Meeting Packet - Professions and Public Health Subcommittee (January 25, 2022)
Summary
Meeting packet for the Professions and Public Health Subcommittee meeting of Tuesday, January 25, 2022, 9:00 AM - 11:00 AM, with Will Robinson as Chair. The notice lists HB 105, HB 517, HB 747, HB 861, HB 931 and HB 953, among others. The staff analysis of HB 105 states that the bill amends the Florida Clean Indoor Air Act to allow counties and municipalities to restrict smoking within the boundaries of any public beach or park they own and changes the act's title to the "Florida Clean Air Act". It states no fiscal impact on state governments, an indeterminate, negative fiscal impact on local governments, and an effective date of July 1, 2022. The packet also holds Amendment No. 1 to HB 955, with a Section 3 effective-date clause tied to HB 953 or similar legislation.
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Professions and Public Health
Subcommittee
Tuesday, January 25, 2022
9:00 AM – 11:00 AM
Webster Hall (212 Knott)
Meeting Packet
Chris Sprowls Will Robinson
Speaker Chair
Committee Meeting Notice
HOUSE OF REPRESENTATIVES
Professions & Public Health Subcommittee
Start Date and Time: Tuesday, January 25, 2022 09:00 am
End Date and Time: Tuesday, January 25, 2022 11:00 am
Location: Webster Hall (212 Knott)
Duration: 2.00 hrs
Consideration of the following bill(s):
HB 105 Regulation of Smoking by Counties and Municipalities by Fine, Altman
HB 517 Dentistry and Dental Hygiene Examinations by Sirois
CS/HB 559 Occupational Licensure of Military Spouses by Regulatory Reform Subcommittee, Hunschofsky,
Smith, D.
HB 747 Protections of Medical Conscience by Snyder
HB 861 Medical Specialty Designations by Massullo
HB 931 Alternate-site Testing by McClure
HB 953 Psychology Interjurisdictional Compact by Hunschofsky
HB 955 Pub. Rec. and Meetings/Psychology Interjurisdictional Compact by Hunschofsky
Consideration of the following proposed committee substitute(s):
PCS for HB 475 -- Alzheimer's Disease and Related Forms of Dementia Education and Public Awareness
PCS for HB 693 -- Department of Health
For information about attending or testifying at a committee meeting, please see the “Visiting the House”
tab at www.myfloridahouse.gov.
NOTICE FINALIZED on 01/21/2022 4:00PM by Osborne.Erin
01/21/2022 04:00:38PM Leagis ® Page 1 of 1
HB 105
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 105 Regulation of Smoking by Counties and Municipalities
SPONSOR(S): Fine and others
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Morris McElroy
2) Environment, Agriculture & Flooding
Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
The Florida Clean Indoor Air Act (FCIAA), implements Article X, Section 20 of the Florida Constitution. Article
X, Section 20 of the Florida Constitution prohibits a person from smoking tobacco or using a vapor-generating
electronic device in an enclosed indoor workplace, with certain exceptions.
The state preempts the regulation of smoking and does not allow counties or municipalities to regulate
smoking. HB 105 amends the FCIAA to allow counties and municipalities to restrict smoking within the
boundaries of any public beach or park they own.
The bill changes the title of the “Florida Clean Indoor Air Act” to the “Florida Clean Air Act” to account for the
broader application of the act proposed in the bill.
The bill has no fiscal impact on state governments. The bill has an indeterminate, negative fiscal impact on
local governments.
The bill provides and effective date of July 1, 2022.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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DATE: 1/24/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Smoking Regulation in Florida
While the Food and Drug Administration (FDA) regulates the manufacture, distribution, and marketing
of tobacco and vaping products, it does not regulate smoking or vaping in public places – leaving that
to the states.
In 1985, the Florida Legislature enacted the Florida Clean Indoor Air Act (FCIAA) 1 to protect the public
health, comfort, and environment by creating areas in public places and at public meetings that were
reasonably free from tobacco smoke. The FCIAA originally prohibited smoking 2 in certain indoor public
places (e.g. government buildings, elevators, public transportation, hospitals, day care centers) or
common areas of an indoor public place (e.g. lobby, hallway, stairwell, restrooms), but did permit
designated smoking areas of specified indoor public places such as places of employment, retail
stores, indoor arenas, and restaurants.
Article X, Section 20 of the Florida Constitution
In the November, 2002 General Election, Floridians voted to create Article X, Section 20 of the Florida
Constitution, titled “Workplaces without tobacco smoke,” which further restricted smoking indoors. 3 The
purpose of this citizens’ initiative was to protect people from the health hazards of secondhand tobacco
smoke by prohibiting smoking in enclosed indoor workplaces, which are defined as:
Any place where one or more persons engage in work, 4 and which place is
predominantly or totally bounded on all sides and above by physical barriers,
regardless of whether such barriers consist of or include uncovered openings,
screened or otherwise partially covered openings; or open or closed windows,
jalousies, doors, or the like. 5
The provision also provided various other definitions and exceptions to the smoking ban, and required
the Legislature to implement the section in law by the following legislative session. Accordingly, in
2003, the Legislature amended the FCIAA to conform existing law and implement the constitutional
provision in a manner consistent with its broad purpose and stated terms. 6
1 Ch. 386, Part II, F.S.; ch. 85-257, Laws of Fla.
2 “Smoking” is defined as “inhaling, exhaling, burning, carrying, or possessing any lighted tobacco product, including cigarettes, cigars,
pipe tobacco, and any other lighted product. S. 386.203(11), F.S.
3 Text available at: https://dos.elections.myflorida.com/initiatives/fulltext/pdf/34548-1.pdf (last visited Dec. 15, 2021). The constitutional
provision does not preclude the Legislature from enacting more restrictive regulation of tobacco smoking.
4 “Work” is defined as “any persons providing any employment or employment-type service for or at the request of another individual or
individuals or any public or private entity, whether for compensation or not, whether full or part-time, whether legally or not.” Fla. Const.,
art. X, s. 20. “Work” includes, without limitation, any such service performed by an employee, independent contractor, agent, partner,
proprietor, manager, officer, director, apprentice, trainee, associate, servant, volunteer, and the like. The term does not include
noncommercial activities performed by members of a membership association. S. 386.203(12), F.S.
5 The smoking ban applies to all enclosed indoor workplaces regardless of whether work is occurring at any given time, Fla. Const., art.
X, s. 20.
6 Ch. 2003-398, Laws of Fla.
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In the November 2018, General Election, Floridians passed Amendment No. 9, which amended Article
X, Section 20 of the Florida Constitution, banning the use of vapor-generating electronic devices, or
vaping, in enclosed indoor workplaces, consistent with the prohibition on tobacco smoking. 7
The FCIAA prohibits smoking and vaping in an enclosed indoor workplace, unless it is a: 8
• Private residence that is not being used commercially to provide child care, adult care, or health
care, or any combination thereof;
• Retail tobacco shop;
• Designated smoking guest room in a public lodging establishment;
• Stand-alone bar; 9
• Smoking cessation program or medical or scientific research; or
• Customs smoking room in an airport.
However, an owner, lessee, or a person otherwise in control of an enclosed indoor workplace may
further prohibit or limit smoking or vaping therein. 10
Additionally, no one under the age of 18 years old may smoke tobacco or vape in, on, or within 1,000
feet of a public or private grade school between 6 a.m. and midnight. 11 Violators of this provision are
subject to a citation from a law enforcement officer. 12
Persons in charge of enclosed indoor workplaces are required to develop and implement smoking and
vaping prohibition policies in line with the FCIAA requirements. 13 Persons in charge of a smoking or
vaping cessation program, medical or scientific research, or an airport terminal that includes a customs
smoking room must all post signs clearly stating that smoking is only permitted in the designated
areas. 14 Additionally, public transportation carriers in certain locations are required to make regular
announcements regarding the smoking and vaping prohibition. 15
The Department of Health (DOH) and the Department of Business and Professional Regulation (DBPR)
are each responsible for the enforcement of the FCIAA as it relates to their respective areas of
regulatory authority. 16 If an enclosed indoor work place violates the FCIAA and does not correct the
violation within 30 days, DOH or DBPR may impose fines against the owner and pursue compliance in
circuit court, if necessary. 17 Additionally, any person who violates the FCIAA by smoking or vaping in
an enclosed indoor work place commits a noncriminal violation and may be subject to a fine of up to
$100 for the first violation and up to $500 for each subsequent violation. 18
7 Text available at: p. 26-30 https://dos.myflorida.com/media/699824/constitutional-amendments-2018-general-election-english.pdf (last
visited Dec. 15, 2021). Note: Amendment No. 9 also amended article II, section 7 of the Florida Constitution to ban offshore oil and gas
drilling.
8 Ss. 386.204 and 386.2045, F.S. Additionally, s. 386.203(5)(c), F.S., by definition of an “enclosed indoor workplace,” excludes any
facility owned or leased by and used exclusively for noncommercial activities performed by the members and guests of a membership
association, including social gatherings, meetings, dining, and dances, if no person or persons are engaged in work.
9 A stand-alone bar is a licensed premises that predominantly or totally serves alcoholic beverages and in which serving food is merely
incidental to the sale of alcohol. Also, it must not share a common entryway or indoor area with a business that predominantly serves
food during the hours the stand-alone bar is operating its business, s. 386.203(11), F.S. See also s. 561.695, F.S.
10 Fla. Const., art X, sec. 20(b).
11 S. 386.212(1), F.S.
12 S. 386.212(2), F.S.
13 S. 386.206(1), F.S.
14 S. 386.206(2)-(3), F.S.
15 S. 386.211, F.S.
16 Ss. 386.207(1) and 561.695, F.S. DBPR enforces the FCIAA in restaurants, bowling centers, dog tracks, horse tracks, bars, billiards,
bingo halls (with food service), and civic/fraternal organizations. DOH enforces the FCIAA in all facilities not regulated by DBPR. Florida
Department of Health, Florida Clean Indoor Air Act, Enforcement, http://www.floridahealth.gov/PROGRAMS-AND-
SERVICES/prevention/tobacco-free-florida/indoor-air-act/index.html (last visited Dec. 15, 2021).
17 S. 386.207(3), F.S.
18 S. 386.208, F.S.
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Currently, the state preempts the regulation of smoking and does not allow counties or municipalities to
regulate smoking, except school districts may further restrict smoking on school district property. 19 The
state does not currently preempt the regulation of vaping. Thus, local governments impose more
restrictive regulation on the use of vapor-generated electronic devices. 20
County and Municipally Owned Parks
The Division of Recreation and Parks within the Florida Department of Environmental Protection
maintains a comprehensive inventory of the existing park facilities and outdoor resources in Florida.
The inventory provides details about the parks and recreation areas in the state and contains
information on more than 13,000 outdoor recreational facilities in Florida, the majority of which are
county and municipal parks. 21
There are 67 county park systems and more than 400 municipal park systems in the state. 22 Such
parks provide a wide variety of activities to the public, including nature trails, bird watching, youth and
adult athletics, bike paths, horse trails, boat ramps, fishing piers, outdoor gyms, and outdoor
pavilions. 23 For example, Orange County maintains and operates 118 county-owned parks, which
consist of a wide array of available activities and facilities. 24 Additionally, municipalities within Orange
County also own and operate parks and outdoor recreational facilities, For example, the City of Winter
Park owns and operates 11 city parks, which offer similar recreational activities to county-owned
parks. 25
Public Beaches
Florida has 825 miles of sandy coastline, attracting over 18 million tourists each year. 26 A significant
portion of Florida’s beaches is publicly owned, including federally-owned areas managed by the
National Park Service, parts of Florida’s 175 state parks, and the many beaches owned and managed
by local governments on the coast. 27 In general, access to these beaches is free through the numerous
public access points along the coast however; some state parks, counties and municipalities charge an
access fee.
19 S. 386.209, F.S.
20 Id.; “Vapor-generating electronic devices” means any product that employs an electronic, a chemical, or a mechanical means capable
of producing vapor or aerosol from a nicotine product or any other substance, including, but not limited to, an electronic cigarette,
electronic cigar, electronic cigarillo, electronic pipe, or other similar device or product, any replacement cartridge for such device, and
any other container of a solution or other substance intended to be used with or within an electronic cigarette, electronic cigar,
electronic cigarillo, electronic pipe, or other similar device or product.
21 Florida Division of Recreation and Parks, Florida Outdoor Recreation Inventory, available at: https://floridadep.gov/parks/florida-
outdoor-recreation-inventory (last visited Dec. 15, 2021)
22 Florida Department of Environmental Protection, Division of Recreation and Parks, Frequently Asked Questions,
https://prodenv.dep.state.fl.us/DrpOrpcr/StaticFiles/FAQ.pdf (last visited Dec. 15, 2021).
23 Id.
24 Orange County Government Florida, Parks, http://www.orangecountyfl.net/CultureParks/Parks.aspx (last visited Dec. 15, 2021).
25 City of Winter Park, Parks, https://cityofwinterpark.org/departments/parks-recreation/parks-playgrounds/parks/ (last visited Dec. 15,
2021).
26 Department of Environmental Protection, Beaches, https://floridadep.gov/water/beaches (last visited at March 14, 2021).
27 National Park Service, Canaveral National Seashore, Nature and Science, https://www.nps.gov/cana/learn/nature/index.htm (last
visited Dec. 15, 2021). Canaveral National Seashore’s 24 miles of undeveloped beach is the longest such stretch on the east coast of
Florida; National Park Service, Gulf Islands National Seashore, Things To Do,
https://www.nps.gov/guis/planyourvisit/things2do.htm (last visited Dec. 15, 2021). Gulf Islands National Seashore stretches for
160 miles along the coasts of both Florida and Mississippi; DEP, Beaches and Coasts at Florida State Parks,
https://www.floridastateparks.org/learn/beaches-and-coasts-florida-state-parks (last visited Dec. 15, 2021). Florida’s state parks include
100 miles of beaches; DEP, Map of Florida’s Coastal Counties, https://floridadep.gov/fco/fcmp/documents/map-floridas-coastal-
counties (last visited Dec. 15, 2021); Beaches in coastal counties are important for tourism and Florida’s “brand”; DEP, Florida Coastal
Management Program, Final Assessment and Strategies, FY 2016 – FY 2020, 30 (2015) available at
https://floridadep.gov/sites/default/files/FCMP_FY2016-20_Assessment.pdf (last visited Dec. 15, 2021). Based on shoreline access
sites, there are approximately 439 miles of public saltwater beach in Florida.
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Health Concerns
In 2020, an estimated 15 percent of the adults in Florida were tobacco smokers. 28 Tobacco smoke
contains over 7,000 chemicals, including hundreds that are toxic and up to 69 that are known to cause
cancer. 29 More than 480,000 deaths annually in the United States are caused by cigarette smoking,
with exposure to secondhand smoke causing an estimated 41,000 deaths each year. 30 Secondhand
smoke is generally defined as smoke from burning tobacco products or smoke that is exhaled by a
tobacco smoker. 31 Exposure to secondhand smoke can cause numerous health problems and has
been causally linked to cancer and other fatal diseases. 32 Studies suggest that secondhand smoke in
crowded outdoor areas can cause concentrations of air contaminants comparable to those caused by
indoor smoking. 33
Effect of Proposed Changes
The bill authorizes counties and municipalities to further restrict smoking within the boundaries of any
public beaches and public parks they own. Municipalities may further restrict smoking within the
boundaries of public beaches and public parks that are within their jurisdiction, but owned by the
county, unless such restriction conflicts with county ordinance.
The bill changes the title of Part II of ch. 386, F.S., from “Indoor Air: Smoking and Vaping” to “Smoking
and Vaping.”
The bill provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Renames Part II of chapter 386, F.S., from “INDOOR AIR: SMOKING AND VAPING” to
“SMOKING AND VAPING.”
Section 2: Amends s. 386.201, F.S., relating to popular name.
Section 3: Amends s. 386.209, F.S., relating to regulation of smoking preempted to state.
Section 4: Amends s. 381.84, F.S., relating to Comprehensive Statewide Tobacco Education and
Use Prevention Program.
Section 5: Amends s. 386.211, F.S., relating to public announcements in mass transportation
terminals.
Section 6: Provides an effective date of July 1, 2022.
28 United Health Foundation, America’s Health Rankings, Annual Report, available at:
https://www.americashealthrankings.org/explore/annual/measure/Smoking/state/FL (last visited Dec. 15, 2021).
29 Id.; U.S. Department of Health and Human Services, The Health Consequences of Smoking—50 Years of Progress: A Report of the
Surgeon General, 148 (2014), https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf (last visited Dec. 15,
2021).
30 Centers for Disease Control and Prevention, Tobacco-Related Mortality,
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm (last visited Dec. 15, 2021).
31 Centers for Disease Control and Prevention, Secondhand Smoke (SHS) Facts,
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm (last visited Dec. 15, 2021).
32 Id.
33 Nipapun Kungskulniti et al., Secondhand Smoke Point-Source Exposures Assessed By Particulate Matter At Two Popular Public
Beaches in Thailand, 40 J. Public Health 3, 527–532 (2017),
https://academic.oup.com/jpubhealth/article/40/3/527/4110319?guestAccessKey=5947c328-fd75-4b6c-acfe-28f989c4c639 (last visited
Dec. 15, 2021); James Repace, Benefits of Smoke-free Regulations in Outdoor Settings: Beaches, Golf Courses, Parks, Patios and in
Motor Vehicles, 34 WM Mitchell L. Rev. 1621, 1622–1624, 1638 (2008), https://open.mitchellhamline.edu/wmlr/vol34/iss4/15/ (last
visited Dec. 15, 2021).
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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:
To the extent that any imposed smoking restrictions deter or encourage visitation of county and
municipal beaches and parks, local governments may experience and indeterminate fluctuation in
revenues generated by any fees for beach and park admittance.
2. Expenditures:
Counties and municipalities that opt to restrict smoking within the boundaries of public parks may
incur indeterminate expenses related to enacting and enforcing such restrictions.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Visitors to county or municipal parks who violate smoking restrictions imposed by a county or
municipality may be subject to any applicable fines or civil penalties for such violations.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to require counties or municipalities to spend funds or take
action requiring the expenditure of funds; reduce the authority that counties or municipalities have to
raise revenues in the aggregate; or reduce the percentage of state tax shared with counties or
municipalities.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
Rulemaking authority is not needed to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/ COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 105 2022
1 A bill to be entitled
2 An act relating to the regulation of smoking by
3 counties and municipalities; revising the title of
4 part II of ch. 386, F.S.; amending s. 386.201, F.S.;
5 revising a short title; amending s. 386.209, F.S.;
6 authorizing counties and municipalities to further
7 restrict smoking within the boundaries of public
8 beaches and public parks under certain circumstances;
9 amending ss. 381.84 and 386.211, F.S.; conforming
10 provisions to changes made by the act; providing an
11 effective date.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15 Section 1. Part II of chapter 386, Florida Statutes,
16 entitled "INDOOR AIR: SMOKING AND VAPING," is renamed "SMOKING
17 AND VAPING."
18 Section 2. Section 386.201, Florida Statutes, is amended
19 to read:
20 386.201 Short title Popular name.—This part may be cited
21 as by the popular name the "Florida Clean Indoor Air Act."
22 Section 3. Section 386.209, Florida Statutes, is amended
23 to read:
24 386.209 Regulation of smoking preempted to state. —This
25 part expressly preempts regulation of smoking to the state and
Page 1 of 3
CODING: Words stricken are deletions; words underlined are additions.
hb0105-00
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 105 2022
26 supersedes any county or municipal municipal or county ordinance
27 on the subject; however, counties and municipalities may further
28 restrict smoking within the boundaries of any public beaches and
29 public parks that they own. A municipality may further restrict
30 smoking within the boundaries of public beaches and public parks
31 that are within its jurisdiction but are owned by the county,
32 unless such restriction conflicts with a county ordinance.
33 School districts may further restrict smoking by persons on
34 school district property. This section does not preclude the
35 adoption of county or municipal municipal or county ordinances
36 that impose more restrictive regulation on the use of vapor-
37 generating devices than is provided in this part.
38 Section 4. Paragraph (h) of subsection (3) of section
39 381.84, Florida Statutes, is amended to read:
40 381.84 Comprehensive Statewide Tobacco Education and Use
41 Prevention Program.—
42 (3) PROGRAM COMPONENTS AND REQUIREMENTS.—The department
43 shall conduct a comprehensive, statewide tobacco education and
44 use prevention program consistent with the recommendations for
45 effective program components contained in the 1999 Best
46 Practices for Comprehensive Tobacco Control Programs of the CDC,
47 as amended by the CDC. The program shall include the following
48 components, each of which shall focus on educating people,
49 particularly youth and their parents, about the health hazards
50 of tobacco and discouraging the use of tobacco:
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 105 2022
51 (h) Enforcement and awareness of related laws.—In
52 coordination with the Department of Business and Professional
53 Regulation, the program shall monitor the enforcement of laws,
54 rules, and policies prohibiting the sale or other provision of
55 tobacco to minors, as well as the continued enforcement of the
56 Florida Clean Indoor Air Act prescribed in chapter 386. The
57 advertisements produced in accordance with paragraph (a) may
58 also include information designed to make the public aware of
59 these related laws and rules. The departments may enter into
60 interagency agreements to carry out this program component.
61 Section 5. Section 386.211, Florida Statutes, is amended
62 to read:
63 386.211 Public announcements in mass transportation
64 terminals.—Announcements about the Florida Clean Indoor Air Act
65 shall be made regularly over public address systems in terminals
66 of public transportation carriers located in metropolitan
67 statistical areas with populations over 230,000 according to the
68 latest census. These announcements shall be made at least every
69 30 minutes and shall be made in appropriate languages. Each
70 announcement must include a statement to the effect that Florida
71 is a clean indoor air state and that smoking and vaping are
72 prohibited except as provided in this part.
73 Section 6. This act shall take effect July 1, 2022.
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hb0105-00
PCS for HB 475
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 475 Alzheimer's Disease and Related Forms of Dementia Education and Public
Awareness
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 Guzzo McElroy
Subcommittee
SUMMARY ANALYSIS
Alzheimer’s disease is the most prevalent form of dementia, a general term for memory loss. It is a progressive
brain disorder that damages and eventually destroys brain cells, leading to memory loss and changes in the
functions of the brain. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases. There are an
estimated 5.8 million people in the United States with Alzheimer’s disease, including 5.6 million people aged 65
and older and 200,000 individuals under age 65 who have younger-onset Alzheimer’s disease.
Florida has several programs and initiatives under the oversight of the Department of Elder Affairs (DOEA) that
provide resources and support for individuals suffering from Alzheimer’s disease and other dementia-related
disorders. The Florida Department of Health (DOH) licenses physicians, osteopathic physicians, and nursing
professionals who provide care, among others, to patients with Alzheimer’s disease and other dementia-
related disorders.
The bill creates the Ramping up Education of Alzheimer’s and Dementia for You (READY) Act which requires
DOH, in partnership with DOEA and the Alzheimer’s Association, to educate physicians and nursing
professionals about Alzheimer’s disease and related forms of dementia. This effort will occur through existing
public health and community outreach programs and include education on:
• The importance of early detection and timely diagnosis of Alzheimer’s disease and related forms of
dementia;
• Utilization of a validated cognitive assessment tool;
• The value and effectiveness of Medicare annual wellness visits in detecting Alzheimer’s disease
and related forms of dementia;
• The use of Medicare billing codes for care planning for individuals with Alzheimer’s disease and
related forms of dementia; and
• Methods to reduce the risk of cognitive decline, particularly among individuals in diverse
communities who are at greater risk of developing Alzheimer’s disease and related forms of
dementia.
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.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Alzheimer’s Disease
Alzheimer’s disease is a form of dementia, a general term for memory loss. It is a progressive brain
disorder that damages and eventually destroys brain cells, leading to memory loss and changes in the
functions of the brain. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases.
Alzheimer's disease is a progressive disease in which dementia symptoms worsen gradually over time.
In the early stages of Alzheimer’s disease, memory loss is mild; in late-stages, individuals lose the
ability to carry on a conversation and respond to their environment. Currently, the disease has no cure,
but treatment can temporarily slow the worsening of symptoms. 1
There are an estimated 6.2 million people in the United States with Alzheimer’s disease. 2 By 2050, the
number of people age 65 and older with Alzheimer’s disease in the U.S. is expected to double to a
projected 12.7 million people. 3
Florida has an increasing number of individuals with Alzheimer’s disease. An estimated 580,000
Floridians have Alzheimer’s disease. 4 The projected number of Floridians with Alzheimer’s disease is
estimated to increase by 24% to 720,000 individuals by 2025. 5
Alzheimer’s Disease Initiative
Section 430.503, F.S., creates the Alzheimer’s Disease Initiative (ADI) within the Department of Elder
Affairs (DOEA). 6 The Alzheimer’s Disease Initiative is a statewide program that provides services to
individuals and families affected by Alzheimer’s disease. The ADI includes the following programs: 7
• Respite care and other support services for caregivers;
• Memory Disorder Clinics;
• Specialized Alzheimer’s Adult Day Care Centers; and
• The Florida Alzheimer’s Brain Bank, which is a service- and research-oriented network of
regional sites which collect and study the brains of deceased dementia patients. 8
Memory Disorder Clinics
1 Alzheimer’s Association, 2021 Alzheimer’s Disease Facts and Figures, available at https://www.alz.org/media/documents/alzheimers-
facts-and-figures.pdf (last accessed January 20, 2022).
2 Rajan KB, Weuve J, Barnes LL, McAninch EA, Wilson RS, Evans DA, Population Estimate of People with Clinical AD and Mild
Cognitive Impairment in the United States (2020-2060). Alzheimers Dement. 2021 Dec;17(12):1966-1975. doi: 10.1002/alz.12362.
Epub 2021 May 27. PMID: 34043283.
3 Id.
4 Florida Department of Elder Affairs, 2021 Alzheimer’s Disease Advisory Committee Annual Report, available at
https://elderaffairs.org/wp-content/uploads/ADAC-Report-2021_FINAL.pdf (last accessed January 20, 2022).
5 Id.
6 S. 430.503(1), F.S.
7 Florida Department of Elder Affairs, Alzheimer’s Disease Initiative, available at http://elderaffairs.state.fl.us/doea/alz.php (last
accessed January 20, 2022).
8 Florida Department of Elder Affairs, The Florida Brain Bank, available at http://elderaffairs.state.fl.us/doea/BrainBank/docs/BrainBank-
brochure.pdf (last accessed January 20, 2022).
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Section 430.502(1), F.S., designates 17 memory disorder clinics (MDCs) 9 that provide comprehensive
assessments, diagnostic services, and treatment to individuals who exhibit symptoms of Alzheimer's
disease and related memory disorders. The MDCs operate in 13 distinct service areas. 10
MDC Service Areas and Locations 11
MDCs also develop training programs and materials and conduct training for caregivers, respite service
providers, and health care professionals in the care of persons with Alzheimer's disease and related
memory disorders. 12 In addition, MDCs conduct service-related research projects through model day
9 S. 430.502(1), F.S.
10 Florida Department of Elder Affairs, Summary of Programs and Services 2019, available at
http://elderaffairs.state.fl.us/doea/pubs/pubs/sops2019/2019_SOPS_A.pdf (last accessed January 20, 2022).
11 Id.
12 Supra note 7.
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care programs and respite care programs. 13 MDCs are established at medical schools, teaching
hospitals, and public and private not-for-profit hospitals throughout the state in accordance with s.
430.502, F.S. MDCs served 9,753 clients in 2017-2018. 14
Purple Ribbon Task Force and Alzheimer’s Disease State Plan
Chapter 2012-172, Laws of Florida, created the Purple Ribbon Task Force. The task force was
composed of 18 members with 6 members appointed by the Governor, 6 members appointed by the
Speaker of the House of Representatives, and 6 members appointed by the President of the Senate. 15
The law required the task force to conduct an interim study regarding Alzheimer’s disease in the state
and directed the Task Force to: 16
• Assess the current and future impact of Alzheimer’s disease on the state;
• Examine existing industries, services, and resources that address the needs of persons with
Alzheimer’s disease;
• Develop a strategy to mobilize a state response to Alzheimer’s disease; and
• Gather information on state trends and policy regarding Alzheimer’s disease.
Additionally, the law required the task force to submit a report in the form of an Alzheimer’s disease
state plan. 17 The 2013 completed report by the task force is the State Plan on Alzheimer’s Disease and
Related Forms of Dementia. 18 The state report included the task force’s findings and recommendations.
Upon submission of this report, pursuant to law, the Purple Ribbon Task Force terminated.
Current law requires DOEA to review and update the Alzheimer’s disease state plan every three years.
The state plan must include an assessment of the current and future impact of Alzheimer’s disease, an
examination of existing resources available to persons living with Alzheimer’s disease, and other
information regarding Alzheimer’s disease trends and policies in the state. 19
Alzheimer’s Disease Advisory Committee
Section 430.501, F.S., establishes the Alzheimer’s Disease Advisory Committee (Committee) to advise
DOEA on legislative, programmatic, and administrative matters regarding individuals with Alzheimer’s
disease and their caretakers. The committee is established within DOEA and composed of 11
members appointed by the Governor, 2 members appointed by the Senate President (one of which
must be a sitting Senator), and 2 members appointed by the Speaker of the House of Representatives
(one of which must be a sitting Representative). 20 The Governor’s appointments must reflect the
following representation: 21
• At least four members must be persons licensed pursuant to ch. 458 or 459, F.S., or hold a
Ph.D. degree and be currently involved in research on Alzheimer’s disease;
• At least four persons who have been caregivers of victims of Alzheimer’s disease; and
• Whenever possible, a gerontologist, a geriatric psychiatrist, a geriatrician, a neurologist, a
social worker, and a registered nurse.
Committee members are appointed to four-year staggered terms. The chair is elected by the
Committee and serves a one-year term. The Committee may establish subcommittees as necessary to
carry out the functions of the Committee. Currently, the Committee has four standing subcommittees
13 Id.
14 Supra note 10.
15 Ch. 2012-172, Laws of Fla.
16 Id.
17 Id.
18 Florida Department of Elder Affairs, Purple Ribbon Task Force State Plan on Alzheimer’s Disease and Related Forms of Dementia,
available at https://www.alz.org/media/Documents/florida-state-plan-august-2013.pdf (last accessed January 20, 2022).
19 S. 430.501, F.S.
20 Id.
21 Id.
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regarding clinical services, home- and community-based care, education and research, and legislative
advocacy. 22
The Committee is required to submit an annual report to the Governor, the President of the Senate, the
Speaker of the House of Representatives, and the Secretary of Elder Affairs by September 1 of each
year. The report must include recommendations on Alzheimer’s disease policy, all state-funded
Alzheimer’s disease efforts, and proposed updates to the Alzheimer’s disease state plan.
DOEA must use the report submitted by the Committee and collaborate with other organizations and
professionals when updating the state plan. DOEA must submit the updated state plan every three
years to the Governor, the President of the Senate, and the Speaker of the House of
Representatives. 23
Dementia Care and Cure Initiative
The DOEA announced the Dementia Care and Cure Initiative (DCCI) in 2015 to engage communities
across the state to be more dementia-caring, promote better care for Floridians affected by dementia,
and support research efforts to find a cure. In collaboration with Florida’s 11 Area Agencies on Aging
and 17 memory disorder clinics, participating DCCI communities organize task forces consisting of
community professionals and stakeholders who work to bring about education, awareness of, and
sensitivity regarding the needs of those affected by dementia. 24
Health Care Licensure in Florida
Chapter 458, F.S., governs licensure and regulation of the practice of medicine by the Florida Board of
Medicine in conjunction with the Florida Department of Health (DOH). Physicians holding a Doctor of
Medicine (M.D.) degree are licensed under this chapter.
