House of Representatives Staff Analysis — PCS for HB 1565 Department of Health (3/15/2021)
- Issuer
- Congressional materials
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- 2021 3093 Professions Public Health Subcommittee Proposed Committee Bill Analyses Fn Pcs15
Summary
A Florida House of Representatives staff analysis of the PCS for HB 1565, Department of Health, sponsored by the Professions & Public Health Subcommittee and dated 3/15/2021. The analysis states that the bill updates the Targeted Outreach for Pregnant Women Act to account for current medication options, HIV information and mental health issues. It also describes changes to health care professions regulated by Medical Quality Assurance, including replacing regional with institutional accreditation references, clarifying the department's ability to prosecute nurses licensed under ch. 464, F.S., midwife training requirements, and continued licensing of marriage and family therapy graduates until July 1, 2026. The analysis finds an insignificant, negative fiscal impact on the department that current resources can absorb, and gives an effective date of July 1, 2021.
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“House of Representatives Staff Analysis — PCS for HB 1565 Department of Health (3/15/2021).”
Original at www.flhouse.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2021-3093-professions-public-health-subcommittee-proposed-committee-bill-analyses-fn-pcs1565-pph/
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HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 1565 Department of Health
SPONSOR(S): Professions & Public Health Subcommittee
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
Orig. Comm.: Professions & Public Health Morris McElroy
Subcommittee
SUMMARY ANALYSIS
PCS for HB 1565 makes numerous changes to programs under the Department of Health (DOH) and health
care professions regulated by Medical Quality Assurance (MQA) within DOH.
DOH administers the Targeted Outreach for Pregnant Women Act (TOPWA) which supports high risk pregnant
women that aim to prevent heath issues for themselves and their newborns. The PCS updates the TOPWA to
account for current medication options, information on HIV, and mental health issues that may lead to a
pregnancy being high risk.
MQA regulates health care practitioners in this state. MQA works in conjunction with 22 boards and 4 councils
to license and regulate 7 types of health facilities and 40 health care professions. Each profession is regulated
by an individual practice act and by ch. 456, F.S., which provides general regulatory authority and licensure
authority for MQA. The PCS:
Updates institutional accreditation references for chiropractic medicine, clinical laboratory personnel,
and mental clinical social workers and marriage and family therapists;
Clarifies DOH’s ability to prosecute nurses licensed under ch. 464, F.S.;
Removes obsolete references to DOH issued licensure examinations for clinical social workers and
marriage and family therapists;
Clarifies education, training, and temporary certification requirement for midwives;
Removes obsolete form and fee requirements for fingerprinting of orthotists and prosthetists;
Clarifies educational requirements for psychologists applying for licensure by endorsement; and
Allows DOH to continue to issue licenses to marriage and family therapy graduates until July 1, 2026,
while such programs seek accreditation.
The PCS has an insignificant, negative fiscal impact on DOH, which current resources are adequate to absorb.
The PCS has no fiscal impact on local governments.
The PCS provides an effective date of July 1, 2021.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives .
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Targeted Outreach for Pregnant Women
Current Situation
The Targeted Outreach for Pregnant Women Act (TOPWA) supports targeted outreach programs that
aim to prevent vertical HIV transmission and other health issues by linking high-risk pregnant women
with services that can help them have healthier pregnancies and deliveries and can aid them in
ensuring their newborn gets a healthy start.1 In 2019, there were 453 HIV-exposed births in Florida.2
TOPWA programs aim to provide outreach and linkage services to pregnant women who may not seek
proper prenatal care, who suffer from substance-use disorders, or who are living with HIV or are at
increased risk for HIV acquisition.3 Many of the women targeted by TOPWA programs would not
otherwise receive prenatal care or know their HIV status. In 2019, there were seven funded TOPWA
programs in Florida.4 TOPWA programs provided services to 7,703 women from January 2016 to July
2020. Black women represented 48 percent of enrollees, Hispanic women represented 39 percent, and
white women represented 10 percent.5 Women living with HIV made up just under 10 percent of TOPW
enrollments.6
If a pregnant woman tests positive for HIV, medical interventions, like antiretroviral (ARV) medication
and delivery by caesarian section, can greatly reduce her risk of transmitting the virus to her baby
during childbirth.7 Prevention methods, like avoiding breastfeeding, can reduce her risk of transmitting
the virus to her child post childbirth. Providing ARV medication to the newborn also decreases the
chances of seroconversion in the event of an HIV-exposed birth.8 DOH has developed a program, Baby
Rxpress, which provides a six-week course of ARV medication to HIV-exposed newborns at no cost to
the mother.9 In 2019, this program filled 304 prescriptions to 264 HIV-exposed newborns.10
TOPWA programs aim to engage women into care who very likely do not already have knowledge of or
access to these interventions. Without these types of interventions, a mother’s chances of transmitting
HIV to her newborn can be up to 45 percent.11 With these interventions, the chances of transmission
are less than 2 percent.12
There were no known perinatal HIV transmissions in 2019; however, DOH does not have a definitive
status on roughly 25 percent of the 453 HIV-exposed births.13
Effect of Proposed Changes – Targeted Outreach for Pregnant Women
1 Department of Health, Targeted Outreach for Pregnant Women Act, http://stlucie.floridahealth.gov/programs-and-services/infectious-
disease-services/hiv-aids/topwa.html (last visited March 10, 2021).
