Professions and Public Health Subcommittee — Meeting Packet (January 19, 2022)

Summary

Meeting packet of the Professions & Public Health Subcommittee of the Florida House of Representatives for Wednesday, January 19, 2022, 1:00 PM, with Will Robinson as Chair. The notice lists HB 5 Reducing Fetal and Infant Mortality, CS/HB 469, HB 817, HB 847 Occupational Therapy, and a proposed committee substitute on HB 731 Drug-related Overdose Prevention. The staff analysis of HB 5 states that the bill requires the Department of Health to contract for additional fetal and infant mortality review committees in all regions and prohibits abortions if the physician determines the gestational age of the fetus is more than 15 weeks. It states that the bill appropriates $260,000 in recurring General Revenue to the Department of Health.

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

Cite this document

“Professions and Public Health Subcommittee — Meeting Packet (January 19, 2022).” Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2022-01-19-3093-professions-public-health-subcommittee-meeting-packets-baf99a3d5c/, SHA-256 cb65d2aaa56f8f432b45d0ca48953876faa1ddf2741ff18ecc4a7624270849cc.

Full text

Professions and Public Health
Subcommittee
Wednesday, January 19, 2022
1:00 PM – 3:00 PM
Webster Hall (212 Knott)

Meeting Packet

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

Professions & Public Health Subcommittee

Start Date and Time: Wednesday, January 19, 2022 01:00 pm

End Date and Time: Wednesday, January 19, 2022 03:00 pm

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

Consideration of the following bill(s):

HB 5 Reducing Fetal and Infant Mortality by Grall, Persons-Mulicka
CS/HB 469 Patient Care in Health Care Facilities by Finance & Facilities Subcommittee, Trabulsy
HB 817 Emergency Medical Care and Treatment to Minors Without Parental Consent by Massullo
HB 847 Occupational Therapy by Koster

Consideration of the following proposed committee substitute(s):

HB 731 Drug-related Overdose Prevention by Caruso

For information about attending or testifying at a committee meeting, please see the “Visiting the House”
tab at www.myfloridahouse.gov.

NOTICE FINALIZED on 01/14/2022 4:03PM by Osborne.Erin

01/14/2022 04:03:46PM Leagis ® Page 1 of 1
HB 5
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 5 Reducing Fetal and Infant Mortality
SPONSOR(S): Grall and others
TIED BILLS: IDEN./SIM. BILLS: SB 146

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

1) Professions & Public Health Subcommittee McElroy McElroy

2) Health Care Appropriations Subcommittee

3) Health & Human Services Committee

SUMMARY ANALYSIS
Infant mortality is the death of an infant before the first birthday. The infant mortality rate in the United States is 5.6 deaths per
1,000 live births and Florida ranks 18th in the nation in infant mortality with a rate of six deaths per 1,000 live births. Abortion is
the termination of a human pregnancy with an intention other than to produce a live birth or to remove a dead fetus. The bill
addresses fetal and infant mortality reduction related to fetal and infant mortality reviews (FIMR), hospital quality initiatives,
comprehensive statewide tobacco education and use prevention, and abortion policy.

Fetal and infant mortality review (FIMR) is a community-based fetal and infant mortality review process to identify and address
factors that affect infant mortality and morbidity. The Department of Health (DOH) contracts with Healthy Start Coalitions
around the state for FIMR programs; however, FIMR programs are not available statewide. The bill requires DOH to contract
for additional FIMR committees in all regions of the state. Each Coalition must report FIMR committee findings and
recommendations to DOH annually and DOH must submit such in a report to the Governor, President of the Senate, and
Speaker of the House of Representatives.

The Florida Perinatal Quality Collaborative (FPQC) partners with stakeholders and partners across the state to develop and
implement quality initiatives to reduce maternal and infant mortality. FPQC’s initiatives provide quality improvement data
reports, toolkits, online toolboxes, and technical assistance to hospitals to assist with implementing process changes to carry
out quality improvement initiatives. While many hospitals participate in FPQC initiatives, participation is voluntary and many do
not. The bill requires hospitals that provide birthing services (labor and delivery) to participate in at least two quality
improvement initiatives developed in collaboration with the FPQC.

The Comprehensive Statewide Tobacco Education and Use Prevention Program (Program) is a program based on best
practices from the U.S. Centers for Disease Control and Prevention. The Program educates Floridians, particularly youth and
their parents, about the hazards of tobacco and preventing use. The bill requires the Program to include a focus on pregnant
women and women who may become pregnant.

Florida law prohibits abortions during the third trimester with certain medical exceptions. Current law also requires the physician
performing the abortion to determine, by ultrasound, the gestational age of the fetus at the time the abortion is to be performed.

HB 5 prohibits abortions if the physician performing abortion determines the gestational age of the fetus is more than 15 weeks,
based on the first day of the woman’s last menstrual period. This replaces the current prohibition against abortions during the
third trimester. The bill retains the current medical exception to prohibited abortions and, adds an exception for fatal fetal
abnormalities.

Current law requires abortion providers to submit a monthly report to AHCA. Abortion providers are not currently required to
report whether the abortion was due to human trafficking or the number of medication abortion regimens prescribed or
dispensed by abortion providers.

HB 5 enhances and clarifies current abortion reporting requirements. The bill requires abortion providers to report whether
abortions were due to human trafficking. The bill addresses potential data reporting gaps by clarifying that both surgical and
medication-induced abortions must be reported and to report the number of medication abortion regimens prescribed and
dispensed. The bill also requires AHCA, the Board of Medicine and the Board of Osteopathic Medicine to adopt an electronic
reporting form.
The bill has a significant, negative fiscal impact to the Department of Health and no fiscal impact to local governments. The bill
appropriates $260,000 in recurring General Revenue to DOH for these costs.

The bill provides an effective date of July 1, 2022.

This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0005.PPH
DATE: 1/18/2022
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Background

Infant Mortality

Infant mortality is the death of an infant before the first birthday. The infant mortality rate is the number
of infant deaths for every 1,000 live births. In addition to giving key information about maternal and
infant health, the infant mortality rate is a marker of the overall health of a society. In 2019, the infant
mortality rate in the United States was 5.6 deaths per 1,000 live births. 1

Infant Mortality Rates by State – 2019 2

1 Centers for Disease Control and Prevention, Infant Mortality,

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm (last visited Jan. 12, 2022).
2 Centers for Disease Control and Prevention, Infant Mortality Rates by State,

https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm (last visited Jan. 12, 2022).
STORAGE NAME: h0005.PPH PAGE: 2
DATE: 1/18/2022
Infant Mortality Rates, U.S. States, 2019
10
9
8
7 31st
6
Rate 5
4
3
2
1
0
NH CA NY ID MN OR AK KY HI ME TX NM KS VA WI FL DE MI SD AR SC WY OK AL MS
State 3

Infant Mortality in Florida

The Department of Health (DOH) reports annually on fetal and infant deaths through the Florida Vital
Statistics Annual Report. 4 This report provides the number of fetal deaths per 1,000 live births, the
number of deaths by race, and compares that data to national figures. Florida ranks 18th in the nation in
infant mortality with a rate of six deaths per 1,000 live births (1,213 in 2020). 5

In Florida, the leading causes of infant mortality, per 1,000 live births, are: 6

• Birth defects (1.1);
• Preterm and low birth weight (0.9);
• Unintentional injuries (0.5);
• Maternal complications of pregnancy (0.4);
• Complications of placenta, cord, and membranes (0.3); and
• Sudden Infant Death Syndrome (0.3).

3 Centers for Disease Control and Prevention, Reproductive Health – Infant Mortality Rates by State, 2019,

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm#infant (last visited Jan. 12, 2022).
Note that Vermont’s rate was determined unreliable for 2019 by the CDC and is not included in this chart.
4 Florida Vital Statistics Annual Report 2020, http://www.flpublichealth.com/VSbook/PDF/2020/Fetal.pdf (last visited

Jan. 12, 2022).
5 Id. See also Centers for Disease Control and Prevention, Infant Mortality Rates by State (2019),

https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm (last visited Jan. 12, 2022).
6 Presentation by Shay Chapman, BSN, MBA, Deputy Division Director, Community Health Promotion, Sept. 21, 2021

meeting of the Professions and Public Health Subcommittee, available at
https://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?PublicationType=Committees&CommitteeId=3093&S
ession=2022&DocumentType=Meeting+Packets&FileName=pph+9-21-21.pdf (last visited Jan. 12, 2022).
STORAGE NAME: h0005.PPH PAGE: 3
DATE: 1/18/2022
Source: Florida CHARTS, www.flhealthcharts.com.

Florida Infant Mortality Rates by County 7

7 Id.
STORAGE NAME: h0005.PPH PAGE: 4
DATE: 1/18/2022
Fetal and Infant Mortality Review

Fetal and infant mortality review (FIMR) is a process of community-based fetal and infant mortality
reviews aimed at addressing factors and issues that affect infant mortality and morbidity. FIMR
committees aim to gain knowledge through the reviews to empower communities to enhance services,
influence policy, and direct planning efforts that will ultimately lower infant mortality rates. The process
is based on the National FIMR model which supports case review and interventions at the local level. 8

FIMR Process

In Florida, FIMR committees operate in a two-tier structure consisting of Healthy Start Coalitions
(Coalition) and Case Review Teams (CRT). The FIMR process begins when infant death cases are
selected for review by a committee within the Healthy Start Coalition (Coalition) based on specific
criteria, including type of death, residence and race. Information is abstracted from birth, death,
medical, hospital and autopsy records. Efforts are also made to interview the family. No information
which identifies the family or medical providers is included on the abstraction form. 9

Case summaries are developed by the Coalition committee and presented to the CRT, a
multidisciplinary group of community medical and social service professionals. This group usually
includes a district and local health officer, obstetrician, pediatrician, social worker, nurse-midwife, a
hospital and community nurse, coroner or medical examiner, interviewer, abstractor, community
outreach worker, mental health counselor, and other people important to the individual reviews. The
CRT examines each case to determine medical, social, financial and other issues that may have
impacted the poor birth outcome. Recommendations for community action are crafted by the CRT
based on review findings. These recommendations are shared with the Community Action Group, a
group of volunteers working with at-risk families and other partner agencies 10 in the region to implement
and develop street-level outreach activities. 11

FIMR work has several benefits, such as including the perspective of the family, identifying issues
unique to a community, allowing for targeted initiatives, and engaging community leaders to identify and
implement solutions. 12

FIMR in Florida

DOH contracts with Healthy Start Coalitions around the state for FIMR programs. 13 Rather, FIMIR is not
a statewide program and there is no statutory directive for the FIMR process; programs are authorized
in the General Appropriations Act. Approximately half of the counties in the state participate in a FIMR
program. 14 Currently, Florida has: 15

8 Florida Department of Health. FIMR, available at http://www.doh.state.fl.us/family/mch/FIMR/fimr_facts.html (last visited

Jan. 12, 2022).
9 Id.
10 Partner agencies may include health departments, hospitals, medical societies, schools, community and business

leaders, and consumers
11 Supra, note 8.
12 National Fetal and Infant Mortality Review Program, A Guide for Communities: Fetal and Infant Mortality Review

Manual, 2nd Edition (2008), https://ncfrp.org/wp-content/uploads/NCRPCD-Docs/FIMRManual.pdf (last visited Jan 12,
2022).
13 Email from Andrew Love, Director of Legislative Planning, Department of Health, Infant Mortality Policy

Recommendations (Sept. 2, 2021) and
14 Email from Andrew Love, Director of Legislative Planning, Department of Health, Follow Up Documents (July 26, 2021).

See also Presentation by Cathy Timuta, CEO, Florida Association of Healthy Start Coalitions, Inc., and Faye Johnson,
CEO, Northeast Florida Healthy Start Coalition, Inc., Oct. 13, 2021 meeting of the Professions and Public Health
Subcommittee, available at
https://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?PublicationType=Committees&CommitteeId=3093&S
ession=2022&DocumentType=Meeting+Packets&FileName=pph+10-13-21.pdf (last visited Jan., 12, 2022).
15 Id.
STORAGE NAME: h0005.PPH PAGE: 5
DATE: 1/18/2022
• 11 state-funded FIMR programs though contracts with Healthy Start;
• 3 FIMRs funded through the County Health Departments (Orange, Osceola, and Palm Beach
counties); and
• 2 FIMRs independently funded (Hillsborough and Indian River counties); and
• 1 inactive FIMR (St. Lucie County).

Healthy Start Coalition FIMR Programs 16

16 Presentation by Cathy Timuta, CEO, Florida Association of Healthy Start Coalitions, Inc., and Faye Johnson, CEO,

Northeast Florida Healthy Start Coalition, Inc., Oct. 13, 2021 meeting of the Professions and Public Health Subcommittee,
available at
https://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?PublicationType=Committees&CommitteeId=3093&S
ession=2022&DocumentType=Meeting+Packets&FileName=pph+10-13-21.pdf (last visited Jan., 12, 2022).
STORAGE NAME: h0005.PPH PAGE: 6
DATE: 1/18/2022
Comprehensive Statewide Tobacco Education and Use Prevention

On November 7, 2006, the voters in the State of Florida adopted Amendment 4, creating the
Comprehensive Statewide Tobacco Education and Prevention Program. 17 Pursuant to the amendment,
the state is required to create a comprehensive, statewide program consistent with the United States
Department of Health and Human Services, Centers for Disease Control and Prevention 1999 best
practices, as periodically amended. The program must consist, at a minimum, of the following
components: 18

• An advertising campaign, funded by at least one-third of the required annual appropriation;
• Evidence-based curricula and programs to educate youth about tobacco and discourage their
use of it;
• Programs of local community-based partnerships;
• Enforcement of laws, regulations, and policies against the sale or other provision of tobacco to
minors, and the possession of tobacco by minors; and
• Publicly-reported annual evaluations to ensure that moneys appropriated for the program are
spent properly.

The Constitution specifies that the Legislature must appropriate 15 percent of the total gross funds that
tobacco companies paid to the State of Florida in 2005 under the Tobacco Settlement. This amount
must be adjusted annually for inflation using the Consumer Price Index. For Fiscal Year 2021-2022, the
mandated appropriation is $73.9 million. 19

In 2007, the Legislature created section 381.84, Florida Statutes, the Comprehensive Statewide
Tobacco Education and Use Prevention Program (Program), to implement the constitutional
amendment. The Program consists of nine components: 20

• Counter-marketing and advertising;
• Cessation programs, counseling and treatment;
• Surveillance and education;
• Youth and school programs;
• Community programs and chronic disease prevention;
• Training of health care practitioners, tobacco-use cessation counselors and teachers;
• Administration and management;
• Enforcement and awareness of related laws; and
• The area health education centers (AHEC) tobacco-use cessation initiative.

The Program requires each component to focus on educating people, particularly youth and their
parents, about the hazards of tobacco and discouraging the use of tobacco. The Program does not
specifically address pregnant women and women who may become pregnant.

Hospitals and Infant Mortality

Hospitals are regulated by the Agency for Health Care Administration (AHCA) under chapter 395, F.S.,
and the general licensure provisions of part II, of chapter 408, F.S. Hospitals offer a range of health
care services with beds for use beyond 24 hours by individuals requiring diagnosis, treatment, or
care. 21 Hospitals must make regularly available at least clinical laboratory services, diagnostic X-ray
services, and treatment facilities for surgery or obstetrical care, or other definitive medical treatment. 22

17 Art. X, s. 27, Fla. Const.
18 Id.
19 Fla. General Appropriation Act Fiscal Year 2021-2022, SB 2500 item 458.
20 S. 381.84(3), F.S.
21 S. 395.002(12), F.S.
22 Id.
STORAGE NAME: h0005.PPH PAGE: 7
DATE: 1/18/2022
Currently, hospitals that provide birthing services must incorporate information on safe sleep practices
and the possible causes of Sudden Unexpected Infant Death into postpartum instruction on the care of
newborns. Hospitals must also provide parents with an informational pamphlet on infant and childhood
eye and vision disorders. 23

Florida Perinatal Quality Collaborative

The Florida Perinatal Quality Collaborative (FPQC) was established in 2010 and housed in the Chiles
Center at the University of South Florida College of Public Health. FPQC aims to improve Florida’s
maternal and infant health outcomes through evidence-based perinatal care. FPQC partners with
stakeholders, such as perinatal-related organizations, individuals, families, health professionals,
hospitals, and payers to develop and implement quality improvement initiatives at partner hospitals that
provide birthing services (labor and delivery) to address maternal and infant mortality. 24 FPQC’s
initiatives provide quality improvement data reports, toolkits, online toolboxes, and technical assistance
to hospitals to assist with implementing process changes to carry out quality improvement initiatives.

Hospital participation in FPQC initiatives is voluntary.

Currently, FPQC has four active initiatives: 25

• Promoting Primary Vaginal Deliveries (PROVIDE): 26 The goal of the PROVIDE Initiative is to
improve maternal and newborn outcomes by applying evidence-based interventions to promote
primary vaginal deliveries at Florida delivery hospitals and ultimately reduce Nulliparous, Term,
Singleton, Vertex cesareans. 27 Seventy-five hospitals currently participate in PROVIDE.
• Family-Centered Care in the NICU (PAIRED): 28 PAIRED helps hospital neonatal intensive
care units (NICU) develop and implement unit-specific strategies to improve how a family
engages with the NICU staff to assist in the care of their infant in a way that provides value to
the family and to the NICU team. As its centerpiece project, this initiative facilitates adoption or
expansion of safe skin-to-skin care, which has a growing evidence base for achieving better
infant and family outcomes. Sixteen hospitals currently participate in PAIRED.
• Perinatal Quality Indicators System (PQI): 29 The PQI initiative supports hospital quality
improvement efforts by providing hospital-specific semi-annual or quarterly reports of perinatal
indicators and related reports. PQI is offered to all Florida delivery hospitals at no charge and
hospitals can enroll at any time. Fifty-six hospitals currently participate in PQI.
• Maternal Opioid Recovery Effort (MORE): 30 MORE works with providers, hospitals, and other
stakeholders to improve identification, clinical care, and coordinated treatment and support for
pregnant women with opioid use disorder (OUD) and their infants. MORE focuses on
standardization related to OUD screening, prevention, treatment, and comprehensive discharge
planning. Thirty-one hospitals are currently participating in MORE.

23 S. 395.1053, F.S.
24 USF Health College of Public Health, Florida Perinatal Quality Collaborative – About the FPQC,

https://health.usf.edu/publichealth/chiles/fpqc/about (last visited Jan. 12, 2022).
25 USF Health College of Public Health, Florida Perinatal Quality Collaborative,

https://health.usf.edu/publichealth/chiles/fpqc (last visited Jan. 12, 2022).
26 USF Health College of Public Health, Florida Perinatal Quality Collaborative – Promoting Vaginal Deliveries,

https://health.usf.edu/publichealth/chiles/fpqc/provide (last visited Jan. 12, 2022).
27 Nulliparous, Term, Singleton, Vertex (NTSV) Cesareans are cesarean births where babies are at or beyond 37.0

weeks gestation to women in their first pregnancy, that are singleton (no twins or beyond) and in the vertex presentation
(no breech or transverse positions).
28 USF Health College of Public Health, Florida Perinatal Quality Collaborative – PAIRED Initiative,

https://health.usf.edu/publichealth/chiles/fpqc/paired (last visited Jan. 12, 2022).
29 USF Health College of Public Health, Florida Perinatal Quality Collaborative – Perinatal Quality Indicators System,

https://health.usf.edu/publichealth/chiles/fpqc/indicators (last visited Jan. 12, 2022).
30 USF Health College of Public Health, Florida Perinatal Quality Collaborative – Maternal Opioid Recovery Effort

(MORE), https://health.usf.edu/publichealth/chiles/fpqc/MORE (last visited Jan. 12, 2022).
STORAGE NAME: h0005.PPH PAGE: 8
DATE: 1/18/2022
Since the MORE initiative began in November 2019, participating hospitals have substantially
increased screening for substance use disorder, mental health, intimate partner violence, and infectious
diseases, as indicated by the graph below. 31

Maternal Screening in MORE Participating Hospitals 32

Federal Law on Abortion

In 1973, the foundation of modern abortion jurisprudence, Roe v. Wade 33, was decided by the U.S.
Supreme Court (Supreme Court). The Supreme Court determined that a woman’s right to an abortion is
part of a fundamental right to privacy guaranteed under the Due Process Clause of the Fourteenth
Amendment of the U.S. Constitution. Further, the Court reasoned that state regulation limiting the
exercise of this right is subject to strict scrutiny: it must be justified by a compelling state interest, and
must be narrowly drawn. 34 In 1992, the fundamental holding of Roe was upheld by the U.S. Supreme
Court in Planned Parenthood v. Casey. 35

The Viability Standard

In Roe v. Wade, the Supreme Court established a rigid trimester framework dictating when, if ever,
states can regulate abortion. 36 The Court held that states could not regulate abortions during the first
trimester of pregnancy. 37 With respect to the second trimester, the Court held that states could only
enact regulations aimed at protecting the mother’s health, not the fetus’s life. Therefore, no ban on
abortions is permitted during the second trimester. The state’s interest in the life of the fetus becomes
sufficiently compelling only at the beginning of the third trimester, allowing it to prohibit abortions. Even
then, the Court requires states to permit an abortion in circumstances necessary to preserve the health
or life of the mother. 38

31 Presentation by William Sappenfield, MD, MPH, CPH, Professor, Director of Chiles Center, University of South Florida,

Oct. 13, 2021 meeting of the Professions and Public Health Subcommittee, available at:
https://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?PublicationType=Committees&CommitteeId=3093&S
ession=2022&DocumentType=Meeting+Packets&FileName=pph+10-13-21.pdf (last visited Jan. 12, 2022).
32 Id.
33 Roe v. Wade, 410 U.S. 113 (1973).
34 Id.
35 Casey, 505 U.S. 833 (1992).
36 Roe, 410 U.S. 113 (1973).
37 Id. at 163-64.
38 Id. at 164-165.