Chapter 459, F.S., provides for the licensure and regulation of the practice of medicine by the Florida
Board of Osteopathic Medicine in conjunction with DOH. Osteopathic Physicians holding a Doctor of
Osteopathic Medicine (D.O.) are licensed under this chapter.
Chapter 464, F.S., provides for the licensure and regulations of the practice of nursing by the Florida
Board of Nursing in conjunction with DOH. Individuals licensed under this chapter include registered
nurses (RN), advanced practice registered nurses (APRN), licensed practical nurses (LPN), and
certified nursing assistants (CNA).
Medicare Program
Medicare is a federal health insurance program for people 65 or older, people under 65 with certain
disabilities, and people of any age with end-stage renal disease (permanent kidney failure requiring
dialysis or a kidney transplant). 25 The program is administered by the Centers for Medicare and
Medicaid Services in the U.S. Department of Health and Human Services.
Medicare will pay for some services during every stage of Alzheimer’s disease and dementia care,
such as: 26
• Cognitive assessments;
• Home safety evaluations
22 Alzheimer’s Disease Advisory Committee, 2009-2016 Summary of Accomplishments,
http://elderaffairs.state.fl.us/doea/alz/ADI_Accomplishments.pdf (last accessed January 20, 2022).
23 S. 430.501(3)(b)8., F.S.
24 Department of Elder Affairs, Dementia Care and Cure Initiative, http://elderaffairs.state.fl.us/doea/dcci.php (last accessed January 20,
2022).
25 Medicare.gov, What’s Medicare, https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare
(last accessed January 20, 2022).
26 Centers for Medicare and Medicaid Services, Medicare and Medicaid Benefits for People with Dementia, August 2017,
https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Downloads/Medicare-and-Medicaid-Benefits-for-
People-with-Dementia.pdf (last accessed January 20, 2022).
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• Planning for care;
• Hospital stays; and,
• Prescription drugs — Medicare Part D pays a portion of drug costs for individuals diagnosed
with dementia.
Effect of Proposed Changes
The bill creates the Ramping up Education of Alzheimer’s and Dementia for You (READY) Act. The bill
requires DOH to use existing public health and community outreach programs to educate physicians
and nursing professionals on a range of topics related to the diagnosis and treatment of Alzheimer’s
disease and related forms of dementia. Specifically, the bill requires DOH to educate physicians and
nursing professions on:
• The importance of early detection and timely diagnosis of Alzheimer’s disease and related
forms of dementia;
• Utilization of a validated cognitive assessment tool;
• The value and effectiveness of Medicare annual wellness visits in detecting Alzheimer’s
disease and related forms of dementia;
• The use of Medicare billing codes for care planning for individuals with Alzheimer’s disease
and related forms of dementia; and
• Methods to reduce the risk of cognitive decline, particularly among individuals in diverse
communities who are at greater risk of developing Alzheimer’s disease and related forms of
dementia.
The bill provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Creates s. 381.825, F.S., relating to Alzheimer’s disease and dementia-related disorders
education.
Section 2: Provides an effective date of July 1, 2022.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
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B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
No rule-making authority is necessary to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
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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 475 2022
1 A bill to be entitled
2 An act relating to Alzheimer's disease and related
3 forms of dementia education and public awareness;
4 creating s. 381.825, F.S.; providing a short title;
5 requiring the Department of Health to educate certain
6 licensed health care providers regarding specified
7 information related to Alzheimer's disease and related
8 forms of dementia; providing an effective date.
9
10 Be It Enacted by the Legislature of the State of Florida:
11
12 Section 1. Section 381.825, Florida Statutes, is created
13 to read:
14 381.825 Education and public awareness relating to
15 Alzheimer's disease and related forms of dementia.—
16 (1) This section may be cited as the "Ramping up Education
17 of Alzheimer's and Dementia for You (READY) Act."
18 (2) The Department of Health shall, through existing,
19 relevant public health and community outreach programs, educate
20 health care providers licensed under chapters 458, 459, and 464
21 regarding all of the following information:
22 (a) The importance of early detection and timely diagnosis
23 of Alzheimer's disease and related forms of dementia.
24 (b) Using a validated cognitive assessment tool.
25 (c) The value and effectiveness of the Medicare annual
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26 wellness visit in detecting Alzheimer's disease and related
27 forms of dementia.
28 (d) Using Medicare advance care planning billing codes for
29 persons with Alzheimer's disease and related forms of dementia.
30 (e) Reducing the risk of cognitive decline, particularly
31 among persons in diverse communities who are at greater risk of
32 developing Alzheimer's disease and related forms of dementia.
33 Section 2. This act shall take effect July 1, 2022.
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hb0475-00
HB 517
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 517 Dentistry and Dental Hygiene Examinations
SPONSOR(S): Sirois
TIED BILLS: IDEN./SIM. BILLS: SB 926
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Rahming McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
The Board of Dentistry, within the Department of Health (DOH), regulates dental practice in Florida, including
dentists, dental hygienists, and dental assistants under the Dental Practice Act. A dentist is licensed to
examine, diagnose, treat, and care for conditions within the human oral cavity and its adjacent tissues and
structures. A dental hygienist provides education and preventive and delegated therapeutic dental services.
Currently, all applicants for licensure as a dentist or dental hygienist must pass a practical or clinical
examination developed by the American Board of Dental Examiners, Inc. (ADEX), in addition to meeting other
qualifications. A live patient must be used during the clinical examination.
In response to the COVID-19 pandemic, on March 31, 2021, the State Surgeon General issued Emergency
Order 21-001, which suspended the prohibition against the use of manikins or simulated patients in lieu of live
patients during the administration of the ADEX examinations. The Emergency Order expired on June 30, 2021.
HB 517 requires the use of the CompeDont DTX manufactured tooth for the restorative and periodontal skills
portions on the dental clinical examination and for the dental hygiene clinical examination. This eliminates the
requirement for dental and dental hygienist applicants to perform clinical examination components on a live
patient. The bill also removes the following provisions that are unnecessary because the examination is no
longer on live patients:
• The requirement for dental students to obtain, and the Board of Dentistry’s authority to require,
specified medical malpractice insurance;
• The requirement for dental schools to make arrangements for patients who require follow-up dental
care as a result of procedures performed during the clinical examination; and
• The requirement that dental schools ensure that a student’s academic record does not include any
evidence that the student poses an unreasonable risk to a patient during the clinical examination.
The bill has an insignificant, negative fiscal impact on the DOH, which current resources are adequate to
absorb. The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2022.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Dentistry
The Board of Dentistry, within the Department of Health (DOH), regulates dental practice in Florida,
including dentists, dental hygienists, and dental assistants under the Dental Practice Act. 1 A dentist is
licensed to examine, diagnose, treat, and care for conditions within the human oral cavity and its
adjacent tissues and structures. 2 A dental hygienist provides education, preventive and delegated
therapeutic dental services. 3
Dental Licensure
Any person wishing to practice dentistry in this state must apply to the DOH and meet specified
requirements. Section 466.006, F.S., requires dentistry licensure applicants to sit for and pass the
following licensure examinations:
• The National Board of Dental Examiners dental examination (NBDE);
• A written examination on Florida laws and rules regulating the practice of dentistry; and
• The American Dental Licensing Examination, a practical or clinical examination developed by
the American Board of Dental Examiners. 4
To qualify to take the Florida dental licensure examination, an applicant must be 18 years of age or
older, be a graduate of a dental school accredited by the American Dental Association Commission on
Dental Accreditation or be a student in the final year of a program at an accredited institution, and have
successfully completed the NBDE dental examination. 5
Dental Hygiene Licensure
Any person wishing to be licensed as a dental hygienist must apply to DOH and meet the following
qualifications: 6
• Be 18 years of age or older;
• Be a graduate of an accredited dental hygiene college or school; 7 and
• Obtain a passing score on the:
o National Board Dental Hygiene Examination;
o Dental Hygiene Examination, a practical or clinical examination developed by the
American Board of Dental Examiners, Inc.; and
o A written examination on Florida laws and rules regulating the practice of dental
hygiene.
A dental hygienist may also apply to be certified to administer local anesthesia, under the direct
supervision of a dentist, to a non-sedated, adult patient if the dental hygienist is certified in basic or
advanced cardiac life support and successfully completes an accredited course that includes a
1 S. 466.004, F.S.
2 S. 466.003(3), F.S.
3 Ss. 466.003(4)-(5), F.S.
4 A passing score is valid for 365 days after the date the official examination results are published. The same is true for a passing score
on the American Dental Licensing Examination administered in another state on or after Oct. 1, 2011.
5 S. 466.006(2), F.S.
6 S. 466.007, F.S.
7 If the school is not accredited, the applicant must have completed a minimum of 4 years of postsecondary dental education and
received a dental school diploma, which must be reviewed and approved by the Board of Dentistry.
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minimum of 30 hours of didactic training, 30 hours of clinical experience, and additional training in
specified areas. 8
American Board of Dental Examiners
The American Board of Dental Examiners, Inc. (ADEX) is an organization of state and regional dental
boards that provides for the ongoing development of uniform national dental and dental hygiene
licensure examinations. 9 The ADEX examination is widely used: 48 states accept the ADEX for dental
licensure. 10
The Commission on Dental Competency Assessment (CDCA), formerly known as the Northeast
Regional Board, and the Council of Interstate Testing Agencies (CITA) administers the ADEX dental
licensure examination to graduates of accredited dental schools and students in their senior year at an
accredited dental school. 11
The ADEX dental examination consists of three portions: a computer-based examination, simulated
clinical examinations, and clinical examinations on live patients. 12 The simulated clinical examinations
assesses skills related to endodontics and fixed prosthodontics. The clinical examinations on live
patients assesses skills related to restorative and periodontal procedures. As of December 2021, only
four states require live patient-based examinations: Florida, Nevada, Oklahoma, and Wyoming. 13
8 S. 466.017(5), F.S.
9 American Board of Dental Examiners, Inc., About ADEX, https://adexexams.org/about-adex/ (last visited Dec. 22, 2021).
10 CDCA/WREB, 2021 ADEX Acceptance Map, https://www.cdcaexams.org/adex-acceptance-map/ (last visited Dec. 22, 2021).
11 Commission on Dental Competency Assessments (CDCA), Registration and DSE OSCE Manual: 2021 ADEX Dental Examination
Series, https://www.cdcaexams.org/wp-content/uploads/2021/03/Dental_DSE_OSCE2021-2.pdf (last visited Dec. 22, 2021).The cost
of the ADEX dental examinations is $2,295; however, additional fees may be assessed, such as a facility or score report fee. The fee is
reduced for partial exams and retakes. See CDCA, Dental (ADEX), https://www.cdcaexams.org/dental-exams/ (last visited Dec. 22,
2021).
12 CDCA, supra note 11, at 4. The simulated clinical examinations assesses skills related to endodontics and fixed prosthodontics. The
clinical examinations on live patients assesses skills related to restorative and periodontal procedures.
13 Email from Andrew Love, Director of Legislative Affairs, Florida Department of Health, RE: HB 517 Data Inquiry, regarding states that
require live patient ADEX examinations (Dec. 22, 2021).
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As with the dental examination, CDCA and CITA administer the ADEX dental hygiene examination. 14
The ADEX dental hygiene examination consists of two portions: a computer-simulated examination and
a clinical examination on live patients. 15 The computer-simulated examination assesses various levels
of diagnosis and treatment planning knowledge, skills, and abilities. The clinical examinations on live
patients evaluates the applicants ability to detect and remove calculus, measure periodontal pocket
depths, and present the case for evaluation of calculus removal and soft and/or hard tissue damage. 16
Only nine states require live patient-based examinations: Alaska, Florida, Idaho, Missouri, Nevada,
New Mexico, Oklahoma, Utah, and Wyoming. 17
The ADEX examination is widely used: 47 states accept the ADEX for dental hygiene licensure. 18
The DOH contracts with the CDCA to administer the ADEX examinations, as well as the jurisprudence
examinations. 19 In Fiscal Year 2020-2021, 1,196 dentists and 1,392 dental hygienists applied to the
take the ADEX examinations. 20
In April 2020, the ADEX approved the use of CompeDont™ DTX, a new manikin tooth technology
developed by the CDCA 21 that allows dental licensure candidates to choose a non-patient-based
restorative examination option to demonstrate readiness for practice. The CompeDont™ accurately
represents infected, affected and sclerotic dentin. 22 According to CDCA Director of Examinations, Dr.
Ellis Hall, “[b]oth examiners and students reported that the tooth mimics decay, stickiness and tug-back
and can be restored as if it were a natural tooth in this way.” 23 The CompeDont™’s new technology
14 CDCA, Candidate Registration and CSCE OSCE Manual: 2021 ADEX Dental Hygiene Examination, available at
https://www.cdcaexams.org/documents/manuals/Dental_Hygiene_Candidate_Registration2021.pdf (last visited Dec. 22, 2021). The
cost of the ADEX dental hygiene examinations is $995; however, additional fees may be assessed, such as a facility or score report
fee. See CDCA, Dental Hygiene (ADEX), https://www.cdcaexams.org/dental-hygiene-adex-exam/ (last visited Dec. 22, 2021).
15 Id.
16 DOH, 2022 Agency Legislative Bill Analysis for HB 517, p. 2 (Nov. 19, 2021).
17 Email, supra note 13.
18 CDCA, supra note 10.
19 DOH, 2021 Agency Legislative Bill Analysis for HB 497, p. 3 (Feb. 24, 2021).
20 DOH, 2022 Agency Legislative Bill Analysis for HB 517, p. 3 (Nov. 19, 2021).
21 The CDCA partnered with Acadental, Inc. for the development and production of the CompeDont™ DTX. See, CDCA, ADEX
Approves CompeDont(TM) Non-Patient Based Exam Alternative, https://www.cdcaexams.org/adex-approves-compedont/ (last visited
Jan. 11, 2022).
22 Id.
23 Id.
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provides an option to many state dental boards seeking to address public health concerns in the wake
of COVID-19 without reducing existing licensure standards. 24
In response to the COVID-19 pandemic, on March 31, 2021, the State Surgeon General issued
Emergency Order 21-001, which suspended the prohibition against the use of manikins or simulated
patients in lieu of live patients during the administration of the ADEX examinations. This expired on
June 30, 2021.
Malpractice Insurance
Under current law, dental students must possess medical malpractice insurance to take the licensure
examinations. 25 Additionally, the Board of Dentistry may require dental and dental hygiene applicants to
maintain medical malpractice insurance to cover any harmful incident to a patient during the clinical
examination. 26 The CDCA has a blanket malpractice insurance policy that covers all dental and dental
hygiene applicants for ADEX examinations. 27 This means that applicants are not required to obtain
additional insurance. 28
Patient Care
Under current law, dental schools must ensure that a student’s academic record does not include any
evidence that the student poses an unreasonable risk to a patient during the clinical examination. 29 The
schools must inform patients in writing of their right to follow-up dental care before the examination and
also make arrangements for patients who require follow-up care as a result of performed procedures. 30
Effect of Proposed Changes
Dentistry
HB 517 requires the use of the CompeDont DTX manufactured tooth for the restorative and periodontal
skills portions on the dental clinical examination and for the dental hygiene clinical examination. This
eliminates the requirement for dental and dental hygienist applicants to perform clinical examination
components on a live patient.
The bill also removes the following provisions that are unnecessary because the examination is no
longer on live patients:
• The requirement for dental students to obtain, and the Board of Dentistry’s authority to require,
specified medical malpractice insurance;
• The requirement for dental schools to make arrangements for patients who require follow-up
dental care as a result of procedures performed during the clinical examination; and
• The requirement that dental schools ensure that a student’s academic record does not include
any evidence that the student poses an unreasonable risk to a patient during the clinical
examination.
The bill provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Amends s. 466.006, F.S., relating to examination of dentists.
Section 2: Amends s. 466.0065, F.S., relating to regional licensure examinations.
Section 3: Amends s. 466.007, F.S., relating to examination of dental hygienists.
24 Id. See statement of CDCA Chair, Dr. Harvey Weingarten.
25 S. 466.0065 (c), F.S.
26 S. 466.0075, F.S.
27 DOH, 2022 Agency Legislative Bill Analysis for HB 517, p. 3 (Nov. 19, 2021).
28 Id.
29 S. 466.0065 (j), F.S.
30 S. 466.0065 (e). F.S.
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Section 4: Repeals s. 466.0075. F.S., relating to applicants for examination; medical malpractice
insurance.
Section 5: 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 DOH will incur non-recurring costs for rulemaking, which current resources can absorb. 31
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:
The Board of Dentistry has sufficient rulemaking authority to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
31 DOH, 2022 Agency Legislative Bill Analysis for HB 517, p. 4 (Nov. 19, 2021).
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 517 2022
1 A bill to be entitled
2 An act relating to dentistry and dental hygiene
3 examinations; amending ss. 466.006 and 466.007, F.S.;
4 authorizing the use of a specified nonpatient dental
5 device during a licensure examination of a dentist or
6 dental hygienist in lieu of a live patient; amending
7 s. 466.0065, F.S.; conforming provisions to changes
8 made by the act; repealing s. 466.0075, F.S., relating
9 to required medical malpractice insurance for
10 applicants for examination; providing an effective
11 date.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15 Section 1. Paragraph (a) of subsection (5) of section
16 466.006, Florida Statutes, is amended to read:
17 466.006 Examination of dentists.—
18 (5)(a) The practical examination required under subsection
19 (4) shall be the American Dental Licensing Examination developed
20 by the American Board of Dental Examiners, Inc., or its
21 successor entity, if any, provided the board finds that the
22 successor entity's clinical examination complies with the
23 provisions of this section, and shall include, at a minimum:
24 1. A comprehensive diagnostic skills examination covering
25 the full scope of dentistry and an examination on applied
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26 clinical diagnosis and treatment planning in dentistry for
27 dental candidates.;
28 2. Two restorations using the CompeDont DTX manufactured
29 tooth approved by the Commission on Dental Competency
30 Assessments on a live patient or patients. The board by rule
31 shall determine the class of such restorations.;
32 3. A demonstration of periodontal skills using the
33 CompeDont DTX manufactured tooth approved by the Commission on
34 Dental Competency Assessments. on a live patient;
35 4. A demonstration of prosthetics and restorative skills
36 in complete and partial dentures and crowns and bridges and the
37 utilization of practical methods of evaluation, specifically
38 including the evaluation by the candidate of completed
39 laboratory products such as, but not limited to, crowns and
40 inlays filled to prepared model teeth.;
41 5. A demonstration of restorative skills on a manikin
42 mannequin which requires the candidate to complete procedures
43 performed in preparation for a cast restoration.;
44 6. A demonstration of endodontic skills.; and
45 7. A diagnostic skills examination demonstrating ability
46 to diagnose conditions within the human oral cavity and its
47 adjacent tissues and structures from photographs, slides,
48 radiographs, or models pursuant to rules of the board. If an
49 applicant fails to pass the diagnostic skills examination in
50 three attempts, the applicant shall not be eligible for
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51 reexamination unless she or he completes additional educational
52 requirements established by the board.
53
54 The department shall require a mandatory standardization
55 exercise for all examiners prior to each practical or clinical
56 examination and shall retain for employment only those dentists
57 who have substantially adhered to the standard of grading
58 established at such exercise.
59 Section 2. Subsection (2) of section 466.0065, Florida
60 Statutes, is amended to read:
61 466.0065 Regional licensure examinations.—
62 (2) Each school of dentistry in this state which is
63 accredited by the Commission on Accreditation of the American
64 Dental Association or its successor agency may, upon written
65 approval by the Board of Dentistry, offer regional licensure
66 examinations only to dental students in the final year of a
67 program at an approved dental school, if the board has approved
68 the hosting school's written plan to comply with the following
69 conditions:
70 (a) A member of the regional examination body's board of
71 directors or equivalent thereof must be a member of the American
72 Association of Dental Examiners.
73 (b) The student must have successfully passed parts I and
74 II of the National Board of Dental Examiners examination within
75 2 years before taking the regional examination.
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76 (c) The student must possess medical malpractice insurance
77 in amounts not less than the amounts required to take the
78 Florida licensure examinations.
79 (d) At least one of the examination monitors must be a
80 dentist licensed in this state who has completed all necessary
81 standardization exercises required by the regional examination
82 body. Recruitment of examination monitors is the responsibility
83 of the regional examination body.
84 (e) Adequate arrangements, as defined by the regional
85 examination body and as otherwise required by law, must be made,
86 when necessary, for patients who require followup care as a
87 result of procedures performed during the clinical portion of
88 the regional examination. The regional examination body must
89 inform patients in writing of their right to followup care in
90 advance of any procedures performed by a student.
91 (f) The board chair or the chair's designee must be
92 allowed to observe testing while it is in progress.
93 (g) Each student, upon being deemed eligible by the dental
94 school to apply to the regional examination body to take the
95 regional examination, must receive written disclosure in at
96 least 12-point boldface type that states: "This examination does
97 not meet the licensure requirements of chapter 466, Florida
98 Statutes, for licensure in the State of Florida. Persons wishing
99 to practice dentistry in Florida must pass the Florida licensure
100 examinations."
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101 (h) The student must be enrolled as a dental student in
102 the student's final year of a program at an approved dental
103 school that is accredited by the Commission on Accreditation of
104 the American Dental Association or its successor agency.
105 (i) The student must have completed all coursework deemed
106 necessary by the dental school to prepare the student to perform
107 all clinical and diagnostic procedures required to pass the
108 regional examination.
109 (j) The student's academic record must not include any
110 evidence suggesting that the student poses an unreasonable risk
111 to any live patients who are required for the clinical portion
112 of the regional examination. In order to protect the health and
113 safety of the public, the dental school may request additional
114 information and documents pertaining to the candidate's mental
115 and physical health in order to fully assess the candidate's
116 fitness to engage in exercises involving a live patient.
117 Section 3. Subsection (4) of section 466.007, Florida
118 Statutes, is amended to read:
119 466.007 Examination of dental hygienists.—
120 (4) Effective July 1, 2012, to be licensed as a dental
121 hygienist in this state, an applicant must successfully complete
122 the following:
123 (a) A written examination on the laws and rules of this
124 state regulating the practice of dental hygiene.
125 (b) A practical or clinical examination approved by the
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126 board. The examination shall be the Dental Hygiene Examination
127 produced by the American Board of Dental Examiners, Inc., (ADEX)
128 or its successor entity, if any, if the board finds that the
129 successor entity's clinical examination meets or exceeds the
130 provisions of this section. The board shall approve the ADEX
131 Dental Hygiene Examination if the board has attained and
132 continues to maintain representation on the ADEX House of
133 Representatives, the ADEX Dental Hygiene Examination Development
134 Committee, and such other ADEX Dental Hygiene committees as the
135 board deems appropriate through rulemaking to ensure that the
136 standards established in this section are maintained
137 organizationally. The ADEX Dental Hygiene Examination or the
138 examination produced by its successor entity is a comprehensive
139 examination in which an applicant must demonstrate skills within
140 the dental hygiene scope of practice using the CompeDont DTX
141 manufactured tooth approved by the Commission on Dental
142 Competency Assessments on a live patient and any other
143 components that the board deems necessary for the applicant to
144 successfully demonstrate competency for the purpose of
145 licensure.
146 Section 4. Section 466.0075, Florida Statutes, is
147 repealed.
148 Section 5. This act shall take effect July 1, 2022.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 517 (2022)
Amendment No. 1
COMMITTEE/SUBCOMMITTEE ACTION
ADOPTED (Y/N)
ADOPTED AS AMENDED (Y/N)
ADOPTED W/O OBJECTION (Y/N)
FAILED TO ADOPT (Y/N)
WITHDRAWN (Y/N)
OTHER
1 Committee/Subcommittee hearing bill: Professions & Public
2 Health Subcommittee
3 Representative Sirois offered the following:
4
5 Amendment (with title amendment)
6 Remove everything after the enacting clause and insert:
7 Section 1. Paragraph (a) of subsection (5) of section
8 466.006, Florida Statutes, is amended to read:
9 466.006 Examination of dentists.—
10 (5)(a) The practical examination required under subsection
11 (4) is shall be the American Dental Licensing Examination
12 developed by the American Board of Dental Examiners, Inc., or
13 its successor entity, if any, provided the board finds that the
14 successor entity's clinical examination complies with the
15 provisions of this section, and must shall include, at a
16 minimum:
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 517 (2022)
Amendment No. 1
17 1. A comprehensive diagnostic skills examination covering
18 the full scope of dentistry and an examination on applied
19 clinical diagnosis and treatment planning in dentistry for
20 dental candidates;
21 2. Two restorations on a manikin that has typodont teeth
22 with simulated caries as approved by the Commission on Dental
23 Competency Assessments live patient or patients. The board by
24 rule shall determine the class of such restorations;
25 3. A demonstration of periodontal skills on a manikin that
26 has typodont teeth with simulated calculus as approved by the
27 Commission on Dental Competency Assessments live patient;
28 4. A demonstration of prosthetics and restorative skills
29 in complete and partial dentures and crowns and bridges and the
30 utilization of practical methods of evaluation, specifically
31 including the evaluation by the candidate of completed
32 laboratory products such as, but not limited to, crowns and
33 inlays filled to prepared model teeth;
34 5. A demonstration of restorative skills on a manikin
35 mannequin which requires the candidate to complete procedures
36 performed in preparation for a cast restoration;
37 6. A demonstration of endodontic skills; and
38 7. A diagnostic skills examination demonstrating ability
39 to diagnose conditions within the human oral cavity and its
40 adjacent tissues and structures from photographs, slides,
41 radiographs, or models pursuant to rules of the board. If an
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Bill No. HB 517 (2022)
Amendment No. 1
42 applicant fails to pass the diagnostic skills examination in
43 three attempts, the applicant is shall not be eligible for
44 reexamination unless she or he completes additional educational
45 requirements established by the board.
46
47 The department shall require a mandatory standardization
48 exercise for all examiners prior to each practical or clinical
49 examination and shall retain for employment only those dentists
50 who have substantially adhered to the standard of grading
51 established at such exercise.
52 Section 2. Paragraphs (c), (e), and (j) of subsection (2)
53 of section 466.0065, Florida Statutes, are amended to read:
54 466.0065 Regional licensure examinations.—
55 (2) Each school of dentistry in this state which is
56 accredited by the Commission on Accreditation of the American
57 Dental Association or its successor agency may, upon written
58 approval by the Board of Dentistry, offer regional licensure
59 examinations only to dental students in the final year of a
60 program at an approved dental school, if the board has approved
61 the hosting school's written plan to comply with the following
62 conditions:
63 (c) The student must possess medical malpractice insurance
64 in amounts not less than the amounts required to take the
65 Florida licensure examinations.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 517 (2022)
Amendment No. 1
66 (e) Adequate arrangements, as defined by the regional
67 examination body and as otherwise required by law, must be made,
68 when necessary, for patients who require followup care as a
69 result of procedures performed during the clinical portion of
70 the regional examination. The regional examination body must
71 inform patients in writing of their right to followup care in
72 advance of any procedures performed by a student.
73 (j) The student's academic record must not include any
74 evidence suggesting that the student poses an unreasonable risk
75 to any live patients who are required for the clinical portion
76 of the regional examination. In order to protect the health and
77 safety of the public, the dental school may request additional
78 information and documents pertaining to the candidate's mental
79 and physical health in order to fully assess the candidate's
80 fitness to engage in exercises involving a live patient.
81 Section 3. Paragraph (b) of subsection (4) of section
82 466.007, Florida Statutes, is amended to read:
83 466.007 Examination of dental hygienists.—
84 (4) Effective July 1, 2012, to be licensed as a dental
85 hygienist in this state, an applicant must successfully complete
86 the following:
87 (b) A practical or clinical examination approved by the
88 board. The examination shall be the Dental Hygiene Examination
89 produced by the American Board of Dental Examiners, Inc., (ADEX)
90 or its successor entity, if any, if the board finds that the
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Bill No. HB 517 (2022)
Amendment No. 1
91 successor entity's clinical examination meets or exceeds the
92 provisions of this section. The board shall approve the ADEX
93 Dental Hygiene Examination if the board has attained and
94 continues to maintain representation on the ADEX House of
95 Representatives, the ADEX Dental Hygiene Examination Development
96 Committee, and such other ADEX Dental Hygiene committees as the
97 board deems appropriate through rulemaking to ensure that the
98 standards established in this section are maintained
99 organizationally. The ADEX Dental Hygiene Examination or the
100 examination produced by its successor entity is a comprehensive
101 examination in which an applicant must demonstrate skills within
102 the dental hygiene scope of practice on a manikin that has
103 typodont teeth with simulated dentition and calculus as approved
104 by the Commission on Dental Competency Assessments live patient
105 and any other components that the board deems necessary for the
106 applicant to successfully demonstrate competency for the purpose
107 of licensure.
108 Section 4. Section 466.0075, Florida Statutes, is
109 repealed.
110 Section 5. This act shall take effect July 1, 2022.
111
112 -----------------------------------------------------
113 T I T L E A M E N D M E N T
114 Remove everything before the enacting clause and insert:
115 A bill to be entitled
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 517 (2022)
Amendment No. 1
116 An act relating to licensure examinations for dental
117 practitioners; amending s. 466.006, F.S.; revising
118 licensure examination requirements for dentists to
119 require applicants to demonstrate certain clinical
120 skills on a manikin rather than a live patient;
121 amending s. 466.0065, F.S.; revising requirements for
122 regional licensure examinations offered by dental
123 schools to dental students; amending s. 466.007, F.S.;
124 revising licensure examination requirements for dental
125 hygienists to require applicants to demonstrate
126 certain clinical skills on a manikin rather than a
127 live patient; repealing s. 466.0075, F.S., relating to
128 a requirement that applicants for dental practitioner
129 licensure examinations maintain medical malpractice
130 insurance to cover any incident of harm to a patient
131 during the clinical examination; providing an
132 effective date.
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HB 559
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 559 Occupational Licensure of Military Spouses
SPONSOR(S): Regulatory Reform Subcommittee, Hunschofsky and others
TIED BILLS: IDEN./SIM. BILLS: SB 562
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Regulatory Reform Subcommittee 17 Y, 0 N, As CS Thompson Anstead
2) Professions & Public Health Subcommittee Rahming McElroy
3) Appropriations Committee
4) Commerce Committee
SUMMARY ANALYSIS
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners in Florida. The MQA works in conjunction with 22 boards
and four councils to license and regulate ten types of health care facilities and more than 200 licenses in over
40 health care professions. Each profession is regulated by an individual practice act and by ch. 456, F.S.,
which provides general regulatory and licensure authority for the MQA.
DOH provides expedited health care professional licensing to applicants who are a spouse or surviving spouse
of a U.S. Armed Forces active duty member through the Florida Veterans Application for Licensure Online
Response System (VALOR). Veterans and spouses who apply through the VALOR process receive a waiver
of most licensing fees. In Florida, spouses of active duty members are authorized to receive a temporary
license to practice certain health care professions upon submission of specified information and a $65
licensure application fee.
The bill makes several revisions to temporary licensure requirements for the spouse of an active duty member.
The bill:
• Requires DOH to issue a full professional license, rather than a temporary license, to applicants who
satisfy submission requirements;
• Requires the board, or DOH if there is no board, to expedite all applications submitted by an active duty
member’s spouse and issue him or her a temporary professional license that is valid for the duration of
the application review process under specified conditions;
• Allows military spouse licensees to renew the license, which is prohibited under current law; and
• Requires DOH to waive the $65 application fee.
