convenience and necessity, the governing body of each county
173 shall consider the recommendations of municipalities within its
174 jurisdiction. An applicant that is a first responder agency is
175 exempt from this requirement if it is a faith-based, not-for-
176 profit corporation registered under chapter 617 which has been
177 operating in this state for at least 10 consecutive years, has
178 no for-profit subsidiaries, uses volunteers to provide services,
179 is not operating for pecuniary profit or financial gain, and
180 does not distribute to or inure to the benefit of its directors,
181 members, or officers any part of its assets or income.
182 (6)(a) The governing body of each county may adopt
183 ordinances that provide reasonable standards for certificates of
184 public convenience and necessity for basic or advanced life
185 support services and air ambulance services. In developing
186 standards for certificates of public convenience and necessity,
187 the governing body of each county must consider state
188 guidelines, recommendations of the local or regional trauma
189 agency created under chapter 395, and the recommendations of
190 municipalities within its jurisdiction.
191
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HB 1373
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1373 Rare Disease Advisory Council
SPONSOR(S): DuBose
TIED BILLS: IDEN./SIM. BILLS: CS/HB 1373
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Rahming McElroy
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
In the United States (U.S), a rare disease is any condition that nationally affects fewer than 200,000 people.
There may be as many as 7,000 rare diseases impacting the lives of 25-30 million Americans and their
families. This estimate has been used by the rare disease community for several decades to highlight that
while individual diseases may be rare, the total number of people with a rare disease is large.
The National Organization for Rare Disorders, a non-profit patient advocacy organization dedicated to
individuals with rare diseases and the organizations that serve them, is working to establish a Rare Disease
Advisory Council (RDAC) in every state. Currently, 16 states have successfully established RDACs, but Florida
is not one of them.
HB 1373 creates the Rare Disease Advisory Council (Council) adjunct to the Department of Health (DOH). The
bill establishes the membership of the Council as well as the length of the members’ terms. The Council is
required to:
• Consult with experts on rare diseases and solicit public comment to assist in developing
recommendations on improving the treatment of rare diseases in this state.
• Develop recommended strategies for academic research institutions in this state to facilitate
continued research on rare diseases.
• Develop recommended strategies for health care providers to be informed on how to more
efficiently recognize and diagnose rare diseases in order to effectively treat patients.
• Provide written input and feedback to the DOH, the Medicaid program, and other state agencies on
specified matters.
HB 1373 requires the Council to first meet on October 1, 2021, and provide its recommendations to the
Governor and the State Surgeon General by July 1 of each year, beginning in 2022.
The bill has a significant, negative fiscal impact on the DOH. See Fiscal Comments.
The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Rare Disease
In the United States (U.S), a rare disease is any condition that nationally affects fewer than 200,000
people. 1 There may be as many as 7,000 rare diseases impacting the lives of 25-30 million Americans
and their families. 2 This estimate has been used by the rare disease community for several decades to
highlight that while individual diseases may be rare, the total number of people with a rare disease is
large. 3
Nationally, only a few types of rare diseases are tracked when a person is diagnosed. 4 These include
certain infectious diseases, birth defects, and cancers. It also includes the diseases on state newborn
screening tests. 5 Because most rare diseases are not tracked, it is difficult to determine the exact
number of rare diseases or how many people are affected. Researchers have made progress in
learning how to diagnose, treat, and even prevent a variety of rare diseases, however, most rare
diseases have no treatments. 6
The National Institutes of Health (NIH) supports research to improve the health of people with rare
diseases. 7 Many of the 27 Institutes and Centers at the NIH fund medical research for rare diseases,
such as the National Center for Advancing Translational Sciences (NCATS), which focuses on getting
new cures and treatments to all patients more quickly. 8 NCATS supports research through
collaborative projects to study common themes and causes of related diseases. 9 This approach aims to
speed the development of treatments that will eventually serve both rare and common diseases. 10
Efforts to improve and bring to market treatments for rare diseases are coordinated by the Food and
Drug Administration. 11 The Office of Orphan Products Development (OOPD) provides incentives for
drug companies to develop treatments for rare diseases. 12 Between 1973 and 1983, fewer than 10
treatments for rare diseases were approved. 13 Since 1983, the OOPD program has helped develop and
bring to market more than 400 drugs and biologic products for rare diseases. 14
Rare Disease Advisory Council
The National Organization for Rare Disorders (NORD), a non-profit patient advocacy organization
dedicated to individuals with rare diseases and the organizations that serve them, is working to
establish a Rare Disease Advisory Council (RDAC) in every state. An RDAC is an advisory body
providing a platform for the rare disease community to have a stronger voice in state government. 15
1 U.S. Department of Health & Human Services, National Institutes of Health (NIH), FAQs About Rare Diseases,
https://rarediseases.info.nih.gov/diseases/pages/31/faqs-about-rare-
diseases#:~:text=In%20the%20United%20States%2C%20only,on%20state%20newborn%20screening%20tests. (last visited Mar. 18,
2021).
2 Id.
3 Id.
4 Id.
5 Id.
6 Id.
7 National Organization for Rare Diseases (NORD), Rare Disease Advisory Councils (RDACs): Project RDAC,
https://rarediseases.org/rdac-overview/ (last visited Mar. 18, 2021).
8 Id.
9 Id.
10 Id.
11 Id.
12 Id.
13 Id.
14 Id.
15 National Organization for Rare Diseases (NORD), Rare Disease Advisory Councils (RDACs): Project RDAC,
https://rarediseases.org/rdac-overview/ (last visited Mar. 18, 2021).
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RDACs address the needs of affected patients and families by giving stakeholders an opportunity to
make recommendations to state leaders on critical issues including the need for increased awareness,
diagnostic tools and access to affordable treatments and cures. 16 These councils are housed by a
variety of organizations including departments of health, outside nonprofits, universities or grantees
from departments of health. The types of RDACs include councils, task forces, advisory commissions,
or work groups.
Through the support of the NORD, alongside patient organizations and the other members of the rare
disease community, momentum around RDACs is growing. In 2015, the first RDAC was created in
North Carolina by patients, caregivers, families and providers. 17 Currently, there are 16 states with
RDACs and 13 states with RDAC formation in progress: 18
RDACs by State
Advisory Councils in Florida
In Florida, a statutorily created advisory council is appointed to function on a continuing basis for the
study of the problems arising in a specified functional or program area of state government and to
provide recommendations and policy alternatives 19. An advisory council specifically created as an
adjunct to an executive agency is created only after being found to be necessary and beneficial to the
furtherance of a public purpose and must be terminated by the Legislature when it is no longer
necessary. 20
16 Id.
17 Id.
18 NORD, RDACs by State, https://rarediseases.org/rdac-overview/rdacs-by-state/ (last visited Mar. 18, 2021).
19 S. 20.03(7), F.S.
20 S. 20.052, F.S.
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Under current law, an advisory body may not be created unless: 21
• It meets a statutorily defined purpose;
• Its powers and responsibilities conform with the definitions for specified governmental units;
• Its members, unless expressly provided otherwise in the State Constitution, are appointed for
four-year staggered terms; and
• Its members, unless expressly provided otherwise by specific statutory enactment, serve
without additional compensation or honorarium, and are authorized to receive only per diem and
reimbursement for travel expenses as provided in s. 112.061, F.S.
Private citizen members of an advisory body that is adjunct to an executive agency must be appointed
by the Governor, the head of the department, the executive director of the department, or a Cabinet
officer. 22 Unless exempt under law, all advisory council meetings are open to the public under s.
286.011, F.S., and minutes, including a record of all votes cast, must be maintained for all meetings. 23
If an advisory council adjunct to an executive agency is abolished, its records must be appropriately
stored, within 30 days after the effective date of its abolition, by the executive agency to which it was
adjunct, and any property assigned to it must be reclaimed by the executive agency. 24 An advisory
council is prohibited from performing any activities after the effective date of its abolition. 25
Florida currently does not have an RDAC. However, the Department of Health (DOH) supports existing
councils to promote engagement with stakeholders regarding disabilities and development delays: 26
• The Genetics and Newborn Screening Advisory Council.
o This council includes a large array of expertise ranging from pediatricians, audiologists,
representatives from each of the four medical schools in this state, pediatric
hematologist, the Florida Hospital Association, as well as executive representation from
the DOH.
• The Florida Interagency Coordinating Council for Infants and Toddlers.
o This council advises and assists the Early Steps program with its implementation of the
Individuals with Disabilities Education Act, Part C, and includes representation from
public and private providers, the Agency for Health Care Administration, the Department
of Education, and parents.
• The Information Clearinghouse on Developmental Disabilities Advisory Council.
o This council provides resources to parents with children with developmental disabilities
via the Bright Expectations website.
Effect of Proposed Changes
HB 1373 creates s. 381.99, F.S., to establish the Rare Disease Advisory Council (Council). The Council
is created as an adjunct to the DOH for the purpose of providing recommendations on ways to improve
health outcomes for individuals with rare diseases, conditions that affect fewer than 200,000 people in
the United States.
The bill requires the Governor to appoint the following members to the Council:
• A representative of the Department of Health.
• A representative of the Agency for Health Care Administration.
• A representative of the Office of Insurance Regulation.
• A representative of the Department of Education.
21 S. 20.052(4), F.S.
22 S. 20.052(5)(a), F.S.
23 S. 20.052(5)(c), F.S.
24 S. 20.052(5)(d), F.S.
25 Id.
26 Florida Department of Health (DOH), 2021 Agency Legislative Bill Analysis for House Bill 1373, p. 2 (Mar. 1, 2021).
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• Two representatives from academic research institutions in this state which receive any grant
funding for research regarding rare diseases.
• One geneticist practicing in this state.
• One registered nurse or advanced practice registered nurse who is licensed and practicing in
this state with experience treating rare diseases.
• Two physicians who are licensed and practicing in this state with experience treating rare
diseases.
• One hospital administrator from a hospital in this state which provides care to individuals
diagnosed with rare diseases.
• Two individuals who are 18 years of age or older who have a rare disease.
• Two individuals who are caregivers of an individual with a rare disease.
• Two representatives of organizations operating in this state which provide care or other support
for individuals with rare diseases.
• A pharmacist who is licensed and practicing in this state who has experience with drugs that are
used to treat rare diseases.
• A representative of the biotechnology industry.
• A representative of health insurance companies.
Members of the Council must be appointed by September 1, 2021, and are appointed for four-year
terms except that specified members are initially appointed to two-year terms to stagger the
appointments. The Council is required to hold its initial meeting by October 1, 2021, and may meet
upon the call of the chair or upon the request of the majority of its members thereafter. The Council is
authorized to meet electronically.
The bill requires the Council to:
• Consult with experts on rare diseases and solicit public comment to assist in developing
recommendations on improving the treatment of rare diseases in this state.
• Develop recommended strategies for academic research institutions in this state to facilitate
continued research on rare diseases.
• Develop recommended strategies for health care providers to be informed on how to more
efficiently recognize and diagnose rare diseases in order to effectively treat patients. The advisory
council shall provide such strategies to the DOH for publication on the department’s website.
• Provide written input and feedback to the DOH, the Medicaid program, and other state agencies on
specified matters.
The DOH must provide staff and administrative support to the Council. The Council is required to
submit a report to the DOH and the State Surgeon General by July 1 of each year, beginning in 2022,
which describes the activities of the Council in the most recent year and its findings and
recommendations regarding rare disease research and care.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Creates s. 381.99, F.S., relating to the Rare Disease Advisory Council.
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:
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The DOH will incur costs associated with staffing and supporting the Rare Disease Advisory
Council. The DOH estimates one FTE will be required and requests $122,888 in recurring funds
and $4,429 in nonrecurring funds for Fiscal Year 2021-2022. 27
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
Not applicable. The bill does not require rulemaking.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
27 DOH, supra note 26, at 5.
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 1373 2021
1 A bill to be entitled
2 An act relating to the Rare Disease Advisory Council;
3 creating s. 381.99, F.S.; creating the advisory
4 council adjunct to the Department of Health;
5 specifying the purpose of the advisory council;
6 providing for staff and administrative support;
7 defining the term "rare disease"; specifying
8 application of state law governing the establishment
9 of advisory councils; prescribing the composition of
10 the advisory council; providing for initial
11 appointments to the advisory council by a specified
12 date; providing organizational and other meeting
13 requirements for the advisory council; prescribing
14 duties and responsibilities of the advisory council;
15 providing an effective date.
16
17 Be It Enacted by the Legislature of the State of Florida:
18
19 Section 1. Section 381.99, Florida Statutes, is created to
20 read:
21 381.99 Rare Disease Advisory Council.—
22 (1) The Rare Disease Advisory Council, an advisory council
23 as defined in s. 20.03(7), is created adjunct to the Department
24 of Health for the purpose of providing recommendations on ways
25 to improve health outcomes for individuals residing in this
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HB 1373 2021
26 state who have a rare disease. The department shall provide
27 staff and administrative support for the advisory council in the
28 carrying out of its duties and responsibilities. For purposes of
29 this section, the term "rare disease" means a condition that
30 affects fewer than 200,000 people in the United States. Except
31 as otherwise provided in this section, the advisory council
32 shall operate in a manner consistent with s. 20.052.
33 (2) The advisory council is composed of the following
34 members appointed by the Governor:
35 (a) A representative of the Department of Health.