STORAGE NAME: h0005.PPH PAGE: 9
DATE: 1/18/2022
The current viability standard is set forth in Planned Parenthood v. Casey. 39 Recognizing that medical
advancements in neonatal care can advance viability to a point somewhat earlier than the third
trimester, the Supreme Court rejected the trimester framework and, instead, limited the states’ ability to
regulate abortion pre-viability. Thus, while upholding the underlying holding in Roe, which authorizes
states to “regulate, and even proscribe, abortion except where it is necessary, in appropriate medical
judgment, for the preservation of the life or health of the mother[,]” 40 the Court determined that the line
for this authority should be drawn at “viability,” because “there may be some medical developments that
affect the precise point of viability . . . but this is an imprecision within tolerable limits given that the
medical community and all those who must apply its discoveries will continue to explore the matter.” 41
Furthermore, the Court recognized that “[i]n some broad sense it might be said that a woman who fails
to act before viability has consented to the State’s intervention on behalf of the developing child.” 42

The Undue Burden Standard

In Planned Parenthood v. Casey, the Supreme Court established the undue burden standard for
determining whether a law places an impermissible obstacle to a woman’s right to an abortion. The
Court held that health regulations which impose undue burdens on the right to abortion are invalid. 43
State regulation imposes an “undue burden” on a woman's decision to have an abortion if it has the
purpose or effect of placing a substantial obstacle in the path of the woman who seeks the abortion of a
nonviable fetus. 44 However, the court opined, not every law which makes the right to an abortion more
difficult to exercise is an infringement of that right. 45

The Medical Emergency Exception

In Doe v. Bolton, the U.S. Supreme Court was faced with determining, among other things, whether a
Georgia statute criminalizing abortions (pre- and post-viability), except when determined to be
necessary based upon a physician’s “best clinical judgment,” was unconstitutionally void for vagueness
for inadequately warning a physician under what circumstances an abortion could be performed. 46 In its
reasoning, the Court agreed with the district court decision that the exception was not unconstitutionally
vague, by recognizing that:

[T]he medical judgment may be exercised in the light of all factors—physical, emotional,
psychological, familial, and the woman's age-relevant to the well-being of the patient. All
these factors may relate to health. This allows the attending physician the room he needs
to make his best medical judgment. 47

This broad interpretation of what constitutes a medical emergency was later tested in Casey 48, albeit in
a different context. One question before the Supreme Court in Casey was whether the medical
emergency exception to a 24-hour waiting period for an abortion was too narrow in that there were
some potentially significant health risks that would not be considered “immediate.” 49 The exception in
question provided that a medical emergency is:

39 Planned Parenthood of SE Pa. v. Casey, 505 U.S. 833 (1992).
40 See Roe, 410 U.S. at 164-65.
41 See Casey, 505 U.S. at 870.
42 Id.
43 Id. at 878.
44 Id. at 877
45 Id. at 873.
46 Doe, 410 U.S. at 179 (1973). Other exceptions, such as in cases of rape and when, “[t]he fetus would very likely be born with a

grave, permanent, and irremediable mental or physical defect.” Id. at 183. See also, U.S. v. Vuitich, 402 U.S. 62, 71-72 (1971)
(determining that a medical emergency exception to a criminal statute banning abortions would include consideration of the mental
health of the pregnant woman).
47 Doe, 410 U.S. at 192.
48 Casey, 505. U.S. 833 (1992).
49 Id. at 880.

STORAGE NAME: h0005.PPH PAGE: 10
DATE: 1/18/2022
[T]hat condition which, on the basis of the physician’s good faith clinical judgment, so
complicates the medical condition of a pregnant woman as to necessitate the immediate
abortion of her pregnancy to avert her death or for which a delay will create serious risk of
substantial and irreversible impairment of a major bodily function. 50

In evaluating the more objective standard under which a physician is to determine the existence of a
medical emergency, the Court in Casey determined that the exception would not significantly threaten
the life and health of a woman and imposed no undue burden on the woman’s right to have an
abortion. 51

Jackson Women’s Health Organization v. Dobbs

In 2018, Mississippi enacted the Gestational Age Act (Act) which prohibited a person from performing
an abortion if the probable gestational age of the fetus is greater than 15 weeks. Jackson Women’s
Health Organization filed a lawsuit challenging the Act alleging that it was an unconstitutional pre-
viability ban on abortion. The state argued the Act was a constitutional restriction on abortion. The
federal trial court ruled in favor of Jackson Women’s Health Organization, which was upheld by the Fifth
Circuit of Appeals. 52

The lawsuit matter is currently pending before the U.S. Supreme Court, which held oral arguments on
December 1, 2021. 53

Florida Abortion Law

Right to Abortion

The Florida Constitution, as interpreted by Florida courts, affords greater privacy rights than
those provided by the U.S. Constitution. While the federal Constitution traditionally shields
enumerated and implied individual liberties from state or federal intrusion, the U.S. Supreme
Court has noted that state constitutions may provide greater protections. 54 Unlike the U.S.
Constitution, Article I, s. 23 of the Florida Constitution contains an express right to privacy:

Every natural person has the right to be let alone and free from
governmental intrusion into the person’s private life except as otherwise
provided herein. This section shall not be construed to limit the public’s
right of access to public records and meetings as provided by law.

The Florida Supreme Court opined in In re T.W. that this section provides greater privacy rights than
those implied by the U.S. Constitution. 55

The Florida Supreme Court has recognized Florida’s constitutional right to privacy “is clearly implicated
in a woman’s decision whether or not to continue her pregnancy.” 56 In In re T.W., the Florida Supreme
Court ruled that: 57

[P]rior to the end of the first trimester, the abortion decision must be left to
the woman and may not be significantly restricted by the state. Following
this point, the state may impose significant restrictions only in the least
50 Id. at 879 (quoting 18 Pa. Cons. Stat. § 3203 (1990)).
51 Id. at 880.
52 See Jackson Women’s Health Organization v. Dobbs, 945 F.3d 265 (5th Cir. 2019).
53 See Dobbs v. Jackson Women’s Health Organization, Case No. 19-1932, available at

https://www.supremecourt.gov/search.aspx?filename=/docket/docketfiles/html/public/19-1392.html (last visited January 16, 2022).
54 Pruneyard Shopping Center v. Robins, 100 S.Ct. 2035, 2040 (1980), cited in In re T.W., 551 So.2d 1186, 1191 (Fla. 1989).
55 Id. at 1191-1192.
56 Id. at 1192.
57 Id. at 1193.

STORAGE NAME: h0005.PPH PAGE: 11
DATE: 1/18/2022
intrusive manner designed to safeguard the health of the mother.
Insignificant burdens during either period must substantially further
important state interests….Under our Florida Constitution, the state’s
interest becomes compelling upon viability….Viability under Florida law
occurs at that point in time when the fetus becomes capable of
meaningful life outside the womb through standard medical procedures.

The court recognized that after viability, the state can regulate abortion in the interest of the unborn
child if the mother’s health is not in jeopardy. 58

The state may regulate abortion pre-viability based upon its interest in maternal health
beginning in the second trimester. In Fla. Women's Medical Clinic, Inc. v. Smith, the court held
that the state has an interest in maternal health only after the first trimester, not before, and may
not impose substantive clinical standards in the first trimester. 59

Abortion Regulation

Abortion clinics are regulated by the Agency for Health Care Administration (AHCA) under ch.
390, F.S. Physicians performing abortions (which may take place in abortion clinics, hospitals,
physician offices or other physician settings) are regulated by the Department of Health (DOH)
under chs. 458 and 459 F.S.

In Florida, abortion is defined as the termination of a human pregnancy with an intention other
than to produce a live birth or to remove a dead fetus. 60 An abortion must be performed by a
physician 61 licensed under ch. 458, F.S., or ch. 459, F.S., or a physician practicing medicine or
osteopathic medicine in the employment of the United States. 62

Florida law prohibits abortions after viability, as well as during the third trimester, unless a
medical exception exists. Section 390.01112(1), F.S., prohibits an abortion from being
performed if a physician determines that, in reasonable medical judgment, the fetus has
achieved viability. 63 Section 390.0111, F.S., prohibits an abortion from being performed during
the third trimester. 64 Exceptions to both of these prohibitions exist if:

• Two physicians certify in writing that, in reasonable medical judgment, the termination of
the pregnancy is necessary to save the pregnant woman’s life or avert a serious risk of
substantial and irreversible physical impairment of a major bodily function of the
pregnant woman other than a psychological condition; or
• One physician certifies in writing that, in reasonable medical judgment, there is a
medical necessity for legitimate emergency medical procedures for termination of the
pregnancy to save the pregnant woman’s life or avert a serious risk of imminent
substantial and irreversible physical impairment of a major bodily function of the
pregnant woman other than a psychological condition, and another physician is not
available for consultation. 65

58 Id. at 1194.
59 Fla. Women's Medical Clinic, Inc. v. Smith, 478 F.Supp. 233 (S.D. Fla. 1979); Fla. Women’s Medical Clinic, Inc. v. Smith, 536

F.Supp. 1048 (S.D. Fla. 1982).
60 Section 390.011(1), F.S.
61 Section 390.0111(2), F.S.
62 Section 390.011(8), F.S.
63 Viability is defined as the stage of fetal development when the life of a fetus is sustainable outside the womb through standard

medical measures. Section 390.011(13), F.S.
64 Section 390.011(11), F.S., defines the third trimester to mean the weeks of pregnancy after the 24th week of pregnancy.
65 Sections 390.0111(1)(a) and (b) and 390.01112(1)(a) and (b), F.S.

STORAGE NAME: h0005.PPH PAGE: 12
DATE: 1/18/2022
Current law requires the physician performing the abortion to verify the probable gestational age of the
fetus, by ultrasound, at the time the abortion is performed. 66 The physician performing the abortion, or
person qualified to operate an ultrasound who is working with in conjunction with the physician, must
perform the ultrasound. 67

Any person who willfully performs, or actively participates in, an abortion in violation of these
statutory requirements commits a third degree felony and commits a second-degree felony if the
woman dies. 68

Abortion Data Reporting

Section 390.0112, F.S., requires the medical director of medical facilities where abortions are
performed to submit a monthly report to AHCA that must contain information consistent with the United
States Standard Report of Induced Termination of Pregnancy adopted by the Centers for Disease
Control and Prevention (CDC). 69 If the abortion is performed in a location other than a medical facility,
the physician who performed the abortion is responsible for reporting the information to AHCA. 70

In 2020, there were 209,645 live births in Florida. 71 In the same year, there were 72,073 abortion
procedures performed in the state. Of those: 72

• 70,594 were performed in the first trimester (12 weeks and under);
• 4,274 were performed in the second trimester (13 to 24 weeks); and
• None were performed in the third trimester (25 weeks and over).

The majority of the procedures (65,210) were elective. 73 The remainder of the abortions were
performed due to: 74

• Emotional or psychological health of the mother (1,409);
• Physical health of the mother that was not life endangering (1,111);
• Life endangering physical condition (146);
• Rape (112);
• Incest (9)
• Serious fetal genetic defect, deformity, or abnormality (734); and
• Social or economic reasons (15,271).

66 Section 390.0111(3)(a)1.b.II, F.S.
67 Section 390.0111(3), F.S.
68 Section 390.0111(10), F.S. Such regulations include basic clinical standards for abortion clinics performing abortions after the first

trimester and informed consent.
69 The CDC requests the following information from states for the U.S. Standard Report of Induced Termination of Pregnancy: facility

name (clinic or hospital); city, town or location; county; hospital or clinic’s patient identification number (used for querying for missing
information without identifying the patient); age; marital status; date of termination; residence of patient; ethnicity; race; education
attainment; date of last menses; clinical estimate of gestation; previous pregnancy history; previous abortion history; type of abortion
procedure; and name of attending physician and name of person completing report. Centers for Disease Control, Handbook on the
Reporting of Induced Termination of Pregnancy, www.cdc.gov/nchs/data/misc/hb_itop.pdf (last visited on January 6, 2022).
70 Section 390.0112(2), F.S.
71 Total Resident Live Births, Department of Health, available at

https://www.flhealthcharts.gov/ChartsReports/rdPage.aspx?rdReport=Birth.DataViewer&cid=25 (last viewed January 8, 2022).
72 Reported Induced Terminations of Pregnancy by Reason, by Trimester, Agency for Health Care Administration, available at

https://ahca.myflorida.com/mchq/central_services/training_support/docs/TrimesterByReason_2020.pdf (last viewed January 8, 2022).
73 Id.
74 Id.

STORAGE NAME: h0005.PPH PAGE: 13
DATE: 1/18/2022
AHCA must keep this information in a central location from which statistical data can be drawn and
must provide this information to the CDC upon request. 75 The reports are confidential and exempt from
public records requirements. 76 AHCA may impose fines for violations of the reporting requirements. 77

Abortion providers report abortions due to rape or incest, but are not currently required to report
whether the abortion was due to human trafficking.

Additionally, potential gaps in abortion date may exist. If an abortion is performed outside of a medical
facility, the physician performing the abortion must submit a monthly report to AHCA. Because AHCA
has no regulatory oversight of physicians (this authority rests with the Boards), it is unclear whether all
physicians performing abortions outside of medical facilities are reporting. It is equally unclear if all
medication abortions are being reported as abortion providers are not currently required to report the
number of medication abortion regimens 78 prescribed or dispensed.

Effect of the Bill

The bill addresses fetal and infant mortality reduction related to FIMR, hospital quality initiatives,
comprehensive statewide tobacco education and use prevention, and abortion policy.

Fetal and Infant Mortality Review

The bill requires DOH to contract with local Healthy Start Coalitions to establish fetal and infant
mortality review committees in all regions of the state, to improve fetal and infant mortality in each
region. Each committee must:

• Review and analyze the geographic area’s fetal and infant mortality rates, trends, causes, and
other data;
• Develop findings and recommendations for interventions and policy changes to reduce rates;
and
• Engage with local communities and stakeholders to implement recommended policies and
procedures.

Each Coalition must report FIMR committee findings and recommendations to DOH annually.
Beginning on October 1, 2023, DOH must compile FIMR committee findings and submit a report to the
Governor, President of the Senate, and Speaker of the House of Representatives.

Comprehensive Statewide Tobacco Education and Use Prevention

The bill requires the Comprehensive Statewide Tobacco Education and Use Prevention Program to
include a focus on pregnant women and women who may become pregnant in the program’s
components.

Hospitals and Infant Mortality

75 Id. The CDC compiles statistics voluntarily reported by the 50 states, the District of Columbia and New York City, related to

termination of pregnancies to produce a national data report. Abortion Surveillance- United States, 2019, Surveillance Summaries,
Centers for Disease Control and Prevention, November 26, 2021 / 70(9);1–29 https://www.cdc.gov/mmwr/volumes/70/ss/ss7009a1.htm
(last visited on January 6, 2022).
76 Section 390.0112(3), F.S.
77 Section 390.0112(4), F.S.
78 The FDA approved medication abortion regimen consists of mifepristone and misoprostol which may be taken through 70 days

gestation (70 days or less since the first day of a woman’s last menstrual period) to end a pregnancy. Mifeprex (mifepristone)
Information, U.S. Food and Drug Administration, available at https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-
and-providers/mifeprex-mifepristone-information (last visited on January 15, 2022).
STORAGE NAME: h0005.PPH PAGE: 14
DATE: 1/18/2022
The bill requires hospitals that provide birthing services (labor and delivery) to participate in at least two
quality improvement initiatives developed in collaboration with the FPQC at all times.

Abortion Regulation

HB 5 prohibits abortions if the physician performing abortion determines the gestational age of the fetus
is more than 15 weeks, as calculated from the first day of the woman’s last menstrual period. This
replaces the current prohibition against abortions during the third trimester.

The bill retains the same medical exception to prohibited abortions in existing law:

The bill adds an exception for fatal fetal abnormalities if two physicians certify in writing that, in
reasonable medical judgment, the fetus has a fatal fetal abnormality. Because current law prohibits
abortions past the gestational stage of viability, with no exceptions for fatal fetal abnormalities, this
exception applies until the fetus reaches the gestational stage of viability. A fetal anomaly is a terminal
condition that, in reasonable medical judgment, regardless of the provision of life-saving medical
treatment, is incompatible with life outside the womb and will result in death upon birth or imminently
thereafter.

Abortion Reporting

HB 5 enhances and clarifies current abortion reporting requirements. The bill requires abortion
providers to report whether abortions were due to human trafficking. The bill addresses potential data
reporting gaps by requiring abortion providers to report both surgical and medication-induced abortions
and to report the number of medication abortion regimens prescribed and dispensed. The bill also
requires AHCA and the Boards to adopt an electronic reporting form. This provides greater regulatory
oversight over the reporting requirement for physicians performing abortions outside of a medical
facility.

B. SECTION DIRECTORY:
Section 1: Amends s. 381.84, F.S., relating to Comprehensive Statewide Tobacco Education and
Use Prevention Program.
Section 2: Creates s. 383.21625, F.S., relating to fetal and infant mortality review committees.
Section 3: Amends s. 390.011, F.S., relating to definitions.
Section 4: Amends s. 390.0111, F.S., relating to termination of pregnancies.
Section 5: Amends s. 390.0112, F.S., relating to termination of pregnancies; reporting.
Section 6: Creates s. 395.0154, F.S., relating to birthing quality improvement initiatives.
Section 7: Appropriates funds to DOH to establish fetal and infant mortality review committees.

II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT

A. FISCAL IMPACT ON STATE GOVERNMENT:
STORAGE NAME: h0005.PPH PAGE: 15
DATE: 1/18/2022
1. Revenues:
None.

2. Expenditures:
The bill appropriates $260,000 in recurring General Revenue funds to DOH for the purpose of
establishing FIMR committees in areas of the state where no state-funded FIMIR committees exist.
According to DOH, each FIMR committee contract is approximately $22,000 annually, allowing
DOH to contract with local Healthy Start Coalitions to establish 10 new FIMR committees and fund
the 11 existing state-funded FIMR programs with Healthy Start, the three FIMR committees funded
through local county health departments, and the two independently funded FIMR committees.

B. FISCAL IMPACT ON LOCAL GOVERNMENTS:

1. Revenues:
None.

2. Expenditures:
Some local governments may experience an increase in revenues associated with state-funded
FIMR programs as such counties may no longer need to fund local FIMR programs.

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:
See main analysis.