2 E-mail correspondence with DOH, dated Jan. 28, 2021 on file with the Professions and Public Health Subcommittee.
3 Id.
4 Id.
5 Id.
6 Id.
7 Id.
8 Id.
9 Department of Health, Baby Rxpress, http://www.floridahealth.gov/diseases-and-conditions/aids/Prevention/_documents/topwa/baby-
rxpress-program-description-2018.pdf (last visited March 10, 2021).
10 Supra, note 2.
11 Id.
12 Id.
13 Id.
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The PCS adds pregnant women who are suffering from mental health problems to the list of outreach
targets. It also includes mental health services as a linkage option.
The PCS revises the duties of DOH’s administration of the TOPWA and the information and services
DOH provides to the women it serves. The PCS requires DOH to encourage high-risk pregnant women
to be tested for other sexually transmitted diseases, in addition to HIV, as specified by rule. The PCS
requires DOH to provide pregnant women to have HIV with information on the need for ARV medication
for their newborn, their medication options, and how to access medication after hospital discharge. The
PCS removes a reference to a specific type of ARV medication DOH may provide information on and
incorporates more general information on ARV medications, allowing for additional options. The PCS
requires DOH to educate pregnant women who have HIV on the importance or engaging in and
continuing HIV care. Lastly, the PCS requires DOH to conduct additional follow up for HIV-exposed
newborns to ensure final HIV status is known and necessary linkages to care are made.
Institutional Accreditation
Current Situation
Accreditation is the recognition from an accrediting agency that an institution maintains a certain level
of educational standards. Institutional accreditation normally applies to an entire institution and
indicates that each entity of a school contributes to the achievement of the school’s objectives. This
does not necessarily mean that all parts of the school have the same quality level of education.14
Accrediting agencies issue accreditations.15 Institutions or programs that request an agency’s
evaluation and that meet an agency’s criteria are then accredited by that agency.16 Accrediting
agencies are organizations made up of educational professionals that:17
Establish the operating standards for educational or professional institutions and programs;
Determine if a school meets those standards; and
Publically announce their findings through the issuance of accreditations.
While the United States Department of Education (DOE) does not issue accreditations, it does hold
agencies accountable by ensuring that such agencies enforce their accreditation standards effectively.
As part of DOE oversight, the Secretary of Education is required by law to publish a list of nationally
recognized accrediting agencies that the Secretary determines to be reliable authorities as to the
quality of education or training provided by the institutions of higher education and the higher education
programs they accredit.18
The DOE issued finalized regulations in the Federal Register in October 2019 relating to institutional
accrediting agencies.19 DOE issued a letter of guidance on February 26, 2020, specifying that final
regulations omit references to “regional” and “national” accreditation.20 The letter specifies, “[b]ecause
the Department holds all accrediting agencies to the same standards, distinctions between regional and
national accrediting agencies are unfounded.” Provisions implemented in 34 C.F.R. § 602.32(d),
relating to the recognition of accrediting agencies, became effective January 1, 2021.
14 U.S. Department of Homeland Security – Study in the States, The Basics of School Accreditation,
https://studyinthestates.dhs.gov/the-basics-of-school-accreditation (last visited March 10, 2021).
15 Id. See also U.S. Department of Education, Database of Accredited Postsecondary Institutions and Programs,
https://ope.ed.gov/dapip/#/home (last visited March 10, 2021).
16 U.S. Department of Education, Database of Accredited Postsecondary Institutions and Programs, https://ope.ed.gov/dapip/#/home
(last visited March 10, 2021).
17 Supra, note 14.
18 Supra, note 16.
19 84 C.F.R § 58834 (2020). The new regulations delayed implementation of changes to DOE staff’s review of accrediting agency
applications for initial or renewal of recognition under 34 C.R.R. § 602.32(d) until January 1, 2021. The new regulations also delayed
implementation of changes to DOE staff’s process for responding to accrediting agency applications and allowing agency responses
within 180 days under 34 C.F.R. § 602.32(h) until July 1, 2021.
20 U.S. Department of Education, Re: Final Accreditation and State Authorization Regulations (February 26, 2021)
https://sacscoc.org/app/uploads/2020/03/State-Authorization-Letter-w-Diane-Signature-2.26.19.pdf (last visited March 10, 2021).
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Chiropractic Medicine
Chapter 460, F.S., is the practice act for chiropractic medicine that sets the minimum requirements for
safe practice in the state. The Board of Chiropractic Medicine under DOH enforces the practice act,
including licensure, monitoring, and ensuring safe practice of chiropractic professionals.21
A chiropractic physician is authorized to adjust, manipulate, and treat the human body by manual,
mechanical, electrical, or natural methods.22 Chiropractic physicians may not prescribe or administer
legend drugs, perform surgery, or practice obstetrics.23 Licensure requirements for chiropractic
physicians include:24
Graduation from a chiropractic college accredited by the Council on Chiropractic Education;
Passage of the National Board of Chiropractic Examiners; and
Passage of a background screening.