36 (b) A representative of the Agency for Health Care
37 Administration.
38 (c) A representative of the Office of Insurance
39 Regulation.
40 (d) A representative of the Department of Education.
41 (e) Two representatives from academic research
42 institutions in this state which receive any grant funding for
43 research regarding rare diseases.
44 (f) One geneticist practicing in this state.
45 (g) One registered nurse or advanced practice registered
46 nurse who is licensed and practicing in this state with
47 experience treating rare diseases.
48 (h) Two physicians who are licensed and practicing in this
49 state with experience treating rare diseases.
50 (i) One hospital administrator from a hospital in this
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51 state which provides care to individuals diagnosed with rare
52 diseases.
53 (j) Two individuals who are 18 years of age or older who
54 have a rare disease.
55 (k) Two individuals who are caregivers of an individual
56 with a rare disease.
57 (l) Two representatives of organizations operating in this
58 state which provide care or other support for individuals with
59 rare diseases.
60 (m) A pharmacist who is licensed and practicing in this
61 state who has experience with drugs that are used to treat rare
62 diseases.
63 (n) A representative of the biotechnology industry.
64 (o) A representative of health insurance companies.
65
66 Any vacancy on the advisory council shall be filled in the same
67 manner as the original appointment.
68 (3) The initial members of the advisory council shall be
69 appointed by September 1, 2021. Each member shall be appointed
70 to a 4-year term of office. However, in order to achieve
71 staggered terms, the initial members appointed pursuant to
72 paragraphs (2)(a)-(i) shall be appointed to a 2-year term. The
73 Governor shall designate a chair and vice chair of the advisory
74 council from among its membership. The advisory council shall
75 meet for its initial meeting by October 1, 2021. Thereafter, the
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76 advisory council may meet upon the call of the chair or upon the
77 request of a majority of its members. The advisory council may
78 meet via teleconferencing or other electronic means. Notices for
79 any scheduled meetings of the advisory council must be published
80 in advance on the department's website.
81 (4) The advisory council shall:
82 (a) Consult with experts on rare diseases and solicit
83 public comment to assist in developing recommendations on
84 improving the treatment of rare diseases in this state.
85 (b) Develop recommended strategies for academic research
86 institutions in this state to facilitate continued research on
87 rare diseases.
88 (c) Develop recommended strategies for health care
89 providers to be informed on how to more efficiently recognize
90 and diagnose rare diseases in order to effectively treat
91 patients. The advisory council shall provide such strategies to
92 the Department of Health for publication on the department's
93 website.
94 (d) Provide input and feedback in writing to the
95 department, the Medicaid program, and other state agencies on
96 matters that affect people who have been diagnosed with rare
97 diseases, including, but not limited to, pandemic or natural
98 disaster preparedness and response.
99 (e) By July 1 of each year, beginning in 2022, submit a
100 report to the Governor and the State Surgeon General which
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101 describes the activities of the advisory council in the past
102 year and its findings and recommendations regarding rare disease
103 research and care. Additionally, the report must be made
104 available on the department's website.
105 Section 2. This act shall take effect July 1, 2021.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 1373 (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 Plakon offered the following:
4
5 Amendment
6 Remove lines 34-72 and insert:
7 members:
8 (a) As appointed by the Governor:
9 1. A representative of the Department of Health.
10 2. A representative of the Agency for Health Care
11 Administration.
12 3. A representative of the Office of Insurance Regulation.
13 4. A representative of the Department of Education.
14 5. One geneticist practicing in this state.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 1373 (2021)
Amendment No. 1
15 6. One registered nurse or advanced practice registered
16 nurse who is licensed and practicing in this state with
17 experience in treating rare diseases.
18 7. One hospital administrator from a hospital in this
19 state which provides care to individuals diagnosed with rare
20 diseases.
21 8. A pharmacist who is licensed and practicing in this
22 state who has experience with drugs that are used in the
23 treatment of rare diseases.
24 9. A representative of the biotechnology industry.
25 10. A representative of health insurance companies.
26 (b) As appointed by the President of the Senate:
27 1. A representative from an academic research institution
28 in this state which receives grant funding for research
29 regarding rare diseases.
30 2. A physician who is licensed under chapter 458 or
31 chapter 459 and practicing in this state with experience in
32 treating rare diseases.
33 3. An individual who is 18 years of age or older who has a
34 rare disease.
35 4. An individual who is a caregiver of an individual with
36 a rare disease.
37 5. A representative of an organization operating in this
38 state which provides care or other support to individuals with
39 rare diseases.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 1373 (2021)
Amendment No. 1
40 (c) As appointed by the Speaker of the House of
41 Representatives:
42 1. A representative from an academic research institution
43 in this state which receives grant funding for research
44 regarding rare diseases.
45 2. A physician who is licensed under chapter 458 or
46 chapter 459 and practicing in this state with experience in
47 treating rare diseases.
48 3. An individual who is 18 years of age or older who has a
49 rare disease.
50 4. An individual who is a caregiver of an individual with
51 a rare disease.
52 5. A representative of organizations in this state which
53 provide care or other support to individuals with rare diseases.
54 Any vacancy on the advisory council must be filled in the same
55 manner as the original appointment.
56 (3) The initial members of the advisory council must be
57 appointed by September 1, 2021. Each member must be appointed to
58 a 4-year term of office. However, in order to achieve staggered
59 terms, each of the initial members appointed pursuant to
60 paragraph (2)(a) must be appointed to a 2-year term. The
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HB 1381
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1381 Maternal Health Outcomes
SPONSOR(S): Brown
TIED BILLS: IDEN./SIM. BILLS: SB 1540
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Rahming McElroy
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
The Department of Health Office of Minority Health and Health Equity administers multiple health promotion
programs including the “Closing the Gap” (CTG) grant program. The grant program was created by the
Legislature in 2000 to improve health outcomes and eliminate racial and ethnic health disparities in Florida by
providing grants to increase community-based health and disease prevention activities.
Grants are awarded for one year through a proposal process, and may be renewed annually subject to the
availability of funds and the grantee’s achievement of quality standards, objectives, and outcomes. Projects
funded through the CTG grant program must address racial and ethnic disparities associated with one or more
of the following priority areas:
• Increasing adult and child immunization rates in certain racial and ethnic populations.
• Improving neighborhood social determinates of health, such as transportation, safety, and food access.
• Decreasing racial and ethnic disparities in maternal and infant mortality rates, oral health care, or
morbidity and mortality rates related to cancer, HIV/AIDS, cardiovascular disease, diabetes,
Alzheimer’s disease and related dementia, sickle cell disease, and Lupus.
HB 1381 allows the CTG grant program to fund projects directed at decreasing racial and ethnic disparities in
severe maternal morbidity and other maternal outcomes. The bill also adds maternal health programs to
existing community-based programs the DOH is required to coordinate with to avoid duplicative efforts and
promote consistency.
The bill creates telehealth minority maternity care pilot programs in Duval and Orange Counties, Florida, to
expand the capacity for positive maternal health outcomes in racial and ethnic minority populations. The bill
expands the definition of telehealth to include audio-only telephone calls, e-mail messages, and facsimiles
transmission for the purpose of the pilot programs. The pilot programs are required to use telehealth to provide
specified services and education to eligible pregnant women up to the last day of their postpartum period and
provide specified training to participating health care practitioners and other perinatal professionals.
The bill requires that legislative appropriated funds for the CTG grant program be used to fund the pilot
programs. The bill also requires that the DOH’s Division of Community Health Promotion and Office of Minority
Health and Health Equity work together to apply for available federal funds to assist in the implementation of
the bill.
The bill grants rulemaking authority to the DOH to implement the bill’s provisions.
The bill has an indeterminate, negative, significant impact on the DOH.
The bill has no fiscal impact on 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.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Closing the Gap Program
The Department of Health (DOH) Office of Minority Health and Health Equity (Office) is the coordinating
office for consultative services in the areas of cultural and linguistic competency, partnership building,
and program development and implementation to address the heath needs of Florida's minority and
underrepresented populations statewide. The Office administers multiple health promotion programs
including the “Closing the Gap” (CTG) grant program. 1 In 2000, the Legislature created the CTG grant
program to improve health outcomes and eliminate racial and ethnic health disparities in Florida by
providing grants to increase community-based health and disease prevention activities. 2
Currently, the DOH is required to coordinate with existing community-based programs to avoid
duplicative efforts and promote consistency, such as: 3
• Chronic disease intervention programs;
• Cancer prevention ad control programs;
• Diabetes control programs;
• The Healthy Start program;
• The Florida Kidcare Program;
• The HIV/AIDS program;
• Immunization programs; and
• Other related programs at the state and local levels.
Grant Proposals
Grants are awarded for one year through a proposal process, and may be renewed annually subject to
the availability of funds and the grantee’s achievement of quality standards, objectives, and outcomes. 4
Proposals for grants must identify: 5
• The purpose and objectives of the proposed project, including the particular racial or ethnic
disparity the project will address from one or more of the following priority areas:
o Increasing adult and child immunization rates in certain racial and ethnic populations;
o Improving neighborhood social determinates of health, such as transportation, safety,
and food access, as outlined by the Centers for Disease Control and Prevention (CDC),
or
o Decreasing racial and ethnic disparities in:
Maternal and infant mortality rates;
Morbidity and mortality rates relating to cancer;
Morbidity and mortality rates relating to HIV/AIDS;
Morbidity and mortality rates relating to cardiovascular disease;
Morbidity and mortality rates relating to diabetes;
Morbidity and mortality rates relating to sickle cell disease;
Morbidity and mortality rates relating to Lupus; or
Oral health care.
• The target population and its relevance;
1 Florida Department of Health, Minority Health, http://www.floridahealth.gov/%5C/programs-and-services/minority-health/index.html
(last visited Mar. 15, 2021).
2 Ss. 381.7353–381.7356, F.S.
3 S. 381.7353, F.S.
4 S. 381.7356(4), F.S.
5 S. 381.7355, F.S.
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• Methods for obtaining baseline health status data and assessment of community health needs;
• Mechanisms for mobilizing community resources and gaining local commitment;
• Development and implementation of health promotion and disease prevention interventions;
• Mechanisms and strategies for evaluating the project’s objectives, procedures, and outcomes;
• A proposed work plan, including a timeline for implementing the project; and
• The likelihood that project activities will occur and continue in the absence of funding. 6
Grant Funding
The amount of award per applicant may vary, as awards are based on the merit of the grant application
and there are no minimum or maximum amounts for grant awards. 7 Projects receiving grants are
required to provide local matching funds of one dollar for every three dollars awarded. 8 In counties with
populations greater than 50,000, up to 50 percent of the local matching funds may be in-kind in the
form of free services or human resources. 9 In counties with populations of 50,000 or less, local
matching funds may be provided entirely through in-kind contributions. 10
Social Determinants of Health
Healthy People 2020 is an initiative of the U.S. Department of Health and Human Services that
provides 10-year national objectives for improving the health of Americans. 11 This initiative highlights
the importance of social determinants of health as one of its overarching goals. 12 Social determinants of
health (SDOH) refer to the conditions in the places where people live, learn, and play that have an
effect on health risks outcomes. 13 Examples of social determinants include access to health care
services, public safety, social norms and attitudes, access to educational, economic, and job
opportunities, residential segregation, and quality of education and job training. 14 Healthy People
2020’s five key areas of SDOH are: 15
• Economic stability;
• Education;
• Social and community context;
• Health and health care; and
• Neighborhood and built environment.
The CDC has also developed a web-based toolkit to help practitioners recognize the root causes that
can affect the health of a population. 16
Maternal Health Outcomes
The well-being of women, children, and families determines the health of future generations. Life events
influence maternal and child health risks and outcomes. Racial and ethnic differences in maternal
6 Id.
7 S. 381.7356(4), F.S. See also, Florida Department of Health, Application Guidelines FY 2021-2023, available at
http://www.floridahealth.gov/about/administrative-functions/purchasing/grant-funding-opportunities/RFA20-005.pdf (last visited Mar. 15,
2021).
8 S. 381.7356(2), F.S.
9 S. 381.7356(2)(a), F.S.
10 S. 381.7356(2)(b), F.S.
11 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, About Healthy People,
http://www.healthypeople.gov/2020/About-Healthy-People (last visited Mar. 15, 2021).
12 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Social Determinants of Health,
http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health (last visited on Mar. 15, 2021).
13 Centers for Disease Control and Prevention (CDC), Social Determinants of Health: Know What Affects Health (rev. Mar. 9, 2021),
http://www.cdc.gov/socialdeterminants/index.htm (last visited Mar. 15, 2019).
14 Supra note 12.
15 Id.
16 CDC, Tools for Putting Social Determinants of Health into Action, (rev. Mar. 9, 2021),
http://www.cdc.gov/socialdeterminants/tools/index.htm (last visited Mar. 15, 2019).
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health outcomes, such as maternal and infant mortality and severe maternal morbidity, can predict
future public health challenges for families, communities and the health care system.