The bill will likely have an insignificant, negative fiscal impact on DOH and has no 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.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Licensure of Health Care Practitioners
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners in Florida. 1 The MQA works in conjunction with 22
boards and four councils to license and regulate ten types of health care facilities and more than 200
licenses in over 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 the MQA.
Military and Veteran Licensure
Florida offers expedited licensing and fee waivers to a person who serves or has served as a health
care practitioner 3 in the United States Armed Forces, United States Reserve Forces, or the National
Guard 4. To qualify for the expedited licensure and fee waivers, the person must have actively practiced
the profession for which he or she is applying during the preceding 3 years and must: 5
• Submit a complete application;
• Submit proof that he or she has received an honorable discharge within 6 months before, or will
receive an honorable discharge within 6 months after, the date of submission of the application;
• Submit proof that he or she holds an active, unencumbered license issued by another state, the
District of Columbia, or a possession or territory of the United States and who has not had
disciplinary action taken against him or her in the 5 years preceding the date of submission of
the application;
• Attest that he or she is not, at the time of submission of the application, the subject of a
disciplinary proceeding in a jurisdiction in which he or she holds a license or by the U.S.
Department of Defense for reasons related to the practice of the profession for which he or she
is applying; and
• Submit a set of fingerprints for a background screening, if required for the profession for which
he or she is applying.
DOH is required to develop an application form, 6 and each board, or DOH if there is no board, is
required to waive the application fee, licensure fee, and unlicensed activity fee for such applicants. 7
Military Spouse Temporary Licensure
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 2020-2021,
http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/annual-report-1617.pdf (last visited Jan. 3,
2022).
3 Health care practitioner means a health care practitioner as defined in s. 456.001, F.S., and a person licensed under part III of ch.
401, F.S., or part IV of ch. 468, F.S.
4 Includes the United States Army, Navy, Air Force, Marine Corps, and Coast Guard. 10 U.S.C. § 101(a)(4).
5 S. 456.024(3)(b), F.S.
6 R. 64B-9.003, F.A.C.
7 S. 456.024(3)(a), F.S.
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Each board, or DOH if there is no board, is also authorized to issue temporary licenses to military
spouses to practice his or her health care profession in Florida. 8 A temporary license is valid for one
year and is not renewable. 9 To be eligible for a temporary license, a military spouse must: 10
• Submit a completed application and a $65 application fee; 11
• Provide proof that he or she is married to an active duty member of the U.S. Armed Forces
assigned to a duty station in Florida pursuant to official military orders;
• Provide proof of a valid license from another state or jurisdiction to practice the health
profession for which he or she is applying and that such license is not subject to any disciplinary
proceeding;
• Provide proof that he or she would otherwise be entitled to full licensure and is eligible to take
the respective licensure examination as required in this state; and
• Pass a criminal background screening.
DOH provides expedited health care professional licensing to honorably discharged veterans and their
spouses through the Florida Veterans Application for Licensure Online Response System (VALOR). 12
Veterans and spouses who apply through the VALOR process receive a waiver of most licensing
fees. 13
Since its inception in 2016, there have been approximately 1,669 health care licensure applications
submitted by and approved for active duty service members, military veterans, and their spouses
through the VALOR expedited licensing process. There were 352 applications approved for health care
licensure of military spouses and honorably discharged veterans in FY 2020-2021, which accounted for
approximately 1.38% of all DOH issued licenses during this time period. 14
Effect of Proposed Changes
The bill makes several revisions to temporary licensure requirements for the spouse of an active duty
member. The bill:
• Requires DOH to issue a full professional license, rather than a temporary license, to applicants
who satisfy submission requirements;
• Requires the board, or DOH if there is no board, to expedite all applications submitted by an
active duty member’s spouse and issue him or her a temporary professional license that is valid
for the duration of the application review process under specified conditions;
• Allows military spouse licensees to renew the license, which is prohibited under current law; and
• Requires DOH to waive the $65 application fee.
B. SECTION DIRECTORY:
Section 1: Amends s. 456.024, F.S., relating to members of Armed Forces in good standing with
administrative boards or the department; spouses; licensure.
Section 2: Provides an effective date of July 1, 2022.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
8 S. 456.024(4), F.S.
9 S. 456.024(4)(f), F.S.
10 S. 456.024(4)(a)-(d), F.S.
11 R. 64B-4.007, F.A.C.
12 DOH operates the Veterans Application for Licensure Online Response System (VALOR) to provide expedited licensing for active
duty military members, honorably discharged veterans, and spouses of active duty military members with an active license in another
state. See http://www.flhealthsource.gov/valor (last visited Jan. 4, 2021).
13 Florida Department of Health, Agency Analysis of 2022 HB 559, p. 2 (12/14/2021).
14 Id.
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1. Revenues:
The Division of Medical Quality Assurance will experience a recurring loss of revenue with
implementation of the bill, but anticipates that any reduction in licensing fees will have an
insignificant impact on their trust fund. 15
2. Expenditures:
DOH will incur costs associated with implementing the bill, which current resources are adequate to
absorb. 16
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
The bill removes the $65 DOH licensure fee for a spouse of a U.S. Armed Force active duty member.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
Current law provides sufficient rulemaking authority for DOH to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
On January 12, 2021, the Regulatory Reform Subcommittee adopted one amendment and reported the
bill favorably as a committee substitute. The committee substitute removed provisions related to the
Department of Business and Professional Regulation from the bill.
15 Florida Department of Health, Agency Analysis of 2022 HB 559, p. 4 (12/14/2021).
16 Id.
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
CS/HB 559 2022
1 A bill to be entitled
2 An act relating to occupational licensure of military
3 spouses; amending s. 456.024, F.S.; requiring the
4 Department of Health or the applicable board to issue
5 a professional license to spouses of active duty
6 members of the Armed Forces of the United States if
7 certain requirements are met; requiring the department
8 to waive the application fee for such license
9 applications; authorizing applicants issued such
10 licenses to renew their licenses if certain
11 requirements are met; providing construction;
12 requiring the department or applicable board to
13 expedite applications for such licenses; requiring the
14 department or applicable board to issue a temporary
15 professional license under certain circumstances;
16 conforming provisions to changes made by the act;
17 providing an effective date.
18
19 Be It Enacted by the Legislature of the State of Florida:
20
21 Section 1. Paragraphs (a), (c), (e), (f), (g), (h), and
22 (i) of subsection (4) of section 456.024, Florida Statutes, are
23 amended, and paragraph (j) is added to that subsection, to read:
24 456.024 Members of Armed Forces in good standing with
25 administrative boards or the department; spouses; licensure. —
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26 (4)(a) The board, or the department if there is no board,
27 shall may issue a temporary professional license to the spouse
28 of an active duty member of the Armed Forces of the United
29 States who submits to the department:
30 1. A completed application upon a form prepared and
31 furnished by the department in accordance with the board's
32 rules;
33 2. The required application fee;
34 3. Proof that the applicant is married to a member of the
35 Armed Forces of the United States who is on active duty;
36 3.4. Proof that the applicant holds a valid license for
37 the profession issued by another state, the District of
38 Columbia, or a possession or territory of the United States, and
39 is not the subject of any disciplinary proceeding in any
40 jurisdiction in which the applicant holds a license to practice
41 a profession regulated by this chapter;
42 4.5. Proof that the applicant's spouse is assigned to a
43 duty station in this state pursuant to the member's official
44 active duty military orders; and
45 5.6. Proof that the applicant would otherwise be entitled
46 to full licensure under the appropriate practice act, and is
47 eligible to take the respective licensure examination as
48 required in Florida.
49 (c) Each board, or the department if there is no board,
50 shall review the results of the state and federal criminal
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51 history checks according to the level 2 screening standards in
52 s. 435.04 when granting an exemption and when granting or
53 denying the temporary license.
54 (e) The department shall waive the applicant's licensure
55 set an application fee, which may not exceed the cost of issuing
56 the license.
57 (f) An applicant issued a license under this subsection
58 may renew such license upon completion of the conditions for
59 renewal required of licenseholders under the applicable practice
60 act, including, without limitation, continuing education
61 requirements. This paragraph does not limit waiver of initial
62 licensure requirements under this subsection A temporary license
63 expires 12 months after the date of issuance and is not
64 renewable.
65 (g) An applicant for a temporary license under this
66 subsection is subject to the requirements under s. 456.013(3)(a)
67 and (c).
68 (h) An applicant shall be deemed ineligible for a
69 temporary license pursuant to this section if the applicant:
70 1. Has been convicted of or pled nolo contendere to,
71 regardless of adjudication, any felony or misdemeanor related to
72 the practice of a health care profession;
73 2. Has had a health care provider license revoked or
74 suspended from another of the United States, the District of
75 Columbia, or a United States territory;
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76 3. Has been reported to the National Practitioner Data
77 Bank, unless the applicant has successfully appealed to have his
78 or her name removed from the data bank; or
79 4. Has previously failed the Florida examination required
80 to receive a license to practice the profession for which the
81 applicant is seeking a license.
82 (i) The board, or the department if there is no board, may
83 revoke a temporary license upon finding that the individual
84 violated the profession's governing practice act.
85 (j) The board, or the department if there is no board,
86 shall:
87 1. Expedite all applications submitted by a spouse of an
88 active duty member of the Armed Forces of the United States
89 pursuant to this section; and
90 2. Issue a temporary professional license valid for the
91 duration of the application review process to such spouse once
92 the board or department verifies the information provided by the
93 spouse pursuant to paragraph (a) is accurate.
94 Section 2. This act shall take effect July 1, 2022.
Page 4 of 4
CODING: Words stricken are deletions; words underlined are additions.
hb0559-01-c1
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. CS/HB 559 (2022)
Amendment No. 1
COMMITTEE/SUBCOMMITTEE ACTION
ADOPTED (Y/N)
ADOPTED AS AMENDED (Y/N)
ADOPTED W/O OBJECTION (Y/N)
FAILED TO ADOPT (Y/N)
WITHDRAWN (Y/N)
OTHER
1 Committee/Subcommittee hearing bill: Professions & Public
2 Health Subcommittee
3 Representative Hunschofsky offered the following:
4
5 Amendment (with title amendment)
6 Remove lines 85-93 and insert:
7 (j) The board, or the department if there is no board,
8 shall expedite all applications submitted by a spouse of an
9 active duty member of the Armed Forces of the United States
10 pursuant to this section and that satisfy the requirements of
11 paragraph (a).
12
13 -----------------------------------------------------
14 T I T L E A M E N D M E N T
15 Remove lines 13-15 and insert:
16 expedite applications for such licenses;
154827 - h0559-line85.docx
Published On: 1/24/2022 5:53:38 PM
Page 1 of 1
PCS for HB 693
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 693 Department of Health
SPONSOR(S): Professions & Public Health Subcommittee
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
Orig. Comm.: Professions & Public Health Morris McElroy
Subcommittee
SUMMARY ANALYSIS
PCS for HB 693 makes numerous changes to programs under the Department of Health (DOH) and health care professions
regulated by the Division of Medical Quality Assurance (MQA) within DOH.
DOH administers the Targeted Outreach for Pregnant Women Act (TOPWA) Program which supports high risk pregnant women
to prevent heath issues for themselves and their newborns. The bill updates the TOPWA to account for current medication
options, information on HIV, and mental health issues that may lead to a pregnancy being high risk.
DOH is responsible for ensuring medical marijuana products are safe for human consumption and meet THC and CBD potency
and labeling requirements. The bill requires medical marijuana treatment centers to recall all marijuana that fails to meet the
safety and potency requirements, authorizes DOH to test samples of all forms of marijuana from MMTCs, and immunizes DOH
staff from prosecution for possessing marijuana for this purpose.
MQA regulates health care practitioners in this state. MQA works in conjunction with 22 boards and 4 councils to license and
regulate 7 types of health facilities and 40 health care professions. Each profession is regulated by an individual practice act and
by ch. 456, F.S., which provides general regulatory authority and licensure authority for MQA. The bill:
• Updates institutional accreditation references for chiropractic medicine, clinical laboratory personnel, and mental clinical
social workers and marriage and family therapists;
• Authorizes DOH to deny a nursing application or discipline a nurse licensed under ch. 464, F.S. under certain
circumstances;
• Removes obsolete references to DOH-issued licensure examinations for clinical social workers and marriage and family
therapists;
• Revises education, training, and temporary certification requirement for midwives;
• Removes obsolete form and fee requirements for fingerprinting of orthotists and prosthetists;
• Revises educational requirements for psychologists applying for licensure by endorsement; and
• Allows DOH to continue to issue licenses to marriage and family therapy graduates until July 1, 2026, while such
programs seek accreditation.
The Florida Birth-Related Neurological Injury Compensation Association (NICA) is an independent association created by the
Legislature to manage the Florida Birth-Related Neurological Injury Compensation Plan (Plan). The Plan pays for the care of
infants born with certain neurological injuries. NICA is authorized by law to collect annual assessments from physicians to
finance the Plan, though many physicians are delinquent on payments. The bill requires allopathic and osteopathic physicians to
provide proof of payment of NICA assessments as a condition of licensure.
Current law establishes DOH as the lead agency for coordination of staffing special needs shelters during an emergency or
disaster. DOH’s Division of Children’s Medical Services (CMS) is specifically charged with carrying out such duties, though
programmatic and organizational changes within CMS in recent years has impacted the ability of CMS to effectively do so. The
bill designates DOH, rather than CMS specifically, as the lead for the coordination of local medical and health care providers in
developing a plan for the staffing and medical management of pediatric special needs shelters. Additionally, the bill requires
DOH to determine who is responsible for the medical supervision of each special needs shelter.
The bill has an insignificant, negative fiscal impact on DOH, which current resources are adequate to absorb. The bill has no
fiscal impact on local governments.
The bill provides an effective date of July 1, 2022.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Targeted Outreach for Pregnant Women
Current Situation
The Targeted Outreach for Pregnant Women Act (TOPWA) supports targeted outreach programs that
aim to prevent vertical HIV transmission and other health issues by linking high-risk pregnant women
with services that can help them have healthier pregnancies and deliveries and can aid them in
ensuring their newborn gets a healthy start. 1 TOPWA programs aim to provide outreach and linkage
services to pregnant women who may not seek proper prenatal care, who suffer from substance-use
disorders, or who are living with HIV or are at increased risk for HIV acquisition.
In 2021, there were eight funded TOPWA programs in Florida. TOPWA programs provided services to
7,292 women from January 2018 to December 2021. Black women represented 49 percent of
enrollees, Hispanic women represented 40 percent, and white women represented 8 percent. Women
living with HIV made up just over 9 percent of TOPW enrollments. 2
If a pregnant woman tests positive for HIV, medical interventions like antiretroviral (ARV) medication
and delivery by caesarian section can greatly reduce her risk of transmitting the virus to her baby during
childbirth. Prevention methods, like avoiding breastfeeding, can reduce her risk of transmitting the virus
to her child post childbirth. Providing ARV medication to the newborn also decreases the chances of
seroconversion in the event of an HIV-exposed birth. DOH has developed a program, Baby Rxpress,
which provides a six-week course of ARV medication to HIV-exposed newborns at no cost to the
mother. In 2021, this program filled 330 prescriptions to 232 HIV-exposed newborns. 3
Many of the women targeted by TOPWA programs would not otherwise receive prenatal care or know
their HIV status. In 2020, there were 439 HIV-exposed births in Florida and four reported cases of
perinatal HIV transmission. TOPWA programs aim to engage women into care who very likely do not
already have knowledge of or access to these interventions. Without these types of interventions, a
mother’s chances of transmitting HIV to her newborn can be up to 45 percent. With these interventions,
the chances of transmission are less than 2 percent. 4
Effect of Proposed Changes – Targeted Outreach for Pregnant Women
The bill adds pregnant women who are suffering from mental health problems to the list of outreach
targets. It also includes mental health services as a linkage option.
The bill revises the duties of DOH’s administration of the TOPWA and the information and services
DOH provides to the women it serves. The bill requires DOH to encourage high-risk pregnant women to
be tested for other sexually transmitted diseases, in addition to HIV, as specified by rule. The bill
requires DOH to give pregnant women who have HIV information on the need for ARV medication for
their newborn, their medication options, and how to access medication after hospital discharge. The bill
removes a reference to a specific type of ARV medication DOH may provide information on and
incorporates more general information on ARV medications, allowing for additional options. The bill
requires DOH to educate pregnant women who have HIV on the importance of engaging in and
continuing HIV care. Lastly, the bill requires DOH to conduct additional follow up for HIV-exposed
newborns to ensure final HIV status is known and necessary linkages to care are made.
1 Department of Health, Targeted Outreach for Pregnant Women Act, http://stlucie.floridahealth.gov/programs-and-services/infectious-
disease-services/hiv-aids/topwa.html (last visited Jan. 20, 2022).
2 Email from Gangul Gabadage, Legislative Planning Coordinator, Department of Health, TOPWA Numbers (Jan. 24, 2022).
3 Id.
4 Id.
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Institutional Accreditation
Current Situation
Accreditation is the recognition from an accrediting agency that an institution maintains a certain level
of educational standards. Institutional accreditation normally applies to an entire institution and
indicates that each entity of a school contributes to the achievement of the school’s objectives. This
does not necessarily mean that all parts of the school have the same quality level of education. 5
Accrediting agencies issue accreditations. 6 Institutions or programs that request an agency’s evaluation
and that meet an agency’s criteria are then accredited by that agency. 7 Accrediting agencies are
organizations made up of educational professionals that: 8
• Establish the operating standards for educational or professional institutions and programs;
• Determine if a school meets those standards; and
• Publically announce their findings through the issuance of accreditations.
While the United States Department of Education (DOE) does not issue accreditations, it does hold
agencies accountable by ensuring that such agencies enforce their accreditation standards effectively.
As part of DOE oversight, the Secretary of Education is required by law to publish a list of nationally
recognized accrediting agencies that the Secretary determines to be reliable authorities as to the
quality of education or training provided by the institutions of higher education and the higher education
programs they accredit. 9
The DOE issued finalized regulations in the Federal Register in October 2019 relating to institutional
accrediting agencies. 10 DOE issued a letter of guidance on February 26, 2020, specifying that final
regulations omit references to “regional” and “national” accreditation. 11 The letter specifies, “[b]ecause
the Department holds all accrediting agencies to the same standards, distinctions between regional and
national accrediting agencies are unfounded.” Provisions implemented in 34 C.F.R. § 602.32(d),
relating to the recognition of accrediting agencies, became effective January 1, 2021.
However, the education requirements in current Florida law distinguish regional from institutional
accrediting agencies for chiropractic medicine, clinical laboratory directors, and orthotists and
prosthetists, which does not align with the federal guidance.
5 U.S. Department of Homeland Security – Study in the States, The Basics of School Accreditation,
https://studyinthestates.dhs.gov/the-basics-of-school-accreditation (last visited Jan. 20, 2022).
6 Id. See also U.S. Department of Education, Database of Accredited Postsecondary Institutions and Programs,
https://ope.ed.gov/dapip/#/home (last visited March 20, 2021).
7 U.S. Department of Education, Database of Accredited Postsecondary Institutions and Programs, https://ope.ed.gov/dapip/#/home
(last visited Jan. 20, 2022).
8 Supra, note 5.
9 Supra, note 7.
10 84 C.F.R § 58834 (2020). The new regulations delayed implementation of changes to DOE staff’s review of accrediting agency
applications for initial or renewal of recognition under 34 C.R.R. § 602.32(d) until January 1, 2021. The new regulations also delayed
implementation of changes to DOE staff’s process for responding to accrediting agency applications and allowing agency responses
within 180 days under 34 C.F.R. § 602.32(h) until July 1, 2021.
11 U.S. Department of Education, Re: Final Accreditation and State Authorization Regulations (February 26, 2021)
https://sacscoc.org/app/uploads/2020/03/State-Authorization-Letter-w-Diane-Signature-2.26.19.pdf (last visited Jan. 20, 2022).
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Effect of Proposed Changes – Institutional Accreditation
The bill removes all references to “regional” accreditation in the practice acts for chiropractic medicine,
clinical laboratory directors, orthotists and prosthetists, clinical social workers, and marriage and family
therapists. The bill replaces the references with “institutional” accreditation throughout.
Nursing
Current Situation
The Board of Nursing (Board) within DOH, oversees the licensure and regulation of certified nursing
assistants (CNA), licensed practical nurses (LPN), registered nurses (RN), and advanced practice
registered nurses (APRN). The Board has the authority to adopt rules to implement ch. 464, F.S., which
regulates the practice of nursing in this state. 12 Additionally, the Board is responsible for
administratively disciplining a CNA, LPN, RN, and APRN who commits an act prohibited under s.
464.018 or s. 456.072, F.S.
Current law specifies that being found guilty of any offense prohibited by s. 435.04, F.S., or an act of
domestic violence, regardless of adjudication, or entering a plea of nolo contendere or guilty to, is
ground for denial of a nursing license application or disciplinary action against a nursing licensee. 13
However, entering a guilty plea, or pleading nolo contendere, to these crimes is only grounds for
licensure denial if there is a conviction. Other practice acts authorize license denial and discipline for
pleading guilty or nolo contendere regardless of adjudication. 14
Effect of Proposed Changes – Nursing
The bill moves “regardless of adjudication” after “or entered a plea of nolo contendere or guilty to”
which allows DOH to deny a nursing licensure application or discipline a licensed CNA, LPN, RN, or
APRN who is found guilty of, or pleads guilty or no contest to an offense prohibited in ch. 435, F.S., or
domestic violence under s. 741.28, F.S.
Midwifery
Current Situation
Chapter 467, F.S., is the practice act for midwifery (Act). DOH licenses and regulates the practice of
midwifery in this state. Midwifery is the practice of supervising a normal labor and childbirth, with the
informed consent of the parent, advising the parents as to the progress of childbirth, and rendering
prenatal and postpartal care. 15 The Council of Licensed Midwifery assists and advises DOH on
midwifery, including the development of rules relating to regulatory requirements. These regulations
include training requirements, the licensure examination, responsibilities of midwives, emergency care
plans, and reports and records to be filed by licensed midwives. 16
Licensure
An individual must graduate from an approved midwifery program and pass a licensure examination to
be eligible for licensure as a midwife. 17 A licensed midwife must submit a general emergency care plan
to DOH, which addresses consultation with other health care providers, emergency transfer protocols,
and access to neonatal intensive care units and obstetrical units or other patient care areas with his or
12 Section 464.006, F.S.
13 Section 464.018(1)(e), F.S.
14 Examples of other practice acts include allopathic physicians under in s. 458.331(1)(c), F.S., osteopathic physicians in s.
459.015(1)(c), F.S., pharmacists in s. 465.016(1)(f), F.S., and dentists and dental hygienists in s. 466.028(1)(c), F.S.
15 Section 467.003(8), F.S.
16 Section 467.004, F.S.
17 Section 467.011, F.S. Section 467.0125, F.S. DOH no longer administers licensure examinations.
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her application for licensure and licensure renewal. 18 A licensed midwife must also submit proof of
professional liability coverage of at least $100,000, with an annual aggregate of at least $300,000. 19
DOH may issue a license by endorsement for midwifery applicants who: 20
• Holds a valid certificate or diploma from a foreign institution of medicine or from midwifery
program in another state provided the requirements for licensure or certification in another
country or another state are equivalent to or exceed that which is required for licensing in
Florida; or
• Holds a valid certificate or license to practice midwifery in another state provided the
requirements for licensure or certification in another state are equivalent to or exceed that which
is required for licensing in Florida; and
• Has completed a 4-month prelicensure course conducted by an approved program; and
• Has successfully passed the licensed midwifery examination.
Areas of Critical Need
DOH may also issue a temporary certificate to a midwife who qualifies for licensure by endorsement to
practice in areas of critical need. 21 Currently, a temporary certificate issued to practice in areas of
critical need valid as long as an area for which it’s issued remains an area of critical need, but not
longer than two years, and the certificate is not renewable. 22 Currently, if the area in which a midwife is
practicing ceases to be an area of critical need, DOH must immediately initiate disciplinary action to
revoke his or her temporary certificate. 23
Midwifery Students
The Act uses the terms “applicant” and “student midwife” interchangeably. It also sets standards for
admission, education, and clinical training in the context of student requirements, which, according to
DOH, may cause confusion. 24 As an example, current law requires a student midwife to have a high
school diploma or the equivalent to enroll in an education program, but the act does not clearly state
that a high school diploma is a requirement for licensure. 25
According to DOH, the use of the undefined term “student midwife” has led to unlicensed persons
attempting to work with clients and complete clinical requirements without enrolling in or being
educated by an approved midwifery program, as well as midwives attempting to serve as preceptors
who are not affiliated with an approved midwifery program. 26
18 Section 467.017, F.S.
19 Rule 64B24-7.013, F.A.C. An applicant does not have to submit proof of professional liability insurance if the applicant practices
exclusively as an officer, employee, or agent of the federal government, practices only in conjunction with teaching duties at an
approved midwifery school that provides such coverage on the applicant’s behalf, or who does not practice midwifery in this state and
provides proof of such.
20 Section 467.0125(1), F.S.
21 Section 467.0125(2), F.S.
22 Id.
23 Department of Health Agency Analysis of 2022 House Bill 693, (Jan. 7, 2022)
24 Id.
25 Section 467.009, F.S. See also Supra, note 23.
26 Supra, note 2. In general, health care practitioners do not start seeing clients in a clinical setting until they have completed
prerequisite portions of a course of study and are near the end of their educational program.
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Midwifery Education Programs
Any accredited or state-licensed institution of higher learning may provide midwifery education and
training. Midwifery education programs may apply to DOH to obtain approved program status. 27
Approval may be obtained if a program meets requirements for accreditation, faculty, curriculum, and
clinical training. 28 Current law requires nonpublic educational institutions be accredited by the
Commission on Recognition of Postsecondary Accreditation (CRPA) in order to be approved as a
midwifery program. 29 However, CRPA has been succeeded by the Council for Higher Education
Accreditation, which is not recognized in current law. 30
Currently, the Act does not address midwifery programs which are seeking accreditation and are
provisionally approved while awaiting their first graduating class.
Current law allows DOH to place a midwifery educational program on probationary status if it no longer
meets required standards; if the program fails to correct these conditions, DOH may rescind its
approval. 31 However, statutes provide no guidance regarding notification to the program or length of
time a school may remain in probationary status. Additionally, the circumstances under which DOH
may rescind the approval of a midwifery education program under the Act is unclear as it does not
provide a definitive timeline for a non-compliant program to come back into compliance before DOH
may rescind its approval. Current law allows a non-compliant program to correct itself “within a
specified period of time” 32; however no timeline is provided in statute or rule.
Effect of Proposed Changes – Midwifery
The bill makes numerous changes to the midwifery practice act.
Licensure
The bill prohibits endorsement without a license or certification in another state, territory or jurisdiction
and creates a pathway to licensure by examination for applicants who have completed education
equivalent to or exceeds that which is required for licensing in Florida in a state, territory, or jurisdiction
that does not license midwives. These revisions do not change what is actually required to qualify for a
midwifery license, but instead help applicants better understand those requirements. 33
The bill allows midwifery programs to be provisionally approved for five years. This change conforms to
the five-year period that such programs can be provisionally licensed by the U.S. Department of
Education’s Commission for Independent Education when seeking accreditation status. DOH will be
able to give provisional approval to a new program which has met all requirements except for showing
their students have an 80% passage rate on the national exam. Programs provisionally approved will
have five years to demonstrate the required exam approval rate after they are preliminarily approved.
This time period allows completion of the three-year education program for at least one cohort of
students, and for those students to take the exam before the Department tries to determine the passing
rate. 34
The bill removes obsolete references to the DOH-issued exam for midwifery licensure as DOH no
longer administers licensure examinations.
27 Section 467.205, F.S.
28 Rule 64B24-4.002, F.A.C.
29 Section 467.009(8), F.S.
30 Supra, note 23.
31 Section 467.205, F.S.
32 Id.
33 Supra, note 23.
34 Id.
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Areas of Critical Need
When a practice area is no longer designated as an area of critical need, the bill requires a certified
midwife who practices in an area of critical need to relinquish his or her certificate within 30 days, or
move his or her practice to another area of critical need, rather than being immediately subject to
disciplinary action. Only if the midwife holding the temporary certificate fails to act within those thirty
days will DOH initiate disciplinary action to revoke the certificate. 35
Midwifery Students
The bill prohibits a preceptor from supervising a midwifery student unless the student has been enrolled
in an approved midwifery program. This means that an individual cannot begin their clinical practice
before enrolling in an approved midwifery program and will explicitly conform midwifery training with the
requirements of other medical professions, with students having to complete the majority of their
classroom training before working with patients in a clinical setting.
Midwifery Education Programs
The bill updates the accreditation requirement for private educational institutions by replacing the
defunct Commission on Recognition of Postsecondary Accreditation with the Council for Higher
Education Accreditation or provisional licensing by the Commission for Independent Education. The bill
also allows DOH to approve midwifery programs at private educational institutions which are accredited
by an agency recognized and approved by the U.S. Department of Education.
The bill authorizes DOH to grant provisional approval of a new midwifery education program which is
seeking accreditation for up to 5 years.
Lastly, the bill authorizes DOH to place a midwifery program on probationary status for up to 3 years if
such program fails to maintain the requirements of an approved program or has lost accreditation. If a
program in probationary status fails to come into compliance with the requirements of an approved
program or does not regain its accreditation, DOH may rescind the program’s approval.
Orthotists and Prosthetists
Current Situation
The Board of Orthotists and Prosthetists oversees licensure and regulation of orthotists 36 and
prosthetists. 37 A person applying for licensure must first apply to DOH to take the appropriate licensure
examination. The board may accept the exam results of a national orthotic or prosthetic, standards
organization in lieu of administering the state exam. 38 The board must verify that an applicant for
licensure examination meets the following requirements: 39
• Has completed the application form and paid all applicable fees;
• Is of good moral character;
• Is 18 years of age or older;
• Has completed the appropriate educational preparation, including practical training
requirements; and
• Has successfully completed an appropriate clinical internship in the professional area for which
the license is sought.
35 Supra, note 23.
36 An orthotist is a health care professional who evaluates, formulates treatment, measures, designs, fabricates, assembles, fits,
adjusts, services, or provides necessary training to accomplish the fitting of an orthosis or a pedorthic device (s. 468.80(9)-(10), F.S.)
37 An prosthetist is a health care professional who evaluates, formulates treatment, measures, designs, fabricates, assembles, fits,
adjusts, services, or provides necessary training to accomplish the fitting of a prosthesis (s. 468.80(15)-(16), F.S.)
38 Section 468.803(4), F.S. The Board has approved the American Board for Certification in Orthotics, Prosthetics, and Pedorthics
(ABC) exam for orthotist and prosthetist applicants (r. 64B14-4.001, F.A.C.)
39 Section 468.803(2), F.S.
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Background Screening
Chapter 435, F.S., establishes standard procedures and requirements for criminal history background
screening of prospective employees. There are two levels of background screening: level 1 and level 2.