B. RULE-MAKING AUTHORITY:
Current law and the bill provide sufficient rule-making authority to implement the bill’s provisions.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: h0005.PPH PAGE: 16
DATE: 1/18/2022
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 5 2022

1 A bill to be entitled
2 An act relating to reducing fetal and infant
3 mortality; amending s. 381.84, F.S.; revising the
4 purpose and requirements for the Comprehensive
5 Statewide Tobacco Education and Use Prevention
6 Program; revising a provision relating to a certain
7 report to conform to changes made by the act; creating
8 s. 383.21625, F.S.; providing a definition; requiring
9 the Department of Health to contract with local
10 healthy start coalitions for the creation of fetal and
11 infant mortality review committees in all regions of
12 the state; providing requirements for such committees;
13 requiring local healthy start coalitions to report the
14 findings and recommendations developed by the
15 committees to the department annually; requiring the
16 department to compile such findings and
17 recommendations in a report and submit such report to
18 the Governor and Legislature by a specified date and
19 annually; authorizing the department to adopt rules;
20 amending s. 390.011, F.S.; revising and providing
21 definitions; amending s. 390.0111, F.S.; prohibiting a
22 physician from performing a termination of pregnancy
23 if the physician determines the gestational age of a
24 fetus is more than a specified number of weeks;
25 providing an exception; amending s. 390.0112, F.S.;

Page 1 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

26 revising a requirement that the directors of certain
27 medical facilities submit a monthly report to the
28 Agency for Health Care Administration; requiring
29 certain physicians to submit such report to the
30 agency; requiring the report to be submitted
31 electronically on a form adopted by the agency, the
32 Board of Medicine, and the Board of Osteopathic
33 Medicine; requiring the report to include certain
34 additional information; removing obsolete language;
35 creating s. 395.1054, F.S.; requiring that certain
36 hospitals participate in a minimum number of quality
37 improvement initiatives developed in collaboration
38 with the Florida Perinatal Quality Collaborative
39 within the University of South Florida College of
40 Public Health; providing an appropriation; providing
41 an effective date.
42
43 Be It Enacted by the Legislature of the State of Florida:
44
45 Section 1. Subsections (2), (3), and (7) of section
46 381.84, Florida Statutes, are amended to read:
47 381.84 Comprehensive Statewide Tobacco Education and Use
48 Prevention Program.—
49 (2) PURPOSE, FINDINGS, AND INTENT.—It is the purpose of
50 this section to implement s. 27, Art. X of the State

Page 2 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

51 Constitution. The Legislature finds that s. 27, Art. X of the
52 State Constitution requires the funding of a statewide tobacco
53 education and use prevention program that focuses on tobacco use
54 by youth. The Legislature further finds that the primary goals
55 of the program are to reduce the prevalence of tobacco use among
56 youth, adults, and pregnant women, and women who may become
57 pregnant; reduce per capita tobacco consumption; and reduce
58 exposure to environmental tobacco smoke. Further, it is the
59 intent of the Legislature to base increases in funding for
60 individual components of the program on the results of
61 assessments and evaluations. Recognizing that some components
62 will need to grow faster than inflation, it is the intent of the
63 Legislature to fund portions of the program on a nonrecurring
64 basis in the early years so that those components that are most
65 effective can be supported as the program matures.
66 (3) PROGRAM COMPONENTS AND REQUIREMENTS.—The department
67 shall conduct a comprehensive, statewide tobacco education and
68 use prevention program consistent with the recommendations for
69 effective program components contained in the 1999 Best
70 Practices for Comprehensive Tobacco Control Programs of the CDC,
71 as amended by the CDC. The program shall include the following
72 components, each of which shall focus on educating people,
73 particularly pregnant women, women who may become pregnant, and
74 youth and their parents, about the health hazards of tobacco and
75 discouraging the use of tobacco:

Page 3 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

76 (a) Counter-marketing and advertising; Internet resource
77 center.—The counter-marketing and advertising campaign shall
78 include, at a minimum, Internet, print, radio, and television
79 advertising and shall be funded with a minimum of one-third of
80 the total annual appropriation required by s. 27, Art. X of the
81 State Constitution.
82 1. The campaign shall include an Internet resource center
83 for copyrighted materials and information concerning tobacco
84 education and use prevention, including cessation. The Internet
85 resource center must be accessible to the public, including
86 parents, teachers, and students, at each level of public and
87 private schools, universities, and colleges in the state and
88 shall provide links to other relevant resources. The Internet
89 address for the resource center must be incorporated in all
90 advertising. The information maintained in the resource center
91 shall be used by the other components of the program.
92 2. The campaign shall use innovative communication
93 strategies, such as targeting specific audiences who use
94 personal communication devices and frequent social networking
95 websites.
96 (b) Cessation programs, counseling, and treatment. —This
97 program component shall include two subcomponents:
98 1. A statewide toll-free cessation service, which may
99 include counseling, referrals to other local resources and
100 support services, and treatment to the extent funds are

Page 4 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

101 available for treatment services; and
102 2. A local community-based program to disseminate
103 information about tobacco-use cessation, how tobacco-use
104 cessation relates to prenatal care and obesity prevention, and
105 other chronic tobacco-related diseases.
106 (c) Surveillance and evaluation.—The program shall conduct
107 ongoing epidemiological surveillance and shall contract for
108 annual independent evaluations of the effectiveness of the
109 various components of the program in meeting the goals as set
110 forth in subsection (2).
111 (d) Youth school programs.—School and after-school
112 programs shall use current evidence-based curricula and programs
113 that involve youth to educate youth about the health hazards of
114 tobacco, help youth develop skills to refuse tobacco, and
115 demonstrate to youth how to stop using tobacco.
116 (e) Community programs and chronic disease prevention. —The
117 department shall promote and support local community-based
118 partnerships that emphasize programs involving youth, pregnant
119 women, and women who may become pregnant, including programs for
120 the prevention, detection, and early intervention of tobacco -
121 related chronic diseases.
122 (f) Training.—The program shall include the training of
123 health care practitioners, tobacco-use cessation counselors, and
124 teachers by health professional students and other toba cco-use
125 prevention specialists who are trained in preventing tobacco use

Page 5 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

126 and health education. Tobacco-use cessation counselors shall be
127 trained by specialists who are certified in tobacco -use
128 cessation.
129 (g) Administration and management, statewide progr ams, and
130 county health departments.—The department shall administer the
131 program within the expenditure limit established in subsection
132 (8). Each county health department is eligible to receive a
133 portion of the annual appropriation, on a per capita basis, f or
134 coordinating tobacco education and use prevention programs
135 within that county. Appropriated funds may be used to improve
136 the infrastructure of the county health department to implement
137 the comprehensive, statewide tobacco education and use
138 prevention program. Each county health department shall
139 prominently display in all treatment rooms and waiting rooms
140 counter-marketing and advertisement materials in the form of
141 wall posters, brochures, television advertising if televisions
142 are used in the lobby or waiting room, and screensavers and
143 Internet advertising if computer kiosks are available for use or
144 viewing by people at the county health department.
145 (h) Enforcement and awareness of related laws.—In
146 coordination with the Department of Business and Profess ional
147 Regulation, the program shall monitor the enforcement of laws,
148 rules, and policies prohibiting the sale or other provision of
149 tobacco to minors, as well as the continued enforcement of the
150 Clean Indoor Air Act prescribed in chapter 386. The

Page 6 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

151 advertisements produced in accordance with paragraph (a) may
152 also include information designed to make the public aware of
153 these related laws and rules. The departments may enter into
154 interagency agreements to carry out this program component.
155 (i) AHEC tobacco-use cessation initiative.—The AHEC
156 network may administer the AHEC tobacco-use cessation initiative
157 in each county within the state and perform other activities as
158 determined by the department.
159 (7) ANNUAL REPORT REQUIRED.—By January 31 of each year,
160 the department shall provide to the Governor, the President of
161 the Senate, and the Speaker of the House of Representatives a
162 report that evaluates the program's effectiveness in reducing
163 and preventing tobacco use and that recommends improvements to
164 enhance the program's effectiveness. The report must contain, at
165 a minimum, an annual survey of youth attitudes and behavior
166 toward tobacco, as well as a description of the progress in
167 reducing the prevalence of tobacco use among youth, adults, and
168 pregnant women, and women who may become pregnant; reducing per
169 capita tobacco consumption; and reducing exposure to
170 environmental tobacco smoke.
171 Section 2. Section 383.21625, Florida Statutes, is created
172 to read:
173 383.21625 Fetal and infant mortality review committees. —
174 (1) As used in this section, the term "department" means
175 the Department of Health.

Page 7 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

176 (2) The department shall contract with local healthy start
177 coalitions for the creation of fetal and infant mortality review
178 committees in all regions of the state to improve fetal and
179 infant mortality and morbidity in each region. Each committee
180 shall:
181 (a) Review and analyze rates, trends, causes, and other
182 data related to fetal and infant mortality and morbidity in a
183 geographic area.
184 (b) Develop findings and recommendations for interventions
185 and policy changes to reduce fetal and infant mortality and
186 morbidity rates.
187 (c) Engage with local communities and stakeholders to
188 implement recommended policies and procedures to reduce fetal
189 and infant mortality and morbidity.
190 (3) Each local healthy start coalition shall report the
191 findings and recommendations developed by each fetal and infant
192 mortality review committee to the department annually. Beginning
193 October 1, 2023, the department shall compile such findings and
194 recommendations in an annual report, which must be submitted to
195 the Governor, the President of the Senate, and the Speaker of
196 the House of Representatives.
197 (4) The department may adopt rules necessary to implement
198 this section.
199 Section 3. Subsections (6) and (7) of section 390.011,
200 Florida Statutes, are renumbered as subsections (7) and (8),

Page 8 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

201 respectively, present subsections (8) through (13) are
202 renumbered as subsections (10) through (15), respectively,
203 present subsection (6) is amended, and new subsections (6) and
204 (9) are added to that section, to read:
205 390.011 Definitions.—As used in this chapter, the term:
206 (6) "Fatal fetal abnormality" means a terminal condition
207 that, in reasonable medical judgment, regardless of the
208 provision of life-saving medical treatment, is incompatible with
209 life outside the womb and will result in death upon birth or
210 imminently thereafter.
211 (7)(6) "Gestation" means the development of a human embryo
212 or fetus as calculated from the first day of the pregnant
213 woman's last menstrual period between fertilization and birth.
214 (9) "Medical abortion" means the administration or use of
215 an abortion-inducing drug to induce an abortion.
216 Section 4. Subsection (1) of section 390.0111, Florida
217 Statutes, is amended to read:
218 390.0111 Termination of pregnancies.—
219 (1) TERMINATION AFTER GESTATIONAL AGE OF 15 WEEKS IN THIRD
220 TRIMESTER; WHEN ALLOWED.—A physician may not perform a No
221 termination of pregnancy if the physician determines the
222 gestational age of the fetus is more than 15 weeks shall be
223 performed on any human being in the third trimester of pregnancy
224 unless one of the following conditions is met:
225 (a) Two physicians certify in writing that, in reasonable

Page 9 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

226 medical judgment, the termination of the pregnancy is necessary
227 to save the pregnant woman's life or avert a serious risk of
228 substantial and irreversible physical impairment of a major
229 bodily function of the pregnant woman other than a psychological
230 condition.
231 (b) The physician certifies in writing that, in reasonable
232 medical judgment, there is a medical necessity for legitimate
233 emergency medical procedures for termination of the pregnancy to
234 save the pregnant woman's life or avert a serious risk of
235 imminent substantial and irreversible physical impairment of a
236 major bodily function of the pregnant woman other than a
237 psychological condition, and another physician is not available
238 for consultation.
239 (c) The fetus has not achieved viability under s.
240 390.01112 and two physicians certify in writing that, in
241 reasonable medical judgement, the fetus has a fatal fetal
242 abnormality.
243 Section 5. Section 390.0112, Florida Statutes, is amended
244 to read:
245 390.0112 Termination of pregnancies; reporting.—
246 (1) The director of any medical facility in which
247 abortions are performed, including surgical procedures and
248 medical abortions, including a physician's office, shall submit
249 a report each month to the agency. If the abortion is not
250 performed in a medical facility, the physician performing the

Page 10 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

251 abortion shall submit the monthly report. The report must may be
252 submitted electronically on a form adopted by the agency, the
253 Board of Medicine, and the Board of Osteopathic Medicine which,
254 may not include personal identifying information, and must
255 include:
256 (a) Until the agency begins collecting data under
257 paragraph (e), The number of abortions performed.
258 (b) The reasons such abortions were performed. If a woman
259 upon whom an abortion is performed has provided evidence that
260 she is a victim of human trafficking pursuant to s.
261 390.0111(3)(a)1.b.(IV), such reason must be included in the
262 information reported under this section.
263 (c) For each abortion, the period of gestation at the time
264 the abortion was performed.
265 (d) The number of infants born alive or alive immediately
266 after an attempted abortion.
267 (e) Beginning no later than January 1, 2017, Information
268 consistent with the United States Standard Report of Induced
269 Termination of Pregnancy adopted by the Centers for Disease
270 Control and Prevention.
271 (f) The number of medication abortion regimens prescribed
272 or dispensed.
273 (2) The agency shall keep such reports in a central
274 location for the purpose of compiling and analyzing statistical
275 data and shall submit data reported pursuant to paragraph (1)(e)

Page 11 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

276 to the Division of Reproductive Health within the Centers for
277 Disease Control and Prevention, as requested by the Centers for
278 Disease Control and Prevention.
279 (3) If the termination of pregnancy is not performed in a
280 medical facility, the physician performing the procedure shall
281 be responsible for reporting such information as required in
282 subsection (1).
283 (3)(4) Reports submitted pursuant to this section shall be
284 confidential and exempt from the provisions of s. 119.07(1) and
285 shall not be revealed except upon the order of a court of
286 competent jurisdiction in a civil or criminal proceeding.
287 (4)(5) Any person required under this section to file a
288 report or keep any records who willfully fails to file such
289 report or keep such records may be subject to a $200 fine for
290 each violation. The agency shall be required to impose such
291 fines when reports or records required under this section have
292 not been timely received. For purposes of this section, timely
293 received is defined as 30 days following the preceding month.
294 Section 6. Section 395.1054, Florida Statutes, is created
295 to read:
296 395.1054 Birthing quality improvement initiatives. —A
297 hospital that provides birthing services shall at all times
298 participate in at least two quality improvement initiatives
299 developed in collaboration with the Florida Perinatal Q uality
300 Collaborative within the University of South Florida College of

Page 12 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
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 5 2022

301 Public Health.
302 Section 7. For the 2022-2023 fiscal year, the sum of
303 $260,000 in recurring funds from the General Revenue Fund is
304 appropriated to the Department of Health for the purpose of
305 establishing fetal and infant mortality review committees under
306 s. 383.21625, Florida Statutes, in areas of the state in which
307 such state-funded fetal and infant mortality review committees
308 do not exist.
309 Section 8. This act shall take effect July 1, 2022.

Page 13 of 13

CODING: Words stricken are deletions; words underlined are additions.
hb0005-00
HB 469
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 469 Patient Care in Health Care Facilities
SPONSOR(S): Finance & Facilities Subcommittee, Trabulsy
TIED BILLS: IDEN./SIM. BILLS: SB 718

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

1) Finance & Facilities Subcommittee 15 Y, 0 N, As CS Guzzo Lloyd

2) Professions & Public Health Subcommittee Guzzo McElroy

3) Health & Human Services Committee

SUMMARY ANALYSIS
Under current law, home health aides and certified nursing assistants (CNAs) may assist a patient of a home
health agency with self-administration of certain medications after completion of prescribed training.

Current law authorizes home health aides and CNAs to perform certain tasks in providing assistance to
assisted living facility (ALF) residents with self-administration of medication that home health aides and CNAs
are not currently authorized to provide if they work for a home health agency. Current law also authorizes an
ALF to contract with a home health agency to employ home health aides and CNAs, which can cause
confusion as to which tasks a home health aide or CNA may provide when they are employed by a home
health agency but they are working in an ALF. The bill revises home health agency statutes to allow home
health aides and CNAs to perform additional tasks in providing assistance to patients with self-administration of
medication to create consistency.

Specifically, the bill allows a home health aide or CNA to provide assistance with:

• Transdermal patches;
• Insulin syringes that are prefilled with the proper dosage by a pharmacist and insulin pens that are
prefilled by the manufacturer;
• Glucometers to perform blood-glucose level checks;
• Antiembolism stockings;
• Applying and removing oxygen cannulas;
• Using continuous positive airway pressure devices;
• Measuring vital signs; and
• Colostomy bags.

Current law authorizes a registered nurse to delegate to a home health aide or CNA the authority to administer
certain medications. The bill expands the duties a nurse may delegate to a home health aide or CNA to include
administering an insulin syringe that is prefilled with the proper dosage by a pharmacist or an insulin pen that is
prefilled by the manufacturer.

An advanced life support ambulance transporting a patient between two facilities is required to be occupied by
two people, including one patient attendant who may be a paramedic, registered nurse, or a physician, and
one qualified ambulance driver who is an EMT, paramedic, registered nurse, or physician. The bill removes the
requirement for the driver to be an EMT, paramedic, registered nurse, or physician.

The bill has no fiscal impact on state or local government.

The bill provides an effective date of July 1, 2022.

This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0469b.PPH
DATE: 1/18/2022
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Current Situation

Home Health Agencies

A “home health agency” is an organization that provides home health services. 1 Home health services
are health and medical services and supplies furnished to an individual in the individual’s home or
place of residence. 2

Home health aides 3 and certified nursing assistants 4 (CNAs) are unlicensed health care workers
employed by a home health agency to provide personal care 5 to patients and assist them with the
following activities of daily living:

• Ambulation;
• Bathing;
• Dressing;
• Eating;
• Personal hygiene;
• Toileting;
• Physical transferring;
• Assistance with self-administered medication; and
• Administering medications. 6

Medication Administration and Assistance with Self-Administration

Medication Administration

Under certain conditions, home health aides and CNAs are authorized to administer certain types of
medication to a patient of a home health agency, including oral, transdermal, ophthalmic, otic, rectal,
inhaled, enteral, or topical prescription medications. Specifically, the home health aide or CNA must:

• Be delegated such task by a registered nurse;
• Complete an initial 6-hour training course approved by the Board of Nursing (Board) or the
Agency for Health Care Administration (AHCA);
• Be found competent to administer medication to a patient in a safe and sanitary manner; and
• Complete two hours of annual inservice training in medication administration and medication
error prevention approved by the Board. 7

1 S. 400.462(12), F.S.
2 S. 400.462(15), F.S., home health services include the following: nursing care; physical, occupational, respiratory, or speech therapy;

home health aide services; dietetics and nutrition practice and nutrition counseling; and medical supplies, restricted to drugs and
biologics prescribed by a physician.
3 S. 400.462(14), F.S., a home health aide is a person who is trained or qualified, as provided by rule, and who provides hands-on

personal care, performs simple procedures as an extension of therapy or nursing services, assists in ambulation or exercises, assists in
administering medications as permitted in rule and for which the person has received training established by the agency, or performs
tasks delegated to him or her under ch. 464, F.S.
4 S. 464.201(3), F.S., a CNA is a person who meets the qualifications of part II of ch. 464, F.S., and who is certified by the Board of

Nursing as a certified nursing assistant.
5 S. 400.462(23), F.S., defines “personal care” as assistance to a patient in the activities of daily living, such as dressing, bathing,

eating, or personal hygiene, and assistance in physical transfer, ambulation, and in administering medications as permitted by rule.
6 Rule 59A-8.002(3), F.A.C.
7 S. 464.2035, F.S., and s. 400.489, F.S.

STORAGE NAME: h0469b.PPH PAGE: 2
DATE: 1/18/2022
Section 464.0156, F.S., prohibits a registered nurse from delegating to a home health aide or CNA the
administration of a controlled substance listed in Schedule II, Schedule III, or Schedule IV of s. 893.03,
F.S., or 21 U.S.C., s. 812. Controlled substances are classified by their acceptable medical use and
propensity for abuse and dependency. 8 Insulin is not a schedule II, III, or IV controlled substance.

As of 2018, 34.2 million Americans, or 10.5 percent of the population, had diabetes, 9 and 8.3 million of
those people required insulin to regulate blood glucose levels. 10 There are different types of insulin that
vary by how quickly they work, when they peak, and how long they last. 11 All insulin available in the
United States is manufactured in a laboratory. 12

Assistance with Self-Administration

Patients are often capable of administering their own medication, but need assistance to ensure that
they are taking the correct medication, at the proper dosage, and at the correct time. Under current law,
home health aides and CNAs may assist with self-administration of medication after completion of
required training. 13

Home health aides and CNAs must complete two hours of training to assist with self-administration of
medication. 14 The training must include state law and rule requirements for assistance with self-
administration of medication in the home, procedures for assisting the patient with self-administration,
common medications, recognition of side effects and adverse reactions, and procedures to follow if
patients appear to be experiencing side effects or adverse reactions. 15 The training may be provided by
a licensed home health agency or a vocational school approved by the Department of Education. 16

Current law authorizes home health aides and CNAs to perform certain tasks in providing assistance to
assisted living facility (ALF) residents with self-administration of medication that home health aides and
CNAs are not currently authorized to provide if they work for a home health agency. Current law also
authorizes an ALF to contract with a home health agency to employ home health aides and CNAs, 17
which can cause confusion as to which tasks a home health aide or CNA may provide when they are
employed by a home health agency but they are working in an ALF.