Maternal Mortality
Maternal mortality refers to deaths occurring during pregnancy or within 42 days of the end of
pregnancy, regardless of the duration of the pregnancy, from any cause related to or aggravated by the
pregnancy, but not from accidental or incidental causes. 17 Late maternal deaths
(occurring between 43 days and 1 year of death) are not included as part of the World Heath
Organization’s (WHO) definition of maternal mortality. 18 Approximately 700 women die each year in the
United States (U.S.) as a result of pregnancy or delivery complications. 19 The national maternal
mortality rate is 17.4 deaths per 100,000 live births. 20 Racial and ethnic gaps exist between non-
Hispanic black, non-Hispanic white, and Hispanic women. The maternal mortality rate of these groups
is 37.3, 14.9, and 11.8 deaths per 100,000 live births, respectively. 21
Maternal Mortality in Florida
Overall, Florida’s maternal mortality rate has been decreasing and consistently below the national rate
within recent years. As of 2018, the maternal mortality rate in Florida is 16.3 deaths per 100,000 live
births, a decrease from a high of 26.2 per 100,000 live births in 2009: 22
Pregnancy-Related Mortality Rates United States & Florida, 2008 – 2018
Severe Maternal Morbidity
A significant number of women in the U.S. experience severe maternal morbidity, or severe
complications from labor and delivery that start after they leave the hospital. 23 Severe maternal
17 U.S. Department of Health and Human Services, The Surgeon General’s Call to Action to Improve Maternal Health, (Dec. 2020),
https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf (last visited Mar. 16, 2021).
18 Id.
19 CDC, Maternal Mortality, https://www.cdc.gov/reproductivehealth/maternal-mortality/index.html (last visited Mar. 16, 2021).
20 CDC, National Center for Health Statistics, Maternal Mortality, https://www.cdc.gov/nchs/maternal-mortality/index.htm (last visited
Mar. 16, 2021).
21 Id.
22 Presentation by Dr. William M. Sappenfield, MD, MPH, CPH, Professor and Director, Florida Perinatal Quality Collaborative, Feb. 3,
2021 meeting of the House Health and Human Services Committee (on file with Finance and Facilities Subcommittee staff).
23 CDC, Severe Maternal Morbidity after Delivery Discharge among U.S. Women, 2010-2014,
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/smm-after-delivery-discharge-among-us-women/index.htm (last
visited Mar. 16, 2021).
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morbidity (SMM), which includes unexpected outcomes of labor and delivery that result in significant
short- or long-term consequences to a woman’s health, affected more than 50,000 women in the U.S.
in 2014 and has been steadily increasing in recent years. 24
Although it is unclear why SMM rates are increasing, changes in the overall health of the population of
women giving birth, including increases in maternal age, pre-pregnancy obesity, preexisting chronic
medical conditions, and cesarean delivery, have been documented as possible contributors to
increases in complications. 25 The consequences of the increasing SMM prevalence, in addition to the
health effects for the woman, are wide-ranging and include increased medical costs and longer
hospitalization stays. 26
The most common SMM indicators after delivery discharge are: 27
• Blood transfusion
• Pulmonary edema/ acute heart failure
• Sepsis
• Adult respiratory distress syndrome
• Air and thrombotic embolism
• Eclampsia
• Puerperal cerebrovascular disorders
• Acute Renal Failure
The overall SMM rate increased almost 200% over the years, from 49.5 in 1993 to 144.0 in 2014. This
increase has been mostly driven by blood transfusions, which increased from 24.5 in 1993 to 122.3 in
2014. After excluding blood transfusions, the SMM rate increased by about 20% over time, from 28.6 in
1993 to 35.0 in 2014.
24 CDC, Severe Maternal Morbidity in the United States,
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html (last visited Mar. 16, 2021). 2014 is the
most recent year for which data are available on a national level.
25 Id.
26 Id.
27 CDC, supra note 23.
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The following figure shows the trend over time for SMM rates in the U.S.
per 10,000 delivery hospitalizations from 1993–2014:
Impact in Racial and Ethnic Minority Populations
Nationwide, racial disparities in SMM after delivery discharge persist. Among deliveries insured by
Medicaid, the odds of SMM among Black women are about 1.7 times more likely than White women. 28
In Florida, complications during pregnancy or delivery reveal similar racial and ethnic disparities in
SMM: 29
Severe Maternal Morbidity, Rate Per 1,000 Delivery Hospitalizations,
2013-2019
35
30
25
20
15
10
5
0
2013-2015 2015-2017 2017-2019
All Races/Ethincity White Black Hispanic Non-Hispanic
In 2013-2015, Black women in Florida were 1.9 times more likely than White women to have SMM, with
their SMM rate being 29.1 per 1,000 delivery hospitalizations, compared to 15.5 for White women.
Though the overall SMM rate decreased by 2019, Black women were still 1.7 times more likely than
28 CDC, Reproductive Health, Severe Maternal Morbidity after Delivery Discharge among U.S. Women, 2010-2014,
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/smm-after-delivery-discharge-among-us-women/index.htm (last
visited Mar. 16, 2021).
29 Data compiled by Florida House of Representatives, Health & Human Services Committee staff, using information from the Florida
Department of Health, Severe Maternal Morbidity, available at
http://www.flhealthcharts.com/charts/OtherIndicators/NonVitalIndDataViewer.aspx?cid=0867 (last visited Mar. 16, 2021).
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White women to have SMM, with their SMM rate being 25.9 per 1,000 delivery hospitalizations,
compared to 14.9 for White women.
Unlike decreasing racial and ethnic disparities in maternal and infant mortality rates, decreasing such
disparities for severe maternal morbidity is currently not one of the CTG grant program’s priority areas.
Telehealth
As of July 1, 2019, Florida licensed health care professionals, as well as those licensed under a
multistate health care licensure compact of which Florida is a member, are authorized to use telehealth
to deliver health care services within their respective scopes of practice. 30 Currently, telehealth does
not include audio-only telephone calls, e-mail messages, or facsimile transmission.
Effect of Proposed Changes
HB 1381 adds decreasing racial and ethnic disparities in severe morbidity rates and other maternal
health outcomes as a “Closing the Gap” grant program priority area, allowing the CTG grant program to
fund projects directed at decreasing these disparities.
The bill adds maternal health programs to existing community-based programs the DOH is required to
coordinate with to avoid duplicative efforts and promote consistency.
The bill also creates telehealth minority maternity care pilot programs in Duval and Orange Counties,
Florida, to expand the capacity for positive maternal health outcomes in racial and ethnic minority
populations. The bill requires the DOH, by July 1, 2022, to direct and assist these two county health
departments to implement the programs.
The pilot programs are required to use telehealth, which the bill expands to include audio-only
telephone calls, e-mail messages, and facsimiles transmission, to provide the following services and
education to eligible pregnant women up to the last day of their postpartum period, as applicable:
• Services and education addressing health social determinants;
• Evidence-based health literacy and pregnancy, childbirth, and parenting education for women in
the prenatal and postpartum periods;
• For women during their pregnancies through the postpartum periods, connection to support
from doulas and other perinatal health workers; and
• Medical devices to conduct key components of maternal wellness checks.
The bill requires the pilot programs to provide specified training to participating health care practitioners
and other perinatal professionals.
The bill grants discretionary rulemaking authority to the DOH to implement the bill’s provisions.
The bill establishes an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 381.7353, F.S., relating to reducing racial and ethnic health disparities:
Closing the Gap grant program; administration; department duties.
Section 2: Amends s. 381.7355, F.S., relating to project requirements; review criteria.
Section 3: Creates s. 383.2163, F.S., relating to telehealth minority care pilot programs.
Section 4: Provides an effective date of July 1, 2021.
30 S. 456.47, F.S.
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II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None. SMM and other maternal health outcomes proposals will compete with other proposals for
existing grant funds.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
The bill requires that legislative appropriated funds for the Closing the Gap grant program be used to
fund the pilot programs. The 2020-2021 GAA provided $4,850,354 in recurring GR for Minority Health
Initiatives, which includes the CTG grant program. (Specific Appropriation 429).
The bill requires that the DOH’s Division of Community Health Promotion and its Office of Minority
Health and Health Equity work together to apply for available federal funds to assist in the
implementation of the bill.
Adding severe maternal morbidity and other maternal health outcomes as a priority area may reduce
awards for other areas.
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 sufficient rulemaking authority to the DOH to implement the bill’s provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
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IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 1381 2021
1 A bill to be entitled
2 An act relating to maternal health outcomes; amending
3 s. 381.7353, F.S.; revising the Department of Health's
4 duties under the Closing the Gap grant program;
5 amending s. 381.7355, F.S.; revising the requirements
6 for Closing the Gap grant proposals; creating s.
7 383.2163, F.S.; requiring the department to establish
8 telehealth minority maternity care pilot programs in
9 Duval County and Orange County by a specified date;
10 defining terms; providing program purposes; requiring
11 the pilot programs to provide specified telehealth
12 services to eligible pregnant women for a specified
13 period; requiring pilot programs to train
14 participating health care practitioners and perinatal
15 professionals on specified topics; providing for
16 funding for the pilot programs; requiring the
17 department's Division of Community Health Promotion
18 and Office of Minority Health and Health Equity to
19 apply for certain federal funding; authorizing the
20 department to adopt rules; providing an effective
21 date.
22
23 Be It Enacted by the Legislature of the State of Florida:
24
25 Section 1. Paragraph (e) of subsection (2) of section
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26 381.7353, Florida Statutes, is amended to read:
27 381.7353 Reducing Racial and Ethnic Health Disparities:
28 Closing the Gap grant program; administration; department
29 duties.—
30 (2) The department shall:
31 (e) Coordinate with existing community-based programs,
32 such as chronic disease community intervention programs, cancer
33 prevention and control programs, diabetes control programs, the
34 Healthy Start program, the Florida Kidcare Program, the HIV/AIDS
35 program, immunization programs, maternal health programs, and
36 other related programs at the state and local levels, to avoid
37 duplication of effort and promote consistency.
38 Section 2. Paragraph (a) of subsection (2) of section
39 381.7355, Florida Statutes, is amended to read:
40 381.7355 Project requirements; review criteria.—
41 (2) A proposal must include each of the following
42 elements:
43 (a) The purpose and objectives of the proposal, including
44 identification of the particular racial or ethnic disparity the
45 project will address. The proposal must address one or more of
46 the following priority areas:
47 1. Decreasing racial and ethnic disparities in maternal
48 and infant mortality rates.
49 2. Decreasing racial and ethnic disparities in severe
50 maternal morbidity rates and other maternal health outcomes.
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51 3. Decreasing racial and ethnic disparities in morbidity
52 and mortality rates relating to cancer.
53 4.3. Decreasing racial and ethnic disparities in morbidity
54 and mortality rates relating to HIV/AIDS.
55 5.4. Decreasing racial and ethnic disparities in morbidity
56 and mortality rates relating to cardiovascular disease.
57 6.5. Decreasing racial and ethnic disparities in morbidity
58 and mortality rates relating to diabetes.
59 7.6. Increasing adult and child immunization rates in
60 certain racial and ethnic populations.
61 8.7. Decreasing racial and ethnic disparities in oral
62 health care.
63 9.8. Decreasing racial and ethnic disparities in morbidity
64 and mortality rates relating to sickle cell disease.
65 10.9. Decreasing racial and ethnic disparities in
66 morbidity and mortality rates relating to Lupus.
67 11.10. Decreasing racial and ethnic disparities in
68 morbidity and mortality rates relating to Alzheimer's disease
69 and dementia.
70 12.11. Improving neighborhood social determinants of
71 health, such as transportation, safety, and food access, as
72 outlined by the Centers for Disease Control and Prevention's
73 "Tools for Putting Social Determinants of Health into Action."
74 Section 3. Effective January 1, 2022, section 383.2163,
75 Florida Statutes, is created to read:
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76 383.2163 Telehealth minority maternity care pilot
77 programs.—By July 1, 2022, the department shall establish a
78 telehealth minority maternity care pilot program in Duval County
79 and Orange County which uses telehealth to expand the capacity
80 for positive maternal health outcomes in racial and ethnic
81 minority populations. The department shall direct and assist the
82 county health departments in Duval County and Orange County to
83 implement the programs.
84 (1) DEFINITIONS.—As used in this section, the term:
85 (a) "Department" means the Department of Health.
86 (b) "Eligible pregnant woman" means a pregnant woman who
87 is receiving, or is eligible to receive, maternal or infant care
88 services from the department under chapter 381 or chapter 383.
89 (c) "Health care practitioner" has the same meaning as in
90 s. 456.001.
91 (d) "Health professional shortage area" means a geographic
92 area designated as such by the Health Resources and Services
93 Administration of the United States Department of Health and
94 Human Services.
95 (e) "Indigenous population" means any Indian tribe, band,
96 or nation or other organized group or community of Indians
97 recognized as eligible for services provided to Indians by the
98 United States Secretary of the Interior because of their status
99 as Indians, including any Alaskan native village as defined in
100 43 U.S.C. s. 1602(c), the Alaska Native Claims Settlement Act,
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101 as that definition existed on the effective date of this act.
102 (f) "Maternal mortality" means a death occurring during
103 pregnancy or the postpartum period which is caused by pregnancy
104 or childbirth complications.
105 (g) "Medically underserved population" means the
106 population of an urban or rural area designated by the United
107 States Secretary of Health and Human Services as an area with a
108 shortage of personal health care services or a population group
109 designated by the United States Secretary of Health and Human
110 Services as having a shortage of such services.
111 (h) "Perinatal professionals" means doulas, childbirth
112 educators, community health workers, peer supporters, certified
113 lactation consultants, nutritionists and dietitians, social
114 workers, and other licensed and nonlicensed professionals who
115 assist women through their prenatal or postpartum periods.