Level 1 screening includes, at a minimum, employment history checks and statewide criminal
correspondence checks through the Florida Department of Law Enforcement (FDLE) and a check of
the Dru Sjodin National Sex Offender Public Website, 40 and may include criminal records checks
through local law enforcement agencies. A level 2 background screening includes, but, is not limited to,
fingerprinting for statewide criminal history records checks through FDLE and national criminal history
checks through the Federal Bureau of Investigation (FBI), and may include local criminal records
checks through local law enforcement agencies. 41
Every person required by law to be screened pursuant to ch. 435, F.S., must submit a complete set of
information necessary to conduct a screening to his or her employer. 42 Such information for a level 2
screening includes fingerprints, which are taken by a vendor that submits them electronically to
FDLE. 43
Effect of Proposed Changes – Orthotists and Prosthetists
The bill removes obsolete references to form and fee requirements for background screening of
orthotists, prosthetists, and pedorthists which are no longer collected by DOH.
Psychologists
Current Situation
The Board of Psychology oversees the licensure and regulation of psychologists. 44 To receive a license
to practice psychology, an individual must: 45
• Meet one of the following educational requirements:
o Received a doctoral-level psychological education from an institution that had
institutional accreditation from an agency recognized by the United States Department of
Education or was recognized as a member in good standing with the Association of
Universities and Colleges of Canada, and had programmatic accreditation from the
American Psychological Association (APA); 46 or
o Received the equivalent of a doctoral-level education from a program at a school or
university located outside of the United States, which is officially recognized by the
government of the country in which it is located as a program or institution to train
students to practice professional psychology.
• Complete 2 years or 4,000 hours of supervised experience;
• Pass the Examination for Professional Practice in Psychology; 47 and
• Pass an examination on Florida laws and rules.
40 The Dru Sjodin National Sex Offender Public Website is a U.S. government website that links public state, territorial, and tribal sex
offender registries in one national search site. The website is available at https://www.nsopw.gov/ (last visited Jan. 20, 2022).
41 Section 435.04, F.S.
42 Section 435.05(1)(a), F.S.
43 Sections 435.03(1) and 435.04(1)(a), F.S.
44 Section 490.004, F.S.
45 Section 490.005(1), F.S.
46 Section 490.003(3), F.S., defines doctoral-level education as a Psy.D, an Ed.D., or a Ph.D in psychology.
47 Rule 64B19-11.001, F.A.C.
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Applicants for licensure by endorsement must: 48
• Be a diplomate in good standing with the American Board of Professional Psychology;
• Hold a doctoral degree in psychology with at least 10 years of experience as a licensed
psychologist in any jurisdiction or territory of the U.S. within the 25 years preceding the date of
application.
The APA is recognized by the U.S. Department of Education and the Council for Higher Education
Accreditation as the national accrediting authority for professional education and training in
psychology. 49 To be licensed as a psychologist in this state, an applicant with a Doctoral degree must
have received that degree from a program accredited by the APA. Lack of APA accreditation is grounds
for licensure denial under the licensure by endorsement method. 50
Effect of Proposed Changes – Psychologists
The bill allows a psychologist applying by endorsement to obtain a license regardless of whether the
doctoral program was APA accredited. This will allow applicants who did not graduate from an APA
accredited program to be licensed by endorsement while maintaining the needed accreditation and
educational standards for licensure by examination. 51
Marriage and Family Therapy and Mental Health Counseling
Current Situation
Marriage and Family Therapists
Marriage and family therapy incorporates marriage and family therapy, psychotherapy, hypnotherapy,
sex therapy, counseling, behavior modification, consultation, client-centered advocacy, crisis
intervention, and the provision of needed information and education to clients. 52 An applicant seeking
licensure as a mental health counselor must: 53
• Possess a master’s degree from:
o An institution of higher learning accredited by a regional accrediting body recognized by
the Commission on Recognition of Postsecondary Accreditation (CRPA); and
o A program accredited by the Commission on Accreditation for Marriage and Family
Therapy Education; or
o A Florida university program accredited by the Council for Accreditation of Counseling
and Related Educational Programs and board-approved graduate courses. 54
• Complete two years of post-master’s supervised experience under the supervision of a licensed
marriage and family therapist with five years of experience or the equivalent who is a qualified
supervisor as determined by the board;
• Pass a board-approved examination; and
• Demonstrate knowledge of laws and rules governing the practice.
Current law requires licensure applicants to hold a master’s degree from an institution of higher
learning accredited by a regional accrediting body recognized by the CRPA. The CRPA has been
48 Section 490.006, F.S.
49 American Psychological Association, Understanding APA Accreditation, http://www.apa.org/ed/accreditation/about/index.aspx (last
visited Jan. 20, 2022).
50 Supra, note 23
51 Id.
52 American Association for Marriage and Family Therapy, About Marriage and Family Therapists,
https://www.aamft.org/About_AAMFT/About_Marriage_and_Family_Therapists.aspx (last visited Jan. 20, 2022).
53 Section 491.005(3), F.S. An individual may qualify for a dual license in marriage and family therapy if he or she passes an
examination in marriage and family therapy and has held an active license for at least three years as a psychologist, clinical social
worker, mental health counselor, or advanced registered nurse practitioner who is determined by the Board of Nursing to be a specialist
in psychiatric mental health (s. 491.0057, F.S.)
54 Ch. 2020-133, Laws of Fla, required applicants for licensure as a marriage and family therapist to graduate from an accredited
program or an accredited Florida university program.
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succeed by the Council for Higher Education Accreditation, which is not recognized in current law.
Additionally, current board rule requires licensure applicants to pass the board-approved examination
developed by the Examination Advisory Committee of the Association of Marital and Family Therapy
Regulatory Board. 55 This conflicts with current law, which requires applicants to pass an exam
administered by DOH. 56 However, DOH no longer administers licensure examinations.
DOH must verify that an applicant’s education matches the specified courses and hours as outlined in
statute. However, there are organizations that accredit marriage and family therapy education
programs, including the Commission on Accreditation for Marriage and Family Therapy Education
(COAMFTE) and the Council for the Accreditation of Counseling and Related Educational Programs
(CACREP) that establish the minimum standards to meet the requirements to practice the profession. 57
In 2020, the Legislature passed HB 713, which, among other things, revised licensure requirements for
marriage and family therapists. Beginning on July 1, 2020, applicants for licensure must possess a
master’s degree from an a program accredited by COAMFTE or from a Florida university program
accredited by CACREP and board-approved graduate courses. 58 However, a window of time was not
granted for education programs which were unaccredited at the time to apply for and obtain such
accreditation, meaning students who graduate on or after July 1, 2020, from such programs do not
meet the accreditation qualifications for licensure in Florida. 59 Currently, six universities in Florida have
a marriage and family therapy program that is not accredited by either COAMFTE or CACREP. 60
Mental Health Counselors
A mental health counselor is an individual who uses scientific and applied behavioral science theories,
methods, and techniques to describe, prevent, and treat undesired behavior and enhance mental
health and human development and is based on research and theory in personality, family, group, and
organizational dynamics and development, career planning, cultural diversity, human growth and
development, human sexuality, normal and abnormal behavior, psychopathology, psychotherapy, and
rehabilitation. 61 To qualify for licensure as a mental health counselor, an individual must: 62
• Have a master’s degree from a mental health counseling program accredited by CACREP, or a
program related to the practice of mental health counseling that includes coursework and a 700-
hour practicum, internship, or fieldwork of which at least 280 hours must be in direct client
services;
• Have at least two years of post-master’s supervised clinical experience in mental health
counseling;
• Pass an examination from the Professional Examination Service for the National Academy of
Certified Clinical Mental Health Counselors; and
• Pass an eight-hour course on Florida laws and rules approved by the Board of Clinical Social
Work, Marriage and Family Therapy, and Mental Health Counseling. 63
Current board rule requires licensure applicants to pass the board-approved examination from the
National Clinical Mental Health Counseling Examination. 64 This conflicts with current law, which
55 Rule 64B4-3.003(2)(c), F.A.C.
56 Section 491.005(3)(d), F.S.
57 See Commission on Accreditation for Marriage and Family Therapy Education, What Are the Benefits of COAMFTE Accreditation,
https://www.coamfte.org/COAMFTE/Accreditation/About_Accreditation.aspx (last visited Jan. 20, 2022), and Council for the
Accreditation of Counseling and Related Educational Programs, About CACREP, https://www.cacrep.org/about-cacrep/ (last visited
Jan. 20, 2022).
58 Section 491.005, F.S. (2020).
59 Supra, note 23.
60 Id.
61 Sections 491.003(6) and (9), F.S.
62 Section 491.005(4), F.S.
63 Section 491.005(4), F.S., and r. 64B4-3.0035, F.A.C.
64 Rule 64B4-3.003(2)(b), F.A.C.
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requires applicants to pass an exam administered by DOH. 65 However, DOH no longer administers
licensure examinations.
Ch. 2020-133, L.O.F, also revised licensure requirements for mental health counselors. Beginning July
1, 2025, applicants for licensure as a mental health counselor must hold a master’s degree from a
program accredited by CACREP. 66 The CACREP accreditation standards require 60 credits of
specified educational content and a 700-hour practicum requiring face-to-face psychotherapy. 67 There
are currently sixteen universities in this state accredited by CACREP. 68 The University of West Florida’s
(UWF) mental health counselor program is the only program accredited by the Masters in Psychology
and Counseling Accreditation Council in this state. 69 Thus, beginning in 2025, UWF’s current
accreditation for its mental health counselor program will not be sufficient for graduates to meet
licensure requirements in this state.
Effect of the Bill – Marriage and Family Therapy and Mental Health Counseling
Marriage and Family Therapists
The bill allows DOH to continue to issue licenses to graduates of otherwise qualified Florida marriage
and family therapy programs until July 1, 2027, while such programs seek accreditation.
The bill also updates the accreditation requirement for institutions of higher education by replacing the
defunct Commission on Recognition of Postsecondary Accreditation with the Council for Higher
Education Accreditation.
Additionally, the bill removes obsolete references to DOH-issued licensure examinations.
Mental Health Counselors
The bill adds the Masters in Psychology and Counseling Accreditation Council, or an equivalent body,
as an authorized accrediting body for mental health counselor education programs beginning on July 1,
2025. This will allow UWF to continue to graduate students who are eligible for licensure in this state.
Florida Birth-Related Neurological Injury Compensation Association
Current Situation
Florida Birth-Related Neurological Injury Compensation Plan
The Florida Birth-Related Neurological Injury Compensation Plan (Plan) was created by the Legislature
to manage both rising medical malpractice costs and diminishing availability of liability insurance by
creating a hybrid no-fault and tort medical liability system. 70 The Plan was created to pay for the care of
infants born with certain neurological injuries and is available to eligible families without the need for
litigation. By eliminating costly legal proceedings, the Plan aims to ensure that birth-injured infants
receive the care they need while reducing the financial burden on both medical providers and families.
65 Section 491.005(4)(d), F.S.
66 Section 491.005(4)(b), F.S.
67 Supra, note 23.
68 Council for Accreditation for Counseling and Related Educational Programs, Find a Program, https://www.cacrep.org/directory/ (last
visited Jan. 20, 2022).
69 Masters in Psychology and Counseling Accreditation Council, Accredited Programs, http://mpcacaccreditation.org/accredited-
programs/ (last visited Jan. 20, 2022).
70 Id.
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Florida Birth-Related Neurological Injury Compensation Association
In 1988, the Legislature created the Florida Birth-Related Neurological Injury Compensation
Association (NICA) to manage the Plan. 71 NICA is an independent association. Although it is not a
state agency, NICA is subject to regulation and oversight by the Office of Insurance Regulation (OIR)
and the Joint Legislative Auditing Committee. Directors on NICA’s board are appointed by the Chief
Financial Officer (CFO) for staggered terms of 3 years or until their successors are appointed, but there
is no limit on the number of terms a director may serve. 72 The board of directors is composed of: 73
• One citizen representative;
• One representative of participating physicians;
• One representative of hospitals;
• One representative of casualty insurers; and
• One representative of physicians other than participating physicians.
The board of directors may: 74
• Administer the Plan;
• Administer the funds collected on behalf of the Plan;
• Administer the payment of claims on behalf of the Plan;
• Direct the investment and reinvestment of any surplus funds over losses and expenses,
provided that any investment income generated thereby remains credited to the Plan;
• Reinsure the risks of the Plan in whole or in part;
• Sue, be sued, appear, and defend in all actions relating to the Plan;
• Exercise all powers necessary to effect any of the purposes for which the Plan is created.;
• Enter into such contracts as are necessary or proper to administer the Plan;
• Employ or retain such persons as are necessary to perform the administrative and financial
transactions and responsibilities of the Plan’
• Take such legal action as may be necessary to avoid payment of improper claims; and
• Indemnify any person acting on behalf of the Plan in an official capacity, provided that such
person acted in good faith.
Annually, NICA must furnish audited financial reports to any Plan participant upon request, OIR and the
Joint Legislative Auditing Committee. 75
The reports must be prepared in accordance with accepted accounting procedures. OIR or the Joint
Legislative Auditing Committee may conduct an audit of the Plan at any time. 76
Assessments
In July 1988, the Legislature authorized a transfer of $20 million to NICA from the Department of
Insurance (the predecessor agency to OIR) 77 to provide initial funding to administer the Plan. Currently,
the Plan is funded by a combination of physician fees and hospital assessments. 78 A participating
physician is required to pay a $5,000 fee each year for coverage which runs January 1 through
December 31. 79 All licensed Florida physicians pay a mandatory fee of $250, regardless of specialty.
Hospitals pay $50 for each live birth during the previous calendar year. Certain exemptions apply to all
of these categories, including resident physicians, retired physicians, government physicians, and
71 Section 766.315, F.S. and ch. 88-1, s. 74, Laws of Fla.
72 Id.
73 Id.
74 Id.
75 Id.
76 Id.
77 Ch. 88-277, s. 41, Laws of Fla.
78 Section 766.314, F.S.
79 Id.
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facilities. 80 Initial assessments are collected by DOH, though current law states initial assessments are
to be collected by the Department of Business and Professional Regulation (DBPR), which has not had
regulatory authority over health care practitioners since 2000. 81
Between July 2018 and June 2020, NICA’s audited financial statements showed a total of $54,755,762
in assessments was collected. 82 However, a 2021 Auditor General report showed an increase in
delinquent assessments between 2016 and 2021, totaling $14.4 million.
Active Non-Participating Physician Assessments Paid and Delinquent, 2016 – 2021 83
NICA is authorized to enforce collection of unpaid assessments by filing suit in county court and may
recover attorney fees, costs and interest related if it obtains a final judgment. 84 DOH is prohibited from
renewing a physician’s license if NICA notifies DOH that the physician has unpaid assessments and
that there is an unsatisfied final judgment against the physician. 85
Effect of the Bill – NICA
The bill addresses unpaid assessments by requiring allopathic and osteopathic physicians to provide
proof of payment of NICA assessments as a condition of licensure. This may potentially increase timely
payment of the assessment and reduce the need for NICA to seek judicial remedy for unpaid
assessments. The bill also requires NICA to notify DOH and applicable boards of any unpaid final
judgment within seven days of the final judgement.
The bill also updates references from DBPR to DOH throughout.
80 Id.
81 Section 766.134, F.S. The Department of Business and Professional Regulation previously licensed health care practitioners in
Florida when NICA was created. The Legislature moved this responsibility to the Division of Medical Quality Assurance within DOH in
2000. See ch. 2000-160, L.O.F. and supra, note 23.
82 Florida Birth-Related Neurological Injury Compensation Association, State of Florida Auditor General – Operational Audit, August
2021.
83 Id.
84 Section 766.314(6)(b), F.S.
85 Id.
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Medical Marijuana Testing
Current Situation
Presently, processed marijuana products must be tested for contaminants that are harmful for human
consumption and to ensure that products meet the THC and CBD potency requirements. 86 The DOH
must adopt rules determining what contaminants must be tested for and at what levels such
contaminants are unsafe for human consumption, as well as rules for the treatment of marijuana
products that fail the safety and potency requirements. 87
Current law authorizes the DOH to select random samples of edible products available for purchase for
testing to determine whether the THC and CBD potency level on the label is accurate and whether the
edible is safe for human consumption. DOH does not have express authority to sample all other types
of medical marijuana or medical marijuana delivery devices. Additionally, current law does not provide
an exception to criminal law to allow DOH, and its employees acting within the scope of their
employment, to acquire, possess, test, transport, and lawfully dispose of marijuana.
A medical marijuana treatment center (MMTC) must recall all edibles that fail to meet safety and
potency requirements. 88 DOH does not have express authority to require MMTCs to recall other types
of medical marijuana or medical marijuana delivery devices that fail to meet safety and potency
requirements.
Each MMTC is required to contract with a certified marijuana testing laboratory (CMTL) to test
processed marijuana before it is dispensed. 89 Testing results must indicate that the low-THC cannabis
meets the statutory definition; THC potency meets statutory requirements; THC and CBD are labeled
accurately; and the marijuana is safe for human consumption and free from contaminants that are
unsafe for human consumption. 90
Effect of the Bill – Medical Marijuana Testing
The bill requires MMTCs to test all forms of its marijuana, not only processed marijuana, to ensure that
it meets safety and potency requirements before it is dispensed. The bill requires MMTCs to recall all
forms of marijuana that fail to meet the safety and potency requirements, rather than only edibles.
The bill authorizes the DOH to select available samples of all forms of marijuana available in a medical
marijuana treatment center for testing to determine that the marijuana is safe for human consumption
and that the THC and CBD potency level on the label is accurate or to verify medical marijuana testing
laboratory results. The bill also authorizes the DOH to sample marijuana delivery devices from a
marijuana treatment center to determine that the marijuana delivery device is safe for use by qualified
patients. The bill permits the DOH, including employees acting within the scope of their employment, to
acquire, possess, test, transport, and lawfully dispose of marijuana. The bill requires MMTCs to recall
all forms of medical marijuana and marijuana delivery devices that fail to meet safety and potency
requirements.
86 Section 381.986(8)(e)11.d., F.S.
87 Id.
88 Id.
89 Id.
90 Id.
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Special Needs Shelters
Current Situation
Special needs shelters ensure persons with special needs have a safe and secure location during an
emergency or disaster. In 2000, the Legislature established a system to recruit health care practitioners
to staff special needs shelters in times of emergencies or disasters, and required DOH to be the lead
agency for these responsibilities. 91
Current law establishes DOH’s Division of Children’s Medical Services (CMS) as the lead for the
coordination of local medical and health care providers to develop a plan for the staffing and medical
management of pediatric special needs shelters and to participate in local decision-making regarding
the medical supervision of special needs shelters. 92 CMS’s workforce consists of local health care
practitioners with specialized training and experience in the provision of services for children with
special needs. 93 However, through a series of program and organizational changes toward more
effective operation and costs, the CMS workforce has been reduced by more than 70% since 2018. 94
Due to this change in workforce, CMS can no longer support the charges of the statute. 95
Effect of the Bill – Special Needs Shelters
The bill designates DOH, rather than CMS specifically, as the lead for the coordination of local medical
and health care providers in developing a plan for the staffing and medical management of pediatric
special needs shelters. Additionally, the bill require DOH to determine who is responsible for the
medical supervision of each special needs shelter.
Finally, the bill makes various conforming changes.
The bill provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Amends s. 381.0045, F.S., relating to targeted outreach for pregnant women.
Section 2: Amends s. 381.0303, F.S., relating to special needs shelters.
Section 3: Amends s. 381.986, F.S., relating to medical use of marijuana.
Section 4: Amends s. 456.039, F.S., relating to designated health care professionals; information
required for licensure.
Section 5: Amends s. 460.406, F.S., relating to licensure by examination.
Section 6: Amends s. 464.008, F.S., relating to licensure by examination.
Section 7: Amends s. 464.018, F.S., relating to disciplinary actions.
Section 8: Amends s. 467.003, F.S., relating to definitions.
Section 9: Amends s. 467.009, F.S., relating to midwifery programs; education and training
requirements.
Section 10: Amends s. 467.011, F.S., relating to licensure by examination.
Section 11: Amends s. 467.0125, F.S., relating to licensure by endorsement.
Section 12: Amends s. 467.205, F.S., relating to approval of midwifery programs.
Section 13: Amends s. 468.803, F.S., relating to license, registration, and examination requirements.
Section 14: Amends s. 483.824, F.S., relating to qualifications of clinical laboratory director.
Section 15: Amends s. 490.003, F.S., relating to definitions.
Section 16: Amends s. 490.005, F.S., relating to licensure by examination.
Section 17: Amends s. 490.0051, F.S., relating to provisional licensure; requirements.
Section 18: Amends s. 491.005, F.S., relating to licensure by examination.
Section 19: Amends s. 766.314, F.S., relating to assessments; plan of operation.
Section 20: Provides an effective date of July 1, 2022.
91 Ch. 2000-140, L.O.F. See also supra, note 23.
92 Section 381.0303, F.S.
93 Supra, note 23.
94 Id.
95 Id.
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II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
DOH may experience an increase in workload to conduct rulemaking and updating online
application websites to implement the provisions of the bill, the impact of which can be absorbed
within current resources. 96
DOH may also experience an increase in expenditures relating to medical marijuana sampling and
testing, the impact of which can be absorbed within current resources. 97
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:
Current law provides sufficient rule-making authority to implement the provisions of the bill.
96 Id.
97 Id.
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C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
PCS for HB 693 2022
1 A bill to be entitled
2 An act relating to the Department of Health; amending
3 s. 381.0045, F.S.; revising the purpose of the
4 department's targeted outreach program for certain
5 pregnant women; requiring the department to encourage
6 high-risk pregnant women of unknown status to be
7 tested for sexually transmissible diseases; requiring
8 the department to provide specified information to
9 pregnant women who have human immunodeficiency virus
10 (HIV); requiring the department to link women with
11 mental health services when available; requiring the
12 department to educate pregnant women who have HIV on
13 certain information; requiring the department to
14 provide, for a specified purpose, continued oversight
15 of newborns exposed to HIV; amending s. 381.0303,
16 F.S.; removing the Children's Medical Services office
17 from parties required to coordinate in the development
18 of local emergency management plans for special needs
19 shelters; amending s. 381.986, F.S.; authorizing the
20 department to select samples of marijuana from medical
21 marijuana treatment center facilities for certain
22 testing; authorizing the department to select samples
23 of marijuana delivery devices from medical marijuana
24 treatment centers to determine whether the device is
25 safe for use; requiring medical marijuana treatment
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26 centers to recall marijuana and marijuana delivery
27 devices, instead of just edibles, under certain
28 circumstances; exempting the department and its
29 employees from criminal provisions if they acquire,
30 possess, test, transport, or lawfully dispose of
31 marijuana and marijuana delivery devices under certain
32 circumstances; amending s. 456.039, F.S.; requiring
33 applicants to provide certain proof of payment;
34 amending s. 460.406, F.S.; revising provisions related
35 to chiropractic physician licensing; amending s.
36 464.008, F.S.; deleting a requirement that certain
37 nursing program graduates complete a specified
38 preparatory course; amending s. 464.018, F.S.;
39 revising grounds for disciplinary action against
40 licensed nurses; amending s. 467.003, F.S.; revising
41 and defining terms; amending s. 467.009, F.S.;
42 revising provisions related to approved midwifery
43 programs; amending s. 467.011, F.S.; revising
44 requirements for licensure of midwives; amending s.
45 467.0125, F.S.; revising requirements for licensure by
46 endorsement of midwives; revising requirements for
47 temporary certificates to practice midwifery in this
48 state; amending s. 467.205, F.S.; revising provisions
49 relating to approval, continued monitoring,
50 probationary status, provisional approval, and
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51 approval rescission of midwifery programs; amending s.
52 468.803, F.S.; revising provisions related to
53 orthotist and prosthetist registration, examination,
54 and licensing; amending s. 483.824, F.S.; revising
55 educational requirements for clinical laboratory
56 directors; amending s. 490.003, F.S.; defining the
57 terms "doctoral degree from an American Psychological
58 Association accredited program" and "doctoral degree
59 in psychology"; amending ss. 490.005 and 490.0051,
60 F.S.; revising education requirements for psychologist
61 licensure and provisional licensure, respectively;
62 amending s. 491.005, F.S.; revising requirements for
63 licensure of clinical social workers, marriage and
64 family therapists, and mental health counselors;
65 amending s. 766.314, F.S.; deleting obsolete language
66 and updating provisions to conform to current law;
67 revising the frequency with which the department must
68 submit certain reports to the Florida Birth-Related
69 Neurological Injury Compensation Association; revising
70 the content of such reports; requiring the Florida
71 Birth-Related Neurological Injury Compensation
72 Association to notficy the department and the
73 applicable board of any unpaid final judgements
74 against a physician; providing an effective date.
75
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76 Be It Enacted by the Legislature of the State of Florida:
77
78 Section 1. Subsections (2) and (3) of section 381.0045,
79 Florida Statutes, are amended to read:
80 381.0045 Targeted outreach for pregnant women.—
81 (2) It is the purpose of this section to establish a
82 targeted outreach program for high-risk pregnant women who may
83 not seek proper prenatal care, who suffer from substance abuse
84 or mental health problems, or who have acquired are infected
85 with human immunodeficiency virus (HIV), and to provide these
86 women with links to much-needed much needed services and
87 information.
88 (3) The department shall:
89 (a) Conduct outreach programs through contracts with,
90 grants to, or other working relationships with persons or
91 entities where the target population is likely to be found.
92 (b) Provide outreach that is peer-based, culturally
93 sensitive, and performed in a nonjudgmental manner.
94 (c) Encourage high-risk pregnant women of unknown status
95 to be tested for HIV and other sexually transmissible diseases
96 as specified by department rule.
97 (d) Educate women not receiving prenatal care as to the
98 benefits of such care.
99 (e) Provide HIV-infected pregnant women who have HIV with
100 information on the need for antiretroviral medication for their
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101 newborn, their medication options, and how they can access the
102 medication after their discharge from the hospital so they can
103 make an informed decision about the use of Zidovudine (AZT).
104 (f) Link women with substance abuse treatment and mental
105 health services, when available, and act as a liaison with
106 Healthy Start coalitions, children's medical services, Ryan
107 White-funded providers, and other services of the Department of
108 Health.
109 (g) Educate pregnant women who have HIV on the importance
110 of engaging in and continuing HIV care.
111 (h) Provide continued oversight of any newborn exposed to
112 HIV to determine the newborn's final HIV status and ensure
113 continued linkage to care if the newborn is diagnosed with HIV
114 to HIV-exposed newborns.
115 Section 2. Paragraphs (a) and (c) of subsection (2) of
116 section 381.0303, Florida Statutes, are amended to read:
117 381.0303 Special needs shelters.—
118 (2) SPECIAL NEEDS SHELTER PLAN; STAFFING; STATE AGENCY
119 ASSISTANCE.—If funds have been appropriated to support disaster
120 coordinator positions in county health departments:
121 (a) The department shall assume lead responsibility for
122 the coordination of local medical and health care providers, the
123 American Red Cross, and other interested parties in developing a
124 plan for the staffing and medical management of special needs
125 shelters and. The local Children's Medical Services offices
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126 shall assume lead responsibility for the coordination of local
127 medical and health care providers, the American Red Cross, and
128 other interested parties in developing a plan for the staffing
129 and medical management of pediatric special needs shelters.
130 Plans must conform to the local comprehensive emergency
131 management plan.
132 (c) The appropriate county health department, Children's
133 Medical Services office, and local emergency management agency
134 shall jointly decide who has responsibility for medical
135 supervision in each special needs shelter.
136 Section 3. Present paragraphs (e) through (h) of
137 subsection (14) of section 381.986, Florida Statutes, are
138 redesignated as paragraphs (f) through (i), respectively, a new
139 paragraph (e) is added to that subsection, and paragraph (e) of
140 subsection (8) of that section is amended, to read:
141 381.986 Medical use of marijuana.—
142 (8) MEDICAL MARIJUANA TREATMENT CENTERS.—
143 (e) A licensed medical marijuana treatment center shall
144 cultivate, process, transport, and dispense marijuana for
145 medical use. A licensed medical marijuana treatment center may
146 not contract for services directly related to the cultivation,
147 processing, and dispensing of marijuana or marijuana delivery
148 devices, except that a medical marijuana treatment center
149 licensed pursuant to subparagraph (a)1. may contract with a
150 single entity for the cultivation, processing, transporting, and
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151 dispensing of marijuana and marijuana delivery devices. A
152 licensed medical marijuana treatment center must, at all times,
153 maintain compliance with the criteria demonstrated and
154 representations made in the initial application and the criteria
155 established in this subsection. Upon request, the department may
156 grant a medical marijuana treatment center a variance from the
157 representations made in the initial application. Consideration
158 of such a request shall be based upon the individual facts and
159 circumstances surrounding the request. A variance may not be
160 granted unless the requesting medical marijuana treatment center
161 can demonstrate to the department that it has a proposed
162 alternative to the specific representation made in its
163 application which fulfills the same or a similar purpose as the
164 specific representation in a way that the department can
165 reasonably determine will not be a lower standard than the
166 specific representation in the application. A variance may not
167 be granted from the requirements in subparagraph 2. and
168 subparagraphs (b)1. and 2.
169 1. A licensed medical marijuana treatment center may
170 transfer ownership to an individual or entity who meets the
171 requirements of this section. A publicly traded corporation or
172 publicly traded company that meets the requirements of this
173 section is not precluded from ownership of a medical marijuana
174 treatment center. To accommodate a change in ownership:
175 a. The licensed medical marijuana treatment center shall
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176 notify the department in writing at least 60 days before the
177 anticipated date of the change of ownership.
178 b. The individual or entity applying for initial licensure
179 due to a change of ownership must submit an application that
180 must be received by the department at least 60 days before the
181 date of change of ownership.
182 c. Upon receipt of an application for a license, the
183 department shall examine the application and, within 30 days
184 after receipt, notify the applicant in writing of any apparent
185 errors or omissions and request any additional information
186 required.
187 d. Requested information omitted from an application for
188 licensure must be filed with the department within 21 days after
189 the department's request for omitted information or the
190 application shall be deemed incomplete and shall be withdrawn
191 from further consideration and the fees shall be forfeited.
192 e. Within 30 days after the receipt of a complete
193 application, the department shall approve or deny the
194 application.
195 2. A medical marijuana treatment center, and any
196 individual or entity who directly or indirectly owns, controls,
197 or holds with power to vote 5 percent or more of the voting
198 shares of a medical marijuana treatment center, may not acquire
199 direct or indirect ownership or control of any voting shares or
200 other form of ownership of any other medical marijuana treatment
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201 center.
202 3. A medical marijuana treatment center may not enter into
203 any form of profit-sharing arrangement with the property owner
204 or lessor of any of its facilities where cultivation,
205 processing, storing, or dispensing of marijuana and marijuana
206 delivery devices occurs.
207 4. All employees of a medical marijuana treatment center
208 must be 21 years of age or older and have passed a background
209 screening pursuant to subsection (9).
210 5. Each medical marijuana treatment center must adopt and
211 enforce policies and procedures to ensure employees and
212 volunteers receive training on the legal requirements to
213 dispense marijuana to qualified patients.
214 6. When growing marijuana, a medical marijuana treatment
215 center:
216 a. May use pesticides determined by the department, after
217 consultation with the Department of Agriculture and Consumer
218 Services, to be safely applied to plants intended for human
219 consumption, but may not use pesticides designated as
220 restricted-use pesticides pursuant to s. 487.042.
221 b. Must grow marijuana within an enclosed structure and in
222 a room separate from any other plant.
223 c. Must inspect seeds and growing plants for plant pests
224 that endanger or threaten the horticultural and agricultural
225 interests of the state in accordance with chapter 581 and any
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226 rules adopted thereunder.
227 d. Must perform fumigation or treatment of plants, or
228 remove and destroy infested or infected plants, in accordance
229 with chapter 581 and any rules adopted thereunder.