8 U.S. Drug Enforcement Administration, Drug Scheduling, available at https://www.dea.gov/drug-information/drug-scheduling (last

visited November 23, 2021).
9 U.S. Department of Health and Human Services Centers for Disease Control and Prevention, National Diabetes Statistics Report

2020 Estimates of Diabetes and its Burden in the United States, available at https://www.cdc.gov/diabetes/pdfs/data/statistics/national-
diabetes-statistics-report.pdf (last visited November 23, 2021).
10 Tara O’Neill Hayes, Understanding the Insulin Market, American Action Forum (March 3, 2020), available at

https://www.americanactionforum.org/research/understanding-the-insulin-market/ (last visited November 23, 2021).
11 American Diabetes Association, Insulin & Other Injectables, Insulin Basics, available at https://www.diabetes.org/healthy-

living/medication-treatments/insulin-other-injectables/insulin-basics (last visited November 23, 2021). “Rapid-acting insulin” begins to
work about 15 minutes after injection, peaks within one or two hours, and lasts between two to four hours. “Regular or short-acting
insulin” usually reaches the bloodstream within 30 minutes after injection, peaks within two to three hours, and lasts for three to six
hours. “Intermediate-acting insulin” reaches the bloodstream two to four hours after injection, peaks within four to 12 hours, and lasts for
12 to 18 hours.
12 Id.
13 S. 400.488(1)(b), F.S.
14 Rule 59A-8.0095(5), F.A.C.
15 Id.
16 Rule 59A-8.0095(5)(e)-(f), F.A.C.
17 S. 429.256(1)(b), F.S.

STORAGE NAME: h0469b.PPH PAGE: 3
DATE: 1/18/2022
The table below lists the tasks that a home health aide and a CNA in a home health agency 18 may
assist a patient with compared to when they work in an ALF 19.

Task Home Health Agency ALF
Bringing to the patient, an insulin syringe that is prefilled with
the proper dosage by a pharmacist or an insulin pen that is  
prefilled by the manufacturer.
Using a glucometer to perform blood-glucose level checks.  
Assisting with putting on and taking off antiembolism
 
stockings.
Assisting with applying and removing an oxygen cannula but
 
not with titrating the prescribed oxygen settings.
Assisting with the use of a continuous positive airway
pressure device but not with titrating the prescribed setting  
of the device.
Assisting with measuring vital signs.  
Assisting with colostomy bags.  
Taking the medication, in its properly labeled container, from
 
where it is stored to the patient.
Confirming that the medication is intended for that patient,
orally advising the patient of the medication name and
purpose, opening the container, removing a prescribed  
amount of medication from the container, and closing the
container.
Placing an oral dose in the patient’s hand or placing the
dosage in another container and helping the patient by lifting  
the container to his or her mouth.
Returning the medication container to proper storage.  
Keeping a record of when a patient receives assistance.  
Applying topical medications, including routine preventative
skin care and applying and replacing bandages for minor  
cuts and abrasions
Assisting with nebulizer treatments.  

Assistance with self-administration of medication does not include, and a home health aide or CNA with
the authority to assist with self-administration of medication may not perform the following tasks in a
home health agency 20 or an ALF: 21

• Mixing, compounding, converting, or calculating medication doses, except for measuring a
prescribed amount of liquid medication or breaking a scored tablet or crushing a tablet as
prescribed;
• Preparing syringes for injection or administering medications by any injectable route;
• Administering medications by way of a tube inserted in a cavity of the body;
• Administering parenteral preparations; 22

18 S. 400.488(3), F.S.
19 S. 429.256(3), F.S.
20 S. 400.488(4), F.S.
21 S. 429.256(4), F.S.

STORAGE NAME: h0469b.PPH PAGE: 4
DATE: 1/18/2022
• Irrigating or using debriding agents to treat a skin condition;
• Preparing rectal, urethral, or vaginal medications;
• Administering medications ordered by the physician or health care professional with prescriptive
authority to be given “as needed,” unless the order is written with specific parameters that
preclude independent judgment on the part of the home health aide or CNA, and at the request
of a competent patient; or
• Administering medications for which the time of administration, the amount, the strength of
dosage, the method of administration, or the reason for administration requires judgment or
discretion on the part of the unlicensed person.

Emergency Medical Transport Services

Basic Life Support and Advanced Life Support Ambulance Services

Ambulances 23 are used to transport sick or injured people to or between medical facilities. Ambulances
provide two types of services; basic life support services (BLS) and advanced life support services
(ALS).

BLS ambulance services use only basic life support techniques 24 and transport patients who only
require basic medical monitoring. 25 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. 26 The term includes the administration of oxygen and other
techniques that have been approved and are performed under specific conditions. 27 BLS services are
usually performed by emergency medical technicians 28 (EMTs). 29

ALS ambulance services transport patients who require a higher level of medical monitoring. 30 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. 31 ALS services are usually
provided by paramedics. 32

Staffing Requirements

Staffing requirements differ between BLS and ALS ambulance services. They also differ depending on
whether the ambulance is transporting a patient to the hospital in an emergency situation or if the
ambulance is transferring a patient who is in stable condition to another facility.

22 Parenteral means administration of a medication by injection, infusion, or implantation. U.S. Food & Drug Administration, Route of

Administration, available at https://www.fda.gov/drugs/data-standards-manual-monographs/route-administration (last visited November
29, 2021).
23 S. 401.23(5), F.S., defines “ambulance” or “emergency medical services vehicle” as any privately or publicly owned land or water

vehicle that is designed, constructed, reconstructed, maintained, equipped, or operated for, and is used for, or intended to be used for,
land or water transportation of sick or injured persons requiring or likely to require medical attention during transport.
24 S. 401.23(8), F.S.
25 Johns Hopkins Medicine, Lifeline: Basic and Advanced Life Support, available at

https://www.hopkinsmedicine.org/lifeline/trans_services/life_support.html (last visited November 23, 2021).
26 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 November 19, 2021).
27 S. 401.23(7) and (8), F.S.
28 Ss. 401.23(11) and 401.27, F.S. EMTs are licensed by DOH.
29 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 November 19, 2021).
30 Supra note 25.
31 Ss. 401.23(1) and (2), F.S.
32 Ryynanen, et. al, supra note 29.

STORAGE NAME: h0469b.PPH PAGE: 5
DATE: 1/18/2022
A BLS ambulance transporting a patient to a hospital in an emergency situation must be occupied by at
least two people, including one patient attendant who may be an EMT, paramedic, or physician, and
one qualified ambulance driver. 33 The staffing requirements are the same, with one exception, for a
BLS ambulance transporting a patient who is in stable condition between two facilities. The BLS
ambulance transporting a patient who is in stable condition between two facilities can use a registered
nurse in place of the EMT or paramedic. 34

An ALS ambulance transporting a patient to a hospital in an emergency situation must be occupied by
at least two people, including one patient attendant who may be a paramedic or a physician, and one
qualified ambulance driver who may be an EMT, paramedic, or physician. 35 An ALS ambulance
transporting a stable patient between two facilities can use a registered nurse in place of the EMT or
paramedic. 36

Effect of the Bill

The bill revises home health agency statutes to allow home health aides and CNAs to perform
additional tasks in providing assistance to patients with self-administration of medication. This allows
home health aides and CNAs to perform the same functions in home health settings as they can in ALF
settings. Specifically, the bill allows a home health aide or CNA to provide assistance with transdermal
patches, insulin syringes that are prefilled with the proper dosage by a pharmacist, and insulin pens
that are prefilled by the manufacturer.

The bill also allows home health aides and CNAs in a home health setting to assist with the following
tasks:

• Using glucometers to perform blood-glucose level checks;
• Putting on and taking off antiembolism stockings;
• Applying and removing oxygen cannulas;
• Using continuous positive airway pressure devices;
• Measuring vital signs; and
• Assisting with colostomy bags.

The bill makes conforming changes to the ALF statute to separate assistance with medications from
assistance with tasks that do not involve medication.

In 2020, the Legislature authorized home health aides and CNAs to provide assistance to patients of
home health agencies with the use of a nebulizer. 37 However, the 2020 bill did not remove a provision
prohibiting home health aides and CNAs from providing assistance with the administration of
medications through nebulizers. 38 The bill removes this provision.

Current law prohibits a registered nurse from delegating to a home health aide or CNA the
administration of a controlled substance listed in Schedule II, Schedule III, or Schedule IV of s. 893.03,

33 S. 401.25(7)(a), F.S. S. 401.281, F.S., requires drivers to: be at least 18 years of age; certify under oath that they are not addicted to

alcohol or any controlled substance; certify under oath that they are free from any physical or mental defect or disease that might impair
their ability to drive an ambulance; not have been convicted, within the past three years, of driving under the influence of alcohol or
controlled substances, and not had their driver license suspended due to excessive points; possess a valid driver license; be trained in
the safe operation of emergency vehicles and complete an emergency vehicle operator’s course; possess a valid American Red Cross
or National Safety Council standard first aid course card or its equivalent; and possess a valid American Red Cross or American Heart
Association cardiopulmonary resuscitation card.
34 S. 401.252(1), F.S., authorizes a BLS or an ALS ambulance service to conduct an interfacility transfer using a registered nurse in

place of an EMT or a paramedic, if: the registered nurse holds a current certificate of successful course completion in advanced cardiac
life support; the physician in charge has granted permission for such a transfer, has designated the level of service required for such
transfer, and has deemed the patient to be in such a condition appropriate for this type of ambulance staffing; and the registered nurse
operates within the scope of part I of ch. 464, F.S.
35 S. 401.25(7)(b), F.S.
36 Supra note 34.
37 Ch. 2020-9, Laws of Fla.
38 S. 400.488(4)(c), F.S.

STORAGE NAME: h0469b.PPH PAGE: 6
DATE: 1/18/2022
F.S., or 21 U.S.C., s. 812. 39 The bill amends s. 464.0156(2), F.S., to authorize a registered nurse to
delegate to a home health aide or CNA the administration of an insulin syringe that is prefilled with the
proper dosage by a pharmacist or an insulin pen that is prefilled by the manufacturer.

An ALS ambulance transporting a patient between two facilities must be occupied by two people,
including one patient attendant who may be a paramedic, registered nurse, or a physician, and one
EMT, paramedic, registered nurse, or physician if they meet the requirements to be a driver. The bill
retains the requirement for the patient attendant to be a paramedic, registered nurse, or a physician,
but it removes the requirement for the driver to be an EMT, paramedic, registered nurse, or physician.
This change aligns the staffing requirements for interfacility transfer by an ALS ambulance with the
staffing requirements for an interfacility transfer by a BLS ambulance.

Current law authorizes CNAs to provide assistance to ALF residents with insulin syringes and pens.
The bill amends s. 429.256, F.S., to provide consistency with provisions of the bill that provide the
same authority for home health aides and CNAs employed by home health agencies.

The bill provides an effective date of July 1, 2022.

B. SECTION DIRECTORY:
Section 1: Amends s. 400.488, F.S., relating to assistance with self-administration of medication.
Section 2: Amends s. 401.252, F.S., relating to interfacility transfer.
Section 3: Amends s. 464.0156, F.S., relating to delegation of duties.
Section 4: Amends s. 401.25, F.S., relating to licensure as a basic life support or an advanced life
support service.
Section 5: Amends s. 401.27, F.S., relating to personnel; standards and certification.
Section 6: Amends s. 429.256, F.S., relating to assistance with self-administration of medication.
Section 7: Provides an effective date of July 1, 2022.

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:
The bill creates staffing efficiencies for home health agencies and ALS ambulance services, which
could have a positive, but indeterminate, fiscal impact on these providers.

D. FISCAL COMMENTS:

39 S. 464.0156(2), F.S.

STORAGE NAME: h0469b.PPH PAGE: 7
DATE: 1/18/2022
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:
Sufficient rule-making authority exists for AHCA to implement the provisions of the bill.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
On December 2, 2021, the Finance & Facilities Subcommittee adopted two amendments and reported
the bill favorably as a committee substitute. The amendments restructure the proposed change to the
home health agency statute and the current ALF statute to separate assisting with the administration of
medication from assisting with the performance of tasks that do not involve medication.

This analysis is drafted to the committee substitute as passed by the Finance & Facilities
Subcommittee.

STORAGE NAME: h0469b.PPH PAGE: 8
DATE: 1/18/2022
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

CS/HB 469 2022

1 A bill to be entitled
2 An act relating to patient care in health care
3 facilities; amending s. 400.488, F.S.; revising the
4 definitions of the terms "informed consent" and
5 "unlicensed person"; authorizing unlicensed persons to
6 assist patients with other specified tasks; revising
7 provisions relating to medications and devices with
8 which unlicensed persons may assist patients in self-
9 administration under certain circumstances; amending
10 s. 401.252, F.S.; specifying staffing requirements for
11 advanced life support ambulances during interfacility
12 transfers; providing that the person occupying the
13 ambulance who has the highest medical certification in
14 this state is in charge of patient care during the
15 transfer; amending s. 464.0156, F.S.; revising the
16 list of medications that a registered nurse may
17 delegate the administration of to a certified nursing
18 assistant or home health aide; amending ss. 401.25,
19 401.27, and 429.256, F.S.; conforming provisions to
20 changes made by the act; providing an effective date.
21
22 Be It Enacted by the Legislature of the State of Florida:
23
24 Section 1. Section 400.488, Florida Statutes, is amended
25 to read:

Page 1 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

26 400.488 Assistance with self-administration of medication
27 and with other tasks.—
28 (1) For purposes of this section, the term:
29 (a) "Informed consent" means advising the patient, or the
30 patient's surrogate, guardian, or attorney in fact, that the
31 patient may be receiving assistance with self-administration of
32 medication or other tasks from an unlicensed person.
33 (b) "Unlicensed person" means an individual not currently
34 licensed to practice nursing or medicine who is employed by or
35 under contract to a home health agency and who has received
36 training with respect to assisting with the self-administration
37 of medication or other tasks as provided by agency rule.
38 (2) Patients who are capable of self-administering their
39 own medications and performing other tasks without assistance
40 shall be encouraged and allowed to do so. However, an unlicensed
41 person may, consistent with a dispensed prescription's label or
42 the package directions of an over-the-counter medication, assist
43 a patient whose condition is medically stable with the self-
44 administration of routine, regularly scheduled medications that
45 are intended to be self-administered. An unlicensed person may
46 also provide assistance with other tasks specified in subsection
47 (6). Assistance with self-administration of medication or such
48 other tasks self-medication by an unlicensed person may occur
49 only upon a documented request by, and the written informed
50 consent of, a patient or the patient's surrogate, guardian, or

Page 2 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

51 attorney in fact. For purposes of this section, self-
52 administered medications include both legend and over -the-
53 counter oral dosage forms, topical dosage forms, transdermal
54 patches, and topical ophthalmic, otic, and nasal dosage forms,
55 including solutions, suspensions, sprays, inhalers, and
56 nebulizer treatments.
57 (3) Assistance with self-administration of medication
58 includes:
59 (a) Taking the medication, in its previously dispensed,
60 properly labeled container, from where it is stored and bringing
61 it to the patient. For purposes of this paragraph, an insulin
62 syringe that is prefilled with the proper dosage by a pharmacist
63 and an insulin pen that is prefilled by the manufacturer are
64 considered medications in previously dispensed, properly labeled
65 containers.
66 (b) In the presence of the patient, confirming that the
67 medication is intended for that patient, orally advising the
68 patient of the medication name and purpose, opening the
69 container, removing a prescribed amount of medication from the
70 container, and closing the container.
71 (c) Placing an oral dosage in the patient's hand or
72 placing the dosage in another container and helping the patient
73 by lifting the container to his or her mouth.

Page 3 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

74 (d) Applying topical medications, including routine
75 preventive skin care and applying and replacing bandages for
76 minor cuts and abrasions as provided by the agency in rule .
77 (e) Returning the medication container to proper storage.
78 (f) For nebulizer treatments, assisting with setting up
79 and cleaning the device in the presence of the patient,
80 confirming that the medication is intended for that patient,
81 orally advising the patient of the medication name and purpose,
82 opening the container, removing the prescribed amount for a
83 single treatment dose from a properly labeled container, and
84 assisting the patient with placing the dose into the medicine
85 receptacle or mouthpiece.
86 (f)(g) Keeping a record of when a patient receives
87 assistance with self-administration under this section.
88 (g) Assisting with the use of a nebulizer, including
89 removing the cap of a nebulizer, opening the unit dose of
90 nebulizer solutions, and pouring the prescribed premeasured dose
91 of medication into the dispensing cup of the nebulizer.
92 (4) Assistance with self-administration of medication does
93 not include:
94 (a) Mixing, compounding, converting, or calculating
95 medication doses, except for measuring a prescribed amount of
96 liquid medication or breaking a scored tablet or crushing a
97 tablet as prescribed.

Page 4 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

98 (b) The preparation of syringes for injection or the
99 administration of medications by any injectable route.
100 (c) Administration of medications through intermittent
101 positive pressure breathing machines or a nebulizer.
102 (c)(d) Administration of medications by way of a tube
103 inserted in a cavity of the body.
104 (d)(e) Administration of parenteral preparations.
105 (e)(f) The use of irrigations or debriding agents used in
106 the treatment of a skin condition.
107 (f)(g) Assisting with rectal, urethral, or vaginal
108 preparations.
109 (g)(h) Assisting with medications ordered by the physician
110 or health care professional with prescriptive authority to be
111 given "as needed," unless the order is written with specific
112 parameters that preclude independent judgment on the part of the
113 unlicensed person, and at the request of a competent patient.
114 (h)(i) Medications for which the time of administration,
115 the amount, the strength of dosage, the method of
116 administration, or the reason for administration requires
117 judgment or discretion on the part of the unlicensed person.
118 (5) Assistance with the self-administration of medication
119 by an unlicensed person as described in this section does not
120 constitute administration as defined in s. 465.003.
121 (6) Assistance with other tasks includes:

Page 5 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

122 (a) Assisting with the use of a glucometer to perform
123 blood-glucose level checks.
124 (b) Assisting with putting on and taking off antiembolism
125 stockings.
126 (c) Assisting with applying and removing an oxygen cannula
127 but not with titrating the prescribed oxygen settings.
128 (d) Assisting with the use of a continuous positive airway
129 pressure device but not with titrating the prescribed setting of
130 the device.
131 (e) Assisting with measuring vital signs.
132 (f) Assisting with colostomy bags.
133 (7)(6) The agency may by rule establish procedures and
134 interpret terms as necessary to administer this section.
135 Section 2. Section 401.252, Florida Statutes, is amended
136 to read:
137 401.252 Interfacility transfer.—
138 (1) When conducting an interfacility transfer, a permitted
139 advanced life support ambulance must be occupied by at least two
140 persons: one patient attendant who is a certified paramedic, a
141 registered nurse authorized under subsection (2), or a licensed
142 physician; and one who is a certified emergency medical
143 technician, a certified paramedic, a licensed physician, or an
144 ambulance driver who meets the driver requirements of s.
145 401.281. The person occupying the ambulance who has the highest
146 medical certification in this state is in charge of patient care

Page 6 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

147 during the interfacility transfer.
148 (2) A licensed basic or advanced life support ambulance
149 service may conduct interfacility transfers in a permitted
150 ambulance, using a registered nurse in place of an emergency
151 medical technician or paramedic, if:
152 (a) The registered nurse holds a current certificate of
153 successful course completion in advanced cardiac life support;
154 (b) The physician in charge has granted permission for
155 such a transfer, has designated the level of service required
156 for such transfer, and has deemed the patient to be in such a
157 condition appropriate to this type of ambulance staffing; and
158 (c) The registered nurse operates within the scope of part
159 I of chapter 464.
160 (3)(2) A licensed basic or advanced life support service
161 may conduct interfacility transfers in a permitted ambulance if
162 the patient's treating physician certifies that the transfer is
163 medically appropriate and the physician provides reasonable
164 transfer orders. An interfacility transfer must be conducted in
165 a permitted ambulance if it is determined that the patient
166 needs, or is likely to need, medical attention during transport.
167 If the emergency medical technician or paramedic beli eves the
168 level of patient care required during the transfer is beyond his
169 or her capability, the medical director, or his or her designee,
170 must be contacted for clearance prior to conducting the
171 transfer. If necessary, the medical director, or his or her

Page 7 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

172 designee, shall attempt to contact the treating physician for
173 consultation to determine the appropriateness of the transfer.
174 (4)(3) Infants younger less than 28 days old or infants
175 weighing less than 5 kilograms, who require critical care
176 interfacility transport to a neonatal intensive care unit must,
177 shall be transported in a permitted advanced life support or
178 basic life support transport ambulance, or in a permitted
179 advanced life support or basic life support ambulance that is
180 recognized by the department as meeting designated criteria for
181 neonatal interfacility critical care transport.
182 Section 3. Subsection (2) of section 464.0156, Florida
183 Statutes, is amended to read:
184 464.0156 Delegation of duties.—
185 (2) A registered nurse may delegate to a certified nursing
186 assistant or a home health aide the administration of oral,
187 transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
188 topical prescription medications to a patient of a home health
189 agency, if the certified nursing assistant or home health ai de
190 meets the requirements of s. 464.2035 or s. 400.489,
191 respectively. A registered nurse may not delegate the
192 administration of any controlled substance listed in Schedule
193 II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s.
194 812, except for the administration of an insulin syringe that is
195 prefilled with the proper dosage by a pharmacist or an insulin
196 pen that is prefilled by the manufacturer.