Clinical Laboratory Directors
A clinical laboratory is the physical location in which services are performed to provide information or
materials for use in the diagnosis, prevention, or treatment of a disease or the identification or
assessment of a medical or physical condition.25 Services performed in clinical labs include:
The examination of fluids or other materials taken from the human body;26
The examination of tissue taken from the human body;27 and
The examination of cells from individual tissues or fluid taken from the human body.28
Clinical laboratories are regulated under part I of ch. 483, F.S. Clinical laboratories must meet
appropriate standards to maintain compliance with federal laws and regulations.29 Such standards
include overall standards of performance that comply with the federal Clinical Laboratory Improvement
Amendments of 1988 (CLIA), and the federal rules adopted thereunder, for a comprehensive quality
assurance program30 and standards of performance in the examination of specimens for clinical
laboratory proficiency testing programs using external quality control procedures.31
The Board of Clinical Laboratory Personnel (Board) oversees the licensure and regulation of clinical
laboratory personnel, including supervisors, technologists, technicians, directors, and public health
laboratory personnel. Generally, licensure requirements for clinical laboratory personnel include
passage of an exam designated by the Board, completion of a medical technology training program,
and completion of applicable education requirements.32
To qualify as a clinical laboratory director, an individual must:33
Have four years of clinical laboratory experience, with two years of experience or national
certification in the specialty to be directed
Be a physician licensed under chs. 458 or 459, F.S.;
21 Florida Department of Health, Board of Chiropractic Medicine, https://floridaschiropracticmedicine.gov/ (last visited March 10, 2021).
22 Section 460.403(9)(c), F.S.
23 Id. However, there are limited exceptions for ordering, storing, and administering legend drugs and performing surgeries.
24 Section 460.406, F.S.
25 Section 483.041, F.S.
26 Section 483.041(2)(a), F.S.
27 Section 483.041(2)(b), F.S.
28 Section 483.041(2)(c), F.S.
29 Section 483.021, F.S.
30 Section 483.051(2)(a), F.S.
31 Section 483.051(2)(b), F.S.
32 Section 483.809, F.S. and ch. 64B3-5, F.A.C.
33 Section 483.824, F.S.
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Hold a doctoral degree in a chemical, physical, or biological science from a regionally accredited
institution and maintain national certification requirements equal to those required by the federal
Health Care Financing Administration; or
For the subspecialty of oral pathology, be a physician licensed under chs. 458 or 459, F.S., or a
dentist licensed under ch. 466, F.S.
Effect of Proposed Changes – Institutional Accreditation
The PCS removes all references to “regional” accreditation replacing such references with “institutional”
accreditation for chiropractic medicine and clinical laboratory directors.
Nursing
Current Situation
The Board of Nursing (Board) within DOH, oversees the licensure and regulation of certified nursing
assistants, licensed practical nurses, registered nurses, and advanced registered nurse practitioners.
The Board has the authority to adopt rules to implement ch. 464, F.S., which regulates the practice of
nursing in this state.34
Certified Nursing Assistants
Certified Nursing Assistants (CNAs) provide care and assist individuals with tasks relating to the
activities of daily living, such as those associated with personal care, nutrition and hydration,
maintaining mobility, toileting, safety and cleaning, end-of-life care, cardiopulmonary resuscitation and
emergency care.35 An applicant for certification as a CNA must complete an approved training program,
pass a competency examination, and pass a background screening.36 A CNA who is certified in
another state or territory of the U.S. or in the District of Columbia, is listed on that state’s CNA registry 37
and has not been found to have committed abuse, neglect, or exploitation in that state, is eligible for
certification by endorsement in Florida.38
Licensed Practical Nurses
A licensed practical nurse (LPN) is licensed to practice “practical nursing,” which is the performance of
selected acts, including the administration of treatments and medications, under the direction of a
registered nurse, licensed physician, or a licensed dentist, and responsibility for making decisions
based on the individual’s educational preparation and experience in nursing.39 To be licensed as an
LPN, among other things, an individual must complete a board-approved education program consisting
of 50 percent clinical training.40
Registered Nurses
A registered nurse (RN) is licensed to practice “professional nursing,” which is the performance of
those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied
principles of psychological, biological, physical, and social sciences.41 To be licensed as an RN, among
other things, an individual must complete an associate’s degree consisting of 50 percent clinical
34 Section 464.006, F.S.
35 Section 464.201(5), F.S.
36 Section 464.203, F.S. See also Department of Health, Board of Nursing, Certified Nursing Assistant (CNA) by Examination, available
at http://floridasnursing.gov/licensing/certified-nursing-assistant-examination/ (last visited November 25, 2019). An applicant who fails
the competency examination 3 times, may not take the exam again until he or she completes an approved training program.