116 (i) "Postpartum" means the 1-year period beginning on the
117 last day of a woman's pregnancy.
118 (j) "Severe maternal morbidity" means an unexpected
119 outcome caused by a woman's labor and delivery which results in
120 significant short-term or long-term consequences to the woman's
121 health.
122 (k) "Technology-enabled collaborative learning and
123 capacity building model" means a distance health care education
124 model that connects health care professionals, particularly
125 specialists, with other health care professionals through
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126 simultaneous interactive videoconferencing for the purpose of
127 facilitating case-based learning, disseminating best practices,
128 and evaluating outcomes in the context of maternal health care.
129 (l) "Telehealth" has the same meaning as in s. 456.47 but
130 includes audio-only telephone calls, e-mail messages, and
131 facsimile transmissions.
132 (2) PURPOSE.—The purpose of the pilot programs is to:
133 (a) Expand the use of technology-enabled collaborative
134 learning and capacity building models to improve maternal health
135 outcomes for the following populations and demographics:
136 1. Ethnic and minority populations.
137 2. Health professional shortage areas.
138 3. Areas with significant racial and ethnic disparities in
139 maternal health outcomes and high rates of adverse maternal
140 health outcomes, including, but not limited to, maternal
141 mortality and severe maternal morbidity.
142 4. Medically underserved populations.
143 5. Indigenous populations.
144 (b) Provide for the adoption of and use of telehealth
145 services that allow for screening and treatment of common
146 pregnancy-related complications, including, but not limited to,
147 anxiety, depression, substance use disorder, hemorrhage,
148 infection, amniotic fluid embolism, thrombotic pulmonary or
149 other embolism, hypertensive disorders relating to pregnancy,
150 diabetes, cerebrovascular accidents, cardiomyopathy, and other
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151 cardiovascular conditions.
152 (3) TELEHEALTH SERVICES AND EDUCATION.—The pilot programs
153 shall adopt the use of telehealth to provide all of the
154 following services and education to eligible pregnant women up
155 to the last day of their postpartum periods, as applicable:
156 (a) Services and education addressing social determinants
157 of health, including, but not limited to, all of the following:
158 1. Housing placement options.
159 2. Transportation services or information on how to access
160 such services.
161 3. Nutrition counseling.
162 4. Access to healthy foods.
163 5. Lactation support.
164 6. Lead abatement and other efforts to improve air and
165 water quality.
166 7. Child care options.
167 8. Car seat installation and training.
168 9. Wellness and stress management programs.
169 10. Coordination across safety net and social support
170 services and programs.
171 (b) Evidence-based health literacy and pregnancy,
172 childbirth, and parenting education for women in the prenatal
173 and postpartum periods.
174 (c) For women during their pregnancies through the
175 postpartum periods, connection to support from doulas and other
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176 perinatal health workers.
177 (d) Tools to conduct key components of maternal wellness
178 checks, including, but not limited to, all of the following:
179 1. A device to measure body weight, such as a scale.
180 2. A device to measure blood pressure which has a verbal
181 reader to assist the pregnant woman in reading the device and to
182 ensure that the health care practitioner performing the wellness
183 check through telehealth is able to hear the reading.
184 3. A device to measure blood sugar levels with a verbal
185 reader to assist the pregnant woman in reading the device and to
186 ensure that the health care practitioner performing the wellness
187 check through telehealth is able to hear the reading.
188 4. Any other device that the health care practitioner
189 performing wellness checks through telehealth deems necessary to
190 ensure an accurate assessment of pregnant women participating in
191 the program is conducted.
192 (4) TRAINING.—The pilot programs shall provide training to
193 participating health care practitioners and other perinatal
194 professionals on all of the following:
195 (a) Implicit and explicit biases, racism, and
196 discrimination in the provision of maternity care and how to
197 eliminate these barriers to accessing adequate and competent
198 maternity care.
199 (b) The use of remote patient monitoring tools for
200 pregnancy-related complications.
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201 (c) How to screen for social determinants of health risks
202 in the prenatal and postpartum periods, such as inadequate
203 housing, lack of access to nutritional foods, environmental
204 risks, transportation barriers, and lack of continuity of care.
205 (d) Best practices in screening for and, as needed,
206 evaluating and treating maternal mental health conditions and
207 substance use disorders.
208 (e) Information collection, recording, and evaluation
209 activities to:
210 1. Study the impact of the pilot program;
211 2. Ensure access to and the quality of care;
212 3. Evaluate patient outcomes as a result of the pilot
213 program;
214 4. Measure patient experience; and
215 5. Identify best practices for the future expansion of the
216 pilot program.
217 (5) FUNDING.—The pilot programs shall be funded using
218 funds appropriated by the Legislature for the Closing the Gap
219 grant program. The department's Division of Community Health
220 Promotion and Office of Minority Health and Health Equity shall
221 also work in partnership to apply for federal funds that are
222 available to assist the department in accomplishing the
223 program's purpose and successfully implementing the pilot
224 programs.
225 (6) RULES.—The department may adopt rules to implement
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226 this section.
227 Section 4. This act shall take effect July 1, 2021.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 1381 (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 Brown offered the following:
4
5 Amendment
6 Remove lines 111-191 and insert:
7 (h) "Perinatal professionals" means doulas, Healthy Start and
8 home visiting programs, childbirth educators, community health
9 workers, peer supporters, certified lactation consultants,
10 nutritionists and dietitians, social workers, and other licensed
11 and nonlicensed professionals who assist women through their
12 prenatal or postpartum periods.
13 (i) "Postpartum" means the 1-year period beginning on the
14 last day of a woman's pregnancy.
15 (j) "Severe maternal morbidity" means an unexpected
16 outcome caused by a woman's labor and delivery which results in
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 1381 (2021)
Amendment No. 1
17 significant short-term or long-term consequences to the woman's
18 health.
19 (k) "Technology-enabled collaborative learning and
20 capacity building model" means a distance health care education
21 model that connects health care professionals, particularly
22 specialists, with other health care professionals through
23 simultaneous interactive videoconferencing for the purpose of
24 facilitating case-based learning, disseminating best practices,
25 and evaluating outcomes in the context of maternal health care.
26 (2) PURPOSE.—The purpose of the pilot programs is to:
27 (a) Expand the use of technology-enabled collaborative
28 learning and capacity building models to improve maternal health
29 outcomes for the following populations and demographics:
30 1. Ethnic and minority populations.
31 2. Health professional shortage areas.
32 3. Areas with significant racial and ethnic disparities in
33 maternal health outcomes and high rates of adverse maternal
34 health outcomes, including, but not limited to, maternal
35 mortality and severe maternal morbidity.
36 4. Medically underserved populations.
37 5. Indigenous populations.
38 (b) Provide for the adoption of and use of telehealth
39 services that allow for screening and treatment of common
40 pregnancy-related complications, including, but not limited to,
41 anxiety, depression, substance use disorder, hemorrhage,
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 1381 (2021)
Amendment No. 1
42 infection, amniotic fluid embolism, thrombotic pulmonary or
43 other embolism, hypertensive disorders relating to pregnancy,
44 diabetes, cerebrovascular accidents, cardiomyopathy, and other
45 cardiovascular conditions.
46 (3) TELEHEALTH SERVICES AND EDUCATION.—The pilot programs
47 shall adopt the use of telehealth or coordinate with prenatal
48 home visiting programs for services to provide all of the
49 following services and education to eligible pregnant women up
50 to the last day of their postpartum periods, as applicable:
51 (a) Referrals to Healthy Start’s coordinated intake and
52 referral program to offer families prenatal home visiting
53 services.
54 (b) Services and education addressing social determinants
55 of health, including, but not limited to, all of the following:
56 1. Housing placement options.
57 2. Transportation services or information on how to access
58 such services.
59 3. Nutrition counseling.
60 4. Access to healthy foods.
61 5. Lactation support.
62 6. Lead abatement and other efforts to improve air and
63 water quality.
64 7. Child care options.
65 8. Car seat installation and training.
66 9. Wellness and stress management programs.
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Bill No. HB 1381 (2021)
Amendment No. 1
67 10. Coordination across safety net and social support
68 services and programs.
69 (c) Evidence-based health literacy and pregnancy,
70 childbirth, and parenting education for women in the prenatal
71 and postpartum periods.
72 (d) For women during their pregnancies through the
73 postpartum periods, connection to support from doulas and other
74 perinatal health workers.
75 (e) Tools for prenatal women to conduct key components of
76 maternal wellness checks, including, but not limited to, all of
77 the following:
78 1. A device to measure body weight, such as a scale.
79 2. A device to measure blood pressure which has a verbal
80 reader to assist the pregnant woman in reading the device and to
81 ensure that the health care practitioner performing the wellness
82 check through telehealth is able to hear the reading.
83 3. A device to measure blood sugar levels with a verbal
84 reader to assist the pregnant woman in reading the device and to
85 ensure that the health care practitioner performing the wellness
86 check through telehealth is able to hear the reading.
87 4. Any other device that the health care practitioner
88 performing wellness checks through telehealth deems necessary.
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HB 1483
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1483 Solicitation of Non-medical Services
SPONSOR(S): Yarborough
TIED BILLS: IDEN./SIM. BILLS: SB 1992
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Criminal Justice & Public Safety Subcommittee 18 Y, 0 N Padgett Hall
2) Professions & Public Health Subcommittee Guzzo McElroy
3) Judiciary Committee
SUMMARY ANALYSIS
In 2019, the Federal Trade Commission (FTC) noted that the Food and Drug Administration’s Adverse Event
Reporting System contained reports of consumers who had viewed advertisements by law firms and personal injury
lead generating companies about the prescription drugs they were taking. Multiple consumers reported
discontinuing taking such medications and suffering adverse consequences as a result. The FTC warned that
advertisements that cause, or are likely to cause, viewers to discontinue prescription medications may constitute an
unfair act or practice under Federal law.
HB 1483 prohibits as a deceptive and unfair trade practice a solicitation for a non-medical professional service from
containing certain terminology and requires an advertisement to contain specified disclaimers. Specifically, the bill
prohibits a person who submits or approves for submittal a non-medical solicitation for professional services for
publication, broadcast, or dissemination, or who pays for or otherwise sponsors such solicitation for professional
services from:
• Failing to clearly disclose the nature of the message as a paid advertisement for non-medical services at the
outset of the advertisement.
• Failing to disclose the sponsor of the advertisement.
• Including terminology implying that the advertisement is a “medical alert,” “health alert,” “consumer alert,”
“public service announcement,” or similar public alert or announcement.
• Displaying a federal or state government agency logo in a manner that implies affiliation with that agency.
• Implying that a product has been recalled when the product has not been recalled.
• Failing to clearly and conspicuously disclose the individual or entity that will provide professional services to
a person responding to the advertisement or how such person will be otherwise referred.
• Failing to clearly warn a person taking a prescribed medication or using a medical device to not stop taking
the medication or using the medical device without consulting his or her doctor.
• Failing to clearly disclose that a drug or medical device referenced in the advertisement remains approved
by the Food and Drug Administration, unless the product is recalled or withdrawn.
A disclosure required under the bill must be presented in a manner that makes it plainly legible or audible and
presented for sufficient time that it allows the viewer to read or discern the disclosure. The Department of Legal
Affairs or a state attorney may bring an action to enjoin any person who commits a violation, or may bring an action
on behalf of one or more consumers or governmental entities for actual damages caused by a violation.
The bill creates a first degree misdemeanor prohibiting a person from willfully or knowingly using, obtaining, selling,
transferring, or disclosing another person’s protected health information to solicit non-medical professional services
without such person’s written authorization. A person who violates the prohibition for financial gain commits a
second degree felony.
The bill may have a positive indeterminate jail bed and prison bed impact due to the creation of new felony and
misdemeanor offenses.
The effective date for advertising restrictions for a non-medical solicitation is July 1, 2021. The effective date for the
prohibition against the solicitation of professional services by unauthorized use of PHI is October 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Drug Injury Advertising
In 2017, the U.S. Chamber Institute for Legal Reform (ILR) surveyed 1,335 adults, 500 of whom were
currently taking or had taken one of 12 prescription drugs frequently targeted by personal injury
lawyers, and asked how they would respond if they saw an advertisement about a lawsuit for injury
caused by a medication they were taking. 1 Nearly half of the survey respondents said they would
definitely or probably stop taking the drug immediately after seeing the advertisement. 2 When shown
an actual television legal advertisement about a drug they had taken, more than half said they would
reduce the dosage to below the prescribed amount. 3
A 2018 survey found that 90 percent of jurors would be somewhat or very concerned if they saw an
advertisement claiming that a company’s product injured people. 4 Additionally, 72 percent of jurors
agreed that if a lawsuit alleges a company’s product has injured people, then there is probably truth to
the claim. 5
In 2019, the Federal Trade Commission (FTC) contacted seven law firms and lead generating
companies expressing concern that some television advertisements that solicit clients for personal
injury lawsuits against drug manufacturers may be considered deceptive or unfair under federal law. 6
The FTC also noted that the Food and Drug Administration’s (FDA) Adverse Event Reporting System
contained reports of consumers who had viewed advertisements about the prescription drugs they
were taking, discontinued those medications, and suffered adverse consequences. 7 The FTC warned
that advertisements that cause, or are likely to cause, viewers to discontinue their medications may
constitute an unfair act or practice and recommended such advertisements include clear and prominent
audio and visual disclosures stating that a consumer should not stop taking medication without first
consulting a doctor. 8
Legal Advertising
Until 1977, most states prohibited attorney advertising. 9 In Bates v. State Bar of Arizona, however, the
U.S. Supreme Court held that commercial speech is protected by the First Amendment and cannot be
prohibited. 10 The Supreme Court has distinguished advertising that is false, deceptive, or misleading,
which may be prohibited. Moreover, non-misleading commercial speech may be regulated when:
• There is a substantial government interest;
• The regulation directly advances the government’s interest; and
• The regulation is narrowly tailored. 11
1 U.S. Chamber Institute for Legal Reform, Bad for Your Health: Lawsuit Advertising Implications and Solutions (Oct. 2017),
https://www.instituteforlegalreform.com/uploads/sites/1/TLA_Advertising-Paper-WEB.pdf (last visited Mar. 20, 2021).