Page 8 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

197 Section 4. Subsection (7) of section 401.25, Florida
198 Statutes, is amended to read:
199 401.25 Licensure as a basic life support or an advanced
200 life support service.—
201 (7)(a) Each permitted basic life support ambulance not
202 specifically exempted from this part, when transporting a person
203 who is sick, injured, wounded, incapacitated, or helpless, must
204 be occupied by at least two persons: one patient attendant who
205 is a certified emergency medical technician, certified
206 paramedic, or licensed physician; and one ambulance driver who
207 meets the requirements of s. 401.281. This paragraph does not
208 apply to interfacility transfers governed by s. 401.252 s.
209 401.252(1).
210 (b) Each permitted advanced life support ambulance not
211 specifically exempted from this part, when transporting a person
212 who is sick, injured, wounded, incapacitated, or helpless, must
213 be occupied by at least two persons: one who is a certified
214 paramedic or licensed physician; and one who is a certified
215 emergency medical technician, certified paramedic, or licensed
216 physician who also meets the requirements of s. 401.281 for
217 drivers. The person with the highest medical certifications
218 shall be in charge of patient care. This paragraph does not
219 apply to interfacility transfers governed by s. 401.252 s.
220 401.252(1).
221 Section 5. Subsection (1) of section 401.27, Florida

Page 9 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

222 Statutes, is amended to read:
223 401.27 Personnel; standards and certification.—
224 (1) Each permitted ambulance not specifically exempted
225 from this part, when transporting a person who is sick, injured,
226 wounded, incapacitated, or helpless, must be occupied by at
227 least two persons, one of whom must be a certified emergency
228 medical technician, certified paramedic, or licensed physician
229 and one of whom must be a driver who meets the requirements for
230 ambulance drivers. This subsection does not apply to
231 interfacility transfers governed by s. 401.252 s. 401.252(1).
232 Section 6. Section 429.256, Florida Statutes, is amended
233 to read:
234 429.256 Assistance with self-administration of medication
235 and with other tasks.—
236 (1) For the purposes of this section, the term:
237 (a) "Informed consent" means advising the resident, or the
238 resident's surrogate, guardian, or attorney in fact, that an
239 assisted living facility is not required to have a licensed
240 nurse on staff, that the resident may be receiving assistance
241 with self-administration of medication or other tasks from an
242 unlicensed person, and that such assistance, if provided by an
243 unlicensed person, will or will not be overseen by a licensed
244 nurse.
245 (b) "Unlicensed person" means an individual not currently
246 licensed to practice nursing or medicine who is employed by or

Page 10 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

247 under contract to an assisted living facility and who has
248 received training with respect to assisting with the self-
249 administration of medication or other tasks in an assisted
250 living facility as provided under s. 429.52 prior to providing
251 such assistance as described in this section.
252 (2) Residents who are capable of self-administering their
253 own medications and performing other tasks without assistance
254 shall be encouraged and allowed to do so. However, an unlicensed
255 person may, consistent with a dispensed prescription's label or
256 the package directions of an over-the-counter medication, assist
257 a resident whose condition is medically stable with the self -
258 administration of routine, regularly scheduled medications that
259 are intended to be self-administered. An unlicensed person may
260 also provide assistance with other tasks specified in subsection
261 (6). Assistance with self-administration of medication or such
262 other tasks self-medication by an unlicensed person may occur
263 only upon a documented request by, and the written informed
264 consent of, a resident or the resident's surrogate, guardian, or
265 attorney in fact. For the purposes of this section, self -
266 administered medications include both legend and over -the-
267 counter oral dosage forms, topical dosage forms, transd ermal
268 patches, and topical ophthalmic, otic, and nasal dosage forms
269 including solutions, suspensions, sprays, and inhalers.
270 (3) Assistance with self-administration of medication
271 includes:

Page 11 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

272 (a) Taking the medication, in its previously dispensed,
273 properly labeled container, including an insulin syringe that is
274 prefilled with the proper dosage by a pharmacist and an insulin
275 pen that is prefilled by the manufacturer, from where it is
276 stored, and bringing it to the resident. For purposes of this
277 paragraph, an insulin syringe that is prefilled with the proper
278 dosage by a pharmacist and an insulin pen that is prefilled by
279 the manufacturer are considered medications in previously
280 dispensed, properly labeled containers.
281 (b) In the presence of the resident, confirming that the
282 medication is intended for that resident, orally advising the
283 resident of the medication name and dosage, opening the
284 container, removing a prescribed amount of medication from the
285 container, and closing the container. The resident may sign a
286 written waiver to opt out of being orally advised of the
287 medication name and dosage. The waiver must identify all of the
288 medications intended for the resident, including names and
289 dosages of such medications, and must immediately be updated
290 each time the resident's medications or dosages change.
291 (c) Placing an oral dosage in the resident's hand or
292 placing the dosage in another container and helping the resident
293 by lifting the container to his or her mouth.
294 (d) Applying topical medications.
295 (e) Returning the medication container to proper storage.

Page 12 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

296 (f) Keeping a record of when a resident receives
297 assistance with self-administration under this section.
298 (g) Assisting with the use of a nebulizer, including
299 removing the cap of a nebulizer, opening the unit dose of
300 nebulizer solution, and pouring the prescribed premeasured dose
301 of medication into the dispensing cup of the nebulizer.
302 (h) Using a glucometer to perform blood-glucose level
303 checks.
304 (i) Assisting with putting on and taking off antiembolism
305 stockings.
306 (j) Assisting with applying and removing an oxygen cannula
307 but not with titrating the prescribed oxygen settings.
308 (k) Assisting with the use of a continuous positive airway
309 pressure device but not with titrating the prescribed setting of
310 the device.
311 (l) Assisting with measuring vital signs.
312 (m) Assisting with colostomy bags.
313 (4) Assistance with self-administration of medication does
314 not include:
315 (a) Mixing, compounding, converting, or calculating
316 medication doses, except for measuring a prescribed amount of
317 liquid medication or breaking a scored tablet or crushing a
318 tablet as prescribed.
319 (b) The preparation of syringes for injection or the
320 administration of medications by any injectable route.

Page 13 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

321 (c) Administration of medications by way of a tube
322 inserted in a cavity of the body.
323 (d) Administration of parenteral preparations.
324 (e) The use of irrigations or debriding agents used in the
325 treatment of a skin condition.
326 (f) Assisting with rectal, urethral, or vaginal
327 preparations.
328 (g) Assisting with medications ordered by the physician or
329 health care professional with prescriptive authority to be given
330 "as needed," unless the order is written with specific
331 parameters that preclude independent judgment on the part of the
332 unlicensed person, and the resident requesting the medication is
333 aware of his or her need for the medication and understands the
334 purpose for taking the medication.
335 (h) Medications for which the time of administration, the
336 amount, the strength of dosage, the method of administration, or
337 the reason for administration requires judgment or discretion on
338 the part of the unlicensed person.
339 (5) Assistance with the self-administration of medication
340 by an unlicensed person as described in this section shall not
341 be considered administration as defined in s. 465.003.
342 (6) Assistance with other tasks includes:
343 (a) Assisting with the use of a glucometer to perform
344 blood-glucose level checks.

Page 14 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
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

CS/HB 469 2022

345 (b) Assisting with putting on and taking off antiembolism
346 stockings.
347 (c) Assisting with applying and removing an oxygen cannula
348 but not with titrating the prescribed oxygen settings.
349 (d) Assisting with the use of a continuous positive airway
350 pressure device but not with titrating the prescribed setting of
351 the device.
352 (e) Assisting with measuring vital signs.
353 (f) Assisting with colostomy bags.
354 (7)(6) The agency may by rule establish facility
355 procedures and interpret terms as necessary to implement this
356 section.
357 Section 7. This act shall take effect July 1, 2022.

Page 15 of 15

CODING: Words stricken are deletions; words underlined are additions.
hb0469-01-c1
PCS for HB 731
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 731 Drug-related Overdose Prevention
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 Woodruff McElroy
Subcommittee

SUMMARY ANALYSIS
An overabundance of opioids in the body can lead to a fatal overdose. Opioid antagonists are used in opioid
overdoses to counteract life-threatening depression of the central nervous system and respiratory system,
allowing an overdose victim to breathe normally.

Current law authorizes health care practitioner to prescribe and dispense an emergency opioid antagonist to a
patient or caregiver, and pharmacists may dispense an emergency opioid antagonist pursuant to a prescription
or non-patient-specific standing order. A patient or caregiver can store and possess approved emergency
opioid antagonists and, in an emergency, when a physician is not immediately available, administer the
emergency opioid antagonists to a person believed in good faith to be experiencing an opioid overdose,
regardless of whether the person has a prescription for an emergency opioid antagonist. Emergency
responders and crime laboratory personnel are authorized to possess, store, and administer emergency opioid
antagonists. Current law affords civil liability immunity to anyone who possesses, administers, prescribes,
dispenses, or stores an approved emergency opioid antagonist.

Current law allows emergency medical technicians and paramedics who provide basic and advanced life
support services to report controlled substances overdoses to the Department of Health (DOH). Hospital
emergency departments and urgent care centers that treat suspected or actual overdoses are not required to
report such information. This creates a potential gap in the data related to any person that was not transported
by a basic life support service or an advanced life support service to a hospital or urgent care center.

The Florida Public Health Institute (Institute) is a not-for-profit corporation established by s. 381.98, F.S., with
the purpose of advancing the knowledge and practice of public health, including promoting health awareness in
Florida. The law requires the Institute to, in consultation with DOH, coordinate monthly health awareness
campaigns with national, state, and local health care organizations and government entities on numerous
topics, including substance abuse.

HB 731 amends s. 381.887, F.S., to reflect that the purpose of the section is for the prescribing, ordering, and
dispensing of emergency opioid antagonists. The bill requires the Institute, in consultation with DOH, to
educate the public regarding the use of emergency opioid antagonist. Further, the bill allows pharmacist to
order and dispense an emergency opioid antagonist to a patient or caregiver.

The bill expressly authorizes personnel of a law enforcement agency or other agency, including, correctional
probation officers and child protective investigators to possess, store, and administer emergency opioid
antagonists. The bill also amends s. 395.1041, F.S., to require hospital emergency departments and urgent
care centers to report the treatment of suspected or actual overdose victims under certain circumstances.

The bill has no fiscal impact on state or local government.

The bill provides an effective date of July 1, 2022.

This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: pcs0731.PPH
DATE: 1/18/2022
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Opioids

Opioids are psychoactive substances derived from the opium poppy, or their synthetic analogues. 1
They are commonly used as pain relievers to treat acute and chronic pain. An individual experiences
pain because of a series of electrical and chemical exchanges among the individual’s peripheral
nerves, spinal cord, and brain. 2 Opioid receptors occur naturally and are distributed widely throughout
the central nervous system and in peripheral sensory and autonomic nerves. 3 When an individual
experiences pain, the body releases hormones, such as endorphins, which bind with targeted opioid
receptors. 4 This disrupts the transmission of pain signals through the central nervous system and
reduces the perception of pain. 5 Opioids function in the same way by binding to specific opioid
receptors in the brain, spinal cord and gastrointestinal tract, thereby reducing the perception of pain. 6

Opioids include prescription medications used to treat pain, as well as illegal drugs. Opioids include 7:

• Buprenorphine (Subutex, Suboxone)
• Codeine
• Fentanyl (Duragesic, Fentora)
• Heroin
• Hydrocodone (Vicodin, Lortab, Norco)
• Hydromorphone (Dilaudid, Exalgo)
• Meperidine
• Methadone
• Morphine
• Oxycodone (OxyContin, Percodan, Percocet)
• Oxymorphone
• Tramadol
• U-47700

In 2019, an estimated 62 million people used opioids for non-medical reasons worldwide. 8 Opioids are
commonly abused, with an estimated 36.3 million people worldwide suffering from drug use disorders. 9
Opioids can create a euphoric feeling because they affect the regions of the brain involved with
pleasure and reward, which can lead to abuse. 10 Continued use of these drugs can lead to the
development of tolerance and psychological and physical dependence. 11 This dependence is
characterized by a strong desire to take opioids, impaired control over opioid use, persistent opioid use

1 World Health Organization, Opioid Overdose, https://www.who.int/news-room/fact-sheets/detail/opioid-overdose (last visited Jan. 4,

2022).
2 Medical News Today, What is pain, and how do you treat it? (Sept. 7, 2020),

https://www.medicalnewstoday.com/articles/145750#:~:text=People%20feel%20pain%20when%20specific,immediate%20contraction%
20of%20the%20muscles (last visited Jan. 4, 2022).
3 Gjermund Henriksen, Frode Willoch, Imaging of Opioid Receptors in the Central Nervous System, Brain (2008) 131 (5): 1171-1196.
4 Id.
5 Id.
6 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, SAMHSA Opioid

Overdose Toolkit: Facts for Community Members (2018).
7 Florida Department of Law Enforcement, Drugs Identified in Deceased Persons by Florida Medical Examiners 2019 Report, (Nov.

2020).
8 United Nations Office on Drugs and Crime, World Drug Report 2021, Global Overview: Drug Demand and Drug Supply (Jun. 2021),

WDR21_Booklet_2.pdf (unodc.org) (last visited Jan. 4, 2022).
9 Id.
10 National Institute on Drug Abuse, How Do Opioids Affect the Brain and Body?, (June 2020)

http://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/how-do-opioids-affect-brain-body (last visited Jan. 4,
2022).
11 Supra note 6.

STORAGE NAME: pcs0731.PPH PAGE: 2
DATE: 1/18/2022
despite harmful consequences, a higher priority given to opioid use than to other activities and
obligations, and a physical withdrawal reaction when opioids are discontinued. 12

An overabundance of opioids in the body can lead to a fatal overdose. In addition to their presence in
major pain pathways, opioid receptors are also located in the respiratory control centers of the brain. 13
Opioids disrupt the transmission of signals for respiration in the identical manner that they disrupt the
transmission of pain signals (figure 1). This leads to a reduction, and potentially cessation, of an
individual’s respiration. Oxygen starvation will eventually stop vital organs like the heart, then the brain,
and can lead to unconsciousness, coma, and possible death. 14 Within 3-5 minutes without oxygen,
brain damage starts to occur, soon followed by death. 15 However, this does not occur instantaneously
as people will commonly stop breathing slowly, minutes to hours after the drug or drugs were used. 16
An opioid overdose can be identified by a combination of three signs and symptoms referred to as the
“opioid overdose triad”: 17

• Pinpoint pupils.
• Unconsciousness.
• Respiratory depression.
Figure 1

Source: Maya Doe-Simkins, MPH, Boston Medical Center.

The rise in opioid overdose deaths can be outlined in three distinct waves:
1. The first wave began with increase prescribing of opioids in the 1990s, with overdose deaths
involving prescription opioids increasing since at least 1999.
2. The second wave began in 2010, with rapid increase in overdose deaths involving heroin.
3. The third wave began in 2013 with significant increases in overdose deaths involving synthetic
opioids, particularly those involving illicitly manufactured fentanyl. The market for illicitly
manufactured fentanyl continues to change, and it can be found in combination with heroin,
counterfeit pills, and cocaine. 18

More than 70,000 Americans died from drug-involved overdose in 2019, including illicit drugs and
prescription opioids. 19 Overall, drug overdose deaths increased from 2018 to 2019 with 70,630 drug

12 Supra note 1.
13 Pattinson, K.T.S., Opioids and the Control of Respiration, BJA, Vol. 100, Issue 6, Pages 747-758. https://doi.org/10.1093/bja/aen094.
14 Harm Reduction Coalition, Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects, (Aug. 31,

2020) http://harmreduction.org/our-work/overdose-prevention/ (last visited Jan. 4, 2022).
15 Id.
16 Id.
17 Supra note 1.
18 Centers for Disease Control and Prevention, Understanding the Epidemic, https://www.cdc.gov/drugoverdose/epidemic/index.html

(last visited Jan. 4, 2022).
19 National institute on Drug Abuse, Overdose Death Rates, https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-

rates (last visited Jan. 4, 2022).
STORAGE NAME: pcs0731.PPH PAGE: 3
DATE: 1/18/2022
overdoses reported in 2019. 20 The following graph provides information on the total number of U.S.
overdose deaths involving any opioid 21 from 1999 to 2019. 22 Opioid-involved overdose deaths
increased from 21,088 in 2010 to 47,600 in 2017, and remained steady in 2018 with 46,802. 23 This was
following by a significant increase in 2019 to 49,860 overdose deaths. 24

In 2019, Florida reported 5,268 opioid overdose deaths. 25 This was an 11.9 percent increase from
2018. 26 Florida also experienced 4,152 opioid and 10,464 all drug non-fatal overdoses between July
and September 2019. 27

With the onset of the COVID-19 pandemic, the incidence of opioid use disorder and resulting overdose
deaths has once again risen. A report from Project Opioid details provisional data from the Florida
Department of Health (DOH) showing that deaths from drug overdoses have increased by 43 percent
between 2019 and 2020, from 56 deaths per 100,000 in 2019 to 94 deaths per 100,000 in 2020. 28
Additionally, fentanyl, an extremely potent opioid drug, is the leading cause of overdose deaths in
Florida, and the incidence of fentanyl overdose deaths increased by 38 percent from 2,348 in 2019 to
3,244 in 2020. 29

Opioid Antagonist

An opioid antagonist, such as Narcan or Naloxone, is a drug that blocks the effects of exogenously
administered opioids. Opioid antagonists are used in opioid overdoses to counteract life-threatening

20 Id.
21 Any opioid includes prescription opioids (natural and semi-synthetic opioids and methadone), heroin and synthetic opioids other than

methadone (primarily fentanyl).
22 Supra note 19.
23 Id.
24 Id.
25 Center for Disease Control and Prevention, Drug Overdose Deaths, https://www.cdc.gov/drugoverdose/data/statedeaths/drug-

overdose-death-2019.html (last visited Jan. 4, 2022).
26 Center for Disease Control and Prevention, 2018-2019 Drug Overdose Death Rate Increase,

https://www.cdc.gov/drugoverdose/data/statedeaths/drug-overdose-death-2019.html (last visited Jan. 17, 2022).
27 Florida Department of Health, Non-Fatal Opioid and All Drug Overdose Surveillance Report, Florida Q4-2019,

http://www.floridahealth.gov/statistics-and-data/fl-dose/_documents/non-fatal-od-2019-q4.pdf
28 Project Opioid, A Pandemic Fueling an Epidemic in Florida in 2020, https://projectopioid.org/wp-content/uploads/2020/12/PO-2020-

Data-Study-Final_New-Section.pdf (last visited Jan. 4, 2022).
29 Id.

STORAGE NAME: pcs0731.PPH PAGE: 4
DATE: 1/18/2022
depression of the central nervous system and respiratory system, allowing an overdose victim to
breathe normally. 30 This occurs because opioid antagonists create a stronger bond with opioid
receptors than opioids. This forces the opioids from the opioid receptors and allows the transmission of
signals for respiration to resume. 31 This effect lasts only for a short period of time 32 with the narcotic
effect of the opioids returning if still present in large quantities in the body. In this scenario, additional
doses of an opioid antagonist would be required and it is why it is generally recommended that anyone
who has experienced an overdose seek medical attention.