37 A CNA Registry is a listing of CNAs who received certification and maintain an active certification. (r. 64B9-15.004, F.A.C.)
38 Section 464.203(1)(c), F.S.
39
Section 464.003(18), F.S.
40
Section 464.019(1)(b), F.S., and r. 64B9-2.021, F.A.C.
41
Section 464.003(19), F.S.
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training or a bachelor’s degree consisting of 40 percent clinical training from a board-approved
education program.42
Advanced Practice Registered Nurses
In Florida, an advanced practice registered nurse (APRN)43 is licensed in one of four roles: a certified
nurse practitioner, certified nurse midwife, clinical nurse specialist, or certified registered nurse
anesthetist.44
The Board provides by rule the eligibility criteria for applicants to be licensed as APRNs and the
applicable regulatory standards for APRN nursing practices. Additionally, the Board is responsible for
administratively disciplining an APRN who commits an act prohibited under ss. 464.018 or 456.072,
F.S.
Section 464.003(2), F.S., defines the term “advanced or specialized nursing practice” to include, in
addition to practices of professional nursing that registered nurses are authorized to perform,
advanced-level nursing acts approved by the Board as appropriate for APRNs to perform by virtue of
their post-basic specialized education, training, and experience. Advanced or specialized nursing acts
may only be performed if authorized under a supervising physician’s protocol.45 In addition to advanced
or specialized nursing practices, APRNs are authorized to practice certain medical acts, as opposed to
nursing acts, as authorized within the framework of an established supervisory physician’s protocol.46
To be eligible to be licensed as an APRN, an applicant must be licensed as a registered nurse, have a
master’s degree in a nursing clinical specialty area with preparation in specialized practitioner skills,
and submit proof that the applicant holds a current national advanced practice certification from a
board-approved nursing specialty board.47 A nursing specialty board must:48
Attest to the competency of nurses in a clinical specialty area;
Require a written examination prior to certification;
Require nurses to complete a formal program prior to eligibility for examination;
Maintain program accreditation or review mechanism that adheres to criteria which are
substantially equivalent to requirements in Florida; and
Identify standards or scope of practice statements appropriate for each nursing specialty.
Effect of Proposed Changes – Nursing
The PCS clarifies DOH’s ability to prosecute licensees under ch. 464, F.S., who had adjudication
withheld in their court cases after having entered a plea of nolo contender or guilty to an offense
prohibited in ch. 435, F.S., or domestic violence under s. 741.20, F.S.
Midwifery
Current Situation
Chapter 467, F.S., is the practice act for midwifery (Act). DOH licenses and regulates the practice of
midwifery in this state. Midwifery is the practice of supervising a normal labor and childbirth, with the
informed consent of the parent, advising the parents as to the progress of childbirth, and rendering
prenatal and postpartal care.49 The Council of Licensed Midwifery assists and advises DOH on
midwifery, including the development of rules relating to regulatory requirements. These regulations
42
Section 464.019(1)(b), F.S., and Rule 64B9-2.021, F.A.C.
43 Section 464.003(3), F.S.
44 Section 464.012(4), F.S. In 2018, the Florida Legislature changed the occupational title from “Advanced Registered Nurse
Practitioner” to “Advanced Practice Registered Nurse,” and reclassified a CNS as a type of APRN (see ch. 2018-106, Laws of Fla.).
45 Section 464.012(3)-(4), F.S.
46 Section 464.003, F.S., and s. 464.012, F.S.
47 Section 464.012(1), F.S., and Rule 64B9-4.002, F.A.C.
48 Rule 64B9-4.002(3), F.A.C.
49 Section 467.003(8), F.S.
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include training requirements, the licensure examination, responsibilities of midwives, emergency care
plans, and reports and records to be filed by licensed midwives.50
Licensure
An individual must graduate from an approved midwifery program and pass a licensure examination to
be eligible for licensure as a midwife.51 A licensed midwife must submit a general emergency care plan
to DOH, which addresses consultation with other health care providers, emergency transfer protocols,
and access to neonatal intensive care units and obstetrical units or other patient care areas with his or
her application for licensure and licensure renewal.52 A licensed midwife must also submit proof of
professional liability coverage of at least $100,000, with an annual aggregate of at least $300,000.53
DOH may issue a license by endorsement for midwifery applicants who:54
Holds a valid certificate or diploma from a foreign institution of medicine or from midwifery
program in another state provided the requirements for licensure or certification in another
country or another state are equivalent to or exceed that which is required for licensing in
Florida; or
Holds a valid certificate or license to practice midwifery in another state provided the
requirements for licensure or certification in another state are equivalent to or exceed that which
is required for licensing in Florida; and
Has completed a 4-month prelicensure course conducted by an approved program; and
Has successfully passed the licensed midwifery examination.