230 7. Each medical marijuana treatment center must produce
231 and make available for purchase at least one low-THC cannabis
232 product.
233 8. A medical marijuana treatment center that produces
234 edibles must hold a permit to operate as a food establishment
235 pursuant to chapter 500, the Florida Food Safety Act, and must
236 comply with all the requirements for food establishments
237 pursuant to chapter 500 and any rules adopted thereunder.
238 Edibles may not contain more than 200 milligrams of
239 tetrahydrocannabinol, and a single serving portion of an edible
240 may not exceed 10 milligrams of tetrahydrocannabinol. Edibles
241 may have a potency variance of no greater than 15 percent.
242 Edibles may not be attractive to children; be manufactured in
243 the shape of humans, cartoons, or animals; be manufactured in a
244 form that bears any reasonable resemblance to products available
245 for consumption as commercially available candy; or contain any
246 color additives. To discourage consumption of edibles by
247 children, the department shall determine by rule any shapes,
248 forms, and ingredients allowed and prohibited for edibles.
249 Medical marijuana treatment centers may not begin processing or
250 dispensing edibles until after the effective date of the rule.
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251 The department shall also adopt sanitation rules providing the
252 standards and requirements for the storage, display, or
253 dispensing of edibles.
254 9. Within 12 months after licensure, a medical marijuana
255 treatment center must demonstrate to the department that all of
256 its processing facilities have passed a Food Safety Good
257 Manufacturing Practices, such as Global Food Safety Initiative
258 or equivalent, inspection by a nationally accredited certifying
259 body. A medical marijuana treatment center must immediately stop
260 processing at any facility which fails to pass this inspection
261 until it demonstrates to the department that such facility has
262 met this requirement.
263 10. A medical marijuana treatment center that produces
264 prerolled marijuana cigarettes may not use wrapping paper made
265 with tobacco or hemp.
266 11. When processing marijuana, a medical marijuana
267 treatment center must:
268 a. Process the marijuana within an enclosed structure and
269 in a room separate from other plants or products.
270 b. Comply with department rules when processing marijuana
271 with hydrocarbon solvents or other solvents or gases exhibiting
272 potential toxicity to humans. The department shall determine by
273 rule the requirements for medical marijuana treatment centers to
274 use such solvents or gases exhibiting potential toxicity to
275 humans.
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276 c. Comply with federal and state laws and regulations and
277 department rules for solid and liquid wastes. The department
278 shall determine by rule procedures for the storage, handling,
279 transportation, management, and disposal of solid and liquid
280 waste generated during marijuana production and processing. The
281 Department of Environmental Protection shall assist the
282 department in developing such rules.
283 d. Test the processed marijuana using a medical marijuana
284 testing laboratory before it is dispensed. Results must be
285 verified and signed by two medical marijuana treatment center
286 employees. Before dispensing, the medical marijuana treatment
287 center must determine that the test results indicate that low-
288 THC cannabis meets the definition of low-THC cannabis, the
289 concentration of tetrahydrocannabinol meets the potency
290 requirements of this section, the labeling of the concentration
291 of tetrahydrocannabinol and cannabidiol is accurate, and all
292 marijuana is safe for human consumption and free from
293 contaminants that are unsafe for human consumption. The
294 department shall determine by rule which contaminants must be
295 tested for and the maximum levels of each contaminant which are
296 safe for human consumption. The Department of Agriculture and
297 Consumer Services shall assist the department in developing the
298 testing requirements for contaminants that are unsafe for human
299 consumption in edibles. The department shall also determine by
300 rule the procedures for the treatment of marijuana that fails to
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301 meet the testing requirements of this section, s. 381.988, or
302 department rule. The department may select samples of marijuana
303 a random sample from edibles available for purchase in a medical
304 marijuana treatment center dispensing facility which shall be
305 tested by the department to determine whether that the marijuana
306 edible meets the potency requirements of this section, is safe
307 for human consumption, and is accurately labeled with the
308 labeling of the tetrahydrocannabinol and cannabidiol
309 concentration or to verify the result of marijuana testing
310 conducted by a marijuana testing laboratory. The department may
311 also select samples of marijuana delivery devices from a medical
312 marijuana treatment center to determine whether the marijuana
313 delivery device is safe for use by qualified patients is
314 accurate. A medical marijuana treatment center may not require
315 payment from the department for the sample. A medical marijuana
316 treatment center must recall marijuana edibles, including all
317 marijuana and marijuana products edibles made from the same
318 batch of marijuana, that fails which fail to meet the potency
319 requirements of this section, that is which are unsafe for human
320 consumption, or for which the labeling of the
321 tetrahydrocannabinol and cannabidiol concentration is
322 inaccurate. A medical marijuana treatment center must also
323 recall all marijuana delivery devices determined to be unsafe
324 for use by qualified patients. The medical marijuana treatment
325 center must retain records of all testing and samples of each
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326 homogenous batch of marijuana for at least 9 months. The medical
327 marijuana treatment center must contract with a marijuana
328 testing laboratory to perform audits on the medical marijuana
329 treatment center's standard operating procedures, testing
330 records, and samples and provide the results to the department
331 to confirm that the marijuana or low-THC cannabis meets the
332 requirements of this section and that the marijuana or low-THC
333 cannabis is safe for human consumption. A medical marijuana
334 treatment center shall reserve two processed samples from each
335 batch and retain such samples for at least 9 months for the
336 purpose of such audits. A medical marijuana treatment center may
337 use a laboratory that has not been certified by the department
338 under s. 381.988 until such time as at least one laboratory
339 holds the required certification, but in no event later than
340 July 1, 2018.
341 e. Package the marijuana in compliance with the United
342 States Poison Prevention Packaging Act of 1970, 15 U.S.C. ss.
343 1471 et seq.
344 f. Package the marijuana in a receptacle that has a firmly
345 affixed and legible label stating the following information:
346 (I) The marijuana or low-THC cannabis meets the
347 requirements of sub-subparagraph d.
348 (II) The name of the medical marijuana treatment center
349 from which the marijuana originates.
350 (III) The batch number and harvest number from which the
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351 marijuana originates and the date dispensed.
352 (IV) The name of the physician who issued the physician
353 certification.
354 (V) The name of the patient.
355 (VI) The product name, if applicable, and dosage form,
356 including concentration of tetrahydrocannabinol and cannabidiol.
357 The product name may not contain wording commonly associated
358 with products marketed by or to children.
359 (VII) The recommended dose.
360 (VIII) A warning that it is illegal to transfer medical
361 marijuana to another person.
362 (IX) A marijuana universal symbol developed by the
363 department.
364 12. The medical marijuana treatment center shall include
365 in each package a patient package insert with information on the
366 specific product dispensed related to:
367 a. Clinical pharmacology.
368 b. Indications and use.
369 c. Dosage and administration.
370 d. Dosage forms and strengths.
371 e. Contraindications.
372 f. Warnings and precautions.
373 g. Adverse reactions.
374 13. In addition to the packaging and labeling requirements
375 specified in subparagraphs 11. and 12., marijuana in a form for
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376 smoking must be packaged in a sealed receptacle with a legible
377 and prominent warning to keep away from children and a warning
378 that states marijuana smoke contains carcinogens and may
379 negatively affect health. Such receptacles for marijuana in a
380 form for smoking must be plain, opaque, and white without
381 depictions of the product or images other than the medical
382 marijuana treatment center's department-approved logo and the
383 marijuana universal symbol.
384 14. The department shall adopt rules to regulate the
385 types, appearance, and labeling of marijuana delivery devices
386 dispensed from a medical marijuana treatment center. The rules
387 must require marijuana delivery devices to have an appearance
388 consistent with medical use.
389 15. Each edible shall be individually sealed in plain,
390 opaque wrapping marked only with the marijuana universal symbol.
391 Where practical, each edible shall be marked with the marijuana
392 universal symbol. In addition to the packaging and labeling
393 requirements in subparagraphs 11. and 12., edible receptacles
394 must be plain, opaque, and white without depictions of the
395 product or images other than the medical marijuana treatment
396 center's department-approved logo and the marijuana universal
397 symbol. The receptacle must also include a list of all the
398 edible's ingredients, storage instructions, an expiration date,
399 a legible and prominent warning to keep away from children and
400 pets, and a warning that the edible has not been produced or
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401 inspected pursuant to federal food safety laws.
402 16. When dispensing marijuana or a marijuana delivery
403 device, a medical marijuana treatment center:
404 a. May dispense any active, valid order for low-THC
405 cannabis, medical cannabis and cannabis delivery devices issued
406 pursuant to former s. 381.986, Florida Statutes 2016, which was
407 entered into the medical marijuana use registry before July 1,
408 2017.
409 b. May not dispense more than a 70-day supply of marijuana
410 within any 70-day period to a qualified patient or caregiver.
411 May not dispense more than one 35-day supply of marijuana in a
412 form for smoking within any 35-day period to a qualified patient
413 or caregiver. A 35-day supply of marijuana in a form for smoking
414 may not exceed 2.5 ounces unless an exception to this amount is
415 approved by the department pursuant to paragraph (4)(f).
416 c. Must have the medical marijuana treatment center's
417 employee who dispenses the marijuana or a marijuana delivery
418 device enter into the medical marijuana use registry his or her
419 name or unique employee identifier.
420 d. Must verify that the qualified patient and the
421 caregiver, if applicable, each have an active registration in
422 the medical marijuana use registry and an active and valid
423 medical marijuana use registry identification card, the amount
424 and type of marijuana dispensed matches the physician
425 certification in the medical marijuana use registry for that
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426 qualified patient, and the physician certification has not
427 already been filled.
428 e. May not dispense marijuana to a qualified patient who
429 is younger than 18 years of age. If the qualified patient is
430 younger than 18 years of age, marijuana may only be dispensed to
431 the qualified patient's caregiver.
432 f. May not dispense or sell any other type of cannabis,
433 alcohol, or illicit drug-related product, including pipes or
434 wrapping papers made with tobacco or hemp, other than a
435 marijuana delivery device required for the medical use of
436 marijuana and which is specified in a physician certification.
437 g. Must, upon dispensing the marijuana or marijuana
438 delivery device, record in the registry the date, time,
439 quantity, and form of marijuana dispensed; the type of marijuana
440 delivery device dispensed; and the name and medical marijuana
441 use registry identification number of the qualified patient or
442 caregiver to whom the marijuana delivery device was dispensed.
443 h. Must ensure that patient records are not visible to
444 anyone other than the qualified patient, his or her caregiver,
445 and authorized medical marijuana treatment center employees.
446 (14) EXCEPTIONS TO OTHER LAWS.—
447 (e) Notwithstanding s. 893.13, s. 893.135, s. 893.147, or
448 any other law, but subject to the requirements of this section,
449 the department, including an employee of the department acting
450 within the scope of his or her employment, may acquire, possess,
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451 test, transport, and lawfully dispose of marijuana and marijuana
452 delivery devices as provided in this section, in s. 381.988, and
453 by department rule.
454 Section 4. Subsection (1) of section 456.039, Florida
455 Statutes, is amended to read:
456 456.039 Designated health care professionals; information
457 required for licensure.—
458 (1) Each person who applies for initial licensure as a
459 physician under chapter 458, chapter 459, chapter 460, or
460 chapter 461, except a person applying for registration pursuant
461 to ss. 458.345 and 459.021, must, at the time of application,
462 and each physician who applies for license renewal under chapter
463 458, chapter 459, chapter 460, or chapter 461, except a person
464 registered pursuant to ss. 458.345 and 459.021, must, in
465 conjunction with the renewal of such license and under
466 procedures adopted by the Department of Health, and in addition
467 to any other information that may be required from the
468 applicant, furnish the following information to the Department
469 of Health:
470 (a)1. The name of each medical school that the applicant
471 has attended, with the dates of attendance and the date of
472 graduation, and a description of all graduate medical education
473 completed by the applicant, excluding any coursework taken to
474 satisfy medical licensure continuing education requirements.
475 2. The name of each hospital at which the applicant has
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476 privileges.
477 3. The address at which the applicant will primarily
478 conduct his or her practice.
479 4. Any certification that the applicant has received from
480 a specialty board that is recognized by the board to which the
481 applicant is applying.
482 5. The year that the applicant began practicing medicine.
483 6. Any appointment to the faculty of a medical school
484 which the applicant currently holds and an indication as to
485 whether the applicant has had the responsibility for graduate
486 medical education within the most recent 10 years.
487 7. A description of any criminal offense of which the
488 applicant has been found guilty, regardless of whether
489 adjudication of guilt was withheld, or to which the applicant
490 has pled guilty or nolo contendere. A criminal offense committed
491 in another jurisdiction which would have been a felony or
492 misdemeanor if committed in this state must be reported. If the
493 applicant indicates that a criminal offense is under appeal and
494 submits a copy of the notice for appeal of that criminal
495 offense, the department must state that the criminal offense is
496 under appeal if the criminal offense is reported in the
497 applicant's profile. If the applicant indicates to the
498 department that a criminal offense is under appeal, the
499 applicant must, upon disposition of the appeal, submit to the
500 department a copy of the final written order of disposition.
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501 8. A description of any final disciplinary action taken
502 within the previous 10 years against the applicant by the agency
503 regulating the profession that the applicant is or has been
504 licensed to practice, whether in this state or in any other
505 jurisdiction, by a specialty board that is recognized by the
506 American Board of Medical Specialties, the American Osteopathic
507 Association, or a similar national organization, or by a
508 licensed hospital, health maintenance organization, prepaid
509 health clinic, ambulatory surgical center, or nursing home.
510 Disciplinary action includes resignation from or nonrenewal of
511 medical staff membership or the restriction of privileges at a
512 licensed hospital, health maintenance organization, prepaid
513 health clinic, ambulatory surgical center, or nursing home taken
514 in lieu of or in settlement of a pending disciplinary case
515 related to competence or character. If the applicant indicates
516 that the disciplinary action is under appeal and submits a copy
517 of the document initiating an appeal of the disciplinary action,
518 the department must state that the disciplinary action is under
519 appeal if the disciplinary action is reported in the applicant's
520 profile.
521 9. Relevant professional qualifications as defined by the
522 applicable board.
523 (b) In addition to the information required under
524 paragraph (a), each applicant who seeks licensure under chapter
525 458, chapter 459, or chapter 461, and who has practiced
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526 previously in this state or in another jurisdiction or a foreign
527 country must provide the information required of licensees under
528 those chapters pursuant to s. 456.049. An applicant for
529 licensure under chapter 460 who has practiced previously in this
530 state or in another jurisdiction or a foreign country must
531 provide the same information as is required of licensees under
532 chapter 458, pursuant to s. 456.049.
533 (c) Each applicant who seeks licensure under chapter 458
534 or chapter 459 must provide proof of payment of the assessment
535 required under s. 766.314, if applicable.
536 Section 5. Subsection (1) of section 460.406, Florida
537 Statutes, is amended to read:
538 460.406 Licensure by examination.—
539 (1) Any person desiring to be licensed as a chiropractic
540 physician must apply to the department to take the licensure
541 examination. There shall be an application fee set by the board
542 not to exceed $100 which shall be nonrefundable. There shall
543 also be an examination fee not to exceed $500 plus the actual
544 per applicant cost to the department for purchase of portions of
545 the examination from the National Board of Chiropractic
546 Examiners or a similar national organization, which may be
547 refundable if the applicant is found ineligible to take the
548 examination. The department shall examine each applicant whom
549 who the board certifies has met all of the following criteria:
550 (a) Completed the application form and remitted the
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551 appropriate fee.
552 (b) Submitted proof satisfactory to the department that he
553 or she is not less than 18 years of age.
554 (c) Submitted proof satisfactory to the department that he
555 or she is a graduate of a chiropractic college which is
556 accredited by or has status with the Council on Chiropractic
557 Education or its predecessor agency. However, any applicant who
558 is a graduate of a chiropractic college that was initially
559 accredited by the Council on Chiropractic Education in 1995, who
560 graduated from such college within the 4 years immediately
561 preceding such accreditation, and who is otherwise qualified is
562 shall be eligible to take the examination. An No application for
563 a license to practice chiropractic medicine may not shall be
564 denied solely because the applicant is a graduate of a
565 chiropractic college that subscribes to one philosophy of
566 chiropractic medicine as distinguished from another.
567 (d)1. For an applicant who has matriculated in a
568 chiropractic college before prior to July 2, 1990, completed at
569 least 2 years of residence college work, consisting of a minimum
570 of one-half the work acceptable for a bachelor's degree granted
571 on the basis of a 4-year period of study, in a college or
572 university accredited by an institutional accrediting agency
573 recognized and approved by the United States Department of
574 Education. However, before prior to being certified by the board
575 to sit for the examination, each applicant who has matriculated
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576 in a chiropractic college after July 1, 1990, must shall have
577 been granted a bachelor's degree, based upon 4 academic years of
578 study, by a college or university accredited by an institutional
579 a regional accrediting agency that which is a member of the
580 Commission on Recognition of Postsecondary Accreditation.
581 2. Effective July 1, 2000, completed, before prior to
582 matriculation in a chiropractic college, at least 3 years of
583 residence college work, consisting of a minimum of 90 semester
584 hours leading to a bachelor's degree in a liberal arts college
585 or university accredited by an institutional accrediting agency
586 recognized and approved by the United States Department of
587 Education. However, before prior to being certified by the board
588 to sit for the examination, each applicant who has matriculated
589 in a chiropractic college after July 1, 2000, must shall have
590 been granted a bachelor's degree from an institution holding
591 accreditation for that degree from an institutional a regional
592 accrediting agency that which is recognized by the United States
593 Department of Education. The applicant's chiropractic degree
594 must consist of credits earned in the chiropractic program and
595 may not include academic credit for courses from the bachelor's
596 degree.
597 (e) Successfully completed the National Board of
598 Chiropractic Examiners certification examination in parts I, II,
599 III, and IV, and the physiotherapy examination of the National
600 Board of Chiropractic Examiners, with a score approved by the
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601 board.
602 (f) Submitted to the department a set of fingerprints on a
603 form and under procedures specified by the department, along
604 with payment in an amount equal to the costs incurred by the
605 Department of Health for the criminal background check of the
606 applicant.
607
608 The board may require an applicant who graduated from an
609 institution accredited by the Council on Chiropractic Education
610 more than 10 years before the date of application to the board
611 to take the National Board of Chiropractic Examiners Special
612 Purposes Examination for Chiropractic, or its equivalent, as
613 determined by the board. The board shall establish by rule a
614 passing score.
615 Section 6. Subsection (4) of section 464.008, Florida
616 Statutes, is amended to read:
617 464.008 Licensure by examination.—
618 (4) If an applicant who graduates from an approved program
619 does not take the licensure examination within 6 months after
620 graduation, he or she must enroll in and successfully complete a
621 board-approved licensure examination preparatory course. The
622 applicant is responsible for all costs associated with the
623 course and may not use state or federal financial aid for such
624 costs. The board shall by rule establish guidelines for
625 licensure examination preparatory courses.
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626 Section 7. Paragraph (e) of subsection (1) of section
627 464.018, Florida Statutes, is amended to read:
628 464.018 Disciplinary actions.—
629 (1) The following acts constitute grounds for denial of a
630 license or disciplinary action, as specified in ss. 456.072(2)
631 and 464.0095:
632 (e) Having been found guilty of, regardless of
633 adjudication, or entered a plea of nolo contendere or guilty to,
634 regardless of adjudication, any offense prohibited under s.
635 435.04 or similar statute of another jurisdiction; or having
636 committed an act which constitutes domestic violence as defined
637 in s. 741.28.
638 Section 8. Present subsections (13) and (14) of section
639 467.003, Florida Statutes, are redesignated as subsections (14)
640 and (15), respectively, a new subsection (13) is added to that
641 section, and subsections (1) and (12) of that section are
642 amended, to read:
643 467.003 Definitions.—As used in this chapter, unless the
644 context otherwise requires:
645 (1) "Approved midwifery program" means a midwifery school
646 or a midwifery training program which is approved by the
647 department pursuant to s. 467.205.
648 (12) "Preceptor" means a physician licensed under chapter
649 458 or chapter 459, a licensed midwife licensed under this
650 chapter, or a certified nurse midwife licensed under chapter
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651 464, who has a minimum of 3 years' professional experience, and
652 who directs, teaches, supervises, and evaluates the learning
653 experiences of a the student midwife as part of an approved
654 midwifery program.
655 (13) "Prelicensure course" means a course of study,
656 offered by an accredited midwifery program and approved by the
657 department, which an applicant for licensure must complete
658 before a license may be issued and which provides instruction in
659 the laws and rules of this state and demonstrates the student’s
660 competency to practice midwifery under this chapter.
661 Section 9. Section 467.009, Florida Statutes, is amended
662 to read:
663 467.009 Accredited and approved midwifery programs;
664 education and training requirements.—
665 (1) The department shall adopt standards for accredited
666 and approved midwifery programs which must include, but need not
667 be limited to, standards for all of the following:
668 (a) . The standards shall encompass Clinical and classroom
669 instruction in all aspects of prenatal, intrapartal, and
670 postpartal care, including all of the following:
671 1. Obstetrics.;
672 2. Neonatal pediatrics.;
673 3. Basic sciences.;
674 4. Female reproductive anatomy and physiology.;
675 5. Behavioral sciences.;
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676 6. Childbirth education.;
677 7. Community care.;
678 8. Epidemiology.;
679 9. Genetics.;
680 10. Embryology.;
681 11. Neonatology.;
682 12. Applied pharmacology.;
683 13. The medical and legal aspects of midwifery.;
684 14. Gynecology and women's health.;
685 15. Family planning.;
686 16. Nutrition during pregnancy and lactation.;
687 17. Breastfeeding.; and
688 18. Basic nursing skills; and any other instruction
689 determined by the department and council to be necessary.
690 (b) The standards shall incorporate the Core competencies,
691 incorporating those established by the American College of Nurse
692 Midwives and the Midwives Alliance of North America, including
693 knowledge, skills, and professional behavior in all of the
694 following areas:
695 1. Primary management, collaborative management, referral,
696 and medical consultation.;
697 2. Antepartal, intrapartal, postpartal, and neonatal
698 care.;
699 3. Family planning and gynecological care.;
700 4. Common complications.; and
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701 5. Professional responsibilities.
702 (c) Noncurricular The standards shall include
703 noncurriculum matters under this section, including, but not
704 limited to, staffing and teacher qualifications.
705 (2) An accredited and approved midwifery program must
706 offer shall include a course of study and clinical training for
707 a minimum of 3 years which incorporates all of the standards,
708 curriculum guidelines, and educational objectives provided in
709 this section and the rules adopted hereunder.
710 (3) An accredited and approved midwifery program may
711 reduce If the applicant is a registered nurse or a licensed
712 practical nurse or has previous nursing or midwifery education,
713 the required period of training may be reduced to the extent of
714 the student's applicant's qualifications as a registered nurse
715 or licensed practical nurse or based on prior completion of
716 equivalent nursing or midwifery education, as determined under
717 rules adopted by the department rule. In no case shall the
718 training be reduced to a period of less than 2 years.
719 (4)(3) An accredited and approved midwifery program may
720 accept students who To be accepted into an approved midwifery
721 program, an applicant shall have both:
722 (a) A high school diploma or its equivalent.
723 (b) Taken three college-level credits each of math and
724 English or demonstrated competencies in communication and
725 computation.
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726 (5)(4) As part of its course of study, an accredited and
727 approved midwifery program must require clinical training that
728 includes all of the following:
729 (a) A student midwife, during training, shall undertake,
730 under the supervision of a preceptor, The care of 50 women in
731 each of the prenatal, intrapartal, and postpartal periods under
732 the supervision of a preceptor., but The same women need not be
733 seen through all three periods.
734 (b)(5) Observation of The student midwife shall observe an
735 additional 25 women in the intrapartal period before qualifying
736 for a license.
737 (6) Clinical The training required under this section must
738 include all of the following:
739 (a) shall include Training in either hospitals or
740 alternative birth settings, or both.
741 (b) A requirement that students demonstrate competency in
742 the assessment of and differentiation, with particular emphasis
743 on learning the ability to differentiate between low-risk
744 pregnancies and high-risk pregnancies.
745 (7) A hospital or birthing center receiving public funds
746 shall be required to provide student midwives access to observe
747 labor, delivery, and postpartal procedures, provided the woman
748 in labor has given informed consent. The Department of Health
749 shall assist in facilitating access to hospital training for
750 accredited and approved midwifery programs.
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751 (8)(7) The Department of Education shall adopt curricular
752 frameworks for midwifery programs offered by conducted within
753 public educational institutions under pursuant to this section.
754 (8) Nonpublic educational institutions that conduct
755 approved midwifery programs shall be accredited by a member of
756 the Commission on Recognition of Postsecondary Accreditation and
757 shall be licensed by the Commission for Independent Education.
758 Section 10. Section 467.011, Florida Statutes, is amended
759 to read:
760 467.011 Licensed midwives; qualifications; examination
761 Licensure by examination.—
762 (1) The department shall administer an examination to test
763 the proficiency of applicants in the core competencies required
764 to practice midwifery as specified in s. 467.009.
765 (2) The department shall develop, publish, and make
766 available to interested parties at a reasonable cost a
767 bibliography and guide for the examination.
768 (3) The department shall issue a license to practice
769 midwifery to an applicant who meets all of the following
770 criteria:
771 (1) Demonstrates that he or she has graduated from one of
772 the following:
773 (a) An accredited and approved midwifery program.
774 (b) A medical or midwifery program offered in another
775 state, jurisdiction, territory, or country whose graduation
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776 requirements were equivalent to or exceeded those required by s.
777 467.009 and the rules adopted thereunder at the time of
778 graduation.
779 (2) Demonstrates that he or she has and successfully
780 completed a prelicensure course offered by an accredited and
781 approved midwifery program. Students graduating from an
782 accredited and approved midwifery program may meet this
783 requirement by showing that the content requirements for the
784 prelicensure course were covered as part of their course of
785 study.
786 (3) Submits an application for licensure on a form
787 approved by the department and pays the appropriate fee.
788 (4) Demonstrates that he or she has received a passing
789 score on an the examination specified by the department, upon
790 payment of the required licensure fee.
791 Section 11. Section 467.0125, Florida Statutes, is amended
792 to read:
793 467.0125 Licensed midwives; qualifications; Licensure by
794 endorsement; temporary certificates.—
795 (1) The department shall issue a license by endorsement to
796 practice midwifery to an applicant who, upon applying to the
797 department, demonstrates to the department that she or he meets
798 all of the following criteria:
799 (a)1. Holds a valid certificate or diploma from a foreign
800 institution of medicine or midwifery or from a midwifery program
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801 offered in another state, bearing the seal of the institution or
802 otherwise authenticated, which renders the individual eligible
803 to practice midwifery in the country or state in which it was
804 issued, provided the requirements therefor are deemed by the
805 department to be substantially equivalent to, or to exceed,
806 those established under this chapter and rules adopted under
807 this chapter, and submits therewith a certified translation of
808 the foreign certificate or diploma; or
809 2. Holds an active, unencumbered a valid certificate or
810 license to practice midwifery in another state, jurisdiction, or
811 territory issued by that state, provided the licensing
812 requirements of that state, jurisdiction, or territory at the
813 time the license was issued were therefor are deemed by the
814 department to be substantially equivalent to, or exceeded to
815 exceed, those established under this chapter and the rules
816 adopted hereunder under this chapter.
817 (b) Has successfully completed a 4-month prelicensure
818 course conducted by an accredited and approved midwifery program
819 and has submitted documentation to the department of successful
820 completion.
821 (c) Submits an application for licensure on a form
822 approved by the department and pays the appropriate fee Has
823 successfully passed the licensed midwifery examination.
824 (2) The department may issue a temporary certificate to
825 practice in areas of critical need to an applicant any midwife
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826 who is qualifying for a midwifery license licensure by
827 endorsement under subsection (1) and who meets all of the
828 following criteria, with the following restrictions:
829 (a) Submits an application for a temporary certificate on
830 a form approved by the department and pays the appropriate fee,
831 which may not exceed $50 and is in addition to the fee required
832 for licensure by endorsement under subsection (1).
833 (b) Specifies on the application that he or she will The
834 Department of Health shall determine the areas of critical need,
835 and the midwife so certified shall practice only in one or more
836 of the following locations:
837 1. A county health department.
838 2. A correctional facility.
839 3. A United States Department of Veterans Affairs clinic.
840 4. A community health center funded by s. 329, s. 330, or
841 s. 340 of the Public Health Service Act.
842 5. Any other agency or institution that is approved by the
843 State Surgeon General and provides health care to meet the needs
844 of an underserved population in this state.
845 (c) Will practice only those specific areas, under the
846 supervision auspices of a physician licensed under pursuant to
847 chapter 458 or chapter 459, a certified nurse midwife licensed
848 under pursuant to part I of chapter 464, or a midwife licensed
849 under this chapter, who has a minimum of 3 years' professional
850 experience.
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851 (3) The department may issue a temporary certificate under
852 this section with the following restrictions:
853 (a) A requirement that a temporary certificateholder
854 practice only in areas of critical need. The State Surgeon
855 General shall determine the areas of critical need, which Such
856 areas shall include, but are not be limited to, health
857 professional shortage areas designated by the United States
858 Department of Health and Human Services.
859 (b) A requirement that if a temporary certificateholder's
860 practice area ceases to be an area of critical need, within 30
861 days after such change the certificateholder must either:
862 1. Report a new practice area of critical need to the
863 department; or
864 2. Voluntarily relinquish the temporary certificate.
865 (4) The department shall review a temporary
866 certificateholder's practice at least annually to determine
867 whether the certificateholder is meeting the requirements of
868 subsections (2) and (3) and the rules adopted thereunder. If the
869 department determines that a certificateholder is not meeting
870 these requirements, the department must revoke the temporary
871 certificate.
872 (5) A temporary certificate issued under this section is
873 shall be valid only as long as an area for which it is issued
874 remains an area of critical need, but no longer than 2 years,
875 and is shall not be renewable.
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876 (c) The department may administer an abbreviated oral
877 examination to determine the midwife's competency, but no
878 written regular examination shall be necessary.
879 (d) The department shall not issue a temporary certificate
880 to any midwife who is under investigation in another state for
881 an act which would constitute a violation of this chapter until
882 such time as the investigation is complete, at which time the
883 provisions of this section shall apply.
884 (e) The department shall review the practice under a
885 temporary certificate at least annually to ascertain that the
886 minimum requirements of the midwifery rules promulgated under
887 this chapter are being met. If it is determined that the minimum
888 requirements are not being met, the department shall immediately
889 revoke the temporary certificate.
890 (f) The fee for a temporary certificate shall not exceed
891 $50 and shall be in addition to the fee required for licensure.
892 Section 12. Section 467.205, Florida Statutes, is amended
893 to read:
894 467.205 Approval of midwifery programs.—
895 (1) The department must approve an accredited or state-
896 licensed public or private institution seeking to provide
897 midwifery education and training as an approved midwifery
898 program in this state if the institution meets all of the
899 following criteria:
900 (a) Submits an application for approval on a form approved
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901 by the department.
902 (b) Demonstrates to the department's satisfaction that the
903 proposed midwifery program complies with s. 467.009 and the
904 rules adopted thereunder.
905 (c) For a private institution, demonstrates its
906 accreditation by a member of the Council for Higher Education
907 Accreditation or and accrediting agency approved by the United
908 States Department of Education as an institutional accrediting
909 agency for direct-entry midwifery education programs or an
910 accrediting agency approved by the United States Department of
911 Education and its licensing or provisional licensing by the
912 Commission for Independent Education An organization desiring to
913 conduct an approved program for the education of midwives shall
914 apply to the department and submit such evidence as may be
915 required to show that it complies with s. 467.009 and with the
916 rules of the department. Any accredited or state-licensed
917 institution of higher learning, public or private, may provide
918 midwifery education and training.