In February 2019, Florida issued a statewide Standing Order for Naloxone. The Standing Order
authorizes pharmacists to dispense certain naloxone formulations to emergency responders for
administration to persons exhibiting signs of opioid overdose. 33 Under the Standing Order, emergency
responders, including law enforcement, firefighters, paramedics, and emergency medical technicians,
can go to a pharmacy or community-based program for training on opioid antagonist administration and
receive an opioid antagonist without a patient-specific prescription. Access to naloxone is available at
most pharmacies in Florida. The following map provides information on pharmacy locations where
naloxone is available a prescription. 34

30 Harm Reduction Coalition, Understanding Naloxone, (Sept. 8, 2020) http://harmreduction.org/issues/overdose-

prevention/overview/overdose-basics/understanding-naloxone/ (last visited Jan. 4, 2022).
31 Supra note 13.
32 The half-life for a common opioid antagonist in adults ranged from 30 to 81 minutes. Acute opiate withdrawal is a potential side-effect

of naloxone; however, this would be time limited to the half-life of naloxone.
33 Florida Department of Health, State of Florida, Statewide Standing Order for Naloxone (Feb. 25, 2019),

http://www.floridahealth.gov/licensing-and-regulation/ems-system/_documents/standing-order-naloxone.pdf (last visited Jan. 4, 2022).
34 New America, National Naloxone Access Map,

https://opioidepidemic.maps.arcgis.com/home/item.html?id=153b0c32fefc432eae6a0e8439b9f56b (last visited Jan. 4, 2022). The
National Naloxone Map accumulates data from many difference sources, with participation from thousands of CVS, Walmart, and
Walgreens pharmacies, along with other independent distributors. The map is meant to be a community effort, and contributing
locations is encouraged to participate, to make it the best possible representation of resources. The map is not complete, and naloxone
prescription needs and costs vary by state, but this effort represents over 25,000 locations to obtain naloxone.
STORAGE NAME: pcs0731.PPH PAGE: 5
DATE: 1/18/2022
Florida law allows an authorized health care practitioner to prescribe and dispense an emergency
opioid antagonist to a patient or caregiver, and pharmacists may dispense an emergency opioid
antagonist pursuant to a prescription or to a non-patient-specific standing order. 35 Current law defines a
“caregiver” as a family member, friend, or person that has recurring contact with a person at risk of
experiencing an opioid overdose. 36 Current law broadly defines a “person” to include individuals and
children. 37 Therefore, an authorized health care practitioner may prescribed any person falling under
the definition an emergency opioid antagonist.

Any person prescribed an opioid antagonist, or distributed an emergency opioid antagonist pursuant to
a non-patient-specific standing order, may store and possess approved emergency opioid antagonists.
In an emergency, when a physician is not immediately available, that person may administer the
emergency opioid antagonists to an individual believed in good faith to be experiencing an opioid
overdose, regardless of whether that person has a prescription for an emergency opioid antagonist. 38

35 S. 381.887, F.S.
36 S. 381.887(1)(c), F.S.
37 S. 1.01 (3), F.S.
38 S. 381.887(3), F.S.

STORAGE NAME: pcs0731.PPH PAGE: 6
DATE: 1/18/2022
Current law also allows emergency responders and crime laboratory personnel to possess, store, and
administer emergency opioid antagonists. 39

A person who possesses, administers, prescribes, dispenses, or stores an approved emergency opioid
antagonist is afforded the civil liability immunity protections under s. 768.13, F.S. (Good Samaritan
Act). 40

Emergency Response to Overdose

In 2017, U.S. drug overdose deaths increased 9.6% from 2016. Emergency departments treated
967,615 nonfatal drug overdoses in 2017. 41 From 2016 to 2017, rates for nonfatal overdoses increased
for those involving all drugs (4.3%), all opioids (3.1%), nonheroin opioids (3.6%), heroin (3.6%), and
cocaine (32.9%). 42

The following table provides information on emergency department visits related to heroin and
nonmedical use of prescription opioids by age from April 2019 to December 2020. 43 Patients aged 26
to 45 accounted for more than half (52%) of emergency department visits related to non-medical use of
prescription opioids. 44

70%
63.90%

60%
51.50%
50%

40%

30.00%
30%
23.40%

20% 16.10%
12.30%
10%
2.30%
0.30%
0%
Heroin Nonmedical Use of Prescription Opioids

Under 18 18 to 25 26 to 45 Over 45

Florida Emergency Response to Overdoses Reporting Requirements

Current law allows emergency medical technicians 45 (EMT) and paramedics 46 who provide basic and
advanced life support services to report controlled substances overdoses to DOH. A report must
contain:

39 S. 381.887(4), F.S.
40 S. 381.887(5), F.S.
41 Centers for Disease Control and Prevention, Nonfatal Drug Overdoses Treated in Emergency Departments – United States, 2016-

2017, (Apr. 3, 2020), https://www.cdc.gov/mmwr/volumes/69/wr/mm6913a3.htm (last visited Jan. 10, 2022).
42 Id.
43 U.S. Department of Health, Substance Abuse and Mental Health services Administration, DAWN: Heroin and Nonmedical Use of

Prescription Opioids, https://www.samhsa.gov/data/sites/default/files/reports/rpt32814/DAWN%20Opioids%20Profile.pdf (last visited
Jan. 4, 2022).
44 Id.
45 S. 401.23(11), F.S., defines an EMT as a person who is certified by DOH to perform basic life support.
46 S. 401.23(17), F.S., defines a paramedic as a person who is certified by DOH to perform basic and advanced life support.

STORAGE NAME: pcs0731.PPH PAGE: 7
DATE: 1/18/2022
• The date and time of the overdose.
• The address of where the patient was picked up or where the overdose took place.
• Whether an emergency opioid antagonist was administered.
• Whether the overdose was fatal or non-fatal.

Additionally, the report must include the approximate age and gender of the patient and the suspected
controlled substance involved in the overdose, if permitted by its reporting mechanism. Reporters must
attempt to make the report within 120 hours.

A report must be filed with DOH using the Emergency Medical Tracking and Reporting System
(EMSTARS), 47 the Washington/Baltimore High Intensity Drug Tracking Overdoes Detection Mapping
Application Program, 48 or other program identified by DOH in rule.

Section 395.1041(6))(b), F.S., requires hospitals with an emergency department to develop a best
practices policy to promote the prevention of unintentional drug overdoses. The policy may include, but
is not limited to:

• A process to obtain a patient’s consent to notify next of kin, and each physician or health care
practitioner who prescribes a controlled substance to the patient, regarding the patient’s
overdose, the patient’s location, and the nature of the substance or controlled substance
involved in the overdose.
• A process for providing the patient or the patient’s next of kin with information about licensed
substance abuse treatment services.
• Guidelines for emergency department health care practitioners authorized to prescribe
controlled substances to reduce the risk of opioid use, misuse, and addiction.
• The use of licensed or certified behavioral health professionals or peer specialists in the
emergency department to encourage the patient to seek substance abuse treatment.
• The use of screening, brief intervention, and referral to treatment protocols in the emergency
department.

Hospital emergency departments and urgent care centers that treat suspected or actual overdoses are
not required to report such information. This creates a potential gap in the data related to any person
that was not transported by a basic life support service or an advanced life support service to a hospital
or urgent care center.

The Florida Public Health Institute, Inc.

The Florida Public Health Institute (Institute) is a not-for-profit corporation established by s. 381.98,
F.S., with the purpose of advancing the knowledge and practice of public health, including promoting
health awareness in Florida. The Institute is tasked with procuring funds to complement, supplement,
and enhance the missions of the various organizations, entities, and departments that provide public
health initiatives by serving as the lead corporation in the state for promoting public health awareness.
The Institute is required to enter into partnerships with providers of continuing education for health care
practitioners, including, but not limited to, hospitals and state and local medical organizations, to ensure
that practitioners are aware of the most recent and complete diagnostic and treatment tools.

Additionally, s. 381.981, F.S., requires the Institute to, in consultation with DOH, coordinate monthly
health awareness campaigns, with national, state, and local health care organizations and government

47 DOH maintains the EMSTARS to collect data and analyze the incident level data from EMS agencies for benchmarking and quality

improvement initiatives. The electronic patient care records submitted by licensed EMS agencies to EMSTARS are confidential and
exempt pursuant to s. 401.30(4), F.S.
48 The Washington/Baltimore High Intensity Drug Trafficking Area (HIDTA) is a federal grant program administered by the White House

Office of National Drug Control Policy which provides resources to assist federal, state, local, and tribal agencies coordinate activities
that address drug trafficking. HIDTA created an app, known as the Overdose Detection Mapping Application Program, which allows
EMS agencies to report overdose incidents that are then transmitted in real time with electronic map showing the location, date, time,
and incident type. The app does not allow EMS agencies to report on the patient’s age or gender or suspected controlled substance
involved in the overdose.
STORAGE NAME: pcs0731.PPH PAGE: 8
DATE: 1/18/2022
entities, targeting a wide range of the public, including parents, teachers, other school employees,
students in 4th through 12th grade, colleges, universities, state agency employees, county and local
government employees, patents of county health departments, Medicaid recipients, health care
professionals and providers, and the public in general. The health awareness campaigns must include
the following diseases in at least one monthly campaign every 24 months:

• Cancer, including breast, prostate, cervical, ovarian, colorectal, and skin cancer, and leukemia.
• Heart Disease.
• Stroke.
• Lung disease, including asthma and smoking-related disease.
• Neurological disorders and disease, including Alzheimer’s disease, Parkinson’s disease, and
epilepsy.
• Gastrointestinal disease.
• Kidney disease.
• Diabetes.
• Liver disease.
• Autoimmune disorders.
• Birth defects and prenatal care.
• Obesity and malnutrition.
• Sexually transmissible disease.
• Hepatitis A, hepatitis B, and hepatitis C.
• Arthritis.
• Vaccine-preventable disease.
• Infectious diseases, including HIV/AIDS.
• Substance abuse.
• Mental illness.
• Lupus.
• Osteoporosis.

Effect of Proposed Changes

HB 731 amends s. 381.887, F.S., to specify that the purpose of the section is for the prescribing,
ordering, and dispensing of emergency opioid antagonists. It requires the Institute, in consultation with
DOH, to educate the public regarding the use of emergency opioid antagonists.

The bill allows a pharmacist to order an emergency opioid antagonist with an autoinjection delivery
system or intranasal application delivery system for a patient or caregiver for use in accordance with s.
381.887, F.S. It further allows a pharmacist to dispense an emergency opioid antagonist pursuant to a
prescription by an authorized health care practitioner. Pharmacists may dispense an emergency opioid
antagonist with an autoinjection delivery system or intranasal application delivery system, which must
be appropriately labeled with instructions for use, pursuant to a pharmacist’s order or pursuant to a
non-patient standing order.

The bill expressly authorizes personnel of a law enforcement agency or other agency, including, but not
limited to, correctional probation officers and child protective investigators to possess, store, and
administer emergency opioid antagonists. Personnel of a law enforcement agency or other agency are
immune from civil liability or criminal liability as a result of administering an emergency opioid
antagonist.

Further, the bill amends s. 395.1041, F.S., to require hospital emergency departments or urgent care
centers that treat and release a person in response to a suspected or actual overdose of a controlled
substance to report such information to DOH, if that person was not transported by a basic life support
service or an advanced life support service. When making such a report, hospital emergency
departments and urgent care centers must use best efforts to make the report to DOH within 120 hours
after discovering an incident. The bill requires reports to be made using an appropriate method with

STORAGE NAME: pcs0731.PPH PAGE: 9
DATE: 1/18/2022
secure access, including, but not limited to, the Washington/Baltimore High Intensity Drug Trafficking
Overdose Detection Mapping Application Program or other program identified by DOH through rule.

The bill provides an effective date of July 1, 2022.

B. SECTION DIRECTORY:
Section 1: Amending s. 381.887, F.S., relating to emergency treatment for suspected opioid overdose.
Section 2: Amending s. 381.981, F.S., relating to health awareness campaigns.
Section 3: Amending s. 395.1041, F.S., relating to access to emergency services and care.
Section 4: Providing an effective date.

II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT

A. FISCAL IMPACT ON STATE GOVERNMENT:

1. Revenues:
None.

2. Expenditures:
None.

B. FISCAL IMPACT ON LOCAL GOVERNMENTS:

1. Revenues:
None.

2. Expenditures:
None.

C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.

D. FISCAL COMMENTS:
None.

III. COMMENTS

A. CONSTITUTIONAL ISSUES:

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

2. Other:
None.

B. RULE-MAKING AUTHORITY:
DOH has sufficient rulemaking authority to implement the bill’s provisions.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
STORAGE NAME: pcs0731.PPH PAGE: 10
DATE: 1/18/2022
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: pcs0731.PPH PAGE: 11
DATE: 1/18/2022
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 731 2022

1 A bill to be entitled
2 An act relating to drug-related overdose prevention;
3 amending s. 381.887, F.S.; revising the purpose of
4 specified provisions relating to the prescribing,
5 ordering, and dispensing of emergency opioid
6 antagonists to certain persons by authorized health
7 care practitioners; authorizing pharmacists to order
8 certain emergency opioid antagonists; providing
9 certain authorized persons immunity from civil or
10 criminal liability for administering emergency opioid
11 antagonists under certain circumstances; authorizing
12 personnel of law enforcement agencies to administer
13 emergency opioid antagonists under certain
14 circumstances; amending s. 381.981, F.S.; requiring a
15 health awareness campaign; amending s. 395.1041, F.S.;
16 requiring a hospital emergency room and urgent care
17 facility to report incidents involving a suspected or
18 actual overdose to the department under certain
19 circumstances; providing requirements for the report;
20 requiring hospital emergency rooms and urgent care
21 facilities to use best efforts to report such
22 incidents to the department within a specified
23 timeframe; providing an effective date.
24
25 Be It Enacted by the Legislature of the State of Florida:

Page 1 of 6

CODING: Words stricken are deletions; words underlined are additions.
hb0731-00
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

PCS for HB 731 2022

26 Section 1. Subsections (2), (3), and (4) of section
27 381.887, Florida Statutes, are amended to read:
28 381.887 Emergency treatment for suspected opioid
29 overdose.—
30 (2) The purpose of this section is to provide for the
31 prescribing, ordering, and dispensing prescription of emergency
32 opioid antagonists an emergency opioid antagonist to patients
33 and caregivers and to encourage the prescribing, ordering, and
34 dispensing prescription of emergency opioid antagonists by
35 authorized health care practitioners.
36 (3)(a) An authorized health care practitioner may
37 prescribe and dispense an emergency opioid antagonist to, and a
38 pharmacist may order an emergency opioid antagonist with an
39 autoinjection delivery system or intranasal application delivery
40 system for, a patient or caregiver for use in accordance with
41 this section., and
42 (b) A pharmacist pharmacists may dispense an emergency
43 opioid antagonist pursuant to a prescription by an authorized
44 health care practitioner. A pharmacist may dispense an emergency
45 opioid antagonist with such a prescription or pursuant to a non-
46 patient-specific standing order for an autoinjection delivery
47 system or intranasal application delivery system, which must be
48 appropriately labeled with instructions for use, pursuant to a
49 pharmacist's order or pursuant to a nonpatient-specific standing
50 order.

Page 2 of 6

CODING: Words stricken are deletions; words underlined are additions.
hb0731-00
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

PCS for HB 731 2022

51 (c) A such patient or caregiver is authorized to store and
52 possess approved emergency opioid antagonists and, in an
53 emergency situation when a physician is not immediately
54 available, administer the emergency opioid antagonist to a
55 person believed in good faith to be experiencing an opioid
56 overdose, regardless of whether that person has a prescription
57 for an emergency opioid antagonist.
58 (4) The following persons are authorized to possess,
59 store, and administer emergency opioid antagonists as clinically
60 indicated and are immune from any civil liability or criminal
61 liability as a result of administering an emergency opioid
62 antagonist:
63 (a) Emergency responders, including, but not limited to,
64 law enforcement officers, paramedics, and emergency medical
65 technicians.
66 (b) Crime laboratory personnel for the statewide criminal
67 analysis laboratory system as described in s. 943.32, including,
68 but not limited to, analysts, evidence intake personnel, and
69 their supervisors.
70 (c) Personnel of a law enforcement agency or other agency,
71 including, but not limited to, correctional probation officers
72 and child protective investigators who, while acting within the
73 scope or course of employment, come into contact with a
74 controlled substance or persons at risk of experiencing an
75 opioid overdose.

Page 3 of 6

CODING: Words stricken are deletions; words underlined are additions.
hb0731-00
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

PCS for HB 731 2022

76 Section 2. Subsection (2) of section 381.981, Florida
77 Statutes, is amended to read:
78 381.981 Health awareness campaigns.—
79 (2) The awareness campaigns shall include the provision of
80 educational information about preventing, detecting, treating,
81 and curing the following diseases or conditions. Additional
82 diseases and conditions that impact the public health may be
83 added by the board of directors of the Florida Public Health
84 Institute, Inc.; however, each of the following diseases or
85 conditions must be included in an awareness campaign during at
86 least 1 month in any 24-month period:
87 (a) Cancer, including breast, prostate, cervical, ovarian,
88 colorectal, and skin cancer and leukemia.
89 (b) Heart disease.
90 (c) Stroke.
91 (d) Lung disease, including asthma and smoking-relating
92 disease.
93 (e) Neurological disorders and disease, including
94 Alzheimer's disease, Parkinson's disease, and epilepsy.
95 (f) Gastrointestinal disease.
96 (g) Kidney disease.
97 (h) Diabetes.
98 (i) Liver disease.
99 (j) Autoimmune disorders.
100 (k) Birth defects and prenatal care.

Page 4 of 6

CODING: Words stricken are deletions; words underlined are additions.
hb0731-00
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

PCS for HB 731 2022

101 (l) Obesity and malnutrition.
102 (m) Sexually transmissible disease.
103 (n) Hepatitis A, hepatitis B, and hepatitis C.
104 (o) Arthritis.
105 (p) Vaccine-preventable diseases.
106 (q) Infectious diseases, including HIV/AIDS.
107 (r) Substance abuse, including, but not limited to,
108 emergency opioid antagonists.
109 (s) Mental illness.
110 (t) Lupus.
111 (u) Osteoporosis.
112 Section 3. Subsection (8) is added to section 395.1041,
113 Florida Statutes, to read:
114 395.1041 Access to emergency services and care.—
115 (8) REPORTING OF CONTROLLED SUBSTANCE OVERDOSES.—A
116 hospital emergency room or urgent care center that treats and
117 releases a person in response to a suspected or actual overdose
118 of a controlled substance must report such incident to the
119 department if the patient was not transported by a transport
120 service as defined in s. 401.23. Such reports must be made using
121 an appropriate method with secure access, including, but not
122 limited to, the Washington/Baltimore High Intensity Drug
123 Trafficking Overdose Detection Mapping Application Program,
124 EMSTARS, or other program identified by department rule. If a
125 hospital emergency room or urgent care center reports such

Page 5 of 6

CODING: Words stricken are deletions; words underlined are additions.
hb0731-00
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

PCS for HB 731 2022

126 incidents, it must make its best efforts to make the report to
127 the department within 120 hours after knowledge of the incident.
128 Section 4. This act shall take effect July 1, 2022.

Page 6 of 6

CODING: Words stricken are deletions; words underlined are additions.
hb0731-00
HB 817
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 817 Emergency Medical Care and Treatment to Minors Without Parental Consent
SPONSOR(S): Massullo
TIED BILLS: IDEN./SIM. BILLS: SB 1114

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

1) Professions & Public Health Subcommittee Rahming McElroy

2) Health & Human Services Committee

SUMMARY ANALYSIS
It is well settled that the interest of parents in the care, custody, and control of their children is perhaps the
oldest of the recognized fundamental liberty interests protected by the Due Process Clause of the Fourteenth
Amendment to the United States Constitution. The Florida Supreme Court has likewise recognized that parents
have a fundamental liberty interest in determining the care and upbringing of their children. Parents generally
have the right to be informed about, and give consent for, proposed medical procedures on their children.
However, the state also has an obligation to ensure that children receive reasonable medical treatment that is
necessary for the preservation of life.

Current Florida law requires a health care practitioner, or his or her employees, to obtain written parental
consent before performing health care services on a minor child. Physicians licensed under chapters 458 and
459, F.S., may provide emergency medical care or treatment to a minor without parental consent when a child
has been injured in an accident or is suffering from an acute illness, disease, or condition and delaying
treatment would endanger the health or physical well-being of the minor. This is limited to care or treatment
that is administered in either a hospital or college health service. Paramedics, emergency medical technicians
(EMTs), and other emergency medical services personnel may provide emergency care or treatment in a
prehospital setting, such as an ambulance or roadside.