DOH may also issue a temporary certificate to a midwife who qualifies for licensure by endorsement to
practice in areas of critical need.55 The fee for a temporary certificate is $50 in addition to the fee
required for licensure.56
Midwifery Students
The Act uses the terms “applicant” and “student midwife” interchangeably. It also sets standards for
admission, education, and clinical training in the context of student requirements, which, according to
DOH, may cause confusion. As an example, a student must have a high school diploma or the
equivalent to enroll in a program, but the statutes do not clearly state that a high school diploma is a
requirement for licensure.57
The use of the undefined term “midwifery student” has led to unlicensed persons attempting to work
with clients and complete clinical requirements without enrolling in or being educated by an approved
midwifery program, as well as midwives attempting to serve as preceptors who are not affiliated with an
approved midwifery program.58
The Act does not include any provisions explicitly allowing a new midwifery program to be provisionally
approved nor does it provide clear guidance to schools regarding the circumstances under which DOH
may rescind the approval of a program.
50 Section 467.004, F.S.
51 Section 467.011, F.S. Section 467.0125, F.S. DOH no longer administers licensure examinations.
52 Section 467.017, F.S.
53 Rule 64B24-7.013, F.A.C. An applicant does not have to submit proof of professional liability insurance if the applicant practices
exclusively as an officer, employee, or agent of the federal government, practices only in conjunction with teaching duties at an
approved midwifery school that provides such coverage on the applicant’s behalf, or who does not practice midwifery in this state and
provides proof of such.
54 Section 467.0125(1), F.S.
55 Section 467.0125(2), F.S.
56 Section 467.0125(2)(f), F.S.
57 Supra, note 2.
58 Id. In general, health care practitioners do not start seeing clients in a clinical setting until they have completed prerequisite portions
of a course of study and are near the end of their educational program.
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Effect of Proposed Changes – Midwifery
The PCS makes numerous clarifying changes to the midwifery practice act.
The PCS clarifies that a preceptor may not supervise a midwifery student unless the student has been
enrolled in an approved midwifery program. This clarifies that an individual cannot begin their clinical
practice before enrolling in an approved midwifery program and will explicitly conform midwifery training
with the requirements of other medical professions, with students having to complete the majority of
their classroom training before working with patients in a clinical setting.
The PCS clarifies licensing requirements and updates licensing methods. The PCS prohibits
endorsement without a license or certification in another state, territory or jurisdiction and creates a
pathway to licensure by examination for applicants who have completed education equivalent to or
exceeds that which is required for licensing in Florida in a state, territory, or jurisdiction that does not
license midwives. These revisions do not change what is actually required to qualify for a midwifery
license, but instead clarify licensure requirements allowing applicants to better understand those
requirements.59
The PCS clarifies education and training requirements for approved midwifery programs. The PCS
allows midwifery programs to be provisionally approved for five years. This change conforms to the
five-year period that such programs can be provisionally licensed by the U.S. Department of
Education’s Commission for Independent Education when seeking accreditation status. DOH will be
able to give provisional approval to a new program who has meet all requirements except for showing
their students have an 80% passage rate on the national exam. Programs provisionally approved will
have five years to demonstrate the required exam approval rate after they are preliminary approved.
This time period allows completion of the three-year education program for at least one cohort of
students, and for those students to take the exam before the Department tries to determine the passing
rate.60
The PCS clarifies the requirements for temporary certification of a midwife to practice in an area of
critical need. The PCS allows a midwife certified to practice in an area of critical need to report a new
area of critical need or relinquish the certificate within a specified timeframe following a change in an
areas designated status, rather than being immediately subject to disciplinary action, while retaining the
DOH’s ability to revoke a certificate for non-compliance.61
The PCS removes obsolete references to the DOH issued exam for midwifery licensure as DOH no
longer administers licensure examinations.
Lastly, the PCS clarifies the circumstances under which DOH may rescind the approval of a midwifery
program.
Orthotists and Prosthetists
Current Situation
The Board of Orthotists and Prosthetists oversees the licensure and regulation of orthotists62 and
prosthetists.63 A person applying for licensure must first apply to DOH to take the appropriate licensure
examination. The board may accept the exam results of a national orthotic or prosthetic, standards
59 Id.
60 Id.
61 Id.
62 An orthotist is a health care professional who evaluates, formulates treatment, measures, designs, fabricates, assembles, fits,
adjusts, services, or provides necessary training to accomplish the fitting of an orthosis or a pedorthic device (s. 468.80(9)-(10), F.S.)
63 An prosthetist is a health care professional who evaluates, formulates treatment, measures, designs, fabricates, assembles, fits,
adjusts, services, or provides necessary training to accomplish the fitting of a prosthesis (s. 468.80(15)-(16), F.S.)
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organization in lieu of administering the state exam.64 The board must verify that an applicant for
licensure examination meets the following requirements:65
Has completed the application form and paid all applicable fees;
Is of good moral character;
Is 18 years of age or older;
Has completed the appropriate educational preparation, including practical training
requirements; and
Has successfully completed an appropriate clinical internship in the professional area for which
the license is sought.