2 Id.
3 Id.
4 American Tort Reform Association, Local Legal Services Advertising (Jan. 2020), http://www.atra.org/wp-
content/uploads/2020/01/ATRA-Q3-Legal-Services-Ad-Report-FL.pdf (last visited Mar. 16, 2021).
5 Id.
6 Federal Trade Commission, FTC Flags Potentially Unlawful TV Ads for Prescription Drug Lawsuits (Sept. 24, 2019),
https://www.ftc.gov/news-events/press-releases/2019/09/ftc-flags-potentially-unlawful-tv-ads-prescription-drug-lawsuits (last visited Mar.
20, 2021).
7 Id.
8 Id.
9 JD Supra, Remember When Lawyers Couldn't Advertise? (Oct. 26, 2018), https://www.jdsupra.com/legalnews/remember-when-
lawyers-couldn-t-advertise-11628/ (last visited Mar. 20, 2021).
10 Bates v. State Bar of Arizona, 433 U.S. 350 (1977).
11 Central Hudson Gas & Elec. v. Public Service Commission, 447 U.S. 557 (1980).
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The U.S. Supreme Court has also recognized that states not only have an interest in protecting their
citizens from misleading advertisements, but state bars also have an interest in protecting their image
as a profession and the public’s perception of the judicial system. 12
Legal Advertisement Regulation
The Florida Bar is an extension of the Florida Supreme Court and approves lawyer advertising, issues
advisory opinions interpreting the Bar rules, and investigates and prosecutes attorneys for alleged
violations. 13 Florida’s legal advertising rules apply to all forms of communication soliciting legal services
in any print or electronic form, including but not limited to newspapers, magazines, brochures, flyers,
television, radio, direct mail, electronic mail, and Internet, including banners, pop-ups, websites, social
media, and video sharing platforms. 14 Advertisements in specified media must be submitted to the
Legal Division of the Florida Bar at least 20 days prior to dissemination, including print, television, radio,
direct mail, and Internet. 15
The Legal Division reviews an advertisement to determine whether it complies with the Florida Bar’s
advertising rules. The Legal Division issues an opinion either approving or disapproving the
advertisement. The Disciplinary Counsel of the Florida Bar investigates and prosecutes attorneys for
alleged violations of the Bar’s advertising rules. 16
Florida Bar rules require legal advertising to include:
• The name of the lawyer or law firm; 17
• The location of the law practice; 18 and
• Certain disclosures when relevant, including whether:
• A case will be referred to another lawyer; 19
• A spokesperson in the advertisement is not an employee or member of the law firm; 20 or
• A scene depicted is a dramatization and not an actual event. 21
Such required information must be reasonably prominent and clearly legible if written and clearly
audible if spoken aloud. 22
Florida Deceptive and Unfair Trade Practices Act
The Florida Deceptive and Unfair Trade Practices Act (FDUTPA) prohibits unfair methods of
competition, and unconscionable, unfair or deceptive acts or practices in the conduct of any trade or
commerce. 23,24 FDUTPA operates for the purposes of: 25
• Simplifying, clarifying, and modernizing the law governing consumer protection, unfair methods
of competition, and unconscionable, deceptive, and unfair trade practices;
• Protecting the consuming public and legitimate business enterprises from those who engage in
unfair methods of competition, or unconscionable, deceptive, or unfair acts or practices in the
conduct of any trade or commerce; and
12 Florida Bar v. Went For It, Inc., 515 U.S. 618, 635 (1995).
13 The Florida Bar, Frequently Asked Questions About the Florida Bar, https://www.floridabar.org/about/faq/ (last visited Mar. 20, 2021).
14 Fla. Bar Code Prof. Resp. D. R. 4-7.11(a).
15 Fla. Bar Code Prof. Resp. D. R. 4-7.11.
16 Fla. Bar Code Prof. Resp. D. R. 4-7.19.
17 Fla. Bar Code Prof. Resp. D. R. 4-7.12(a)(1).
18 Fla. Bar Code Prof. Resp. D. R. 4-7.12(a)(2).
19 Fla. Bar Code Prof. Resp. D. R. 4-7.12(b).
20 Fla. Bar Code Prof. Resp. D. R. 4-7.13(b)(5).
21 Fla. Bar Code Prof. Resp. D. R. 4-7.13(b)(6).
22 Fla. Bar Code Prof. Resp. D. R. 4-7.12(d).
23 The term “trade or commerce” is defined as “advertising, soliciting, providing, offering, or distributing, whether by sale, rental, or
otherwise, of any good or service, or any property, whether tangible or intangible, or any other article, commodity, or thing of value,
wherever situated. The term includes the conduct of any trade or commerce including any nonprofit or not-for-profit person or activity.
S. 501.203(8), F.S.
24 S. 501.204(1), F.S.
25 S. 501.202, F.S.
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• Making state consumer protection and enforcement consistent with established policies of
federal law relating to consumer protection.
FDUTPA provides investigative and enforcement authority to a state attorney if a violation occurs in or
affects the judicial circuit under the office’s jurisdiction, and to the Department of Legal Affairs (DLA) if a
violation occurs in or affects more than one judicial circuit, or if a state attorney defers to DLA. 26 An
enforcing authority may, within four years after a violation occurs or within two years after the last
payment in a transaction involved in a violation, bring an action:
• To obtain a declaratory judgment that an act or practice violates FDUTPA;
• To enjoin any person who has violated, is violating, or is otherwise likely to violate FDUTPA; or
• On behalf of one or more consumers or governmental entities for the actual damages caused
by an act or practice in violation of FDUTPA. 27
Additionally, an enforcing authority may collect a civil penalty of up to $10,000 per violation plus
reasonable attorney fees and costs for a willful violation and up to a $15,000 penalty plus reasonable
attorney fees and costs for a willful violation involving a senior citizen, a disabled person, a military
servicemember, or the spouse or dependent child of a military servicemember. 28 DLA may also issue a
cease and desist order if such order would be in the interest of the public. 29
FDUTPA authorizes a private cause of action for any person aggrieved by a violation of FDUTPA to:
• Obtain a declaratory judgement that an act or practice violates FDUTPA;
• Enjoin a person who has violated, is violating, or is otherwise likely to violate this part; and
• Recover actual damages plus reasonable attorney fees and costs. 30
The Health Insurance Portability and Accountability Act
The Federal Health Insurance Portability and Accountability Act (HIPAA), protects personal health
information (PHI). 31 The U.S. Department of Health and Human Services privacy rules establish
national standards to protect medical records and other PHI. 32 The rules address, among other things,
the use and disclosure of a person’s PHI. Only “covered entities” are subject to HIPAA’s provisions,
including:
• Health plans;
• Health care providers;
• Health care clearinghouses; and
• Business associates of any of the above. 33
HIPAA requires the disclosure of a person’s PHI to the person who is the subject of the PHI information
or his or her personal representative, upon his or her request. 34 The punishment for a HIPAA violation
can either be a civil or criminal penalty. A civil penalty varies based on the severity of the violation, the
number of people affected, the nature of the data exposed, the length of time a violation was allowed to
persist, the prior compliance history of the covered entity, and the knowledge the covered entity had of
the violation. 35 Criminal penalties for a HIPAA violation are triggered when a person obtains PHI for
26 Ss. 501.203(2), 501.206, and 501.207, F.S.
27 S. 501.207(1) and (5), F.S.
28 Ss. 501.2075, 501.2077, and 501.2105, F.S.
29 S. 501.208(1), F.S.
30 Ss. 501.2105 and 501.211, F.S.
31 Protected health information includes all individually identifiable health information held or transmitted by a covered entity or its
business associate. Pub. L. No. 104-191 (1996).
32 U.S. Department of Health and Human Services, Health Information Privacy, https://www.hhs.gov/hipaa/for-
professionals/privacy/index.html (last visited Mar. 20, 2021).
33 U.S. Department of Health and Human Services, Office for Civil Rights, Summary of the HIPAA Privacy Rule, (last rev. May 2003),
https://www.hhs.gov/sites/default/files/privacysummary.pdf. (last visited Mar. 20, 2021).
34 Id.
35 HIPAA Journal, What are the penalties for HIPAA Violations?, https://www.hipaajournal.com/what-are-the-penalties-for-hipaa-
violations-7096/ (last visited Mar. 20, 2021).
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financial gain or under false pretenses. 36 The criminal penalty for such HIPAA violations are punishable
by up to 10 years imprisonment. 37
Effect of Proposed Changes
HB 1483 prohibits a person who submits or approves the submittal of a non-medical solicitation for
professional services which contains information about a drug or device, 38 for publication, broadcast, or
dissemination, or who pays for or otherwise sponsors such non-medical solicitation from:
• Failing to clearly disclose, "This is a paid advertisement for non-medical services," at the outset
of the advertisement.
• Including terminology implying that the advertisement is a “medical alert,” “health alert,”
“consumer alert,” “public service announcement,” or similar public alert or announcement.
• Displaying a federal or state government agency logo in a manner that implies affiliation with
such an agency.
• Including terminology that implies a product has been recalled when the product has not been
recalled.
• Failing to clearly disclose the sponsor of the advertisement.
• Failing to clearly and conspicuously disclose the individual or entity that will provide professional
services to a person who responds to the advertisement.
• Failing to clearly disclose that the drug or medical device remains approved by the Food and
Drug Administration, unless the product has actually been recalled or withdrawn.
• If the advertisement solicits clients who may allege injury from a prescription drug, failing to
clearly disclose the following warning:
o "Do not stop taking a prescribed medication without first consulting your doctor.
Discontinuing a prescribed medication without your doctor's advice can result in injury or
death."
A disclosure required by the bill must be clearly legible, if written, and, if displayed electronically,
displayed for sufficient time to enable the viewer to easily see and fully read the disclosure. A spoken
disclosure must be plainly audible and clearly intelligible.
The bill defines “non-medical solicitation” as a paid solicitation for non-medical professional services
which contains information about a drug or device as defined in s. 499.003, F.S., and which is directed
to the public through television; radio; the Internet, including a domain name; a newspaper or other
periodical; an outdoor advertising sign; or another written, electronic, or recorded communication.
Under the bill, a violation constitutes a deceptive and unfair trade practice. DLA or a state attorney may
bring an action:
• To obtain a declaratory judgment that the non-medical solicitation violates FDUTPA;
• To enjoin any person who has violated these provisions from continuing to disseminate the non-
medical solicitation; or
• For actual damages caused by a violation on behalf of consumers.
The bill creates a first degree misdemeanor offense prohibiting a person from willfully or knowingly
using, obtaining, selling, transferring, or disclosing another person’s PHI to solicit non-medical
professional services without such person’s written authorization. A person who violates the prohibition
commits a deceptive and unfair trade practice subject to penalties and remedies under ch. 501, part II
and:
36 Id.
37 Id.
38 The bill defines “device” in accordance with s. 499.003, F.S., as any instrument, apparatus, implement, machine, contrivance,
implant, in vitro reagent, or other similar or related article, including its components, parts, or accessories, which is:
(a) Recognized in the current edition of the United States Pharmacopoeia and National Formulary, or any supplement thereof,
(b) Intended for use in the diagnosis, cure, mitigation, treatment, therapy, or prevention of disease in humans or other animals, or
(c) Intended to affect the structure or any function of the body of humans or other animals,
and that does not achieve any of its principal intended purposes through chemical action within or on the body of humans or other
animals and which is not dependent upon being metabolized for the achievement of any of its principal intended purposes.
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• A first degree misdemeanor for a willful and knowing violation. 39
• A second degree felony for a willful and knowing violation with the intent to sell, transfer, or use
PHI for financial gain, 40 except the term of imprisonment may not exceed 10 years and the fine
may exceed $10,000 but may not exceed $250,000.
The provisions of the bill relating to advertising regulations for a non-medical solicitation are effective
July 1, 2021. The provisions of the bill prohibiting the solicitation of professional services by the use,
sale, transfer, or disclosure of PHI without a person’s written authorization are effective October 1,
2021.
B. SECTION DIRECTORY:
Section 1: Creates s. 501.2106, F.S., related to non-medical solicitation; deceptive and unfair trade
practices.
Section 2: Creates s. 877.025, F.S., related to solicitation of non-medical services; wrongful use or
disclosure of protected health information.