Health care practitioners and health care facilities that violate parental consent requirements are subject to
disciplinary action under their respective practice acts and may be subject to criminal penalties.

The bill authorizes physicians licensed under chapters 458 and 459, F.S., to provide emergency medical care
or treatment to a minor without parental consent. This allows physicians to provide such care in prehospital
settings, similar to EMTs and paramedics, or in hospital settings.

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

The bill provides an effective date of July 1, 2022.

This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0817.PPH
DATE: 1/18/2022
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Present Situation

Constitutional Principles

It is well settled that the interest of parents in the care, custody, and control of their children is perhaps
the oldest of the recognized fundamental liberty interests protected by the Due Process Clause of the
Fourteenth Amendment to the United States Constitution. 1 This fundamental liberty interest is rooted in
the fundamental right of privacy from interference in making important decisions relating to marriage,
family relationships, and child rearing and education. 2 The United States Supreme Court has explained
the fundamental nature of this right is rooted in history and tradition: 3

The history and culture of Western civilization reflect a strong tradition of parental
concern for the nurture and upbringing of their children. This primary role of the
parents in the upbringing of their children is now established beyond debate as an
enduring American tradition.

The Florida Supreme Court has likewise recognized that parents have a fundamental liberty interest in
determining the care and upbringing of their children. 4 These rights may not be intruded upon absent a
compelling state interest. 5 According to the Florida Supreme Court, when analyzing a statute that
infringes on the fundamental right of privacy, the applicable standard of review requires that the statute
survive the highest level of scrutiny: 6

The right of privacy is a fundamental right which we believe demands the compelling state
interest standard. This test shifts the burden of proof to the state to justify an intrusion on
privacy. The burden can be met by demonstrating that the challenged regulation serves a
compelling state interest and accomplishes its goal through the use of the least intrusive
means.

Health Care

Parental Consent for Medical Treatment

Parents generally have the right to be informed about, and give consent for, proposed medical
procedures on their children. However, the state also has an obligation to ensure that children receive

1 Santosky v. Kramer, 455 U.S. 745, 748 and 753 (1982) (holding the fundamental liberty interest of natural parents in the care custody,

and management of their child is protected by the Fourteenth Amendment, and termination of any parental rights requires due process
proceedings); Troxel v. Granville, 530 U.S. 57, 66 (2000) (holding there is a fundamental right under the Fourteenth Amendment for
parents to oversee the care, custody, and control of their children).
2 Carey v. Population Svcs. Int’l, 431 US 678, 684-685 (1977) (recognizing the right of privacy in personal decisions relating to

marriage, family relationships, child rearing, and education); See Wisconsin v. Yoder, 406, U.S. 205, 232-33 (1972) (holding a state law
requiring that children attend school past eight grade violates the parents’ constitutional right to direct the religious upbringing of their
children); See Parham v. J.R., 442 U.S. 584, 602 (1979) (recognizing the presumption that parents act in their children’s best interest);
Meyer v. Nebraska, 262 U.S. 390, 400-01 (1923) (affirming that the Constitution protects the preferences of the parent in education
over those of the state); Pierce v. Society of Sisters, 268 U.S. 510, 534-35 (1925) (recognizing the right of parents to direct the
upbringing of and education of their children).
3 Wisconsin v. Yoder, 406, U.S. 205, 232 (1972).
4 Beagle v. Beagle, 678 So. 2d 1271, 1272 (Fla. 1996) (holding a state law violated a parent’s constitutional right to privacy by imposing

grandparent visitation rights over objection of the parent without evidence of harm to the child or other compelling state interest).
5 Id. See, e.g., Shevin v. Byron, Harless, Schaffer, Reid & Assocs., Inc., 379 So. 2d 633, 637 (Fla. 1980) and Belair v. Drew, 776 So. 2d

1105, 1107 (Fla. 5th DCA 2001).
6 Winfield v. Division of Pari-Mutuel Wagering, Dept. of Bus. Regulation, 477 So. 2d 544, 547 (Fla. 1985).

STORAGE NAME: h0817.PPH PAGE: 2
DATE: 1/18/2022
reasonable medical treatment that is necessary for the preservation of life. 7 The state's interest
diminishes as the severity of an affliction and the likelihood of death increase: 8

There is a substantial distinction in the State's insistence that human life be saved where
the affliction is curable, as opposed to the State interest where . . . the issue is not whether,
but when, for how long and at what cost to the individual . . . life may be briefly extended.

Current law establishes parental consent requirements for health care services. Specifically, unless
otherwise permitted by law, without written, parental consent: 9

• A health care practitioner, 10 or an individual employed by such health care practitioner, may not
provide or solicit or arrange to provide health care services or prescribe medicinal drugs to a
minor.
• A provider, as defined in s. 408.803, F.S., 11 may not allow a medical procedure to be performed
on a minor child in its facility.

A parent may reject medical treatment for a child and the state may not interfere with such decision if
the evidence is not sufficiently compelling to establish the primacy of the state's interest, or that the
child's own welfare would be best served by such treatment. 12

Medical Treatment without Parental Consent

Current Florida law provides exceptions for circumstances in which someone other than a parent may
consent for medical care of a minor or provide medical care without parental consent.

Section 743.064, F.S., allows allopathic 13 and osteopathic 14 physicians to provide emergency medical
care or treatment to a minor without parental consent when a child has been injured in an accident or is
suffering from an acute illness, disease, or condition and delaying treatment would endanger the health
or physical well-being of the minor. This is limited to care or treatment is administered in either a
hospital or college health service. Paramedics, emergency medical technicians (EMTs), and other
emergency medical services personnel may provide emergency care or treatment in a prehospital
setting, such as an ambulance or roadside. 15

Even in emergency situations, medical treatment can only be provided without parental consent if: 16

• The child’s condition has rendered him or her unable to reveal the identity of his or her parents,
guardian, or legal custodian, and such information is unknown to any person who accompanied
the child to the hospital.
• The parents, guardian, or legal custodian cannot be immediately located by telephone at their
place of residence or business.

The hospital must notify the parent or legal guardian as soon as possible after the emergency medical
care or treatment is administered and document in the hospital records the reason parental consent
was not initially obtained. This must include a statement from the attending physician that immediate
emergency medical care or treatment was necessary for the child’s health or physical well-being. 17

7 Von Eiff v. Azicri, 720 So. 2d 510, 515 (Fla. 1998).
8 M.N. v. S. Baptist Hosp., 648 So. 2d 769, 771 (Fla. 1st DCA 1994).
9 S. 1014.06, F.S.
10 S. 456.001, F.S.
11 “Provider” means any activity, service, agency, or facility regulated by the agency and listed in s. 408.802, F.S.
12 Id.
13 Physicians licensed under ch. 458, F.S.
14 Physicians licensed under ch. 459, F.S.
15 For example, an ambulance or roadside.
16 S. 743.064(2), F.S.
17 S. 743.064(3), F.S.

STORAGE NAME: h0817.PPH PAGE: 3
DATE: 1/18/2022
Section 743.0645, F.S., establishes a list of people, by priority, who may consent to the medical care or
treatment of a minor in instances where the treatment provider is unable to contact the parent or legal
guardian and the provider has not been given contrary instructions. Specifically, the following people
may consent, in this order:
• A health care surrogate or a person with power of attorney to provide medical consent for the
minor; 18
• The stepparent;
• The grandparent of the minor;
• An adult brother or sister of the minor; or
• An adult aunt or uncle of the minor.

If a parent or legal guardian cannot be reached while the child is committed to the Department of
Children Families or the Department of Juvenile Justice, 19 then the following individuals may consent to
the medical care or treatment of a minor, unless the parent or legal guardian has expressly stated
otherwise: 20

• The caseworker, juvenile probation officer, or person primarily responsible for the case
management of the child.
• The administrator of the state-licensed facility 21 or state-contracted or state-operated
delinquency residential treatment facility where the child is committed.

In both of these instances, the treatment provider must document the reasonable attempts made to
contact the parent or legal guardian in the minor’s treatment records, and must notify the parent or legal
guardian as soon as possible after the medical care or treatment is administered. 22

Health care practitioners and health care facilities that violate parental consent requirements are
subject to disciplinary action 23 under their respective practice acts and may be subject to criminal
penalties. 24

Effect of Proposed Changes

The bill authorizes physicians licensed under chapters 458 and 459, F.S., to provide emergency
medical care or treatment to a minor without parental consent. This allows physicians to provide such
care in prehospital settings, similar to EMTs and paramedics, or in hospital settings.

The bill provides an effective date of July 1, 2022.

B. SECTION DIRECTORY:
Section 1: Amends s, 743.064, F.S., relating to emergency medical care or treatment to minors without
parental consent.
Section 2: Provides an effective date of July 1, 2022.

II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT

A. FISCAL IMPACT ON STATE GOVERNMENT:

18 A health care surrogate designation under s. 765.2035, F.S., executed after September 30, 2015, or a power of attorney executed

after July 1, 2001, to provide medical consent for a minor includes the power to consent to medically necessary surgical and general
anesthesia services for the minor unless such services are excluded by the individual who executes the health care surrogate for a
minor or power of attorney, s. 743.0645(2)(a), F.S.
19 Specifically, under chs. 39, 984, or 985, F.S.
20 S. 743.0645, F.S.
21 S. 393.067, F.S., licensed facilities for individuals with developmental disabilities; s. 394.875, F.S., licensed mental health facilities for

children and adolescents; s. 409.175, F.S., licensed family foster homes, residential child-caring agencies, and child-placing agencies.
22 S. 743.0645(2)-(4), F.S.
23 S. 456.072(1), F.S., provides grounds for disciplinary action against health care practitioners. S. 408.813, F.S., authorizes the Agency

for Health Care Administration to impose administrative fines against providers for violations of its regulations.
24 Violators commit a first-degree misdemeanor, which is punishable by a fine of up to $1,000 and imprisonment of up to one year S.

1014(5), F.S.
STORAGE NAME: h0817.PPH PAGE: 4
DATE: 1/18/2022
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:
None. The bill does not appear to affect county or municipal governments.

2. Other:
None.

B. RULE-MAKING AUTHORITY:
None.

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: h0817.PPH PAGE: 5
DATE: 1/18/2022
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 817 2022

1 A bill to be entitled
2 An act relating to emergency medical care and
3 treatment to minors without parental consent; amending
4 s. 743.064, F.S.; removing the requirement that
5 emergency medical care or treatment to a minor without
6 parental consent be administered in a hospital or
7 college health service; providing an effective date.
8
9 Be It Enacted by the Legislature of the State of Florida:
10
11 Section 1. Subsection (1) of section 743.064, Florida
12 Statutes, is amended to read:
13 743.064 Emergency medical care or treatment to minors
14 without parental consent.—
15 (1) The absence of parental consent notwithstanding, a
16 physician licensed under chapter 458 or an osteopathic physician
17 licensed under chapter 459 may render emergency medical care or
18 treatment to any minor who has been injured in an accident or
19 who is suffering from an acute illness, disease, or condition
20 if, within a reasonable degree of medical certainty, delay in
21 initiation or provision of emergency medical care or treatment
22 would endanger the health or physical well-being of the minor,
23 and provided such emergency medical care or treatment is
24 administered in a hospital licensed by the state under chapter
25 395 or in a college health service. Emergency medical care or

Page 1 of 2

CODING: Words stricken are deletions; words underlined are additions.
hb0817-00
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 817 2022

26 treatment may also be rendered in the prehospital setting by
27 paramedics, emergency medical technicians, and other emergency
28 medical services personnel, provided such care is rendered
29 consistent with the provisions of chapter 401. These persons
30 shall follow the general guidelines and notification provisions
31 of this section.
32 Section 2. This act shall take effect July 1, 2022.

Page 2 of 2

CODING: Words stricken are deletions; words underlined are additions.
hb0817-00
HB 847
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 847 Occupational Therapy
SPONSOR(S): Koster
TIED BILLS: IDEN./SIM. BILLS: CS/SB 632

REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF

1) Professions & Public Health Subcommittee Morris McElroy

2) Health & Human Services Committee

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

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

• Assessment, treatment, education of, and consultation with individuals whose abilities to participate
safely in occupations are impaired or at risk for impairment;
• Methods to determine abilities and limitations related to the performance of occupations; and
• Specific occupational therapy techniques used for treatment.

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

The bill clarifies the fieldwork experience time requirement for licensure as an occupational therapist by
referencing it in weeks, not months.

It is not uncommon for licensed health care practitioners’ scopes of practice to overlap with other licensed
health care practitioners’ scopes of practice. Numerous professions’ practice acts have exemptions to avoid
unlicensed practice allegations when the scope of two or more practices overlap. The bill provides an
exemption from the application of the Occupational Therapy Practice Act to licensed mental health counselors,
marriage and family therapists, and clinical social workers. The bill also provides an exemption to licensed
occupational therapists and occupational therapy assistants from the application of the Psychological Services
Act and the Clinical, Counseling, and Psychotherapy Act.

The bill has an indeterminate, insignificant, negative fiscal impact on DOH. The bill does not have a fiscal
impact on local governments.

The bill provides an effective date of July 1, 2022.

This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0847.PPH
DATE: 1/18/2022
FULL ANALYSIS

I. SUBSTANTIVE ANALYSIS

A. EFFECT OF PROPOSED CHANGES:
Current Situation

Department of Health

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

Occupational Therapy

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

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

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

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

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

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

available at http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/2019-2020-annual-report.pdf
(last visited Jan. 13, 2022).
3 Britannica, Occupational Therapy, https://www.britannica.com/science/occupational-therapy (last visited Jan. 13, 2022).
4 Section 468.203(4), F.S.
5 Id.
6 American Occupational Therapy Association, About Occupational Therapy – What is Occupational Therapy?,

https://www.aota.org/about-occupational-therapy.aspx (last visited Jan. 13, 2022).
7 Section 468.203(8), F.S. Responsible supervision and control by the licensed OT includes providing both the initial direction in

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

STORAGE NAME: h0847.PPH PAGE: 2
DATE: 1/18/2022
therapy skills and techniques as part of their professions, when they practice their profession under
their own practice acts. 9

Occupational therapy services include, but are not limited to: 10

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

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

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

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

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

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

9 Section 468.225, F.S.
10 Section 468.203(4)(b), F.S.
11 Section 468.203(4)a.2.,F.S. “Assessment” means the use of skilled observation or the administration and interpretation of

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

Standards and Interpretive Guide (effective July 31, 2020) August 2020 Interpretive Guide Version, at pp. 20 and 49,
https://acoteonline.org/wp-content/uploads/2020/10/2018-ACOTE-Standards.pdf (last visited Jan. 13, 2022). The Ph.D. in occupational
therapy requires a minimum of six years of full time academic education and a Doctorial Capstone which is an in-depth exposure to a
concentrated area, which is an integral part of the program’s curriculum design. This in-depth exposure may be in one or more of the
following areas: clinical practice skills, research skills, scholarship, administration, leadership, program and policy development,
advocacy, education, and theory development. The doctoral capstone consists of two parts: the capstone experience and the capstone
project.
STORAGE NAME: h0847.PPH PAGE: 3
DATE: 1/18/2022
Occupational therapy candidates are required to complete two levels of fieldwork, the second of which
depends on the degree level sought. 13 Level I fieldwork required for Ph.D., O.T.R., and C.O.T.A.
candidates can be met through one or more of the following instructional methods: 14

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

Level II fieldwork required for Doctorate level and Master’s level candidates includes a minimum of 24
weeks of full-time level II fieldwork which may be completed in one setting if reflective of more than one
practice area, or in a maximum of four different settings. 15 Baccalaureate level and Associate degree
level candidates are required to complete a minimum of 16 weeks full-time level II fieldwork which may
be completed in one setting if reflective of more than one practice area, or in a maximum of three
different settings. 16

Licensure
To be licensed as an occupational therapist, or occupational therapy assistant, an individual must: 17

• Submit the licensure application and required application fee of $100;
• Be of good moral character;
• Have graduated from an ACOTE/AOTA accredited occupational therapy program or
occupational therapy assistant program;
• Have completed a minimum of six months of supervised fieldwork experience for occupational
therapists, and a minimum of two months for occupational therapy assistants, at a recognized
educational institution or a training program approved by the education institution where you
met the academic requirements; and
• Have passed an examination approved by the National Board of Certification in Occupational
Therapy (NBCOT).

Current law allows applicants who have practiced as a state-licensed or AOTA-certified occupational
therapy assistant for four years and who, prior to January 24, 1988, have completed a minimum of six
months of supervised occupational-therapist-level fieldwork experience to obtain licensure. Such
individuals may take the examination approved by the NBCOT to be licensed as an occupational
therapist without meeting the educational requirements for occupational therapists to have graduated
from a program accredited by the ACOTE/AOTA. 18 The NBCOT requires the same amount of fieldwork,
but expresses it in weeks (24) not months, which may result in confusion.

Endorsement is another path to licensure for an occupational therapists, or occupational therapist
assistants, in which the Board may waive the examination requirement and grant a license to any
person who presents proof of: 19

• A current certification as an occupational therapist or occupational therapy assistant by a
national certifying organization if the Board determines the requirements for such certification to
be equivalent to the requirements for Florida licensure; or

13 Supra note 12, p. 39.
14 Id.
15 Id at p. 42.
16 Id.
17 Section 468.209, F.S. and ch. 64B-11.2003, F.A.C.
18 Section 468.209(2), F.S.
19 Section 468.213, F.S.

STORAGE NAME: h0847.PPH PAGE: 4
DATE: 1/18/2022
• A current licensure as an occupational therapist or occupational therapy assistant in another
state, the District of Columbia, or any territory or jurisdiction of the United States or foreign
national jurisdiction which requires standards for licensure determined by the Board to be
equivalent to the requirements for Florida licensure.

In fiscal year 2020-2021, there were 9,298 active licensed occupational therapists and 6,247 active
licensed occupational therapy assistants in Florida. 20

Exemptions

It is not uncommon for licensed health care practitioners’ scopes of practice to overlap with other
licensed health care practitioners’ scopes of practice. For example, the psychology practice act
provides an exemption to the application of its provisions to licensed allopathic and osteopathic
physicians so long as such physicians do not hold themselves out to the public as psychologists. 21 This
is done to avoid unlicensed practice allegations when the scope of two or more practices overlap.

Currently, the provisions of the Occupational Therapy Practice Act do not apply to certain licensed
health care practitioners, including: 22

• Allopathic and osteopathic physicians;
• Physicians assistants;
• Nurses;
• Physical therapists;
• Clinical psychologists;
• Speech language pathologists; and
• Audiologists.

Health care professions not exempt from the provisions of the Occupational Therapy Practice Act
include:

• School speech and language providers;
• Clinical social workers;
• Marriage and family therapists;
• Mental health counselors; and
• Orthotists and prosthetists.

Title Regulation

Current law prohibits a person from using the titles, “occupational therapist,” “licensed occupational
therapist,” “occupational therapist registered,” “occupational therapy assistant,” “licensed occupational
therapy assistant,” “certified occupational therapy assistant;” or the letters “O.T.,” “L.O.T.,” “O.T.R.,”
“O.T.A.,” “L.O.T.A.,” or “C.O.T.A.;” or any other words, letters, abbreviations, or insignia indicating or
implying the user is an occupational therapist or an occupational therapy assistant, unless the person
holds a valid license. Any person who does so commits a second degree misdemeanor. 23

20 Department of Health, Division of Medical Quality Assurance, Annual Report and Long Range Plan for 2020-2021,

http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/2020-2021-annual-report.pdf (last visited Jan. 13, 2022).
21 Section 490.014(1)(a), F.S.
22 Section 468.225(2), F.S.
23 Sections 468.215 and 468.223, F.S. A second degree misdemeanor is punishable by a fine of up to $500 and imprisonment of up to

60 days. See Sections 775.082(4) and 775.083(1)(e), F.S.
STORAGE NAME: h0847.PPH PAGE: 5
DATE: 1/18/2022
Effect of Proposed Changes

Occupational Therapy

The bill revises occupational therapy to include the therapeutic use of occupations with individuals,
groups, or populations, along with their families or organizations to support participation, performance,
and function in roles and situations in the home, school, workplace, community, and other settings.
Under the bill, occupational therapy services are provided for clients who have or are at risk for
developing an:

• Illness;
• Injury;
• Disease;
• Disorder;
• Condition;
• Impairment;
• Disability;
• Activity limitation; or
• Participation restriction.