In addition to the requirements listed above, an applicant must meet the following requirements for
each license sought:66
A Bachelor of Science degree in Orthotics and Prosthetics from a regionally accredited college
or university from an accredited college or university recognized by the Commission on
Accreditation of Allied Health Education Programs, or a bachelor’s degree with a certificate in
orthotics or prosthetics from a program recognized by the Commission on Accreditation of Allied
Health Education Programs, or its equivalent;
An internship of one year of qualified experience or a residency program recognized by the
board;
Completion of the mandatory classes;67 and
Passage of the state orthotic examination or board-approved orthotic examination if applying for
an orthotist license, or the state prosthetic examination or board-approved examination if
applying for a prosthetist license.
Background Screening
Chapter 435, F.S., establishes standard procedures and requirements for criminal history background
screening of prospective employees. There are two levels of background screening: level 1 and level 2.
Level 1 screening includes, at a minimum, employment history checks and statewide criminal
correspondence checks through the Florida Department of Law Enforcement (FDLE) and a check of
the Dru Sjodin National Sex Offender Public Website,68 and may include criminal records checks
through local law enforcement agencies. A level 2 background screening includes, but, is not limited to,
fingerprinting for statewide criminal history records checks through FDLE and national criminal history
checks through the Federal Bureau of Investigation (FBI), and may include local criminal records
checks through local law enforcement agencies.69
Every person required by law to be screened pursuant to ch. 435, F.S., must submit a complete set of
information necessary to conduct a screening to his or her employer.70 Such information for a level 2
screening includes fingerprints, which are taken by a vendor that submits them electronically to FDLE. 71
For both level 1 and 2 screenings, the employer must submit the information necessary for screening to
FDLE within five working days after receiving it.72 Additionally, for both levels of screening, FDLE must
perform a criminal history record check of its records.73 For a level 1 screening, this is the only
64 Section 468.803(4), F.S. The Board has approved the American Board for Certification in Orthotics, Prosthetics, and Pedorthics
(ABC) exam for orthotist and prosthetist applicants (r. 64B14-4.001, F.A.C.)
65 Section 468.803(2), F.S.
66 Section 468.803(5), F.S. Licenses must be renewed biennially.
67 Pursuant to r. 64B14-5.005, F.A.C., mandatory courses include two hours on Florida laws and rules, two hours on the prevention of
medical errors, one hour on infection disease control, and a CPR certification course.
68 The Dru Sjodin National Sex Offender Public Website is a U.S. government website that links public state, territorial, and tribal sex
offender registries in one national search site. The website is available at https://www.nsopw.gov/ (last visited March 10, 2021).
69 Section 435.04, F.S.
70 Section 435.05(1)(a), F.S.
71 Sections 435.03(1) and 435.04(1)(a), F.S.
72 Section 435.05(1)(b)-(c), F.S.
73 Id.
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information searched, and once complete, FDLE responds to the employer or agency, who must then
inform the employee whether screening has revealed any disqualifying information.74 For level 2
screening, FDLE also requests the FBI to conduct a national criminal history record check of its records
for each employee for whom the request is made.75 As with a level 1 screening, FDLE responds to the
employer or agency, and the employer or agency must inform the employee whether screening has
revealed disqualifying information. If the employer or agency finds that an individual has a history
containing one of these offenses, it must disqualify that individual from employment.
The person whose background is being checked must supply any missing criminal or other necessary
information upon request to the requesting employer or agency within 30 days after receiving the
request for the information.76
Disqualifying Offenses
Regardless of whether the screening is level 1 or level 2, the screening employer or agency must make
sure that the applicant has good moral character by ensuring that the employee has not been arrested
for and is awaiting final disposition of, been found guilty of, regardless of adjudication, or entered a plea
of nolo contendere or guilty to, or been adjudicated delinquent and the record has not been sealed or
expunged for, certain offenses under Florida law, or similar law of another jurisdiction.77
Health Care Practitioner Background Screening Under Ch. 456, F.S.
Section 456.0135, F.S., requires physicians, physician assistants, chiropractic physicians, podiatric
physicians, nurses, certified nursing assistants, pharmacy owners, athletic trainers, massage
therapists, and massage establishment owners to undergo a Level 2 background screening as a part of
the licensure process. The appropriate regulatory board reviews the background screening results of
an applicant or licensee to determine if there is a disqualifying offense. The only automatic disqualifying
offenses for licensure are the following offenses under federal law or Florida law, or similar law in
another jurisdiction:78
A felony under:
o Chapter 409, related to social and economic assistance;
o Chapter 817, relating to fraudulently practices; and
o Chapter 893, relating to drug abuse prevention and control.
A felony under 21 U.S.C. ss. 801-970, relating to controlled substances, or 42 U.S.C. ss. 1395-
1396, relating to health insurance for the aged and disabled, if the sentence and any
subsequent probation ended less than 15 years before the date of application.