919 (2) The department shall adopt rules regarding educational
920 objectives, faculty qualifications, curriculum guidelines,
921 administrative procedures, and other training requirements as
922 are necessary to ensure that approved programs graduate midwives
923 competent to practice under this chapter.
924 (3) The department shall survey each organization applying
925 for approval. If the department is satisfied that the program
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926 meets the requirements of s. 467.009 and rules adopted pursuant
927 to that section, it shall approve the program.
928 (2)(4) The department shall, at least once every 3 years,
929 certify whether each approved midwifery program is currently
930 compliant, and has maintained compliance, complies with the
931 requirements of standards developed under s. 467.009 and the
932 rules adopted thereunder.
933 (3)(5) If the department finds that an approved midwifery
934 program is not in compliance with the requirements of s. 467.009
935 or the rules adopted thereunder, or has lost its accreditation
936 status, the department must provide its finding to the program
937 in writing and no longer meets the required standards, it may
938 place the program on probationary status for a specified period
939 of time, which may not exceed 3 years until such time as the
940 standards are restored.
941 (4) If a program on probationary status does not come into
942 compliance with the requirements of s. 467.009 or the rules
943 adopted thereunder, or regain its accreditation status, as
944 applicable, within the period specified by the department fails
945 to correct these conditions within a specified period of time,
946 the department may rescind the program's approval.
947 (5) A Any program that has having its approval rescinded
948 has shall have the right to reapply for approval.
949 (6) The department may grant provisional approval of a new
950 program seeking accreditation status, for a period not to exceed
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951 5 years, provided that all other requirements of this section
952 are met.
953 (7) The department may rescind provisional approval of a
954 program that fails to meet the requirements of s. 467.009, this
955 section, or the rules adopted thereunder, in accordance with
956 procedures provided in subsections (3) and (4) may be granted
957 pending the licensure results of the first graduating class.
958 Section 13. Subsections (2), (3), and (4) and paragraphs
959 (a) and (b) of subsection (5) of section 468.803, Florida
960 Statutes, are amended to read:
961 468.803 License, registration, and examination
962 requirements.—
963 (2) An applicant for registration, examination, or
964 licensure must apply to the department on a form prescribed by
965 the board for consideration of board approval. Each initial
966 applicant shall submit a set of fingerprints to the department
967 in accordance with on a form and under procedures specified by
968 the department, along with payment in an amount equal to the
969 costs incurred by the department for state and national criminal
970 history checks of the applicant. The department shall submit the
971 fingerprints provided by an applicant to the Department of Law
972 Enforcement for a statewide criminal history check, and the
973 Department of Law Enforcement shall forward the fingerprints to
974 the Federal Bureau of Investigation for a national criminal
975 history check of the applicant. The board shall screen the
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976 results to determine if an applicant meets licensure
977 requirements. The board shall consider for examination,
978 registration, or licensure each applicant whom who the board
979 verifies:
980 (a) Has submitted the completed application and completed
981 the fingerprinting requirements fingerprint forms and has paid
982 the applicable application fee, not to exceed $500, and the cost
983 of the state and national criminal history checks. The
984 application fee is and cost of the criminal history checks shall
985 be nonrefundable;
986 (b) Is of good moral character;
987 (c) Is 18 years of age or older; and
988 (d) Has completed the appropriate educational preparation.
989 (3) A person seeking to attain the orthotics or
990 prosthetics experience required for licensure in this state must
991 be approved by the board and registered as a resident by the
992 department. Although a registration may be held in both
993 disciplines, for independent registrations the board may not
994 approve a second registration until at least 1 year after the
995 issuance of the first registration. Notwithstanding subsection
996 (2), a person who has been approved by the board and registered
997 by the department in one discipline may apply for registration
998 in the second discipline without an additional state or national
999 criminal history check during the period in which the first
1000 registration is valid. Each independent registration or dual
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1001 registration is valid for 2 years after the date of issuance
1002 unless otherwise revoked by the department upon recommendation
1003 of the board. The board shall set a registration fee not to
1004 exceed $500 to be paid by the applicant. A registration may be
1005 renewed once by the department upon recommendation of the board
1006 for a period no longer than 1 year, as such renewal is defined
1007 by the board by rule. The renewal fee may not exceed one-half
1008 the current registration fee. To be considered by the board for
1009 approval of registration as a resident, the applicant must have
1010 one of the following:
1011 (a) A Bachelor of Science or higher-level postgraduate
1012 degree in orthotics and prosthetics from an a regionally
1013 accredited college or university recognized by the Commission on
1014 Accreditation of Allied Health Education Programs.
1015 (b) A minimum of a bachelor's degree from an
1016 institutionally a regionally accredited college or university
1017 and a certificate in orthotics or prosthetics from a program
1018 recognized by the Commission on Accreditation of Allied Health
1019 Education Programs, or its equivalent, as determined by the
1020 board.
1021 (c) A minimum of a bachelor's degree from an
1022 institutionally a regionally accredited college or university
1023 and a dual certificate in both orthotics and prosthetics from
1024 programs recognized by the Commission on Accreditation of Allied
1025 Health Education Programs, or its equivalent, as determined by
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1026 the board.
1027 (4) The department may develop and administer a state
1028 examination for an orthotist or a prosthetist license, or the
1029 board may approve the existing examination of a national
1030 standards organization. The examination must be predicated on a
1031 minimum of a baccalaureate-level education and formalized
1032 specialized training in the appropriate field. Each examination
1033 must demonstrate a minimum level of competence in basic
1034 scientific knowledge, written problem solving, and practical
1035 clinical patient management. The board shall require an
1036 examination fee not to exceed the actual cost to the board in
1037 developing, administering, and approving the examination, which
1038 fee must be paid by the applicant. To be considered by the board
1039 for examination, the applicant must have:
1040 (a) For an examination in orthotics:
1041 1. A Bachelor of Science or higher-level postgraduate
1042 degree in orthotics and prosthetics from an institutionally a
1043 regionally accredited college or university recognized by the
1044 Commission on Accreditation of Allied Health Education Programs
1045 or, at a minimum, a bachelor's degree from an institutionally a
1046 regionally accredited college or university and a certificate in
1047 orthotics from a program recognized by the Commission on
1048 Accreditation of Allied Health Education Programs, or its
1049 equivalent, as determined by the board; and
1050 2. An approved orthotics internship of 1 year of qualified
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1051 experience, as determined by the board, or an orthotic residency
1052 or dual residency program recognized by the board.
1053 (b) For an examination in prosthetics:
1054 1. A Bachelor of Science or higher-level postgraduate
1055 degree in orthotics and prosthetics from an institutionally a
1056 regionally accredited college or university recognized by the
1057 Commission on Accreditation of Allied Health Education Programs
1058 or, at a minimum, a bachelor's degree from an institutionally a
1059 regionally accredited college or university and a certificate in
1060 prosthetics from a program recognized by the Commission on
1061 Accreditation of Allied Health Education Programs, or its
1062 equivalent, as determined by the board; and
1063 2. An approved prosthetics internship of 1 year of
1064 qualified experience, as determined by the board, or a
1065 prosthetic residency or dual residency program recognized by the
1066 board.
1067 (5) In addition to the requirements in subsection (2), to
1068 be licensed as:
1069 (a) An orthotist, the applicant must pay a license fee not
1070 to exceed $500 and must have:
1071 1. A Bachelor of Science or higher-level postgraduate
1072 degree in orthotics and prosthetics from an institutionally a
1073 regionally accredited college or university recognized by the
1074 Commission on Accreditation of Allied Health Education Programs,
1075 or a bachelor's degree from an institutionally accredited
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1076 college or university and with a certificate in orthotics from a
1077 program recognized by the Commission on Accreditation of Allied
1078 Health Education Programs, or its equivalent, as determined by
1079 the board;
1080 2. An approved appropriate internship of 1 year of
1081 qualified experience, as determined by the board, or a residency
1082 program recognized by the board;
1083 3. Completed the mandatory courses; and
1084 4. Passed the state orthotics examination or the board-
1085 approved orthotics examination.
1086 (b) A prosthetist, the applicant must pay a license fee
1087 not to exceed $500 and must have:
1088 1. A Bachelor of Science or higher-level postgraduate
1089 degree in orthotics and prosthetics from an institutionally a
1090 regionally accredited college or university recognized by the
1091 Commission on Accreditation of Allied Health Education Programs,
1092 or a bachelor's degree from an institutionally accredited
1093 college or university and with a certificate in prosthetics from
1094 a program recognized by the Commission on Accreditation of
1095 Allied Health Education Programs, or its equivalent, as
1096 determined by the board;
1097 2. An internship of 1 year of qualified experience, as
1098 determined by the board, or a residency program recognized by
1099 the board;
1100 3. Completed the mandatory courses; and
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1101 4. Passed the state prosthetics examination or the board-
1102 approved prosthetics examination.
1103 Section 14. Section 483.824, Florida Statutes, is amended
1104 to read:
1105 483.824 Qualifications of clinical laboratory director.—A
1106 clinical laboratory director must have 4 years of clinical
1107 laboratory experience with 2 years of experience in the
1108 specialty to be directed or be nationally board certified in the
1109 specialty to be directed, and must meet one of the following
1110 requirements:
1111 (1) Be a physician licensed under chapter 458 or chapter
1112 459;
1113 (2) Hold an earned doctoral degree in a chemical,
1114 physical, or biological science from an a regionally accredited
1115 institution and maintain national certification requirements
1116 equal to those required by the federal Health Care Financing
1117 Administration; or
1118 (3) For the subspecialty of oral pathology, be a physician
1119 licensed under chapter 458 or chapter 459 or a dentist licensed
1120 under chapter 466.
1121 Section 15. Subsection (3) of section 490.003, Florida
1122 Statutes, is amended to read:
1123 490.003 Definitions.—As used in this chapter:
1124 (3)(a) "Doctoral degree from an American Psychological
1125 Association accredited program" means Effective July 1, 1999,
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1126 "doctoral-level psychological education" and "doctoral degree in
1127 psychology" mean a Psy.D., an Ed.D. in psychology, or a Ph.D. in
1128 psychology from a psychology program at an educational
1129 institution that, at the time the applicant was enrolled and
1130 graduated:
1131 1.(a) Had institutional accreditation from an agency
1132 recognized and approved by the United States Department of
1133 Education or was recognized as a member in good standing with
1134 the Association of Universities and Colleges of Canada; and
1135 2.(b) Had programmatic accreditation from the American
1136 Psychological Association.
1137 (b) "Doctoral degree in psychology" means a Psy.D., an
1138 Ed.D. in psychology, or a Ph.D. in psychology from a psychology
1139 program at an educational institution that, at the time the
1140 applicant was enrolled and graduated, had institutional
1141 accreditation from an agency recognized and approved by the
1142 United States Department of Education or was recognized as a
1143 member in good standing with the Association of Universities and
1144 Colleges of Canada.
1145 Section 16. Subsection (1) of section 490.005, Florida
1146 Statutes, is amended to read:
1147 490.005 Licensure by examination.—
1148 (1) Any person desiring to be licensed as a psychologist
1149 shall apply to the department to take the licensure examination.
1150 The department shall license each applicant whom who the board
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1151 certifies has met all of the following requirements:
1152 (a) Completed the application form and remitted a
1153 nonrefundable application fee not to exceed $500 and an
1154 examination fee set by the board sufficient to cover the actual
1155 per applicant cost to the department for development, purchase,
1156 and administration of the examination, but not to exceed $500.
1157 (b) Submitted proof satisfactory to the board that the
1158 applicant has received:
1159 1. A doctoral degree from an American Psychological
1160 Association accredited program Doctoral-level psychological
1161 education; or
1162 2. The equivalent of a doctoral degree from an American
1163 Psychological Association accredited program doctoral-level
1164 psychological education, as defined in s. 490.003(3), from a
1165 program at a school or university located outside the United
1166 States of America which was officially recognized by the
1167 government of the country in which it is located as an
1168 institution or program to train students to practice
1169 professional psychology. The applicant has the burden of
1170 establishing that this requirement has been met.
1171 (c) Had at least 2 years or 4,000 hours of experience in
1172 the field of psychology in association with or under the
1173 supervision of a licensed psychologist meeting the academic and
1174 experience requirements of this chapter or the equivalent as
1175 determined by the board. The experience requirement may be met
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1176 by work performed on or off the premises of the supervising
1177 psychologist if the off-premises work is not the independent,
1178 private practice rendering of psychological services that does
1179 not have a psychologist as a member of the group actually
1180 rendering psychological services on the premises.
1181 (d) Passed the examination. However, an applicant who has
1182 obtained a passing score, as established by the board by rule,
1183 on the psychology licensure examination designated by the board
1184 as the national licensure examination need only pass the Florida
1185 law and rules portion of the examination.
1186 Section 17. Subsection (1) of section 490.0051, Florida
1187 Statutes, is amended to read:
1188 490.0051 Provisional licensure; requirements.—
1189 (1) The department shall issue a provisional psychology
1190 license to each applicant who the board certifies has:
1191 (a) Completed the application form and remitted a
1192 nonrefundable application fee not to exceed $250, as set by
1193 board rule.
1194 (b) Earned a doctoral degree from an American
1195 Psychological Association accredited program in psychology as
1196 defined in s. 490.003(3).
1197 (c) Met any additional requirements established by board
1198 rule.
1199 Section 18. Subsections (1), (3), and (4) of section
1200 491.005, Florida Statutes, are amended to read:
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1201 491.005 Licensure by examination.—
1202 (1) CLINICAL SOCIAL WORK.—Upon verification of
1203 documentation and payment of a fee not to exceed $200, as set by
1204 board rule, plus the actual per applicant cost to the department
1205 for purchase of the examination from the American Association of
1206 State Social Worker's Boards or a similar national organization,
1207 the department shall issue a license as a clinical social worker
1208 to an applicant whom who the board certifies has met all of the
1209 following criteria:
1210 (a) Has Submitted an application and paid the appropriate
1211 fee.
1212 (b)1. Has Received a doctoral degree in social work from a
1213 graduate school of social work which at the time the applicant
1214 graduated was accredited by an accrediting agency recognized by
1215 the United States Department of Education or has received a
1216 master's degree in social work from a graduate school of social
1217 work which at the time the applicant graduated:
1218 a. Was accredited by the Council on Social Work Education;
1219 b. Was accredited by the Canadian Association of Schools
1220 of Social Work; or
1221 c. Has been determined to have been a program equivalent
1222 to programs approved by the Council on Social Work Education by
1223 the Foreign Equivalency Determination Service of the Council on
1224 Social Work Education. An applicant who graduated from a program
1225 at a university or college outside of the United States or
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1226 Canada must present documentation of the equivalency
1227 determination from the council in order to qualify.
1228 2. The applicant's graduate program must have emphasized
1229 direct clinical patient or client health care services,
1230 including, but not limited to, coursework in clinical social
1231 work, psychiatric social work, medical social work, social
1232 casework, psychotherapy, or group therapy. The applicant's
1233 graduate program must have included all of the following
1234 coursework:
1235 a. A supervised field placement which was part of the
1236 applicant's advanced concentration in direct practice, during
1237 which the applicant provided clinical services directly to
1238 clients.
1239 b. Completion of 24 semester hours or 32 quarter hours in
1240 theory of human behavior and practice methods as courses in
1241 clinically oriented services, including a minimum of one course
1242 in psychopathology, and no more than one course in research,
1243 taken in a school of social work accredited or approved pursuant
1244 to subparagraph 1.
1245 3. If the course title which appears on the applicant's
1246 transcript does not clearly identify the content of the
1247 coursework, the applicant shall be required to provide
1248 additional documentation, including, but not limited to, a
1249 syllabus or catalog description published for the course.
1250 (c) Has Had at least 2 years of clinical social work
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1251 experience, which took place subsequent to completion of a
1252 graduate degree in social work at an institution meeting the
1253 accreditation requirements of this section, under the
1254 supervision of a licensed clinical social worker or the
1255 equivalent who is a qualified supervisor as determined by the
1256 board. An individual who intends to practice in Florida to
1257 satisfy clinical experience requirements must register pursuant
1258 to s. 491.0045 before commencing practice. If the applicant's
1259 graduate program was not a program which emphasized direct
1260 clinical patient or client health care services as described in
1261 subparagraph (b)2., the supervised experience requirement must
1262 take place after the applicant has completed a minimum of 15
1263 semester hours or 22 quarter hours of the coursework required. A
1264 doctoral internship may be applied toward the clinical social
1265 work experience requirement. A licensed mental health
1266 professional must be on the premises when clinical services are
1267 provided by a registered intern in a private practice setting.
1268 (d) Has Passed a theory and practice examination
1269 designated by board rule provided by the department for this
1270 purpose.
1271 (e) Has Demonstrated, in a manner designated by board rule
1272 of the board, knowledge of the laws and rules governing the
1273 practice of clinical social work, marriage and family therapy,
1274 and mental health counseling.
1275 (3) MARRIAGE AND FAMILY THERAPY.—Upon verification of
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1276 documentation and payment of a fee not to exceed $200, as set by
1277 board rule, plus the actual cost of the purchase of the
1278 examination from the Association of Marital and Family Therapy
1279 Regulatory Board, or similar national organization, the
1280 department shall issue a license as a marriage and family
1281 therapist to an applicant who the board certifies has met all of
1282 the following criteria:
1283 (a) Has Submitted an application and paid the
1284 appropriate fee.
1285 (b)1. Attained one of the following:
1286 a. A minimum of a master's degree in marriage and family
1287 therapy from a program accredited by the Commission on
1288 Accreditation for Marriage and Family Therapy Education;
1289 b. A minimum of a master's degree with a major emphasis in
1290 marriage and family therapy or a closely related field from a
1291 university program accredited by the Council on Accreditation of
1292 Counseling and Related Educational Programs and graduate courses
1293 approved by the board; or
1294 c. Has A minimum of a master's degree with an major
1295 emphasis in marriage and family therapy or a closely related
1296 field, with a degree conferred before September 1, 2027, from an
1297 institutionally accredited college or university from a program
1298 accredited by the Commission on Accreditation for Marriage and
1299 Family Therapy Education or from a Florida university program
1300 accredited by the Council for Accreditation of Counseling and
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1301 Related Educational Programs and graduate courses approved by
1302 the board of Clinical Social Work, Marriage and Family Therapy,
1303 and Mental Health Counseling.
1304 2. If the course title that appears on the applicant's
1305 transcript does not clearly identify the content of the
1306 coursework, the applicant must shall provide additional
1307 documentation, including, but not limited to, a syllabus or
1308 catalog description published for the course. The required
1309 master's degree must have been received in an institution of
1310 higher education that, at the time the applicant graduated, was
1311 fully accredited by an institutional a regional accrediting body
1312 recognized by the Council for Higher Education Accreditation or
1313 its successor organization Commission on Recognition of
1314 Postsecondary Accreditation or publicly recognized as a member
1315 in good standing with the Association of Universities and
1316 Colleges of Canada, or an institution of higher education
1317 located outside the United States and Canada which, at the time
1318 the applicant was enrolled and at the time the applicant
1319 graduated, maintained a standard of training substantially
1320 equivalent to the standards of training of those institutions in
1321 the United States which are accredited by an institutional a
1322 regional accrediting body recognized by the Council for Higher
1323 Education Accreditation or its successor organization Commission
1324 on Recognition of Postsecondary Accreditation. Such foreign
1325 education and training must have been received in an institution
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1326 or program of higher education officially recognized by the
1327 government of the country in which it is located as an
1328 institution or program to train students to practice as
1329 professional marriage and family therapists or psychotherapists.
1330 The applicant has the burden of establishing that the
1331 requirements of this provision have been met, and the board
1332 shall require documentation, such as an evaluation by a foreign
1333 equivalency determination service, as evidence that the
1334 applicant's graduate degree program and education were
1335 equivalent to an accredited program in this country. An
1336 applicant with a master's degree from a program that did not
1337 emphasize marriage and family therapy may complete the
1338 coursework requirement in a training institution fully
1339 accredited by the Commission on Accreditation for Marriage and
1340 Family Therapy Education recognized by the United States
1341 Department of Education.
1342 (c) Completed Has had at least 2 years of clinical
1343 experience during which 50 percent of the applicant's clients
1344 were receiving marriage and family therapy services, which must
1345 have been be at the post-master's level under the supervision of
1346 a licensed marriage and family therapist with at least 5 years
1347 of experience, or the equivalent, who is a qualified supervisor
1348 as determined by the board. An individual who intends to
1349 practice in Florida to satisfy the clinical experience
1350 requirements must register pursuant to s. 491.0045 before
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1351 commencing practice. If a graduate has a master's degree with a
1352 major emphasis in marriage and family therapy or a closely
1353 related field which did not include all of the coursework
1354 required by paragraph (b), credit for the post-master's level
1355 clinical experience may not commence until the applicant has
1356 completed a minimum of 10 of the courses required by paragraph
1357 (b), as determined by the board, and at least 6 semester hours
1358 or 9 quarter hours of the course credits must have been
1359 completed in the area of marriage and family systems, theories,
1360 or techniques. Within the 2 years of required experience, the
1361 applicant must shall provide direct individual, group, or family
1362 therapy and counseling to cases including those involving
1363 unmarried dyads, married couples, separating and divorcing
1364 couples, and family groups that include children. A doctoral
1365 internship may be applied toward the clinical experience
1366 requirement. A licensed mental health professional must be on
1367 the premises when clinical services are provided by a registered
1368 intern in a private practice setting.
1369 (d) Has Passed a theory and practice examination
1370 designated provided by board rule the department.
1371 (e) Has Demonstrated, in a manner designated by board
1372 rule, knowledge of the laws and rules governing the practice of
1373 clinical social work, marriage and family therapy, and mental
1374 health counseling.
1375
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1376 For the purposes of dual licensure, the department shall license
1377 as a marriage and family therapist any person who meets the
1378 requirements of s. 491.0057. Fees for dual licensure may not
1379 exceed those stated in this subsection.
1380 (4) MENTAL HEALTH COUNSELING.—Upon verification of
1381 documentation and payment of a fee not to exceed $200, as set by
1382 board rule, plus the actual per applicant cost of purchase of
1383 the examination from the National Board for Certified Counselors
1384 or its successor organization, the department shall issue a
1385 license as a mental health counselor to an applicant who the
1386 board certifies has met all of the following criteria:
1387 (a) Has Submitted an application and paid the appropriate
1388 fee.
1389 (b)1. Attained Has a minimum of an earned master's degree
1390 from a mental health counseling program accredited by the
1391 Council for the Accreditation of Counseling and Related
1392 Educational Programs which consists of at least 60 semester
1393 hours or 80 quarter hours of clinical and didactic instruction,
1394 including a course in human sexuality and a course in substance
1395 abuse. If the master's degree is earned from a program related
1396 to the practice of mental health counseling which is not
1397 accredited by the Council for the Accreditation of Counseling
1398 and Related Educational Programs, then the coursework and
1399 practicum, internship, or fieldwork must consist of at least 60
1400 semester hours or 80 quarter hours and meet all of the following
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1401 requirements:
1402 a. Thirty-three semester hours or 44 quarter hours of
1403 graduate coursework, which must include a minimum of 3 semester
1404 hours or 4 quarter hours of graduate-level coursework in each of
1405 the following 11 content areas: counseling theories and
1406 practice; human growth and development; diagnosis and treatment
1407 of psychopathology; human sexuality; group theories and
1408 practice; individual evaluation and assessment; career and
1409 lifestyle assessment; research and program evaluation; social
1410 and cultural foundations; substance abuse; and legal, ethical,
1411 and professional standards issues in the practice of mental
1412 health counseling. Courses in research, thesis or dissertation
1413 work, practicums, internships, or fieldwork may not be applied
1414 toward this requirement.
1415 b. A minimum of 3 semester hours or 4 quarter hours of
1416 graduate-level coursework addressing diagnostic processes,
1417 including differential diagnosis and the use of the current
1418 diagnostic tools, such as the current edition of the American
1419 Psychiatric Association's Diagnostic and Statistical Manual of
1420 Mental Disorders. The graduate program must have emphasized the
1421 common core curricular experience.
1422 c. The equivalent, as determined by the board, of at least
1423 700 hours of university-sponsored supervised clinical practicum,
1424 internship, or field experience that includes at least 280 hours
1425 of direct client services, as required in the accrediting
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1426 standards of the Council for Accreditation of Counseling and
1427 Related Educational Programs for mental health counseling
1428 programs. This experience may not be used to satisfy the post-
1429 master's clinical experience requirement.
1430 2. Has Provided additional documentation if a course title
1431 that appears on the applicant's transcript does not clearly
1432 identify the content of the coursework. The documentation must
1433 include, but is not limited to, a syllabus or catalog
1434 description published for the course.
1435
1436 Education and training in mental health counseling must have
1437 been received in an institution of higher education that, at the
1438 time the applicant graduated, was fully accredited by an
1439 institutional a regional accrediting body recognized by the
1440 Council for Higher Education Accreditation or its successor
1441 organization or publicly recognized as a member in good standing
1442 with the Association of Universities and Colleges of Canada, or
1443 an institution of higher education located outside the United
1444 States and Canada which, at the time the applicant was enrolled
1445 and at the time the applicant graduated, maintained a standard
1446 of training substantially equivalent to the standards of
1447 training of those institutions in the United States which are
1448 accredited by an institutional a regional accrediting body
1449 recognized by the Council for Higher Education Accreditation or
1450 its successor organization. Such foreign education and training
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1451 must have been received in an institution or program of higher
1452 education officially recognized by the government of the country
1453 in which it is located as an institution or program to train
1454 students to practice as mental health counselors. The applicant
1455 has the burden of establishing that the requirements of this
1456 provision have been met, and the board shall require
1457 documentation, such as an evaluation by a foreign equivalency
1458 determination service, as evidence that the applicant's graduate
1459 degree program and education were equivalent to an accredited
1460 program in this country. Beginning July 1, 2025, an applicant
1461 must have a master's degree from a program that is accredited by
1462 the Council for Accreditation of Counseling and Related
1463 Educational Programs, the Masters in Psychology and Counseling
1464 Accreditation Council, or an equivalent accrediting body which
1465 consists of at least 60 semester hours or 80 quarter hours to
1466 apply for licensure under this paragraph.
1467 (c) Completed Has had at least 2 years of clinical
1468 experience in mental health counseling, which must be at the
1469 post-master's level under the supervision of a licensed mental
1470 health counselor or the equivalent who is a qualified supervisor
1471 as determined by the board. An individual who intends to
1472 practice in Florida to satisfy the clinical experience
1473 requirements must register pursuant to s. 491.0045 before
1474 commencing practice. If a graduate has a master's degree with a
1475 major related to the practice of mental health counseling which
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1476 did not include all the coursework required under sub-
1477 subparagraphs (b)1.a. and b., credit for the post-master's level
1478 clinical experience may not commence until the applicant has
1479 completed a minimum of seven of the courses required under sub-
1480 subparagraphs (b)1.a. and b., as determined by the board, one of
1481 which must be a course in psychopathology or abnormal
1482 psychology. A doctoral internship may be applied toward the
1483 clinical experience requirement. A licensed mental health
1484 professional must be on the premises when clinical services are
1485 provided by a registered intern in a private practice setting.
1486 (d) Has Passed a theory and practice examination
1487 designated provided by board rule the department for this
1488 purpose.
1489 (e) Has Demonstrated, in a manner designated by board
1490 rule, knowledge of the laws and rules governing the practice of
1491 clinical social work, marriage and family therapy, and mental
1492 health counseling.
1493 Section 19. Subsection (6) and paragraph (c) of subsection
1494 (9) of section 766.314, Florida Statutes, are amended to read:
1495 766.314 Assessments; plan of operation.—
1496 (6)(a) The association shall make all assessments required
1497 by this section, except initial assessments of physicians
1498 licensed on or after October 1, 1988, which assessments will be
1499 made by the Department of Health Business and Professional
1500 Regulation, and except assessments of casualty insurers pursuant
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1501 to subparagraph (5)(c)1., which assessments will be made by the
1502 Office of Insurance Regulation. Beginning October 1, 1989, for
1503 any physician licensed between October 1 and December 31 of any
1504 year, the Department of Business and Professional Regulation
1505 shall make the initial assessment plus the assessment for the
1506 following calendar year. The Department of Health Business and
1507 Professional Regulation shall provide the association, in an
1508 electronic format, with a monthly report such frequency as
1509 determined to be necessary, a listing, in a computer-readable
1510 form, of the names and license numbers addresses of all
1511 physicians licensed under chapter 458 or chapter 459.
1512 (b)1. The association may enforce collection of
1513 assessments required to be paid pursuant to ss. 766.301-766.316
1514 by suit filed in county court. The association shall be entitled
1515 to an award of attorney's fees, costs, and interest upon the
1516 entry of a judgment against a physician for failure to pay such
1517 assessment, with such interest accruing until paid.
1518 Notwithstanding the provisions of chapters 47 and 48, the
1519 association may file such suit in either Leon County or the
1520 county of the residence of the defendant. The association shall
1521 notify the Department of Health and the applicable board of any
1522 unpaid final judgement against a physician within 7 days of the
1523 final judgement.
1524 2. The Department of Business and Professional Regulation,
1525 upon notification by the association that an assessment has not
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1526 been paid and that there is an unsatisfied judgment against a
1527 physician, shall not renew any license to practice for such
1528 physician issued pursuant to chapter 458 or chapter 459 until
1529 such time as the judgment is satisfied in full.
1530 (c) The Agency for Health Care Administration shall, upon
1531 notification by the association that an assessment has not been
1532 timely paid, enforce collection of such assessments required to
1533 be paid by hospitals pursuant to ss. 766.301-766.316. Failure of
1534 a hospital to pay such assessment is grounds for disciplinary
1535 action pursuant to s. 395.1065 notwithstanding any provision of
1536 law to the contrary.
1537 (9)
1538 (c) If In the event the total of all current estimates
1539 equals 80 percent of the funds on hand and the funds that will
1540 become available to the association within the next 12 months
1541 from all sources described in subsections (4) and (5) and
1542 paragraph (7)(a), the association may shall not accept any new
1543 claims without express authority from the Legislature. Nothing
1544 in this section precludes herein shall preclude the association
1545 from accepting any claim if the injury occurred 18 months or
1546 more before prior to the effective date of this suspension.
1547 Within 30 days after of the effective date of this suspension,
1548 the association shall notify the Governor, the Speaker of the
1549 House of Representatives, the President of the Senate, the
1550 Office of Insurance Regulation, the Agency for Health Care
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1551 Administration, and the Department of Health, and the Department
1552 of Business and Professional Regulation of this suspension.
1553 Section 20. This act shall take effect July 1, 2022.
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HB 747
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 747 Protections of Medical Conscience
SPONSOR(S): Snyder
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Poche McElroy
2) Judiciary Committee
3) Health & Human Services Committee
SUMMARY ANALYSIS
A network of federal and state statutes creates legal protections for health care providers’ rights of conscience.
These laws originated after the U.S. Supreme Court’s 1973 decision in Roe v. Wade, to ensure that physicians who
opposed abortion on grounds of religion or conscience would not be compelled to participate in those procedures.