Section 3: Provides an effective date of July 1, 2021, unless otherwise provided in the bill.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The bill may have a positive indeterminate prison bed impact due to the creation of a new felony
offense.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
The bill may have a positive indeterminate jail bed impact due to the creation of a new
misdemeanor offense.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
39 A first degree misdemeanor, punishable by up to one year in county jail and a $1,000 fine. Ss. 775.082 and 775.083, F.S.
40 A second degree felony is punishable by up to 15 years imprisonment, and a $10,000 fine. Ss. 775.082 and 775.083, F.S.
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Although commercial speech enjoys protection under the First Amendment, courts have held that it
is subject to greater restrictions than noncommercial speech. 41 As such, false or misleading
advertising and other forms of fraudulent commercial speech are not protected under the First
Amendment, and can be restricted by the government. 42 The restrictions on the solicitation of non-
medical services in the bill are narrowly tailored to address a specific category of professional
services on the limited subjects of drugs and medical devices. Furthermore, each advertising
prohibition is a statement or omission that is intended to mislead a member of the public into
believing the advertisement has been disseminated by the government, or with the approval of a
government agency. Because the advertising restrictions in the bill are narrow in scope and focused
on misleading statements which have no First Amendment protection, the bill likely complies with
constitutional requirements.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
Not applicable.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
41 Board of Trs. of State Univ. of N.Y. v. Fox, 492 U.S. 469 (1989).
42 Friedman v. Rogers, 440 U.S. 1 (1979).
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 1483 2021
1 A bill to be entitled
2 An act relating to the solicitation of non-medical
3 services; creating s. 501.2106, F.S.; defining terms;
4 providing that a person who submits or sponsors a non-
5 medical solicitation that contains certain terminology
6 or fails to include specified disclosures commits a
7 deceptive and unfair trade practice, subject to the
8 penalties and remedies of the Florida Deceptive and
9 Unfair Trade Practices Act; creating s. 877.025, F.S.;
10 defining terms; prohibiting the unauthorized use,
11 sale, or transfer of protected health information for
12 the purpose of soliciting professional services;
13 providing that a person who willfully and knowingly
14 violates such prohibition commits a deceptive and
15 unfair trade practice, subject to the penalties and
16 remedies of the Florida Deceptive and Unfair Trade
17 Practices Act; providing criminal penalties for
18 willful and knowing violations and enhanced criminal
19 penalties for violations committed for financial gain;
20 providing applicability; providing effective dates.
21
22
23 Be It Enacted by the Legislature of the State of Florida:
24
25 Section 1. Section 501.2106, Florida Statutes, is created
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26 to read:
27 501.2106 Non-medical solicitation; deceptive and unfair
28 trade practices.—
29 (1) As used in this section, the term:
30 (a) "Client" means a prospective customer, client, or
31 patron of non-medical professional services.
32 (b) "Non-medical solicitation" means a paid solicitation
33 for non-medical professional services which contains information
34 about a drug or device as defined in s. 499.003 and which is
35 directed to the public through television; radio; the Internet,
36 including a domain name; a newspaper or other periodical; an
37 outdoor advertising sign; or another written, electronic, or
38 recorded communication.
39 (c) "Person" has the same meaning as in s. 1.01(3).
40 (2) A person who submits or approves the submittal of a
41 non-medical solicitation for publication, broadcast, or
42 dissemination, or who pays for or otherwise sponsors a non-
43 medical solicitation, commits a deceptive and unfair trade
44 practice under this part if the solicitation, once published,
45 broadcast, or disseminated, does any of the following:
46 (a) Fails to clearly and conspicuously disclose at the
47 outset of the solicitation the phrase, "This is a paid
48 advertisement for non-medical services."
49 (b) Includes terminology implying that the advertisement
50 is a "medical alert," "health alert," "consumer alert," "public
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51 service announcement," or similar public alert or announcement.
52 (c) Displays the logo, or a similar facsimile thereof, of
53 a federal or state governmental agency in a manner implying
54 affiliation with, or sponsorship by, a governmental agency.
55 (d) Includes terminology, including use of the term
56 "recall" when referring to a product, implying that the product
57 has been recalled when, in fact, the product has not been
58 recalled by a governmental agency or through agreement between a
59 manufacturer and a governmental agency.
60 (e) Fails to clearly and conspicuously disclose the
61 sponsor of the advertisement.
62 (f) Fails to clearly and conspicuously disclose the
63 individual or entity that will provide professional services to
64 persons responding to the advertisement or how those persons
65 will be referred to such individual or entity.
66 (g) Solicits clients who may allege injury from a
67 prescription drug approved or cleared by, or which is the
68 subject of a monograph authorized by, the United States Food and
69 Drug Administration and fails to clearly and conspicuously
70 disclose the following warning: "Do not stop taking a prescribed
71 medication without first consulting with your doctor.
72 Discontinuing a prescribed medication without your doctor's
73 advice can result in injury or death."
74 (h) Solicits clients who may allege injury from a
75 prescription drug or medical device approved or cleared by, or
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76 which is the subject of a monograph authorized by, the United
77 States Food and Drug Administration and fails to clearly and
78 conspicuously disclose that the drug or medical device remains
79 approved by the United States Food and Drug Administration,
80 unless the product is recalled or withdrawn.
81 (i) Fails to present any disclosure required by this
82 subsection such that:
83 1. A written disclosure is clearly legible and, if
84 televised or displayed electronically, is displayed for
85 sufficient time to enable the viewer to easily see and fully
86 read the disclosure.
87 2. A spoken disclosure is plainly audible and clearly
88 intelligible.
89 Section 2. Effective October 1, 2021, section 877.025,
90 Florida Statutes, is created to read:
91 877.025 Solicitation of non-medical services; wrongful use
92 or disclosure of protected health information.—
93 (1) As used in this section, the term:
94 (a) "Person" has the same meaning as in s. 1.01(3).
95 (b) "Protected health information" has the same meaning as
96 provided in 45 C.F.R. s. 106.103.
97 (c) "Solicit" means to offer to provide professional
98 services by written, recorded, or electronic communication or by
99 in-person, telephone, or real-time electronic contact.
100 (2) A person may not use, cause to be used, obtain, sell,
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101 transfer, or disclose to another person an individual's
102 protected health information, without that individual's written
103 authorization, to solicit professional services.
104 (3)(a) A person who violates subsection (2) commits a
105 deceptive and unfair trade practice subject to the penalties and
106 remedies provided in part II of chapter 501.
107 (b) A person who willfully and knowingly violates
108 subsection (2) commits a misdemeanor of the first degree,
109 punishable as provided in s. 775.082 or s. 775.083.
110 (c) A person who willfully and knowingly violates
111 subsection (2) with intent to sell, transfer, or use protected
112 health information for financial gain commits a felony of the
113 second degree, punishable as provided in s. 775.082, s. 775.083,
114 or s. 775.084, except that the term of imprisonment may not
115 exceed 10 years and the fine must be more than $10,000 but may
116 not exceed $250,000.
117 (4) This section does not apply to the disclosure of
118 protected health information to an attorney, or the attorney's
119 use of such protected health information, in any judicial or
120 administrative proceeding or any other use or disclosure
121 otherwise authorized or required by law.
122 Section 3. Except as otherwise expressly provided in this
123 act, this act shall take effect July 1, 2021.
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PCS for HB 1579
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 1579 Health Care Practitioner Discipline
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
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.
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, including discipline of practitioners.
Under current law, DOH must issue an emergency order suspending the license of a licensed physician,
chiropractor, podiatrist, naturopath, optometrist, nurse, nursing assistant, pharmacist, dentist, optician, or
hearing aid specialist who pleads guilty to or is convicted of certain violations of federal law and offenses
relating to Medicare, fraud, drug offenses, and reproductive battery. PCS for HB 1579 expands DOH’s
authority to issue an emergency suspension order to all licensed health care practitioners and adds homicide
to the list of offenses that DOH must issue an emergency suspension order.
PCS for HB 1579 also requires DOH to issue an emergency order suspending the license if a health care
practitioner is arrested for committing or attempting, soliciting, or conspiring to commit any act that would
constitute a violation of certain offenses in this state or similar offenses in another jurisdiction. The PCS also
includes such offenses as acts that constitute grounds for discipline of a licensed health care practitioner.
The bill has a negative, indeterminate fiscal impact on DOH. The bill has no fiscal impacts 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: pcs1579.PPH
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Health Care Professional Licensure
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners. 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. 1 Each profession is regulated by an individual practice act and by ch. 456, F.S., which
provides general regulatory and licensure authority for MQA. MQA is statutorily responsible for the
following boards and professions established within the division: 2
• The Board of Acupuncture, created under ch. 457, F.S.;
• The Board of Medicine, created under ch. 458, F.S.;
• The Board of Osteopathic Medicine, created under ch. 459, F.S.;
• The Board of Chiropractic Medicine, created under ch. 460, F.S.;
• The Board of Podiatric Medicine, created under ch. 461, F.S.;
• Naturopathy, as provided under ch. 462, F.S.;
• The Board of Optometry, created under ch. 463, F.S.;
• The Board of Nursing, created under part I of ch. 464, F.S.;
• Nursing assistants, as provided under part II of ch. 464, F.S.;
• The Board of Pharmacy, created under ch. 465, F.S.;
• The Board of Dentistry, created under ch. 466, F.S.;
• Midwifery, as provided under ch. 467, F.S.;
• The Board of Speech-Language Pathology and Audiology, created under part I of ch. 468, F.S.;
• The Board of Nursing Home Administrators, created under part II of ch. 468, F.S.;
• The Board of Occupational Therapy, created under part III of ch. 468, F.S.;
• Respiratory therapy, as provided under part V of ch. 468, F.S.;
• Dietetics and nutrition practice, as provided under part X of ch. 468, F.S.;
• The Board of Athletic Training, created under part XIII of ch. 468, F.S.;
• The Board of Orthotists and Prosthetists, created under part XIV of ch. 468, F.S.;
• Electrolysis, as provided under ch. 478, F.S.;
• The Board of Massage Therapy, created under ch. 480, F.S.;
• The Board of Clinical Laboratory Personnel, created under part III of ch. 483, F.S.;
• Medical physicists, as provided under part IV of ch. 483, F.S.;
• The Board of Opticianry, created under part I of ch. 484, F.S.;
• The Board of Hearing Aid Specialists, created under part II of ch. 484, F.S.;
• The Board of Physical Therapy Practice, created under ch. 486, F.S.;
• The Board of Psychology, created under ch. 490, F.S.;
• School psychologists, as provided under ch. 490, F.S.;
• The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling, created under ch. 491, F.S.; and
• Emergency medical technicians and paramedics, as provided under part III of ch. 401, F.S.;
Background Screening
1 Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year 2019-2020, p.
6, http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/2019-2020-annual-report.pdf (last visited
on March 16, 2021).
2 S. 456.001(4), F.S; Id.
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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, 3 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. 4
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. 5 Such information for a level 2
screening includes fingerprints, which are taken by a vendor that submits them electronically to FDLE. 6
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. 7 Additionally, for both levels of screening, FDLE must
perform a criminal history record check of its records. 8 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. 9 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. 10 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. 11
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. 12
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: 13
3 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 16, 2021).
4 Section 435.04, F.S.
5 Section 435.05(1)(a), F.S.
6 Sections 435.03(1) and 435.04(1)(a), F.S.
7 Section 435.05(1)(b)-(c), F.S.
8 Id.
9 Section 435.05(1)(b), F.S.
10 Section 435.05(1)(c), F.S.
11 Section 435.05(1)(d), F.S.
12 Section 435.04(2), F.S.
13 Section 456.0635, F.S.
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• 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 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 to exempt applicants from that disqualification under certain circumstances: 14
• 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
• 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.
Only the appropriate regulatory board, or the DOH when there is no board, may grant an exemption
from disqualification to a person under the licensing jurisdiction of that board or the DOH, as
applicable. 15
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, 16 career offender, 17 or sexual
offender (unless not required to register) 18 cannot be exempted from disqualification. 19
Discipline
Section 456.072, F.S., authorizes a regulatory board or DOH, if there is no board, to discipline a health
care practitioner’s licensure for a number of offenses, including but not limited to:
• Making misleading, deceptive, or fraudulent representations in or related to the practice of the
licensee’s profession;
• Making deceptive, untrue, or fraudulent representations in or related to the practice of a
profession or employing a trick or scheme in or related to the practice of a profession; or
• Engaging or attempting to engage in sexual misconduct as defined in s. 456.063, F.S.
Sexual misconduct involves a health care practitioner engaging, or attempting to engage, in verbal or
physical sexual activity outside the scope of the professional practice of his or her health care
profession with a patient or client, or an immediate family member, guardian, or representative of a
patient or client. 20
If the board or DOH finds that a licensee committed a violation, the board or DOH may: 21
• Refuse to certify, or to certify with restrictions, an application for a license;
14 Section 435.07(1), F.S.
15 Section 456.36, F.S.
16 Section 775.261, F.S.
17 Section 775.261, F.S.
18 Section 943.0435, F.S.
19 Section 435.07(4)(b), F.S.
20 Section 456.063, F.S. A person who commits such sexual misconduct is disqualified from licensure in this state.
21 Section 456.072(2), F.S.
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• Suspend or permanently revoke a license;
• Place a restriction on the licensee’s practice or license;
• Impose an administrative fine not to exceed $10,000 for each count or separate offense; if the
violation is for fraud or making a false representation, a fine of $10,000 must be imposed for
each count or separate offense;
• Issue a reprimand or letter of concern;
• Place the licensee on probation;
• Require a corrective action plan;
• Refund fees billed and collected from the patient or third party on behalf of the patient; or
• Require the licensee to undergo remedial education.