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

The bill revises the practice of occupational therapy to include:

• Assessment, treatment, education of, and consultation with individuals whose abilities to
participate safely in occupations are impaired or at risk for impairment due to developmental
deficiencies, aging, learning disabilities, environment, injury, disease, cognitive impairment, and
disability;
• Methods to determine abilities and limitations related to the performance of occupations; and
• Specific occupational therapy techniques used for treatment involving training in activities of
daily living, environment modification, assessment of the need for orthotics or orthotic devices,
use of assistive technology and adaptive devices, cognitive activities, therapeutic exercises,
manual therapy techniques, physical agent modalities, and mental health services.

Title Regulation

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

Education

The bill clarifies the length of time required for fieldwork by occupational therapy applicants who have
practiced as a state-licensed or AOTA-certified occupational therapy assistant. The bill expresses the
time as 24 weeks, rather than 6 months, to align with phrasing used by NBCOT.

Licensure Exemptions

The bill exempts clinical social workers, marriage and family therapists, and mental health counselors
from the application of the Occupational Therapy Practice Act. It also exempts occupational therapists
and occupational therapy assistants from the application of the Psychological Services Act under ch.
490, F.S., and the Clinical, Counseling, and Psychotherapy Act under ch. 491, F.S.
STORAGE NAME: h0847.PPH PAGE: 6
DATE: 1/18/2022
The bill also exempts any person fulfilling an occupational therapy doctoral capstone experience that
involves clinical practice or projects, from the application of the Occupational Therapy Practice Act if the
person registers with the DOH before commencing the capstone experience. This will allow Ph.D.
candidates in occupational therapy to commence capstone projects without being subject to
occupational therapy licensure requirements.

The bill makes conforming changes.

The bill provides an effective date of July 1, 2022.

B. SECTION DIRECTORY:
Section 1: Amends s. 468.203, F.S., relating to definitions.
Section 2: Amends s. 468.209, F.S., relating to requirements for licensure.
Section 3: Amends s. 468.215, F.S., relating to issuance of license.
Section 4: Amends s. 468.223, F.S., relating to prohibitions; penalties.
Section 5: Amends s. 468.225, F.S., relating to exemptions.
Section 6: Amends s. 490.014, F.S., relating to exemptions.
Section 7: Amends s. 491.014, F.S., relating to exemptions.
Section 8: Amends s. 490.012, F.S., relating to violations; penalties; injunction.
Section 9: Amends s. 1002.394, F.S., relating to The Family Empowerment Scholarship Program.
Section 10: Reenacts s. 1002.66, F.S., relating to specialized instructional services for children with
disabilities.
Section 11: Provides an effective date of July 1, 2022.

II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT

A. FISCAL IMPACT ON STATE GOVERNMENT:

1. Revenues:
None.

2. Expenditures:
The bill has an indeterminate, insignificant, negative fiscal impact on DOH. DOH may experience an
increase in workload associated with additional complaints due to the bill’s title and initial protection
as well as scope expansion provisions, which current resources are adequate to absorb.

B. FISCAL IMPACT ON LOCAL GOVERNMENTS:

1. Revenues:
None.

2. Expenditures:
None.

C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.

D. FISCAL COMMENTS:
None.

STORAGE NAME: h0847.PPH PAGE: 7
DATE: 1/18/2022
III. COMMENTS

A. CONSTITUTIONAL ISSUES:

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

2. Other:
None.

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

C. DRAFTING ISSUES OR OTHER COMMENTS:
None.

IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES

STORAGE NAME: h0847.PPH PAGE: 8
DATE: 1/18/2022
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 847 2022

1 A bill to be entitled
2 An act relating to occupational therapy; amending s.
3 468.203, F.S.; defining and revising terms; amending
4 s. 468.209, F.S.; revising eligibility requirements
5 for the occupational therapist licensure examination;
6 amending s. 468.215, F.S.; authorizing certain
7 licensed occupational therapists to use a specified
8 title and the associated initials; amending s.
9 468.223, F.S.; prohibiting certain persons from using
10 a specified title and the associated initials;
11 providing criminal penalties; amending ss. 468.225,
12 490.014, and 491.014, F.S.; revising construction;
13 reenacting s. 490.012(1)(c), F.S., relating to
14 violations, penalties, and injunctions, to incorporate
15 the amendment made to s. 490.014, F.S., in a reference
16 thereto; amending s. 1002.394, F.S.; conforming a
17 provision to changes made by the act; reenacting s.
18 1002.66(2)(c), F.S., relating to specialized
19 instructional services for children with disabilities,
20 to incorporate the amendments made to s. 468.203,
21 F.S., in a reference thereto; providing an effective
22 date.
23
24 Be It Enacted by the Legislature of the State of Florida:
25

Page 1 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

26 Section 1. Subsection (4) of section 468.203, Florida
27 Statutes, is amended to read:
28 468.203 Definitions.—As used in this act, the term:
29 (4) "Occupational therapy" means the therapeutic use of
30 occupations through habilitation, rehabilitation, and the
31 promotion of health and wellness with individuals, groups, or
32 populations, along with their families or organizations, to
33 support participation, performance, and function in the home, at
34 school, in the workplace, in the community, and in other
35 settings for clients who have, or who have been identified as
36 being at risk of developing, an illness, an injury, a disease, a
37 disorder, a condition, an impairment, a disability, an activity
38 limitation, or a participation restriction purposeful activity
39 or interventions to achieve functional outcomes.
40 (a) For the purposes of this subsection:
41 1. "Activities of daily living" means functions and tasks
42 for self-care which are performed on a daily or routine basis,
43 including functional mobility, bathing, dressing, eating and
44 swallowing, personal hygiene and grooming, toileting, and other
45 similar tasks "Achieving functional outcomes" means to maximize
46 the independence and the maintenance of health of any individual
47 who is limited by a physical injury or illness, a cognitive
48 impairment, a psychosocial dysfunction, a mental illness, a
49 developmental or a learning disability, or an adverse
50 environmental condition.

Page 2 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

51 2. "Assessment" means the use of skilled observation or
52 the administration and interpretation of standardized or
53 nonstandardized tests and measurements to identify areas for
54 occupational therapy services.
55 3. "Health management" means therapeutic services designed
56 to develop, manage, and maintain health and wellness routines,
57 including self-management, performed with the goal of improving
58 or maintaining health to support participation in occupations.
59 4. "Instrumental activities of daily living" means daily
60 or routine activities a person must perform to live
61 independently within the home and community.
62 5. "Occupational performance" means the ability to
63 perceive, desire, recall, plan, and carry out roles, routines,
64 tasks, and subtasks for the purpose of self-maintenance, self-
65 preservation, productivity, leisure, and rest, for oneself or
66 for others, in response to internal or external demands of
67 occupations and contexts.
68 6. "Occupational therapy services in mental health" means
69 occupation-based interventions and services for individuals,
70 groups, populations, families, or communities to improve
71 participation in daily occupations for individuals who are
72 experiencing, are in recovery from, or are identifi ed as being
73 at risk of developing mental health conditions.
74 7. "Occupations" means meaningful and purposeful everyday
75 activities performed and engaged in by individuals, groups,

Page 3 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

76 populations, families, or communities which occur in contexts
77 and over time, such as activities of daily living, instrumental
78 activities of daily living, health management, rest and sleep,
79 education, work, play, leisure, and social participation. The
80 term includes more specific occupations and the execution of
81 multiple activities that are influenced by performance patterns,
82 performance skills, and client factors, and that result in
83 varied outcomes.
84 (b) The practice of occupational therapy includes services
85 include, but is are not limited to, the following services:
86 1. The Assessment, treatment, and education of or
87 consultation with individuals, groups, and populations whose
88 abilities to participate safely in occupations, including
89 activities of daily living, instrumental activities of daily
90 living, rest and sleep, education, work, play, leisure, and
91 social participation, are impaired or have been identified as
92 being at risk of impairment due to issues related to, but not
93 limited to, developmental deficiencies, the aging process,
94 learning disabilities, physical environment and soc iocultural
95 context, physical injury or disease, cognitive impairments, or
96 psychological and social disabilities the individual, family, or
97 other persons.
98 2. Methods or approaches used to determine abilities and
99 limitations related to performance of occupations, including,
100 but not limited to, the identification of physical, sensory,

Page 4 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

101 cognitive, emotional, or social deficiencies Interventions
102 directed toward developing daily living skills, work readiness
103 or work performance, play skills or leisure capacities, or
104 enhancing educational performance skills.
105 3. Specific occupational therapy techniques used for
106 treatment which include, but are not limited to, training in
107 activities of daily living; environmental modification;
108 assessment of the need for the use of interventions such as the
109 design, fabrication, and application of orthotics or orthotic
110 devices; selecting, applying, and training in the use of
111 assistive technology and adaptive devices; sensory, motor, and
112 cognitive activities; therapeutic exercises; manual techniques;
113 physical agent modalities; and occupational therapy services in
114 mental health Providing for the development of: sensory-motor,
115 perceptual, or neuromuscular functioning; range of motion; or
116 emotional, motivational, cognitive, or psychosocial components
117 of performance.
118
119 These services may require assessment of the need for use of
120 interventions such as the design, development, adaptation,
121 application, or training in the use of assistive technology
122 devices; the design, fabrication, or application of
123 rehabilitative technology such as selected orthotic devices;
124 training in the use of assistive technology; orthotic or
125 prosthetic devices; the application of physical agent modalities

Page 5 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

126 as an adjunct to or in preparation for purposeful activity; the
127 use of ergonomic principles; the adaptation of environments and
128 processes to enhance functional performance; or the promotion of
129 health and wellness.
130 (c) The use of devices subject to 21 C.F.R. s. 801.109 and
131 identified by the board is expressly prohibited except by an
132 occupational therapist or occupational therapy assistant who has
133 received training as specified by the board. The board shall
134 adopt rules to carry out the purpose of this provision.
135 Section 2. Subsection (2) of section 468.209, Florida
136 Statutes, is amended to read:
137 468.209 Requirements for licensure.—
138 (2) An applicant who has practiced as a state-licensed or
139 American Occupational Therapy Association-certified occupational
140 therapy assistant for 4 years and who, before prior to January
141 24, 1988, completed a minimum of 24 weeks 6 months of supervised
142 occupational-therapist-level fieldwork experience may take the
143 examination to be licensed as an occupational therapist without
144 meeting the educational requirements for occupational therapists
145 made otherwise applicable under paragraph (1)(b).
146 Section 3. Subsection (2) of section 468.215, Florida
147 Statutes, is amended to read:
148 468.215 Issuance of license.—
149 (2)(a) Any person who is issued a license as an
150 occupational therapist under the terms of this act may use the

Page 6 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

151 words "occupational therapist," "licensed occupational
152 therapist," or "occupational therapist registered," or he or she
153 may use the letters "O.T.," "L.O.T.," or "O.T.R.," in connection
154 with his or her name or place of business to denote his or her
155 registration hereunder.
156 (b) Any person who is issued a license as an occupational
157 therapist under the terms of this act and holds a doctorate
158 degree in occupational therapy may also use the words
159 "occupational therapist doctorate" and the letters "O.T.D." in
160 connection with his or her name or place of business to denote
161 his or her registration hereunder.
162 Section 4. Section 468.223, Florida Statutes, is amended
163 to read:
164 468.223 Prohibitions; penalties.—
165 (1) A person may not:
166 (a) Practice occupational therapy unless such person is
167 licensed pursuant to ss. 468.201-468.225;
168 (b) Use, in connection with his or her name or place of
169 business, the words "occupational therapist," "licensed
170 occupational therapist," "occupational therapist doctorate,"
171 "occupational therapist registered," "occupational therapy
172 assistant," "licensed occupational therapy assistant,"
173 "certified occupational therapy assistant"; the letters "O.T.,"
174 "L.O.T.," "O.T.D.," "O.T.R.," "O.T.A.," "L.O.T.A.," or
175 "C.O.T.A."; or any other words, letters, abbreviations, or

Page 7 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

176 insignia indicating or implying that he or she is an
177 occupational therapist or an occupational therapy assist ant or,
178 in any way, orally or in writing, in print or by sign, directly
179 or by implication, to represent himself or herself as an
180 occupational therapist or an occupational therapy assistant
181 unless the person is a holder of a valid license issued pursuant
182 to ss. 468.201-468.225;
183 (c) Present as his or her own the license of another;
184 (d) Knowingly give false or forged evidence to the board
185 or a member thereof;
186 (e) Use or attempt to use a license that which has been
187 suspended, revoked, or placed on inactive or delinquent status;
188 (f) Employ unlicensed persons to engage in the practice of
189 occupational therapy; or
190 (g) Conceal information relative to any violation of ss.
191 468.201-468.225.
192 (2) Any person who violates any provision of this section
193 commits a misdemeanor of the second degree, punishable as
194 provided in s. 775.082 or s. 775.083.
195 Section 5. Subsection (2) of section 468.225, Florida
196 Statutes, is amended, and paragraph (e) is added to subsection
197 (1) of that section, to read:
198 468.225 Exemptions.—
199 (1) Nothing in this act shall be construed as preventing
200 or restricting the practice, services, or activities of:

Page 8 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

201 (e) Any person fulfilling an occupational therapy doctoral
202 capstone experience that involves clinical practice or projects.
203 To benefit from an exemption under this paragraph, a person must
204 register with the department in a manner determined by
205 department rule before commencing the capstone experience.
206 (2) No provision of this act shall be construed to
207 prohibit physicians, physician assistants, nurses, physical
208 therapists, osteopathic physicians or surgeons, clinical
209 psychologists, clinical social workers, marriage and family
210 therapists, mental health counselors, speech-language
211 pathologists, or audiologists from using occupational therapy as
212 a part of or incidental to their profession, when they practice
213 their profession under the statutes applicable to their
214 profession.
215 Section 6. Paragraph (b) of subsection (1) of section
216 490.014, Florida Statutes, is amended to read:
217 490.014 Exemptions.—
218 (1)
219 (b) No provision of this chapter shall be construed to
220 limit the practice of nursing, clinical social work, marriage
221 and family therapy, mental health counseling, occupational
222 therapy, or other recognized businesses or professions, or to
223 prevent qualified members of other professions from doing work
224 of a nature consistent with their training, so long as they do
225 not hold themselves out to the public as psychologists or use a

Page 9 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

226 title or description protected by this chapter. Nothing in this
227 subsection shall be construed to exempt any person from the
228 provisions of s. 490.012.
229 Section 7. Subsection (2) of section 491.014, Florida
230 Statutes, is amended to read:
231 491.014 Exemptions.—
232 (2) No provision of this chapter shall be construed to
233 limit the practice of nursing, school psychology, or psychology,
234 or occupational therapy, or to prevent qualified members of
235 other professions from doing work of a nature consistent with
236 their training and licensure, so long as they do not hold
237 themselves out to the public as possessing a license,
238 provisional license, registration, or certificate issued
239 pursuant to this chapter or use a title protected by this
240 chapter.
241 Section 8. For the purpose of incorporating the amendment
242 made by this act to section 490.014, Florida Statutes, in a
243 reference thereto, paragraph (c) of subsection (1) of section
244 490.012, Florida Statutes, is reenacted to read:
245 490.012 Violations; penalties; injunction.—
246 (1)
247 (c) No person shall hold herself or himself out by any
248 title or description incorporating the words, or permutations of
249 them, "psychology," "psychological," or "psychodiagnostic," or
250 describe any test or report as psychological, unless such person

Page 10 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

251 holds a valid, active license under this chapter or is exempt
252 from the provisions of this chapter.
253 Section 9. Paragraph (b) of subsection (4) of section
254 1002.394, Florida Statutes, is amended to read:
255 1002.394 The Family Empowerment Scholarship Program. —
256 (4) AUTHORIZED USES OF PROGRAM FUNDS.—
257 (b) Program funds awarded to a student with a disability
258 determined eligible pursuant to paragraph (3)(b) may be used for
259 the following purposes:
260 1. Instructional materials, including digital devices,
261 digital periphery devices, and assistive technology devices that
262 allow a student to access instruction or instructional content
263 and training on the use of and maintenance agreements for these
264 devices.
265 2. Curriculum as defined in subsection (2).
266 3. Specialized services by approved providers or by a
267 hospital in this state which are selected by the parent. These
268 specialized services may include, but are not limited to:
269 a. Applied behavior analysis services as provided in ss.
270 627.6686 and 641.31098.
271 b. Services provided by speech-language pathologists as
272 defined in s. 468.1125(8).
273 c. Occupational therapy services as defined in s. 468.203.
274 d. Services provided by physical therapists as defined in
275 s. 486.021(8).

Page 11 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

276 e. Services provided by listening and spoken language
277 specialists and an appropriate acoustical environment for a
278 child who has a hearing impairment, including deafness, and who
279 has received an implant or assistive hearing device.
280 4. Tuition or fees associated with full-time or part-time
281 enrollment in a home education program, an eligible private
282 school, an eligible postsecondary educational institution or a
283 program offered by the postsecondary educational institution, a
284 private tutoring program authorized under s. 1002.43, a virtual
285 program offered by a department-approved private online provider
286 that meets the provider qualifications specified in s.
287 1002.45(2)(a), the Florida Virtual School as a private paying
288 student, or an approved online course offered pursuant to s.
289 1003.499 or s. 1004.0961.
290 5. Fees for nationally standardized, norm-referenced
291 achievement tests, Advanced Placement Examinations, industry
292 certification examinations, assessments related to postsecondary
293 education, or other assessments.
294 6. Contributions to the Stanley G. Tate Florida Prepaid
295 College Program pursuant to s. 1009.98 or the Florida College
296 Savings Program pursuant to s. 1009.981 for the benefit of the
297 eligible student.
298 7. Contracted services provided by a public school or
299 school district, including classes. A student who receives
300 services under a contract under this paragraph is not considered

Page 12 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

301 enrolled in a public school for eligibility purposes as
302 specified in subsection (6).
303 8. Tuition and fees for part-time tutoring services
304 provided by a person who holds a valid Florida educator's
305 certificate pursuant to s. 1012.56, a person who holds an
306 adjunct teaching certificate pursuant to s. 1012.57, a person
307 who has a bachelor's degree or a graduate degree in the subject
308 area in which instruction is given, a person who has
309 demonstrated a mastery of subject area knowledge pursuant to s.
310 1012.56(5), or a person certified by a nationally or
311 internationally recognized research-based training program as
312 approved by the department. As used in this paragraph, the term
313 "part-time tutoring services" does not qualify as regular school
314 attendance as defined in s. 1003.01(13)(e).
315 9. Fees for specialized summer education programs.
316 10. Fees for specialized after-school education programs.
317 11. Transition services provided by job coaches.
318 12. Fees for an annual evaluation of educational progress
319 by a state-certified teacher under s. 1002.41(1)(f), if this
320 option is chosen for a home education student.
321 13. Tuition and fees associated with programs offered by
322 Voluntary Prekindergarten Education Program providers approved
323 pursuant to s. 1002.55 and school readiness providers approved
324 pursuant to s. 1002.88.
325 14. Fees for services provided at a center that is a

Page 13 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00
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 847 2022

326 member of the Professional Association of Therapeutic
327 Horsemanship International.
328 15. Fees for services provided by a therapist who is
329 certified by the Certification Board for Music Therapists or
330 credentialed by the Art Therapy Credentials Board, Inc.
331 Section 10. For the purpose of incorporating the amendment
332 made by this act to section 468.203, Florida Statutes, in a
333 reference thereto, paragraph (c) of subsection (2) of section
334 1002.66, Florida Statutes, is reenacted to read:
335 1002.66 Specialized instructional services for children
336 with disabilities.—
337 (2) The parent of a child who is eligible for the
338 prekindergarten program for children with disabilities may
339 select one or more specialized instructional services that are
340 consistent with the child's individual educational plan. These
341 specialized instructional services may include, but are not
342 limited to:
343 (c) Occupational therapy as defined in s. 468.203.
344 Section 11. This act shall take effect July 1, 2022.

Page 14 of 14

CODING: Words stricken are deletions; words underlined are additions.
hb0847-00

File and source

File: 2022-01-19_3093_professions-public-health-subcommittee_meeting-packets_mtg13325.pdf
Size: 1,912,139 bytes
SHA-256: cb65d2aaa56f8f432b45d0ca48953876faa1ddf2741ff18ecc4a7624270849cc
Our copy: 2022-01-19_3093_professions-public-health-subcommittee_meeting-packets_mtg13325.pdf
Original: No public link identified.