Over time, the scope of these conscience protections expanded significantly – today, the laws protect physicians,
pharmacists, other types of health care providers and medical staff, medical students, researchers, and health care
institutions like hospitals and skilled nursing facilities. The laws address various medical procedures beyond
abortion, including sterilization, contraception, emergency contraception, end of life care, aid-in-dying, and stem cell
research. Some laws are broad enough to protect health care providers who object to any medical treatment on
grounds of conscience. Many laws protect not only those who object to performing a specific medical service, but
also those who object to informing patients about, referring patients for, or participating in any way in that service.
The precise scope and content of these protections varies widely across federal and state law.
HB 747 creates s. 381.00321, F.S., establishing a health care provider’s or health care payer’s right to
decline to participate in any health care service that violates the provider’s or payer’s conscience, defined as the
moral, ethical, or religious beliefs or principles held by the provider or payer. The bill also gives a health care
provider that is a business entity and a health care payer that holds itself out as religious, has a religious purpose or
mission evidenced by its operating documents, and has internal procedures to implement the purpose or mission
the right to make employment, staffing, contracting, and credentialing decisions consistent with their religious
beliefs.
The bill also prohibits threatened and actual adverse action against a health care provider or health care payer for
declining to participate in a health care service that violates their conscience; reporting to the appropriate
governmental agency certain violations by the provider or payer’s employer or gross mismanagement, gross waste
of funds, abuse of authority, or any action that is a substantial and specific danger to public health or safety.
Lastly, the bill creates a civil cause of action for treble damages, an injunction, or any other appropriate relief for any
violation of s. 381.00321, F.S. A prevailing plaintiff is also entitled to attorney fees and court costs. The bill provides
immunity from civil, criminal, or administrative liability on the part of a health care provider or health care payer for
exercising their right to conscience.
The bill has no 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.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Conscience
Most definitions in the U.S. legal context broadly define conscience to include moral, ethical, or
religious principles. Some scholars believe that the definition between religion and conscience is a
distinction without a difference. Others have suggested that “the framers viewed ‘free exercise of
religion’ and ‘freedom of conscience’ as virtually interchangeable concepts”. 1 James Madison is
credited with first identifying the right to conscience as fundamental and inalienable, “changing the
Virginia Declaration of Rights from a mere statement of the principle of tolerance to the first official
legislative pronouncement that freedom of conscience and religion are inherent rights of the
individual.” 2 Freedom of conscience is a concept that has been highly valued since the founding of the
United States. 3
The Health Care Right of Conscience Act 4 in Illinois was the first state law of its kind and is model
legislation in the conscience arena. That Act defines ‘conscience’ as “a sincerely held set of moral
convictions arising from belief in and relation to God, or which, though not so derived, arises from a
place in the life of the possessor parallel to that filled by God among adherents to religious faiths.” 5
Conscience cannot to be construed as merely one’s ideas or opinions. 6
Conscience Objections and Health Care Professional Ethics
Health care providers with moral objections to specific health care services have an obligation to alert
their colleagues and supervisors to these objections, in the interests of minimizing disruption in the
delivery of care and minimizing burdens on other providers. Conscientious objection policies may
specify that a professional who has invoked the right to refuse to provide a service must not interfere
with the patient’s ability to obtain it elsewhere. This specification recognizes that it is professionally
inappropriate for health care providers who step away from services to then step between a patient and
another health care provider, whether by refusing to cooperate with the transfer of a patient’s care,
refusing to make a referral, or making a patient feel uncomfortable or ashamed about seeking health
care.
The American Medical Association issued an opinion interpreting its’ Code of Medical Ethics regarding
the physician exercise of conscience in the practice of medicine. 7 Physicians are expected to uphold
the ethical norms of their profession, including fidelity to patients and respect for patient self-
determination. Yet physicians are not defined solely by their profession. They are moral agents in their
own right and, like their patients, are informed by and committed to diverse cultural, religious, and
philosophical traditions and beliefs. For some physicians, their professional calling is imbued with their
foundational beliefs as persons, and at times the expectation that physicians will put patients’ needs
and preferences first may be in tension with the need to sustain moral integrity and continuity across
both personal and professional life.
1 Smith, S.D., What does religion have to do with freedom of conscience?, University of Colorado Law Review, 76, 911-940, 912.
2 Everson v. Board of Education, 330 U.S. 1, 34 (1947).
3 McConnell, M., The Origins and Historical Understanding of Free Exercise of Religion, 103 Harv. L. Rev. 1409 (1990).
4 745 Ill. Comp. Stat. 70/2
5 745 Ill. Comp. Stat. 70/3(e)
6 Von Bergen, CW, and Bressler, M, A matter of conscience: do conflicting beliefs and workplace demands constitute religious
discrimination?, Journal of Behavioral Studies in Business, 3, pgs. 113-126, 114 (April 2011).
7 American Medical Association, Code of Medical Ethics Opinion 1.1.7 – Physician Exercise of Conscience, available at
https://www.ama-assn.org/delivery-care/ethics/physician-exercise-conscience.
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Preserving opportunity for physicians to act or to refrain from acting in accordance with the dictates of
conscience in their professional practice is important for preserving the integrity of the medical
profession as well as the integrity of the individual physician, on which patients and the public rely.
Physicians should have considerable latitude to practice in accord with well-considered, deeply held
beliefs that are central to their self-identities.
Physicians’ freedom to act according to conscience is not unlimited, however. Physicians are expected
to provide care in emergencies, honor patients’ informed decisions to refuse life-sustaining treatment,
and respect basic civil liberties and not discriminate against individuals in deciding whether to enter into
a professional relationship with a new patient.
In other circumstances, physicians may be able to act (or refrain from acting) in accordance with the
dictates of their conscience without violating their professional obligations. Several factors impinge the
decision to act according to conscience. Physicians have stronger obligations to patients with whom
they have a patient-physician relationship, especially one of long standing; when there is imminent risk
of foreseeable harm to the patient or delay in access to treatment would significantly adversely affect
the patient’s physical or emotional well-being; and when the patient is not reasonably able to access
needed treatment from another qualified physician.
In following conscience, the AMA believes that physicians should:
• Thoughtfully consider whether and how significantly an action (or declining to act) will
undermine the physician’s personal integrity, create emotional or moral distress for the
physician, or compromise the physician’s ability to provide care for the individual and other
patients.
• Before entering into a patient-physician relationship, make clear any specific interventions or
services the physician cannot in good conscience provide because they are contrary to the
physician’s deeply held personal beliefs, focusing on interventions or services a patient might
otherwise reasonably expect the practice to offer.
• Take care that their actions do not discriminate against or unduly burden individual patients or
populations of patients and do not adversely affect patient or public trust.
• Be mindful of the burden their actions may place on fellow professionals.
• Uphold standards of informed consent and inform the patient about all relevant options for
treatment, including options to which the physician morally objects.
• In general, physicians should refer a patient to another physician or institution to provide
treatment the physician declines to offer. When a deeply held, well-considered personal belief
leads a physician also to decline to refer, the physician should offer impartial guidance to
patients about how to inform themselves regarding access to desired services.
• Continue to provide other ongoing care for the patient or formally terminate the patient-physician
relationship in keeping with ethics guidance.
Some scholars argue that invoking personal conscience violates medical professional ethics. 8 And
while courts will usually not compel health care providers to participate in procedures that violate their
personal faith or conscience, they construe objections of associated “complicity” narrowly and thus may
require such providers to give patients reasonable information about access to appropriate treatment. 9
Conscience clauses are not without controversy. Several scholars question whether offering legal
protections for health care providers’ exercise of conscience is even justified. 10 Other commentators
argue that conscience laws should not protect providers from criminal prosecution, 11 civil liability, 12 or
regulatory sanction. 13
8 Frader, J., Bosk, C.L., The personal is political, the professional is not: conscientious objection to obtaining/providing/acting on genetic
information, Am J Med Genet C Semin Med Genet. 2009;151C(1):62-67.
9 Lynch, H.F., Conflicts of Conscience in Health Care: An Institutional Compromise, Cambridge, MA, MIT Press, 2008: 231.
10 Charo, R.A., The Celestial Fire of Conscience – Refusing to Deliver Medical Care, New England Journal of Medicine 352 (2005), pgs.
2471-2473, 2473.
11 Nelson, L., Provider Conscientious Refusal of Abortion, Obstetrical Emergencies, and Criminal Homicide Law, American Journal of
Bioethics, July;18(7): pgs. 43-50 (2018).
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Health Care Conscience Protection Laws
Conscience protection laws protect individuals and entities from being required to perform services that
violate their religious beliefs or moral convictions. These statutes have historically related to abortion,
sterilization, and contraception. Conscience protections apply to health care providers who refuse to
perform, accommodate, or assist with certain health care services on religious or moral grounds. The
inspiration for conscience protection laws may have come from the accommodation requirements in
Title VIII civil rights laws; however, most conscience laws do not have the “reasonable” and “undue
hardship” qualifiers for accommodating religious practices under that federal law.
Conscience protection laws are generally designed to reconcile “the conflict between religious health
care providers who provide care in accordance with their religious beliefs and the patients who want
access to medical care that these religious providers find objectionable”. 14 Such laws protect
conscientious objectors from coercive hiring or employment practices, discrimination and other forms of
punishment or pressure. Also, these laws generally include civil liability protection. Federal statutes
protect health care provider conscience rights and prohibit recipients of certain federal funds from
discriminating against health care providers who refuse to participate in these services based on moral
objections or religious beliefs.
Despite the level of interest in tracking legislative developments related to conscience laws in the U.S.,
there exists no empirical data on how frequently these various types of procedural protections arise. 15
Federal Health Care Conscience Protections
Several federal health care provider conscience protection laws, detailed below, prohibit recipients of
certain federal Department of Health and Human Services (HHS) financial assistance from
discriminating against certain health care providers because of their refusal or unwillingness to
participate in certain medical procedures, such as sterilization procedures and abortions, that are
contrary to or consistent with the provider’s religious beliefs or moral convictions. Providers protected
under these federal laws include:
• Individual physicians;
• Researchers;
• Nurses;
• Applicants for internships or residencies;
• Other health care professionals;
• Hospitals;
• Health insurance plans;
• Provider-sponsored organizations;
• Health maintenance organizations;
• Health care facilities; and
• Other health care entities. 16
The following “covered entities” must comply with the federal health care provider conscience laws:
• Federal agencies funded by appropriations to the U.S Departments of Health and Human
Services (HHS), Labor, and Education;
• Qualified health plans offered through a health insurance exchange;
12 Rich, B.A., Your Morality, My Mortality: Conscientious Objection and the Standard of Care, Cambridge Quarterly of Healthcare
Ethics, 24: pgs. 214-230, 228 (2015).
13 Id.
14 White, K.A., Crisis of conscience: Reconciling religious health care providers’ beliefs and patient rights, Stanford Law Review, 51,
1703-1749 (1999).
15 Sawicki, N., The Conscience Defense to Malpractice, 108 Calif. L. Rev. 1255, pg. 1260 (2020).
16 U.S. Department of Health and Human Services, Office for Civil Rights, OCR Fact Sheet: Your Rights Under the Federal Health Care
Provider Conscience Protection Laws, available at
https://www.hhs.gov/sites/default/files/ocr/civilrights/provider_conscience_factsheet.pdf.
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• Any entity receiving federal financial assistance under certain HHS-implemented statutes; and
• Any entity which receives an HHS grant or contract for biomedical or behavioral research. 17
Under the federal health care provider conscience laws, covered entities may not, if it would be contrary
to the individual’s or health care entity’s religious beliefs or moral convictions:
• Require the individual to participate in sterilization or abortion;
• Require the entity to make its facilities available for sterilization or abortion;
• Require the entity to provide personnel to participate in sterilization or abortion;
• Discriminate against any physician or health care personnel in employment or staff privileges
because the individual participated in or refused to participate in sterilization or abortion;
• Discriminate against any physician or health care personnel in employment or staff privileges
because the individual participated in or refused to participate in any lawful health service or
research activity;
• Deny admission to or otherwise discriminate against any training program applicant (including
applicants for internships or residencies) because of the applicant’s reluctance or willingness to
participate in sterilization or abortion; or
• Discriminate against any individual or institutional health care entity that does not train in the
performance of abortions or provide, pay for, provide coverage of, or refer for abortion. 18
Also, covered entities must deem accredited any postgraduate physician training program that would
be accredited, but for the reliance on an accrediting standard that (regardless of whether such standard
provides exceptions or exemptions) requires an entity to perform abortions; or provide training for
abortions. 19
Office of Civil Rights
The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) enforces
federal civil rights laws, conscience and religious freedom laws, the Health Insurance Portability and
Accountability Act (HIPAA) Privacy, Security, and Breach Notification Rules, and the Patient Safety Act
and Rule, which together protect your fundamental rights of nondiscrimination, conscience, religious
freedom, and health information privacy. OCR protects rights by:
• Teaching health and social service workers about civil rights laws, conscience and religious
freedom laws, health information privacy, and patient safety confidentiality laws.
• Educating communities about civil rights, conscience and religious freedom rights, and health
information privacy rights.
• Investigating civil rights, conscience and religious freedom, health information privacy, and
patient safety confidentiality complaints to identify discrimination or violation of the law and
acting to correct problems.
A complaint under the Federal Health Care Provider Conscience Protection Statutes may be filed with
the OCR if an individual believes he or she experienced discrimination because they:
• Objected to, participated in, or refused to participate in specific medical procedures, including
abortion and sterilization, and related training and research activities.
• Were coerced into performing procedures that are against your religious or moral beliefs.
• Refused to provide health care items or services for the purpose of causing, or assisting in
causing, the death of an individual, such as by assisted suicide or euthanasia.
OCR coordinates the handling of complaints with staff of the HHS programs from which the entity, with
respect to whom a complaint has been filed, receives funding. If HHS becomes aware that a state or
local government or an entity has conducted activities that may violate federal conscience protection
17 Id.
18 Id.
19 Id.
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laws, HHS will work with the offending government or entity to achieve voluntary compliance. 20 If
voluntary compliance cannot be reached, HHS considers all legal options, including terminating funding
and collecting fines paid out from violating the statutory conscience protections. 21
OCR receives discrimination complaints under the following statutes:
The “Church Amendments”
The conscience provisions contained in 42 U.S.C. § 300a-7 et seq., collectively known as the “Church
Amendments,” were enacted in the 1970s to protect the conscience rights of individuals and entities
that object to performing or assisting in the performance of abortion or sterilization procedures if doing
so would be contrary to the provider’s religious beliefs or moral convictions. The Church Amendments
were also the first federal conscience provisions to be enacted and are the broadest in scope. This
provision also extends protections to personnel decisions and prohibits any entity that receives a grant,
contract, loan, or loan guarantee under certain Department-implemented statutes from discriminating
against any physician or other health care personnel in employment because the individual either
performed, or refused to perform an abortion if doing so would be contrary to the individual’s religious
beliefs or moral convictions. Specifically, the amendments contain the following major provisions:
• Prohibit courts and other public officials from requiring individuals or institutions receiving grants
under certain federal programs to perform or assist in abortions or sterilizations or to provide
facilities or personal for the same procedures; 22
• Forbid discrimination against physicians or other health care providers because of their religious
or moral objections to performing abortions or sterilizations; 23
• Extend protection to individuals, including researchers and laboratory staff participating in HHS-
funded behavioral or biomedical research; 24 and
• Bar any program funded by HHS from requiring any individual to perform or assist in “any part”
of a “health service program or research activity” if such participation would be contrary to the
individual’s religious beliefs or moral convictions. 25
The Coats-Snowe Amendment
In 1996, Congress passed the Omnibus Consolidated Rescissions and Appropriations Act of 1996.
The Act addressed many issues, including funding for several federal agencies, prison litigation reform,
and funding for the District of Columbia and reform of its schools. The Coats-Snowe Amendment was
included in a general provision portion of the Act. The Amendment provides conscience protections for
health care entities and individuals in connection with abortion training. The Amendment was enacted
to address a new standard from the Accreditation Council for Graduate Medical Education (ACGME),
which governs medical residencies, that required access to experience with induced abortion to be part
of a resident’s education, unless the resident had a moral or religious objection to such abortions. 26
Previously, training for abortions had been voluntary and not required for residency accreditation.
The Coats-Snowe Amendment prevents the federal government and any state or local government that
receives any federal financial assistance from subjecting any “health care entity” to “discrimination” for
refusing to train or arrange for training for induced abortions. 27 Such government units also may not
20 U.S. Department of Health and Human Services, Office of the Secretary, Office for Civil Rights, Enforcement of the Federal Health
Care Provider Conscience Protection Laws, slide 8 (June 9, 2016), available at https://www.hhs.gov/sites/default/files/ocr-provider-
conscience-powerpoint-6-9-2016.pdf.
21 Id.
22 42 U.S.C. s. 300a-7(b)
23 42 U.S.C. s. 300a-7(c)(1); areas of prohibited discrimination include employment, promotion, termination, and extending staff
privileges; the Church Amendments also prohibit discrimination against individuals because of their past involvement in lawful abortions
or sterilizations.
24 42 U.S.C. s. 300a-7(c)(2); under this provision, no individual can be discriminated against on the basis that the individual performed
or assisted in any lawful research activity or the individual refused to perform or assist in any research activity because it would be
contrary to his or her religious beliefs or moral convictions.
25 This provision covers a broad array of activities, including contraception programs and research activities administered by HHS.
26 Accreditation Council for Graduate Medical Education, 1996-1997 Graduate Medical Education Directory 135 (1996), available at
http://acgme.org/Portals/0/PDFs/1996-97.pdf.
27 42 U.S.C. s. 238n(a)(1)-(2)
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discriminate against persons who attend a post-graduate training program that lacks abortion training. 28
The Amendment defines “health care entity” to “include an individual physician, a postgraduate
physician training program, and a participant in a program of training in the health professions.” 29 It
does not define “discrimination.”
The Coats-Snowe Amendment also addresses the accreditation of medical training programs. The
federal government and any state or local government that receives federal funds must accredit a
“health care entity” that, but for its refusal to provide abortion training, would be accredited. 30 As to this
provision only, the Amendment expressly confers rulemaking authority. It provides that “[t]he
government involved shall formulate such regulations . . . as are necessary to comply with this
subsection.”
Public Health Service Act S. 245
Enacted in 1996, section 245 of the Public Health Service Act, contained in 42 U.S.C. § 238n, prohibits
the federal government and any state or local government receiving federal financial assistance from
discriminating against any health care entity on the basis that the entity:
• Refuses to undergo training in the performance of induced abortions, to require or provide such
training, to perform such abortions, or to provide referrals for such training or such abortions; 31
• Refuses to arrange for such activities 32; or
• Attends (or attended) a post-graduate physician training program, or any other program of
training in the health professions, that does not (or did not) perform induced abortions or
require, provide, or refer for training in the performance of induced abortions, or arrange for the
training.
The Weldon Amendment
The Weldon Amendment was originally passed as part of the HHS appropriation and has been
readopted or incorporated by reference in each subsequent HHS appropriations act since 2005. It
provides that “none of the funds made available in this Act [making appropriations for the Departments
of Labor, Health and Human Services, and Education] may be made available to a Federal agency or
program, or to a state or local government, if such agency, program, or government subjects any
institutional or individual health care entity to discrimination on the basis that the health care entity does
not provide, pay for, provide coverage of, or refer for abortions.” The Amendment covers a diverse
group of healthcare entities, including physicians and other healthcare providers, hospitals, provider-
sponsored organizations, HMOs, insurance plans and any kind of healthcare facility, organization or
plan.
Patient Protection and Affordable Care Act (PPACA)
The PPACA (Pub. L. No. 111-148 as amended by Pub. L. No. 111-152) includes health care provider
conscience protections within the health insurance exchange program. Section 1303(b)(4) of the Act
provides that “No qualified health plan offered through an Exchange may discriminate against any
individual health care provider or health care facility because of its unwillingness to provide, pay for,
provide coverage of, or refer for abortions.” An Executive Order from President Obama affirmed that
under the PPACA, longstanding federal health care provider conscience laws remain intact, and new
protections prohibit discrimination against health care facilities and health care providers based on their
unwillingness to provide, pay for, provide coverage of, or refer for abortions. 33
28 Id. at s. 238n(a)(3)
29 Id. at s. 238n(c)(2)
30 Id. at s. 238n(b)(1)
31 42 U.S.C. s. 238n(a)
32 Id.
33 The White House, President Barack Obama, Executive Order 13535, Ensuring Enforcement and Implementation of Abortion
Restrictions in the Patient Protection and Affordable Care Act (March 24, 2010).
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Additionally, section 1553 of the Affordable Care Act incudes conscience protections regarding assisted
suicide: 34 “The Federal Government, and any State or local government or health care provider that
receives Federal financial assistance under this Act (or under an amendment made by this Act) or any
health plan created under this Act (or under an amendment made by this Act), may not subject an
individual or institutional health care entity to discrimination on the basis that the entity does not provide
any health care item or service furnished for the purpose of causing, or for the purpose of assisting in
causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.”
Section 1303 provides that a State may choose to prohibit abortion coverage in its qualified health
plans 35, and that such a plan is not required to provide abortion coverage as part of its “essential health
benefits.” 36 However, a qualified health plan that declines to provide abortion coverage must provide
notice of this exclusion to potential enrollees. 37 And no qualified health plan may “discriminate” against
any health care provider or facility because it refuses to provide, pay for, cover, or “refer for”
abortions. 38 Section 1303 does not define “discriminate” or “refer for.”
Congress recognized the potential conflict between section 1303 and other federal and state statutes,
so the law states that nothing in the PPACA shall be construed to preempt or effect state laws on
abortion, federal laws on abortion, specifically, those related to conscience protection, willingness or
refusal to provide abortion, and discrimination based on that willingness or refusal, 39 or to relieve health
care providers of their obligations to provide emergency services under federal or state laws, including
the Emergency Medical Treatment and Labor Act. 40 Section 1303 also states that it does not “alter the
rights and obligations of employees and employers” under Title VII. 41
Section 1411 addresses exemptions to the PPACA’s “individual responsibility requirement”, known as
the individual mandate. 42 Under this section, HHS may grant exemptions based on hardship, which
HHS has stated includes an individual’s inability to secure affordable coverage that does not provide for
abortions, 43 membership in a particular religious organization, or membership in a health care sharing
ministry. 44
Medicaid and Medicare Advantage Conscience Provisions
In 1997, Congress passed the Balanced Budget Act of 1997, which included conscience provisions in
various sections regarding Medicaid and Medicare. The statute prohibited Medicaid-managed
organizations and Medicare Advantage plans from prohibiting or restricting a physician from informing a
patient about his or her health and full range of treatment options. 45 But it also provided that Medicaid
managed care organizations and Medicare Advantage plans are not required to provide, reimburse for,
or cover a counseling or referral service if the organization or plan objects to the service on moral or
religious grounds. 46 The organization or plan must, however, provide sufficient notice of their moral
objections to prospective enrollees. 47 Neither the Medicaid nor Medicare Advantage provisions define
“referral.” The HHS Secretary does, however, have explicit rulemaking authority under the Social
Security Act to implement these provisions. 48
34 42 USC s. 18113
35 42 U.S.C. s. 18023(a)(1)
36 Id. at s. 18023(b)(1)(A)(i)
37 Id. at s. 18023(b)(3)(A)
38 Id. at s. 18023(b)(4)
39 Id. at s. 18023(c)(2)(A)
40 Id. at s. 18023(d)
41 Id. at s. 18023(c)(3)
42 42 U.S.C. s. 18081(b)(5)(A)
43 84 Fed. Reg. at 23,172
44 42 U.S.C. s. 18081(5)
45 42 U.S.C. s. 1395w–22(j)(3)(A)(Medicare Advantage); 42 U.S.C. s. 1396u–2(b)(3)(A)(Medicaid).
46 42 U.S.C. s. 1395w–22(j)(3)(B)(Medicare Advantage); 42 U.S.C. s. 1396u–2(b)(3)(B)(Medicaid).
47 42 U.S.C. ss. 1395w–22(j)(3)(B)(ii) (Medicare Advantage); 42 U.S.C. s. 1396u–2(b)(3)(B)(ii) (Medicaid).
48 42 U.S.C. s. 1395w–26(b)(1) (Medicare Advantage).
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OCR Enforcement Activities
Some examples of OCR’s enforcement activities include:
• OCR received complaints alleging Vanderbilt University violated the conscience rights of two
nurse residency program applicants under the Church Amendments by requiring a written
promise that the applicants would assist in pregnancy termination procedures. 49 OCR
investigated and worked with Vanderbilt to resolve the complaints. In response, Vanderbilt
agreed to:
o Inform nurse residency candidates that it does not require them to participate in
pregnancy termination procedures, if it is inconsistent with their religious beliefs and
moral convictions;
o Remove to original acknowledgement form and replace it with information clarifying its
accommodations for religious beliefs and moral convictions; and
o Send revised information packets to new candidates, including the complainants. 50
• OCR received complaints alleging Mt. Sinai Hospital forced a nurse to assist in performing an
abortion, against her religious objections. 51 The complaint also alleged the hospital
discriminated against the nurse by reducing the number of on-call shifts she received and
asking her to sign a statement of her willingness to participate in abortions in emergencies, as a
condition of getting assigned more on-call shifts, all of which violated the Church Amendments,
Section 245 of the Public Health Service Act, and the Weldon Amendment. 52 Following an
investigation by OCR, the hospital agreed to:
o Use its best efforts to ensure that non-objecting health care personnel are
available to perform abortions;
o Issue and post a revised Human Resources Policy stating that: “The Mount Sinai
Hospital does not discriminate in the employment, promotion, or termination of
employment of any physician or other health care personnel…, because he or she
performed or assisted in the performance of a lawful sterilization procedure or abortion,
or because he or she refused to perform or assist … [due to his or her] religious beliefs
or moral convictions”;
o Comply with provisions of the Church Amendments; and
o Train operating room managers, nurses and surgical technicians on the hospital’s
obligations to comply with the Church Amendments and train administrative staff to
ensure that the operating room nurses’ and surgical technicians'’ objecting or non-
objecting status is properly recorded. 53
State Health Care Conscience Protections
The states have been leaders in conscience protection in the workplace. 54 While federal conscience
protection laws generally deal with appropriations of federal funding, state laws protect against a
broader range of penalties, including civil liability, criminal prosecution, loss of licensure, employment
discrimination, discrimination in education, and denial of private or public funding. 55 Of these, civil
liability immunity is by far the most common procedural protection. 56 In a majority of states, this
immunity is absolute – providing no exceptions in the cases of malpractice, denial of emergency
treatment, or patient death. 57
49 Supra, FN 13 at slide 21.
50 Id. at slide 22.
51 Id. at slide 23.
52 Id.
53 Id. at slide 24.
54 Sonne, J., Firing Thoreau: Conscience and At-Will Employment, University of Pennsylvania Journal of Labor and Employment Law,
Vol. 9, pgs. 235-291, 267 (2007).
55 Durham, R., Neither Right nor Safe to Go Against It: Defending the Constitutionality of Conscience Laws, University of Cincinnati Law
Review (May 12, 2021), available at https://uclawreview.org/2021/05/12/neither-right-nor-safe-to-go-against-it-defending-the-
constitutionality-of-conscience-laws/
56 Supra, FN 8.
57 Id.
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Three states stand out as examples of broader conscience protections at the state level – Illinois,
Mississippi, and Washington.
Illinois – Any person, public or private institution, or public official may not discriminate against
any other person in any manner because of that person's conscientious refusal to receive,
obtain, accept, perform, assist, counsel, suggest, recommend, refer or participate in any
particular health care service that violates his or her conscience. 58
Mississippi – Any person, health care provider, health care institution, public or private
institution, or public official may not discriminate against any health care provider in any way
because the provider declined to participate in a health care service that violates his or her
conscience.
Washington – A health care provider, religiously sponsored health carrier, or health care facility
may not be required to provide or pay for a health care service if they object to so doing for
reason of conscience or religion. The law prohibits employment or professional privileges
discrimination because of such objection. 59
In addressing all health care services, the statutes in the preceding three states went well beyond the
procedure-specific laws of other states at the time. It is also interesting to note the expansive meaning
of “conscience” in each state – Illinois defines it as a “sincerely held set of moral convictions”;
Mississippi includes “religious, moral, or ethical principles”; and Washington offers no definition at all. 60
Following enactment of the Church Amendments, least 47 states and the District of Columbia passed
conscience protection laws regarding the refusal to perform abortions. 61 Of these, at least 40 states
offer protection from employment discrimination and/or recrimination. 62 The majority of U.S.
jurisdictions (47 states) have conscience laws establishing a right on the part of individual and/or
institutional health care providers to refuse to participate in abortion. 63 Fewer jurisdictions have laws
relating to conscience-driven refusal to participate in sterilization (17 states), contraception (16 states),
or emergency contraception (5 states). 64
Of the forty-seven jurisdictions with abortion-specific conscience laws (forty-six of which protect rights
of refusal), 65 thirty-seven explicitly establish immunity from civil liability for individual and/or institutional
health care providers who refuse to participate in abortion. Thirty states protect providers from
"disciplinary action." This term is often unspecified and undefined, though it is occasionally tied to
specific adverse actors like employers. Twenty-six states protect providers from "discrimination," a
similarly vague term. Another twenty-six states provide explicit protection against adverse actions by
employers (for example, decisions relating to hiring, dismissal, demotion, transfer, wages, or staff
privileges). Protection against adverse action by government actors, educational institutions, criminal
prosecutors, state licensing boards, and funding sources was less common. Only four states establish
a right to refuse but do not explicitly delineate any specific procedural protections. 66
Each of the thirty-seven states that expressly established civil immunity for abortion refusal identified
specific categories of providers entitled to such immunity. The most commonly protected
groups were:
58 745 Ill. Comp. Stat. Ann. 70/5 (2002).
59 Wash. Rev. Code Ann. s. 70.47.160(2)(a) (2002).
60 Supra, FN 47 at pg. 275.
61 Id.
62 Id.
63 Supra, FN 8 at pg. 1273-74.
64 Id.
65 Among the seventeen states with sterilization-specific conscience laws, fifteen provide for civil immunity. Civil liability protections
were less common in laws relating to contraception and emergency contraception. Sixteen states have contraception-specific laws, but
only five establish immunity from civil liability. Five states have laws relating to emergency contraception, but only one establishes
immunity from civil liability.
66 Ariz. Rev. Stat. Ann. § 36-2154 (2020); Conn. Agencies Regs. § 19-13-D54 (2005); Tenn. Code Ann. §§ 39-15-204, 39-15-205
(2007); W. Va. Code § 16-2F-7 (2020).
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• "Any person" (twenty-six states),
• Health care facilities (twenty-six states),
• Physicians (seventeen states),
• Registered nurses (sixteen states), and
• Staff working at health care facilities (fourteen states).