Exemption from Disqualification
If an individual is disqualified due to a pending arrest, conviction, plea of nolo contendere, or
adjudication of delinquency to one or more of the disqualifying offenses, s. 435.07, F.S., allows the
Secretary of the appropriate agency (in the case of substance abuse treatment, DCF) to exempt
applicants from that disqualification under certain circumstances:79
Three years have elapsed since the individual has completed or been lawfully released from
confinement, supervision, or nonmonetary condition imposed by a court for a disqualifying
felony; or
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.
74 Section 435.05(1)(b), F.S.
75 Section 435.05(1)(c), F.S.
76 Section 435.05(1)(d), F.S.
77 Section 435.04(2), F.S.
78 Section 456.0635, F.S.
79 Section 435.07(1), F.S.
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Receiving an exemption allows that individual to work despite the disqualifying crime in that person’s
past. However, an individual who is considered a sexual predator,80 career offender,81 or sexual
offender (unless not required to register)82 cannot ever be exempted from disqualification.83
Effect of Proposed Changes – Orthotists and Prosthetists
The PCS removes obsolete references to form and fee requirements for background screening of the
practice of orthotics, prosthetics, and pedorthics which are no longer required to be collected by DOH.
The PCS removes all references to “regional” accreditation replacing such references with “institutional”
accreditation for Orthotists and Prosthetists.
Psychologists
Current Situation
The Board of Psychology oversees the licensure and regulation of psychologists.84 To receive a license
to practice psychology, an individual must:85
Meet one of the following educational requirements:
o Received a doctoral-level psychological education from an institution that had
institutional accreditation from an agency recognized by the United States Department of
Education or was recognized as a member in good standing with the Association of
Universities and Colleges of Canada, and had programmatic accreditation from the
American Psychological Association;86 or
o Received the equivalent of a doctoral-level education from a program at a school or
university located outside of the United States, which is officially recognized by the
government of the country in which it is located as a program or institution to train
students to practice professional psychology.
Complete 2 years or 4,000 hours of supervised experience;
Pass the Examination for Professional Practice in Psychology;87 and
Pass an examination on Florida laws and rules.
The American Psychological Association (APA) is recognized by the U.S. Department of Education and
the Council for Higher Education Accreditation as the national accrediting authority for professional
education and training in psychology.88
Applicants for licensure by endorsement must:89
Be a diplomate in good standing with the American Board of Professional Psychology;
Hold a doctoral degree in psychology with at least 10 years of experience as a licensed
psychologist in any jurisdiction or territory of the U.S. within the 25 years preceding the date of
application.
Effect of Proposed Changes – Psychologists
80 Section 775.261, F.S.
81 Section 775.261, F.S.
82 Section 943.0435, F.S.
83 Section 435.07(4)(b), F.S.
84 Section 490.004, F.S.
85 Section 490.005(1), F.S.
86 Section 490.003(3), F.S., defines doctoral-level education as a Psy.D, an Ed.D., or a Ph.D in psychology.
87 Rule 64B19-11.001, F.A.C.
88 American Psychological Association, Understanding APA Accreditation, available at
http://www.apa.org/ed/accreditation/about/index.aspx (last visited March 10, 2021).
89 Section 490.006, F.S.
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The PCS allows a psychologist applying by endorsement, who has 10 years licensed experience, to
obtain licensure regardless of whether the doctoral program was APA accredited. This will streamline
licensure by endorsement while maintaining the needed accreditation and educational standards for
licensure by examination.90
Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling
Current Situation
Licensed Clinical Social Workers
Licensed clinical social work uses scientific and applied knowledge, theories, and methods for the
purpose of describing, preventing, evaluating, and treating individual, couple, marital, family, or group
behavior, based on the person-in-situation perspective of psychosocial development, normal and
abnormal behavior, psychopathology, unconscious motivation, interpersonal relationships,
environmental stress, differential assessment, differential planning, and data gathering to prevent and
treat undesired behavior and enhance of mental health.91 An applicant seeking licensure as a clinical
social worker must:92
Possess a master’s or doctoral degree from an accredited program;
Have a least two years’ experience in clinical social work;
Pass a theory and practice examination approved by DOH; and
Demonstrate knowledge of laws and rules governing the practice.
Licensed Clinical Social Workers must pass an examination offered by the American Association of
State Social Worker Boards.93 In 1999, the American Association of State Social Worker Boards
changed its name to the Association of Social Work Boards.94
Marriage and Family Therapists
Marriage and family therapy incorporates marriage and family therapy, psychotherapy, hypnotherapy,
sex therapy, counseling, behavior modification, consultation, client-centered advocacy, crisis
intervention, and the provision of needed information and education to clients.95 An applicant seeking
licensure as a mental health counselor must:96
Possess a master’s degree from an a program accredited by the Commission on Accreditation
for Marriage and Family Therapy Education or from a Florida university program accredited by
the Council for Accreditation of Counseling and Related Educational Programs and board-
approved graduate courses;97
Complete two years of post-master’s supervised experience under the supervision of a licensed
marriage and family therapist with five years of experience or the equivalent who is a qualified
supervisor as determined by the board;
Pass a board-approved examination; and
Demonstrate knowledge of laws and rules governing the practice.