Emergency Suspension of Practitioner Licenses
Under current law, DOH must issue an emergency order suspending the license of a licensed
physician, chiropractor, podiatrist, naturopath, optometrist, nurse, nursing assistant, pharmacist, dentist,
optician, or hearing aid specialist who pleads guilty to or is convicted of certain violations of federal law
and offenses relating to Medicare, fraud, drug offenses, and reproductive battery. The PCS expands
DOH’s authority to issue an emergency suspension order to all licensed health care practitioners and
adds homicide to the list of offenses that DOH must issue an emergency suspension order:22
• 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;
• A misdemeanor or felony under:
o 18 U.S.C. s. 669, relating to theft or embezzlement in connection with health care;
o 18 U.S.C. ss. 285-287, relating to taking or using papers relating to claims, conspiracy to
defraud the government with respect to claims, and false, fictitious of fraudulent claims;
o 18 U.S.C. s. 371, relating to conspiracy to commit offense or to defraud United States;
o 18 U.S.C. s. 1001, relating to statements or entries generally;
o 18 U.S.C. s. 1035, relating to false statements relating to health care matters;
o 18 U.S.C. s. 1341, relating to frauds and swindles;
o 18 U.S.C. s. 1343, relating to fraud by wire, radio, or television;
o 18 U.S.C. s. 1347, relating to health care fraud;
o 18 U.S.C. s. 1349, relating to attempt and conspiracy;
o 18 U.S.C. s. 1518, relating to obstruction of criminal investigations of health care
offenses; or
o 42 U.S.C. ss. 1320a-7b, relating to the Medicaid program.
• A felony under s. 784.086, F.S., relating to a reproductive battery.
DOH is not currently authorized to suspend the license of a health care practitioner who is convicted or
found guilty of, or who enters a plea of nolo contendere to, regardless of adjudication to a felony under
ch. 782, F.S., relating to homicide. DOH is also not currently authorized to issue an emergency order
suspending the license of a health care practitioner upon his or her arrest for any violation.
Effect of the Bill
The bill requires DOH to issue an emergency order suspending the license of a health care practitioner
who pleads guilty to, is convicted or found guilty of, or who enters a plea of nolo contendere to,
regardless of adjudication to any offense under s. 456.074, F.S.
The bill adds a felony under ch. 782, F.S., relating to homicide, to the list of offenses in which case
DOH must issue an emergency suspension order.
22 Section 456.074(1), F.S.
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The bill also requires DOH to issue an emergency order suspending the license of any health care
practitioner who is arrested for committing or attempting, soliciting, or conspiring to commit any act that
would constitute a violation of any of the following criminal offenses in this state or similar offenses in
another jurisdiction:
• Section 393.135(2), F.S., relating to sexual misconduct against an individual with a
developmental disability;
• Section 394.4593(2), F.S., relating to sexual misconduct against a patient of a receiving or
treatment facility or otherwise in the custody of the Department of Children and Families;
• Section 787.01, F.S., relating to kidnapping;
• Section 787.02, F.S., relating to false imprisonment;
• Section 787.025(2), F.S., relating to luring or enticing a child;
• Section 787.06(3)(b),(d), (f), or (g), F.S., relating to human trafficking for commercial sexual
activity;
• Former s. 787.06(3)(h), F.S., relating to human trafficking of a child under the age of 15 for
commercial sexual activity;
• Section 787.07, F.S., relating to human smuggling;
• Section 794.011, F.S., relating to sexual battery, excluding s. 794.011(10), F.S.;
• Section 794.05, F.S., relating to unlawful sexual activity with certain minors;
• Section 794.08, F.S., relating to female genital mutilation;
• Former s. 796.03, F.S., relating to procuring a person under the age of 18 for prostitution;
• Former s. 796.035, F.S., relating to the selling or buying of minors into prostitution;
• Section 796.04, F.S., relating to forcing, compelling, or coercing another to become a prostitute;
• Section 796.05, F.S., relating to deriving support from the proceeds of prostitution;
• Section 796.07(4)(a)3., F.S., relating to a felony of the third degree for a third or subsequent
violation of s. 796.07, relating to prohibiting prostitution and related acts;
• Section 800.04, F.S., relating to lewd or lascivious offenses committed upon or in the presence
of persons younger than 16 years of age;
• Section 810.145(8), F.S., relating to video voyeurism of a minor;
• Section 825.1025, F.S., relating to lewd or lascivious offenses committed upon or in the
presence of an elderly person or disabled person;
• Section 827.071, F.S., relating to sexual performance by a child;
• Section 847.011, F.S., relating to prohibited acts in connection with obscene, lewd, etc.,
materials;
• Section 847.012, F.S., relating to materials harmful to minors;
• Section 847.013, F.S., relating to exposing minors to harmful motion pictures, exhibitions,
shows, presentations, or representations;
• Section 847.0133, F.S., relating to the protection of minors from obscene materials;
• Section 847.0135, F.S., relating to computer pornography, prohibited computer usage, or
traveling to meet minors, excluding s. 847.0135(6) F.S.;
• Section 847.0137, F.S., relating to transmission of child pornography by electronic device or
equipment;
• Section 847.0138, F.S., relating to the transmission of material harmful to minors to a minor by
electronic device or equipment;
• Section 847.0145, F.S., relating to the selling or buying of minors;
• Section 856.022, F.S., relating to loitering or prowling in close proximity to children;
• Section 895.03, F.S., relating to racketeering activity, if the court makes a written finding that the
racketeering activity involved at least one sexual offense listed in this subsection or at least one
offense listed in this subsection which was committed with sexual intent or motive;
• Section 916.1075(2), F.S., relating to sexual misconduct against a forensic client of a civil or
forensic facility for defendants who have a mental illness or an intellectual disability;
• Section 985.701(1), F.S., relating to sexual misconduct against a juvenile offender; or
• Any similar offense committed in this state which has been redesignated from a former statute
number to one of those listed in the bill.
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Under the bill, being found guilty of, entering a plea of guilty or nolo contendere to, regardless of
adjudication, or committing or attempting, soliciting, or conspiring to commit an act that would constitute
a violation of any offense listed above, or a similar offense in another jurisdiction, as acts that constitute
grounds for discipline of any licensed health care practitioner.
A licensed health care practitioner who has his or her license suspended by emergency order will not
be able to practice for the duration of the suspension.
B. SECTION DIRECTORY:
Section 1 Amends s. 456.072, F.S., relating to grounds for discipline; penalties; enforcement.
Section 2 Amends s. 456.074, F.S., relating to certain health care practitioners; immediate
suspension of license.
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:
DOH may experience an increase in workload related to investigating complaints against a health
care practitioner and issuing disciplinary actions or emergency suspension orders, the impact of
which is likely negative, insignificant, and indeterminate.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Licensed health care practitioners who are arrested for certain offenses may experience a decrease in
revenue associated with the suspension of a professional license because he or she will not be able to
practice his or her profession for the duration of the suspension.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
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None.
B. RULE-MAKING AUTHORITY:
Current law provides sufficient rulemaking authority to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
PCS for HB 1579 ORIGINAL 2021
1 A bill to be entitled
2 An act relating to health care practitioner
3 discipline; amending s. 456.072, F.S.; subjecting
4 health care practitioners to disciplinary action for
5 specified offenses; amending s. 456.074, F.S.;
6 revising provisions relating to immediate suspension
7 of licensure to apply to all health care
8 practitioners; requiring the Department of Health to
9 issue emergency orders to suspend health care
10 practitioner licenses if they enter a criminal plea
11 to, or are convicted or found guilty of, a felony
12 relating to homicide or are arrested for committing or
13 attempting, soliciting, or conspiring to commit acts
14 that would constitute violations of specified criminal
15 offenses; providing an effective date; providing an
16 effective date.
17
18 Be It Enacted by the Legislature of the State of Florida:
19
20 Section 1. Paragraph (rr) is added to subsection (1) of
21 section 456.072, Florida Statutes, to read:
22 456.072 Grounds for discipline; penalties; enforcement.—
23 (1) The following acts shall constitute grounds for which
24 the disciplinary actions specified in subsection (2) may be
25 taken:
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26 (rr) Being convicted or found guilty of, entering a plea
27 of guilty or nolo contendere to, regardless of adjudication, or
28 committing or attempting, soliciting, or conspiring to commit an
29 act that would constitute a violation of any of the offenses
30 listed in s. 456.074(5) or a similar offense in another
31 jurisdiction.
32 Section 2. Subsection (5) of section 456.074, Florida
33 Statutes, is renumbered as subsection (6), respectively, and
34 subsection (5) is added to that section, and subsection (1) of
35 that section is amended, to read:
36 456.074 Certain health care practitioners; immediate
37 suspension of license.—
38 (1) The department shall issue an emergency order
39 suspending the license of any health care practitioner person
40 licensed under chapter 458, chapter 459, chapter 460, chapter
41 461, chapter 462, chapter 463, chapter 464, chapter 465, chapter
42 466, or chapter 484 who pleads guilty to, is convicted or found
43 guilty of, or who enters a plea of nolo contendere to,
44 regardless of adjudication, any of the following to:
45 (a) A felony under chapter 409, chapter 817, or chapter 893
46 or under 21 U.S.C. ss. 801-970 or under 42 U.S.C. ss. 1395-
47 1396.;
48 (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
49 285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
50 1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
51 Medicaid program.; or
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52 (c) A felony under s. 784.086, relating to a reproductive
53 battery.
54 (d) A felony under chapter 782, relating to homicide.
55 (5) The department shall issue an emergency order
56 suspending the license of any health care practitioner who is
57 arrested for committing or attempting, soliciting, or conspiring
58 to commit any act that would constitute a violation of any of
59 the following criminal offenses in this state or similar
60 offenses in another jurisdiction:
61 (a) Section 393.135(2), relating to sexual misconduct
62 against an individual with a developmental disability.
63 (b) Section 394.4593(2), relating to sexual misconduct
64 against a patient of a receiving or treatment facility or
65 otherwise in the custody of the Department of Children and
66 Families.
67 (c) Section 787.01, relating to kidnapping.
68 (d) Section 787.02, relating to false imprisonment.
69 (e) Section 787.025(2), relating to luring or enticing a
70 child.
71 (f) Section 787.06(3)(b),(d), (f), or (g), relating to
72 human trafficking for commercial sexual activity.
73 (g) Former s. 787.06(3)(h), relating to human trafficking
74 of a child under the age of 15 for commercial sexual activity.
75 (h) Section 787.07, relating to human smuggling.
76 (i) Section 794.011, relating to sexual battery, excluding
77 s. 794.011(10).
78 (j) Section 794.05, relating to unlawful sexual activity
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79 with certain minors.
80 (k) Section 794.08, relating to female genital mutilation.
81 (l) Former s. 796.03, relating to procuring a person under
82 the age of 18 for prostitution.
83 (m) Former s. 796.035, relating to the selling or buying of
84 minors into prostitution.
85 (n) Section 796.04, relating to forcing, compelling, or
86 coercing another to become a prostitute.
87 (o) Section 796.05, relating to deriving support from the
88 proceeds of prostitution.
89 (p) Section 796.07(4)(a)3., relating to a felony of the
90 third degree for a third or subsequent violation of s. 796.07,
91 relating to prohibiting prostitution and related acts.
92 (q) Section 800.04, relating to lewd or lascivious offenses
93 committed upon or in the presence of persons younger than 16
94 years of age.
95 (r) Section 810.145(8), relating to video voyeurism of a
96 minor.
97 (s) Section 825.1025, relating to lewd or lascivious
98 offenses committed upon or in the presence of an elderly person
99 or disabled person.
100 (t) Section 827.071, relating to sexual performance by a
101 child.
102 (u) Section 847.011, relating to prohibited acts in
103 connection with obscene, lewd, etc., materials.
104 (v) Section 847.012, relating to materials harmful to
105 minors.
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106 (w) Section 847.013, relating to exposing minors to harmful
107 motion pictures, exhibitions, shows, presentations, or
108 representations.
109 (x) Section 847.0133, relating to the protection of minors
110 from obscene materials.
111 (y) Section 847.0135, relating to computer pornography,
112 prohibited computer usage, or traveling to meet minors,
113 excluding s. 847.0135(6).
114 (z) Section 847.0137, relating to transmission of child
115 pornography by electronic device or equipment.
116 (aa) Section 847.0138, relating to the transmission of
117 material harmful to minors to a minor by electronic device or
118 equipment.
119 (bb) Section 847.0145, relating to the selling or buying of
120 minors.
121 (cc) Section 856.022, relating to loitering or prowling in
122 close proximity to children.
123 (dd) Section 895.03, relating to racketeering activity, if
124 the court makes a written finding that the racketeering activity
125 involved at least one sexual offense listed in this subsection
126 or at least one offense listed in this subsection which was
127 committed with sexual intent or motive.
128 (ee) Section 916.1075(2), relating to sexual misconduct
129 against a forensic client of a civil or forensic facility for
130 defendants who have a mental illness or an intellectual
131 disability.
132 (ff) Section 985.701(1), relating to sexual misconduct
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133 against a juvenile offender.