90 Department of Health, Agency Analysis of 2021 House Bill 1565 (March 12, 2021).
91 Section 491.003(7), F.S.
92 Section 491.005(1), F.S.
93 Id.
94 Association of Social Work Boards, History, available at https://www.aswb.org/about/history/ (last visited March 10, 2021).
95 Id.
96 Section 491.005(3), F.S. An individual may qualify for a dual license in marriage and family therapy if he or she passes an
examination in marriage and family therapy and has held an active license for at least three years as a psychologist, clinical social
worker, mental health counselor, or advanced registered nurse practitioner who is determined by the Board of Nursing to be a specialist
in psychiatric mental health (s. 491.0057, F.S.)
97 Ch. 2020-133, Laws of Fla, required applicants for licensure as a marriage and family therapist to graduate from an accredited
program or an accredited Florida university program.
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DOH must verify that an applicant’s education matches the specified courses and hours as outlined in
statute. However, there are organizations that accredit marriage and family therapy education
programs, including the Commission on Accreditation for Marriage and Family Therapy Education and
the Council for the Accreditation of Counseling and Related Educational Programs that establish the
minimum standards to meet the requirements to practice the profession.98
Mental Health Counselors
A mental health counselor is an individual who uses scientific and applied behavioral science theories,
methods, and techniques to describe, prevent, and treat undesired behavior and enhance mental
health and human development and is based on research and theory in personality, family, group, and
organizational dynamics and development, career planning, cultural diversity, human growth and
development, human sexuality, normal and abnormal behavior, psychopathology, psychotherapy, and
rehabilitation.99 To qualify for licensure as a mental health counselor, an individual must:100
Have a master’s degree from a mental health counseling program accredited by the Council of
the Accreditation of Counseling and Related Educational Programs, or a program related to the
practice of mental health counseling that includes coursework and a 700-hour practicum,
internship, or fieldwork of which at least 280 hours must be in direct client services;
Have at least two years of post-master’s supervised clinical experience in mental health
counseling;
Pass an examination from the Professional Examination Service for the National Academy of
Certified Clinical Mental Health Counselors; and
Pass an eight-hour course on Florida laws and rules approved by the Board of Clinical Social
Work, Marriage and Family Therapy, and Mental Health Counseling.101
After July 1, 2025, applicants for licensure as a mental health counselor must hold a master’s degree
from a program accredited by the Council for Accreditation of Counseling and Related Education
Programs.102
Effect of Proposed Changes – Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling
The bill removes all references to “regional” accreditation replacing such references with “institutional”
accreditation for clinical social workers and marriage and family therapists.
The PCS allows DOH to continue to license marriage and family therapy students or graduates who
have graduated from an unaccredited program until July 1, 2026. This will eliminate a barrier to
licensure for such students.103
The PCS also removes obsolete references to DOH issued licensure examinations.
B. SECTION DIRECTORY:
Section 1 Amends s. 381.0045, F.S., relating to targeted outreach for pregnant women.
Section 2 Amends s. 460.406, F.S., relating to licensure by examination.
Section 3 Amends s. 464.018, F.S., relating to disciplinary actions.
Section 4 Amends s. 467.003, F.S., relating to definitions.
98 See Commission on Accreditation for Marriage and Family Therapy Education, What Are the Benefits of COAMFTE Accreditation,
available at https://www.coamfte.org/COAMFTE/Accreditation/About_Accreditation.aspx (last visited March 10, 2021), and Council for
the Accreditation of Counseling and Related Educational Programs, About CACREP, available at https://www.cacrep.org/about-cacrep/
(last visited March 10, 2021).
99 Sections 491.003(6) and (9), F.S.
100 Section 491.005(4), F.S.
101 Section 491.005(4), F.S., and r. 64B4-3.0035, F.A.C.
102 Ch. 2020-133, Laws of Fla.
103 Supra, note 2.
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Section 5 Amends s. 467.009, F.S., relating to midwifery programs; education and training
requirements.
Section 6 Amends s. 467.011, F.S., relating to licensure by examination.
Section 7 Amends s. 467.0125, F.S., relating to licensure by endorsement.
Section 8 Amends s. 467.205, F.S., relating to approval of midwifery programs.
Section 9 Amends s. 468.803, F.S., relating to license, registration, and examination requirements.
Section 10 Amends s. 483.824, F.S., relating to qualifications of clinical laboratory director.
Section 11 Amends s. 490.003, F.S., relating to definitions.
Section 12 Amends s. 490.005, F.S., relating to licensure by examination.
Section 13 Amends s. 490.0051, F.S., relating to provisional licensure; requirements.
Section 14 Amends s. 491.005, F.S., relating to licensure by examination.
Section 15 Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
DOH may experience an increase in workload to conduct rulemaking and updating online
application websites to implement the provisions of the PCS, the impact of which can be absorbed
within current resources.104
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The PCS does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
104 Supra, note 90.
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DOH has sufficient rulemaking authority to implement the PCS.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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