134 (gg) Any similar offense committed in this state which has
135 been redesignated from a former statute number to one of those
136 listed in this subsection.
137 Section 3. This act shall take effect July 1, 2021.
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HB 1627
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1627 Continuing Chiropractic Education
SPONSOR(S): Maggard
TIED BILLS: IDEN./SIM. BILLS: SB 1676
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Morris McElroy
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
Chapter 460, F.S., is the practice act for chiropractic medicine and sets the minimum requirements for safe practice in the
state. The Board of Chiropractic Medicine (Board), under the Department of Health (DOH) enforces the practice act,
including licensure, monitoring, and ensuring safe practice of chiropractic professionals.
Currently, chiropractic licensees are required to complete continuing education courses in a classroom setting. HB 1627
repeals that requirement and requires the Board to approve continuing education courses offered in a distance learning
format.
The bill authorizes continuing education courses to be taught by:
• Current faculty members or postgraduate level instructions of a chiropractic college or school, or a medical or
osteopathic college;
• A person who holds a terminal degree with a minimum of three years of related practice and experience in the
subject matter taught; or
• A person who holds a doctoral degree in chiropractic medicine with a minimum of three years of chiropractic
practice and experience in the subject matter taught.
The bill prohibits the Board from requiring licensees to enroll only in preapproved continuing education courses and
limiting the number or type of continuing education hours that may be completed through distance learning. The bill also
authorizes the Board to rescind continuing education course approval and impose disciplinary action, if appropriate.
Currently, the Board may provide exceptions to continuing education requirements in cases of emergency or hardship.
The bill authorizes the Board to provide exceptions to such requirements during a declared state of emergency in this
state.
The bill has a negative, insignificant fiscal impact on DOH, which can be absorbed within current resources. The bill has
no fiscal impact on local governments.
The bill provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Regulation and Licensure of Chiropractic Physicians
Chapter 460, F.S., is the practice act for chiropractic medicine and sets the minimum requirements for
safe practice in the state. The Board of Chiropractic Medicine (Board), under the Department of Health
(DOH) enforces the practice act, including licensure, monitoring, and ensuring safe practice of
chiropractic professionals. 1
To obtain a chiropractic physician license by examination, one must: 2
• Submit a complete application and pay an application fee;
• Be at least 18 years of age;
• Have graduated from a chiropractic college accredited by the Council on Chiropractic Education
or its predecessor agency;
• Have completed at least 3 years of residence college work prior to graduation, consisting of a
minimum of 90 semester hours leading up to a bachelor’s degree from an accredited college or
university; 3
• Pass the National Board of Chiropractic Examiners certification exams I, II, III, and IV and
physiotherapy exam;
• Pass the Florida Laws and Rules Exam; 4 and
• Submit to background screening for criminal history.
Students in an accredited chiropractic college may practice chiropractic medicine without a license as
part of their clinical training or under the direct supervision of chiropractic physician as part of their
course of study. Students in their final year of education at an accredited college may also apply for
licensure and take all of the requisite exams, but must graduate before receiving their license.
Continuing Education
The board is tasked with approving continuing education courses. 5 The board is required to approve
continuing education courses that are sponsored by chiropractic colleges whose graduates are eligible
to take the national examination and the courses must build upon the basic courses required for the
practice of chiropractic medicine. 6 The board is permitted to approve courses in adjunctive modalities.
Furthermore, the board is directed to require licensees to periodically demonstrate their professional
competence as a condition of license renewal by completing at least 40 classroom hours of continuing
education every biennium. 7 The Board may provide exceptions to continuing education requirements in
cases of emergency or hardship. 8
Accreditation for Chiropractic Colleges
1 Florida Department of Health, Board of Chiropractic Medicine, https://floridaschiropracticmedicine.gov/ (last visited March 16, 2021).
2 S. 460.406, F.S.
3 For applicants who graduated from a chiropractic college before July 2, 1990, only 2 years of residence college work from an
accredited college or university are required. However, anyone who graduated from a chiropractic college after July 1, 1990, must have
been granted a bachelor’s degree based on 4 academic years of study from an accredited college.
4 S. 456.017(6), F.S.; Rule 64B2-11.001(2), F.A.C.
5 S. 460.408, F.S.
6 S. 460.408(1), F.S.
7 S.460.408(1), F.S. and 64B2-13.004, F.A.C.
8 S. 460.408(2), F.S.
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Chiropractic education generally includes a four-year doctoral graduate school program which includes
classroom instruction and clinical training. 9 Licensure laws generally require chiropractic education
from an accredited chiropractic college. Accreditation is a process for validating an educational
program which involves an external peer review board developing evaluation criteria and evaluating a
program’s curriculum, faculty, services and operations, clinical competency, and research to determine
if the program meets recognized standards. 10
U.S. Department of Education
The U.S. Department of Education (USDE) does not accredit individual higher educational programs,
but instead recognizes accreditation agencies to evaluate the individual educational programs for
purposes of participating in USDE’s federal student aid programs. 11 Accreditation agencies are not
required to apply for recognition with the USDE, but if an educational institution wants to participate in
federal student aid programs and offer public financial aid to its students, it must be accredited by an
agency which the USDE has recognized. Therefore, many accreditation agencies choose to apply for
recognition with the USDE. 12 The USDE currently recognizes approximately 67 accreditation
agencies. 13
Council on Higher Education Accreditation
The Council on Higher Education Accreditation (CHEA) is a nongovernmental organization that also
evaluates and recognizes accrediting agencies to ensure the academic quality of institutions and
programs for higher education in the United States. 14 There is significant overlap between accrediting
agencies the USDE and CHEA recognize; however, the USDE limits its review to higher education
related to federal student financial aid programs whereas the CHEA will consider accreditation of all
higher education. 15 CHEA currently recognizes approximately 60 accrediting agencies for various
higher education institutions and programs. 16
Council on Chiropractic Education
The Council on Chiropractic Education (CCE) is the only national organization recognized by the
federal DOE or CHEA to accredit chiropractic education programs for its federal programs. 17 There are
currently approximately 20 chiropractic colleges accredited by the CCE, three of which are in Florida. 18
Effect of Proposed Changes
Continuing Education
9 U.S. Department of Labor, Bureau of Labor Statistics, Chiropractors, https://www.bls.gov/ooh/healthcare/chiropractors.htm#tab-4 (last
visited March 19, 2021).
10 U.S. Department of Education, Overview of Accreditation in the United States,
https://www2.ed.gov/admins/finaid/accred/accreditation.html#Overview (last visited March 19, 2021).
11 Id.
12 Id.
13 U.S. Department of Education, Recognized Accrediting Agencies,
https://www2.ed.gov/admins/finaid/accred/accreditation_pg5.html#NationallyRecognized (last visited March 19, 2021).
14 Council for Higher Education Accreditation, Accreditation & Recognition in the United States, https://www.chea.org/accreditation-
recognition-united-states
15 Id.
16 Council for Higher Education Accreditation, CHEA- and USDE-Recognized Accrediting Organizations, (Apr. 18, 2018),
https://www.chea.org/chea-and-usde-recognized-accrediting-organizations (last visited March 19, 2021).
17 Supra notes 13 and 16.
18 U.S. Department of Education, Database of Accredited Postsecondary Institutions and Programs, https://ope.ed.gov/dapip/#/search-
results (last visited March 19, 2021); Council on Chiropractic Education, Accredited Doctor of Chiropractic Programs/Institutions,
http://www.cce-usa.org/dcp-info.html (last visited March 19, 2021); The 3 FL accredited institutions are the National University of Health
Sciences, Palmer College of Chiropractic, and Keiser University.
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HB 1627 authorizes the Board to rescind continuing education course approval and impose disciplinary
action, if appropriate. The bill repeals the requirement that chiropractic continuing education be
completed in a classroom setting and requires the Board to approve continuing education courses
offered in a distance learning format, which includes synchronous and asynchronous learning. The
Board may not require licensees to enroll only in preapproved continuing education courses nor limit
the number or type of continuing education hours that may be completed through distance learning.
The bill authorizes the Board to provide exceptions to continuing education requirements during a
declared state of emergency in this state.
The bill authorizes continuing education courses to be taught by:
• A current faculty member of a:
o Chiropractic college or school approved by the board; or
o Medical or osteopathic college or university accredited by the CHEA or its successor or
the USDE.
• A postgraduate level instructor of a:
o Chiropractic college or school approved by the Board; or
o Medical or osteopathic college or university accredited by the agency recognized by the
CHEA or its successor or the USDE.
• A person who holds a terminal degree19 with a minimum of three years of related practice and
experience in the subject matter taught; or
• A person who holds a doctoral degree in chiropractic medicine with a minimum of three years of
chiropractic practice and experience in the subject matter taught.
The bill requires, rather than authorizes, the Board to adopt rules to implement the changes under the
bill.
B. SECTION DIRECTORY:
Section 1 Amends s. 460.408, F.S., relating to continuing chiropractic education.
Section 2 Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
DOH will experience an increase in workload associated with any rulemaking needed to implement
the bill and updating the Board’s website, which current resources are adequate to absorb. 20
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
19 A terminal degree is the highest degree that may be obtained in a course of study.
20 Department of Health, Agency Analysis of 2021 House Bill 1627, p. 5 (March 16, 2021).
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DATE: 3/22/2021
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Licensees may incur a reduction in expenses associated with travel to a classroom setting to complete
continuing education hours required for license renewal.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill provides sufficient rulemaking authority for implementation by the Board.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 1627 2021
1 A bill to be entitled
2 An act relating to continuing chiropractic education;
3 amending s. 460.408, F.S.; deleting a requirement that
4 chiropractic continuing education be completed in a
5 classroom setting; authorizing the Board of
6 Chiropractic Medicine to rescind approval for
7 continuing education courses and impose disciplinary
8 action, if appropriate; prohibiting the board from
9 requiring licensees to enroll in only preapproved
10 courses to satisfy continuing education requirements;
11 requiring the board to approve distance learning
12 courses to satisfy continuing education requirements;
13 prohibiting the board from limiting the number of
14 hours and type of continuing education courses a
15 chiropractic physician may complete through distance
16 learning; authorizing the board to make exceptions to
17 continuing education requirements during a declared
18 state of emergency in this state; specifying who may
19 teach board-approved continuing education courses;
20 requiring, rather than authorizing, the board to adopt
21 rules; providing an effective date.
22
23 Be It Enacted by the Legislature of the State of Florida:
24
25 Section 1. Section 460.408, Florida Statutes, is amended
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HB 1627 2021
26 to read:
27 460.408 Continuing chiropractic education.—
28 (1) The board shall require licensees to periodically
29 demonstrate their professional competence as a condition of
30 renewal of a license by completing up to 40 contact classroom
31 hours of continuing education.
32 (a) Continuing education courses sponsored by chiropractic
33 colleges whose graduates are eligible for examination under any
34 provision of this chapter may be approved upon review by the
35 board if all other requirements of board rules setting forth
36 criteria for course approval are met.
37 (b) The board shall approve those courses that build upon
38 the basic courses required for the practice of chiropractic
39 medicine, and the board may also approve courses in adjunctive
40 modalities. Courses that consist of instruction in the use,
41 application, prescription, recommendation, or administration of
42 a specific company's brand of products or services are not
43 eligible for approval. The board may rescind course approval and
44 impose disciplinary action, if appropriate. However, the board
45 may not require licensees to enroll in only those courses that
46 have been preapproved by the board to satisfy continuing
47 education requirements under this section.
48 (c) The board shall approve continuing education courses
49 offered in a distance learning format, including synchronous and
50 asynchronous forms of distance learning, as an alternative to
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51 classroom courses which may be used to satisfy continuing
52 education requirements under this section.
53 (d) The board may not limit the number or type of approved
54 continuing education hours that may be completed through
55 distance learning.
56 (2) The board may provide exceptions to make exception
57 from the requirements of this section in emergency or hardship
58 cases and during a declared state of emergency in this state.
59 (3) A course may be taught by any of the following:
60 (a) A person holding a doctoral degree in chiropractic
61 medicine, with a minimum of 3 years of chiropractic practice and
62 a minimum of 3 years' experience in the subject matter taught,
63 or a person holding a terminal degree, with a minimum of 3 years
64 of related practice and a minimum of 3 years' experience in the
65 subject matter taught.
66 (b) A current faculty member of a chiropractic college or
67 school approved by the board, or a current faculty member of a
68 medical or osteopathic college or university accredited by an
69 accrediting agency recognized by the Council for Higher
70 Education Accreditation or its successor or the United States
71 Department of Education.
72 (c) A postgraduate level instructor of a chiropractic
73 college or school approved by the board, or a postgraduate level
74 instructor of a medical or osteopathic college or university
75 accredited by an accrediting agency recognized by the Council
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76 for Higher Education Accreditation or its successor or the
77 United States Department of Education.
78 (4) The board shall may adopt rules necessary to implement
79 this section within the requirements of this section that are
80 necessary for its implementation.
81 Section 2. This act shall take effect July 1, 2021.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 1627 (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 Maggard offered the following:
4
5 Amendment (with title amendment)
6 Remove lines 56-58
7
8
9 -----------------------------------------------------
10 T I T L E A M E N D M E N T
11 Remove lines 16-18 and insert:
12 Learning; specifying who may
013571 - h1627-line 56.docx
Published On: 3/22/2021 5:17:11 PM
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