Other categories of providers also singled out for civil immunity included:
• Private health care facilities (nine states),
• Health care providers (six states),
• Students (five states),
• Pharmacists (three states),
• Any licensed professionals (two states),
• Mental health professionals (two states),
• Public employees (two states), and
• Religious health care facilities (one state).67
Overall, all but two states protected extremely broad categories of individuals-either "persons" generally
(not including health care professionals), health care providers, or staff and employees of health care
facilities. 68 All but five states provided civil immunity to at least some health care facilities. 69 An
additional five states limited institutional protections to private facilities 70, and one state protected
facilities only if they were religiously affiliated. 71
Although most states explicitly identify narrower categories of providers for civil immunity, almost every
state protects a very broad range of individuals (thirty-five of thirty-seven states), and all or some health
care facilities (thirty-two of thirty-seven states). Thus, in civil immunity states, most individuals and
facilities are immune from suit if their unwillingness to participate in abortion falls below the standard of
care and causes patient injury. 72
In other reproductive health contexts, there are similar patterns. Of the seventeen states with
conscience laws relating to sterilization, only four limit providers' refusal rights in any way. 73 Of the
sixteen states with contraception laws, only six states limit providers' refusal rights or impose conditions
to protect patients. 74 Of the five states with emergency contraception laws, three states limit providers'
refusal rights. 75
Among the forty-seven states with abortion refusal laws, only one state, Maryland, explicitly limits a
provider's civil immunity where their conduct has violated the standard of care. However, Maryland's
law does not provide patients with a remedy for all harms. Rather, it only applies in cases where the
provider breaches a duty to give a referral and that breach causes the patient's "death or
serious physical injury." 76
Other states limit providers' conscience protections in situations where conscience-based refusals
might seriously endanger patients. Thirteen states limit the right to refuse participation in abortion cases
67 Supra, FN 8 at pgs. 1276-77.
68 The two outlier states did not extend their civil immunity provisions to any individual providers. Nev. Rev. Stat. §449.191
(2019)(protecting only private health facilities); Or. Rev. Stat. § 435.475 (2019)(protecting only hospitals).
69 Ga. Code Ann. § 16-12-142 (2013); Iowa Code § 146.2 (2020); Mass. Gen. Laws ch. 112, § 121 (2003); N.C. Gen. Stat. § 14-45-1
(2019).
70 Ky. Rev. Stat. Ann. § 311.800 (2020); Nev. Rev. Stat. § 449.191; Okla. Stat. tit. 63 § 1-741 (2019); S.C. Code Ann. § 44-41-40
(2019); Wyo. Stat. Ann. §§ 35-6-105, 35-6-106 (2019).
71 Cal. Health & Safety Code § 123420(c)(2020)(protecting "nonprofit hospital[s]" and "other facility[ies] or clinic[s] ... organized or
operated by a religious corporation or other religious organization," and also persons, physicians, nurses, and facility staff)
72 Among the fifteen states with sterilization-specific conscience laws that explicitly establish civil immunity, all protect at least one broad
category of individual providers (persons, providers, or facility staff), and all but three protect health care facilities.
73 Ala. Code § 22-21B-4(b)(2019; 745 Ill. Comp. Stat. 70/6 (2019); Id. 70/6.1; Md. Code Ann., Health-Gen. § 20-214(d)(2020); 16 Pa.
Code § 51.31(e)(2019); Id. §§ 51.42(a), .43(a).
74 Cal. Code Regs. tit. 16, § 1746.1(b)(9)(2020); Ga. Code Ann. § 49-7-6 (2001); 745 Ill. Comp. Stat. 70/6; Id. 70/6.1; N.Y. Comp.
Codes R. & Regs. tit. 18 § 463.6(d) (2020); Or. Rev. Stat. § 435.225 (2019); Wis. Stat. Ann. § 253.075(3)(b)(2020).
75 Ariz. Rev. Stat. Ann. § 36-2154(B)(2020); Cal. Code Regs. tit. 16, § 1746(b)(5)(2020); Idaho Code § 18-611(4), (6) (2019).
76 Md. Code Ann., Health-Gen. § 20-214(d).
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where a patient requires emergency treatment. 77 A few states restrict the scope of abortion objections
to exclude procedures intended to treat miscarriage (four states) 78 or ectopic pregnancy (three states) 79
conditions that can seriously threaten a pregnant patient's health.
Some states have also established patient-protective conditions on the exercise of providers' refusal
rights. Eight states impose a duty to notify the patient of the refusal or of the hospital's general policy
opposing abortion. 80 Two states require that providers who refuse to participate directly in abortions
nevertheless ensure that the patient can access the service from another provider. 81 Two states require
refusing providers to give the patient information regarding access to the requested service. 82 Two
states require that a refusing provider return the patient's prescription. 83 Only one state imposes a
statutory requirement that refusing providers satisfy the duty to secure a patient's informed consent,
including the duty to inform patients of "legal treatment options" and the risks and benefits of these
options." 84
The following chart summarizes health care provider conscience protection laws in the states. 85
State Policies Allowing Providers to Refuse to Provide Health Care Services
Due to Conscientious Refusal
Abortion Contraception Sterilization
State
Provider Institution Provider Pharmacist Institution Provider Institution
Fed. Policy X X X X
Alabama X X
Alaska X Private
Arizona X± X± X X X
Arkansas X X X X X X X
California X Religious
Colorado X * Private
Connecticut X
77 Ala. Code § 22-21B-4(b); Cal. Health & Safety Code § 123420(d) (2020); Idaho Code § 18-611(4); Id. § 18-611(6); 745 Ill. Comp.
Stat. 70/6; Iowa Code § 146.1 (2020); Ky. Rev. Stat. Ann. § 311.800(1)(2020); La. Stat. Ann. § 40:1061.23(2020); Id. § 40:1061.5; Md.
Code Ann., Health-Gen. § 20-214(d); Nev. Rev. Stat. § 632.475(3) (2019); Okla. Stat. tit. 63, § 1-741(B)(2019); Id. § 1-741(C); Id. § 1-
728c(1); 16 Pa. Code §§ 51.42(a), .43(a); Id. § 51.43(b) (1977); S.C. Code Ann. § 44-41-40 (2019); Tex. Occ. Code Ann. §
103.004(2020).
78 Cal. Health & Safety Code § 123420(d); La. Stat. Ann. § 40:1061.9(1)(b) (2020); Okla. Stat. tit. 63, § 1-741(C); 16 Pa. Code §
51.43(b).
79 Ariz. Rev. Stat. Ann. § 36-2151(1) (2020); La. Stat. Ann. § 40:1061.9(1)(c); Utah Code Ann. § 76-7-301(1)(b)(ii)(2019).
80 Cal. Health & Safety Code § 123420(c); 745 Ill. Comp. Stat. 70/6.1 (2019); La. Stat. Ann. § 40:1061.20(4) (2020); Neb. Rev. Stat. §
28-337 (1977); N.Y. Comp. Codes R. & Regs. tit. 10, § 405.9(b)(10)(2020); Or. Rev. Stat. § 435.475(1)(2019); 16 Pa. Code § 51.31(e)
(2019); Wyo. Stat. Ann. § 35-6-105 (2019).
81 Ga. Code Ann. § 16-12-142(b) (2013); 745 Ill. Comp. Stat. 70/6.1.
82 745 Ill. Comp. Stat. 70/6.1; N.Y. Comp. Codes R. & Regs. tit. 10, § 405.9(b)(10)(establishing refusal rights and civil immunity for
hospitals, "provided that the hospital ... shall inform the patient of appropriate resources for services or information").
83 Ariz. Rev. Stat. Ann. § 36-2154(B) (2020)(requiring a refusing pharmacy, hospital, health professional, or employee to "return to the
patient the patient's written prescription order"); Ga. Code Ann. § 16-12-142(b)(requiring a refusing pharmacist to "immediately return
the prescription to the prescription holder").
84 45 Ill. Comp. Stat. 70/6 (2019)("Nothing in this Act shall relieve a physician from any duty, which may exist under any laws
concerning current standards of medical practice or care, to inform his or her patient of the patient's condition, prognosis, legal
treatment options, and risks and benefits of treatment options, provided, however, that such physician shall be under no duty to
perform, assist, counsel, suggest, recommend, refer or participate in any way in any form of medical practice or health care service that
is contrary to his or her conscience.")
85 Guttmacher Institute, Policies Allowing Providers to Refuse, available at https://www.guttmacher.org/state-policy/explore/refusing-
provide-health-services.
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State Policies Allowing Providers to Refuse to Provide Health Care Services
Due to Conscientious Refusal
Abortion Contraception Sterilization
State
Provider Institution Provider Pharmacist Institution Provider Institution
Delaware X X
D.C.
Florida X X X *
Georgia X X X X X
Hawaii X X
Idaho X X X X X X
Illinois X X X * X X X
Indiana X Private
Iowa X Private
Kansas X X *+ *+ X X
Kentucky X X X
Louisiana X X
Maine X X X * Private X X
Maryland X X X X
Massachusetts X Private Private X Private
Michigan X X
Minnesota X Private
Mississippi X X X X X X X
Missouri X X
Montana X Private X Private
Nebraska X X
Nevada X Private
New
Hampshire
New Jersey X Private X Private
New Mexico X X X
New York X X
North Carolina X X
North Dakota X X
Ohio X X
Oklahoma X X
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State Policies Allowing Providers to Refuse to Provide Health Care Services
Due to Conscientious Refusal
Abortion Contraception Sterilization
State
Provider Institution Provider Pharmacist Institution Provider Institution
Oregon X Private
Pennsylvania X Private
Rhode Island X X
South Carolina X Private
South Dakota X X X
Tennessee X X X * Private
Texas X Private
Utah X X
Vermont
Virginia X X
Washington X X X X
West Virginia X X X
Wisconsin X X X X
Wyoming X Private
STATE TOTALS 47 44 9 6 8 17 16
(± In Arizona, private hospitals and health facilities may restrict the information that providers give to patients about lawful
health care services if the institution’s objection to providing the information is based on the sincerely held religious or moral
beliefs)
(+ The law permits refusal if the provider “reasonably believes” the drug or device “may result” in an abortion)
(* Broadly worded refusal clause may apply. In Illinois, a state court held that a regulation requiring pharmacies to provide
emergency contraception cannot be enforced against pharmacies that refuse to dispense the medication)
The next chart provides a snapshot of procedural protections in certain conscience laws, 86
Procedural Protections for Providers in Certain Conscience Laws
STATE PROCEDURAL PROTECTIONS
Alabama Civil liability, Criminal prosecution, Discrimination, Education, Government action
Alaska Civil liability
Arizona None
Arkansas Civil liability, Disciplinary action, Government action
California Civil liability, Disciplinary action, Education, Employment action, Education
Colorado N/A
Connecticut None
Delaware Civil liability, Disciplinary action
D.C.* N/A
Florida Civil liability, Disciplinary action
Georgia Civil liability, Disciplinary action
Hawaii Civil liability
Idaho Civil liability, Criminal prosecution, Disciplinary action, Discrimination, Employment
86 Supra, FN 8.
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Procedural Protections for Providers in Certain Conscience Laws
STATE PROCEDURAL PROTECTIONS
action, Government action
Illinois Civil liability, Criminal prosecution, Disciplinary action, Discrimination, Education,
Employment action, Funding, Government action, State licensure
Indiana Disciplinary action, Discrimination, Education, Employment action
Iowa Civil liability, Disciplinary action, Discrimination, Education, Employment action,
Government action, State licensure
Kansas Civil liability, Discrimination, Employment action
Kentucky Civil liability, Disciplinary action, Discrimination, Education, Employment action,
Funding, Government action, State licensure
Louisiana Civil liability, Criminal prosecution, Disciplinary action, Discrimination, Education,
Employment action, Government action
Maine Civil liability, Disciplinary action, Discrimination, Education, Employment action,
Government action
Maryland Civil liability, Disciplinary action, Government action
Massachusetts Civil liability, Disciplinary action, Discrimination, Education, Employment action,
Funding, Government action
Michigan Civil liability, Criminal prosecution, Disciplinary action, Discrimination, Employment
action
Minnesota Civil liability, Discrimination, Employment action
Mississippi* N/A
Missouri Civil liability, Discrimination, Education, Employment action, Funding, Government
action
Montana Civil liability, Disciplinary action, Discrimination, Employment action, Funding,
Government action
Nebraska Civil liability, Disciplinary action, Discrimination, Employment action
Nevada Civil liability, Disciplinary action, Employment action
New Hamp.* N/A
New Jersey Civil liability, Criminal prosecution, Disciplinary action, Discrimination
New Mexico Disciplinary action
New York Civil liability, Discrimination
North Carolina Civil liability, Disciplinary action
North Dakota Discrimination
Ohio Civil liability, Disciplinary action
Oklahoma Civil liability, Disciplinary action, Discrimination, Education, Employment action, State
licensure
Oregon Civil liability
Pennsylvania Civil liability, Criminal prosecution, Disciplinary action, Discrimination, Education,
Employment action, Funding, Government action, State licensure
Rhode Island Civil liability, Disciplinary action
South Carolina Civil liability, Disciplinary action, Discrimination, Employment action
South Dakota Civil liability, Employment action, Government action
Tennessee None
Texas Discrimination, Education, Employment action
Utah Civil liability, Disciplinary action, Discrimination, Employment action
Vermont** Government action
Virginia Civil liability, Disciplinary action, Employment action
Washington Discrimination, Employment action
West Virginia None
Wisconsin Civil liability, Disciplinary action, Discrimination, Education, Employment action
Wyoming Civil liability, Disciplinary action, Discrimination, Employment action
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(* The state has no abortion conscience law)
(** The state has no abortion refusal law; protects participating providers only.)
Florida Conscience Protection Laws
Florida maintains three statutory conscience protection laws:
• Section 381.0051(5), F.S., relating to family planning, allows a physician or other person to
refuse to furnish any contraceptive or family planning service, supplies, or information for
medical or religious reasons.
• Section 390.0111(8), F.S., relating to termination of pregnancies, permits any hospital or person
to refuse to participate in an abortion, and protects an objector from any disciplinary or other
recriminatory action as a result of the refusal.
• Section 483.918, F.S., relating to genetic counselors, permits a counselor to refuse to
participate in counseling that conflicts with his or her deeply held moral or religious beliefs.
Effect of Proposed Changes
HB 747 creates s. 381.00321, F.S., establishing a health care provider’s or health care payer’s right to
decline to participate in any health care service that violates the provider’s or payer’s conscience as
informed the moral, ethical, or religious beliefs or principles held by the provider or payer. The bill
defines conscience similarly to other states with conscience protection laws – as religious, moral, or
ethical beliefs or principles.
Legislative Findings and Intent
The bill includes two statements of legislative findings and intent related to protecting health care
provider and health care payer right of conscience:
• The legislature finds that the right of conscience is a fundamental and inalienable right, and that
threats to that right of health care providers and payers have increased in severity and amount
recently. Certain factors threaten to make the crisis worse unless conscience is restored to its
rightful place. As a patient’s right to decline medical treatment must be respected, so should the
decision of a provider or payer to decline participating in or paying for specific, nonemergency
services that violate their conscience.
• The legislature finds that a health care provider or a health care payer should not be compelled
to participate or pay for any health care service that the provider or payer objects to on the basis
of conscience.
Rights of Conscience
The bill establishes the right of a health care provider to not take part in any way in an inpatient or
outpatient test or treatments or other health care-related research that violates the provider’s or
conscience. Under the bill this applies to a:
• Provider as defined in s. 408.803.
• Clinical laboratory providing services in this state or services to health care providers in this
state, if the clinical laboratory is certified by the Centers for Medicare and Medicaid Services
under the federal Clinical Laboratory Improvement Amendments and the federal rules adopted
thereunder.
• Federally qualified health center as defined in 42 U.S.C. s. 1396d(l)(2)(B), as that definition
existed on the effective date of the bill.
• Site providing health care services which was established for the purpose of responding to the
COVID-19 pandemic pursuant to any federal or state order, declaration, or waiver.
• Health care practitioner as defined in s. 456.001.
• Health care professional licensed under part IV of chapter 468.
• Home health aide as defined in s. 400.462(15).
• Provider licensed under chapter 394 or chapter 397 and its clinical and nonclinical staff
providing inpatient or outpatient services.
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• Continuing care facility licensed under chapter 651.
• Pharmacy permitted under chapter 465.
• Student of a health care education program.
This right also applies to payers, which applies to a health insurer that pays for, or arranges for, the
payment of a health care service provided to a patient, whether that payment is made in whole or in
part. A health insurer includes:
• An authorized insurer offering health insurance, as defined in s. 624.603, F.S., for individual or
group coverage;
• A health maintenance organization, as defined in s. 641.19(12), F.S., issuing coverage through
an individual or group contract; or
• A self-insurance plan, as defined in s. 624.031, F.S.
The conscience protections provided by the bill are very broad in whom they protect and apply to a
broad range of medical treatments or research. The protections are not limited to traditionally
controversial procedures, like abortion or sterilization, but rather apply to any medical treatment,
procedure, or research that violates the provider’s or payer’s conscience.
The bill also establishes the right of a health care provider that is a business entity, or a health care
payer holding itself out to the public as a religious entity, and meeting certain criteria 87 to make
employment, staffing, contracting, and credentialing decisions that are consistent with the provider’s or
payer’s religious beliefs.
Liability
The bill makes health care providers and health care payers immune from civil, criminal, or
administrative liability for exercising the provider’s or payer’s right of conscience. Moreover, a provider
or payer that is a business entity is also immune from civil, criminal, or administrative liability for any
claims arising from a violation of the right of conscience of a person employed by, under contract with,
or credentialed by the provider or payer.
Violations
The bill protects a health care provider or health care payer from any actual or threatened adverse
action by a person, as a result of declining to participate in or pay for a particular health care service on
the basis of conscience, by authorizing a civil cause of action against that person. It also protects a
provider or payer from any actual or threatened adverse action for disclosing any information that the
practitioner reasonably believes evinces the following, on the part of an employer’s:
• Violation of the act’s provisions;
• Any violation of any law, rule, or regulation; or
• Gross mismanagement, gross waste of funds, an abuse of authority, or a substantial and
specific danger to public health or safety.
Civil Remedies
The bill authorizes a health care provider or health care payer to bring a civil action for damages,
injunctive relief, or any other appropriate relief for any actual or threatened adverse action due to
declining to participate in a health care service that violates the provider’s or payer’s conscience. Upon
a finding of a violation, a court must award treble damages, and reasonable costs and attorney’s fees.
A court considering the civil action also may award injunctive relief, including reinstatement of a medical
practitioner to his or her previous position, reinstatement of board certification, and relicensure of a
87 Such criteria include stating in its governing documents that the provider entity has a religious purpose or mission and
maintaining internal operating policies and procedures that implement its purpose or mission.
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health care provider or health care payer. Any additional burden or expense incurred by another
provider or payer is not a defense to a violation of the bill’s provisions.
The bill provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Creates s. 381.00321, F.S., relating to rights of conscience of health care providers and
health care payers.
Section 2: 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:
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.
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2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill does not require rule-making to implement its’ provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 747 2022
1 A bill to be entitled
2 An act relating to protections of medical conscience;
3 creating s. 381.00321, F.S.; providing a short title;
4 providing legislative findings and intent; providing
5 definitions; providing that health care providers and
6 health care payers have the right to not participate
7 in or pay for any health care services that violate
8 their consciences; providing that such providers and
9 payers have a right to make certain decisions
10 consistent with their religious beliefs under certain
11 circumstances; prohibiting a person from taking or
12 threatening to take adverse action against such
13 providers and payers for specified actions; providing
14 for civil remedies and damages; providing immunity
15 from civil, criminal, and administrative liability for
16 such providers and payers under certain circumstances;
17 providing an effective date.
18
19 Be It Enacted by the Legislature of the State of Florida:
20
21 Section 1. Section 381.00321, Florida Statutes, is created
22 to read:
23 381.00321 Rights of conscience of health care providers
24 and health care payers.—
25 (1) SHORT TITLE.—This section may be cited as the
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26 "Healthcare Ethics and Liberty Protection Act."
27 (2) LEGISLATIVE FINDINGS AND INTENT.—
28 (a) The Legislature finds that the right of conscience is
29 a fundamental and inalienable right. Threats to the right of
30 conscience of health care providers and health care payers have
31 become increasingly common and severe in recent years. The swift
32 pace of scientific advancement, the expansion of medical
33 capabilities, and with the mistaken notion that health care
34 providers and health care payers are mere public utilities,
35 promise to make the crisis worse unless action is taken to
36 restore conscience to its rightful place. As patient autonomy to
37 decline a health care service must be respected, health care
38 providers and health care payers must have the right to decline
39 participating in or paying for specific, nonemergency services
40 that violate their consciences.
41 (b) A health care provider or health care payer should not
42 be compelled to participate in or pay for any health care
43 service that the provider or payer objects to on the basis of
44 conscience.
45 (3) DEFINITIONS.—As used in this section, the term:
46 (a) "Conscience" means the religious, moral, or ethical
47 beliefs or principles held by a health care provider or health
48 care payer.
49 (b) "Health care payer" means a health insurer that pays
50 for, or arranges for, the payment of a health care service
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51 provided to a patient, whether such payment is made in whole or
52 in part.
53 (c) "Health care provider" means a health care provider as
54 defined in s. 768.381(1)(f) or a student of a health care
55 education program.
56 (d) "Health care service" means inpatient or outpatient
57 tests or treatments of a human disease, condition, or
58 dysfunction or medical or other health care-related research.
59 (e) "Health insurer" means an authorized insurer offering
60 health insurance as defined in s. 624.603 for individual or
61 group coverage, a health maintenance organization as defined in
62 s. 641.19(12) issuing coverage through an individual or group
63 contract, or a self-insurance plan as defined in 624.031.
64 (f) "Participate" means to take part in any way in
65 providing a health care service or any part of such service.
66 (4) RIGHTS OF CONSCIENCE.—
67 (a) A health care provider or health care payer has the
68 right not to participate in or pay for any specific health care
69 service that violates the provider's or payer's conscience.
70 (b) A health care provider that is a business entity, or a
71 health care payer that holds itself out to the public as
72 religious, and states in its governing documents that it has a
73 religious purpose or mission and has internal operating policies
74 or procedures that implement such purpose or mission, has the
75 right to make employment, staffing, contracting, and
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76 credentialing decisions consistent with the provider's or
77 payer's religious beliefs.
78 (5) VIOLATIONS AND CIVIL REMEDIES.—
79 (a) A person may not take or threaten to take adverse
80 action against a health care provider or health care payer for:
81 1. Declining to participate in a health care service on
82 the basis of conscience.
83 2. Disclosing information to an appropriate governmental
84 agency that the health care provider or health care p ayer
85 reasonably believes is evidence of an employer's:
86 a. Violation of this section;
87 b. Violation of any law, rule, or regulation;
88 c. Violation of any standard of care or other ethical
89 guidelines for the provision of any health care service; or
90 d. Gross mismanagement, gross waste of funds, abuse of
91 authority, or any action that is a substantial and specific
92 danger to public health or safety.
93 (b) A health care provider or health care payer that
94 establishes a violation of this section has a civil cause of
95 action for treble damages, an injunction, or any other
96 appropriate relief in law or equity. Injunctive relief includes,
97 but is not limited to, reinstatement of a health care provider
98 or health care payer to a previous position, reinstatement of
99 board certification, and relicensure. Such damages are
100 cumulative and may not be limited by any other remedies that may
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101 be available under any other law. A prevailing plaintiff is
102 entitled to recover reasonable attorney fees and court costs.
103 Any additional burden or expense incurred by another health care
104 provider or health care payer arising from the exercise of the
105 right of conscience is not a defense to a violation of this
106 section.
107 (6) IMMUNITY FROM LIABILITY.—Health care providers and
108 health care payers are immune from civil, criminal, or
109 administrative liability for exercising the right of conscience
110 with respect to a health care service. A health care provider or
111 health care payer that is a business entity is immune from
112 civil, criminal, or administrative liability for any claims
113 related to or arising out of the exercise of the right of
114 conscience by a person employed, contracted, or credentialed by
115 such provider or payer.
116 Section 2. This act shall take effect July 1, 2022.
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HB 861
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 861 Medical Specialty Designations
SPONSOR(S): Massullo
TIED BILLS: IDEN./SIM. BILLS: SB 1192
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.
An unlicensed individual may be subject to administrative action or criminal penalties if the individual states or
otherwise implies that he or she is a licensed medical professional. This may include the use of certain terms
or titles that the public generally associates with a specific medical profession. DOH does not license a health
care practitioner’s specialty or sub-specialty based upon board certification, but does limit who can hold
themselves out as board-certified specialists.
HB 861 makes using a term designating a medical specialty grounds for discipline of a practitioner unless the
practitioner has completed a residency or fellowship program accredited or recognized by the Accreditation
Council for Graduate Medical Education in such specialty. The bill also requires DOH to discipline a
practitioner who violates the bill’s provisions and grants DOH the same enforcement authority as the applicable
board.
The bill has an indeterminate, negative fiscal impact on DOH, which current resources are adequate to absorb.
The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2022.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Licensure and Regulation of Health Care Practitioners
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners. 1 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. 2 Each profession is regulated by an individual practice act and by ch. 456, F.S., which
provides general regulatory and licensure authority for the MQA. MQA is statutorily responsible for the
following boards and professions established within the division: 3
• The Board of Acupuncture, created under ch. 457, F.S.;
• The Board of Medicine, created under ch. 458, F.S.;
• The Board of Osteopathic Medicine, created under ch. 459, F.S.;
• The Board of Chiropractic Medicine, created under ch. 460, F.S.;
• The Board of Podiatric Medicine, created under ch. 461, F.S.;
• Naturopathy, as provided under ch. 462, F.S.;
• The Board of Optometry, created under ch. 463, F.S.;
• The Board of Nursing, created under part I of ch. 464, F.S.;
• Nursing assistants, as provided under part II of ch. 464, F.S.;
• The Board of Pharmacy, created under ch. 465, F.S.;
• The Board of Dentistry, created under ch. 466, F.S.;
• Midwifery, as provided under ch. 467, F.S.;
• The Board of Speech-Language Pathology and Audiology, created under part I of ch. 468, F.S.;
• The Board of Nursing Home Administrators, created under part II of ch. 468, F.S.;
• The Board of Occupational Therapy, created under part III of ch. 468, F.S.;
• Respiratory therapy, as provided under part V of ch. 468, F.S.;
• Dietetics and nutrition practice, as provided under part X of ch. 468, F.S.;
• The Board of Athletic Training, created under part XIII of ch. 468, F.S.;
• The Board of Orthotists and Prosthetists, created under part XIV of ch. 468, F.S.;
• Electrolysis, as provided under ch. 478, F.S.;
• The Board of Massage Therapy, created under ch. 480, F.S.;
• The Board of Clinical Laboratory Personnel, created under part III of ch. 483, F.S.;
• Medical physicists, as provided under part IV of ch. 483, F.S.;
• The Board of Opticianry, created under part I of ch. 484, F.S.;
• The Board of Hearing Aid Specialists, created under part II of ch. 484, F.S.;
• The Board of Physical Therapy Practice, created under ch. 486, F.S.;
• The Board of Psychology, created under ch. 490, F.S.;
• School psychologists, as provided under ch. 490, F.S.;
• The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling, created under ch. 491, F.S.; and
• Emergency medical technicians and paramedics, as provided under part III of ch. 401, F.S.
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, p.
5, http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/2019-2020-annual-report.pdf (last visited
April 16, 2021).
3 Section 456.001(4), F.S; Id.
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Board Certification and Florida Licensure
DOH does not license health care practitioners by specialty or subspecialty; however, current law limits
which health care practitioners may hold themselves out as board-certified specialists. An allopathic
physician may not hold himself or herself out as a board-certified specialist unless he or she has
received formal recognition as a specialist from a specialty board of the American Board of Medical
Specialties (ABMS) or other recognizing agency 4 approved by the allopathic board. 5 Additionally, an
allopathic physician may not hold himself or herself out as a board-certified specialist in dermatology
unless the recognizing agency, whether authorized in statute or by rule, is triennially reviewed and
reauthorized by the allopathic board. 6 Similarly, an osteopathic physician may not hold himself or
herself out as a board-certified specialist unless he or she has successfully completed the requirements
for certification by the American Osteopathic Association (AOA) or the Accreditation Council on
Graduate Medical Education (ACGME) and is certified as a specialist by a certifying agency 7 approved
by the board. 8
A dentist may not hold himself or herself out as a specialist, or advertise membership in or specialty
recognition by an accrediting organization, unless the dentist has completed a specialty education
program approved by the American Dental Association and the Commission on Dental Accreditation
and the dentist is: 9
• Eligible for examination by a national specialty board recognized by the American Dental
Association; or
• Is a diplomate of a national specialty board recognized by the American Dental Association.
If a dentist announces or advertises a specialty practice for which there is not an approved accrediting
organization, the dentist must clearly state that the specialty is not recognized or that the accrediting
organization has not been approved by the American Dental Association or the Florida Board of
Dentistry. 10
Additionally, advanced practice registered nurses may not advertise or hold themselves out as a
specialist for which he or she has not received certification. 11
Discipline of Health Care Practitioners
Section 456.072, F.S., authorizes a regulatory board or DOH, if there is no board, to discipline a health
care practitioner’s licensure for a number of offenses, including but not limited to:
• Making misleading, deceptive, or fraudulent representations in or related to the practice of the
licensee’s profession; or
• Failing to identify through writing or orally to a patient the type of license under which the
practitioner is practicing.
Using a term designating a medical specialty unless the practitioner has completed a residency or
fellowship program accredited or recognized by the Accreditation Council for Graduate Medical
Education in such specialty is not ground for discipline under current law.
If the board or DOH finds that a licensee committed a violation, the board or DOH may: 12
4 The allopathic board has approved the specialty boards of the ABMS as recognizing agencies. Rule 64B8-11.001(1)(f), F.A.C.
5 Section 458.3312, F.S.
6 Id.
7 The osteopathic board has approved the specialty boards of the ABMS and AOA as recognizing agencies. Rule 64B15-14.001(h),
F.A.C.
8 Section 459.0152, F.S.
9 Section 466.0282, F.S. A dentist may also hold himself or herself out as a specialist if the dentist has continuously held himself or
herself out as a specialist since December 31, 1964, in a specialty recognized by the American Dental Association.
10 Section 466.0282(3), F.S.
11 Section 464.018(1)(s), F.S.
12 Section 456.073(1), F.S.
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• Refuse to certify, or to certify with restrictions, an application for a license;
• Suspend or permanently revoke a license;
• Place a restriction on the licensee’s practice or license;
• Impose an administrative fine not to exceed $10,000 for each count or separate offense; if the
violation is for fraud or making a false representation, a fine of $10,000 must be imposed for
each count or separate offense;
• Issue a reprimand or letter of concern;
• Place the licensee on probation;
• Require a corrective action plan;
• Refund fees billed and collected from the patient or third party on behalf of the patient; or
• Require the licensee to undergo remedial education.
Effect of the Bill
Discipline of Health Care Practitioners
The bill makes using a term designating a medical specialty accredited or recognized by the ACGME
by a practitioner grounds for discipline unless the practitioner has completed a residency or fellowship
program accredited or recognized by the ACGME in such specialty.
The bill requires DOH to discipline a practitioner who violates the bill’s provisions and grants DOH the
same enforcement authority as the applicable board.
The provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Amends s. 456.072, F.S., relating to grounds for discipline; penalties; enforcement.
Section 2: Provides an effective date of upon becoming law.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
DOH may experience a recurring increase in workload associated with rulemaking, which can be
absorbed within current resources. 13
DOH may also experience a recurring increase in workload associated with additional complaints,
investigations, and prosecutions resulting from the bill. The extent to which such complaints,
investigations, and prosecutions may materialize is unknown; therefore, the fiscal impact is
indeterminate. 14
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
13 Department of Health, Agency Analysis of 2022 House Bill 861 (Jan. 11, 2022).
14 Id.
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2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Health care practitioners in violation of the restrictions in this bill may be subject to disciplinary actions
and fines.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill provides sufficient rulemaking authority to DOH to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
The bill requires DOH to enforce the bill’s provisions. This appears to conflict with several sections of
the statutes which specifically vest disciplinary authority in the appropriate boards. Disciplinary authority
is vested in the department only in the absence of a duly appointed board. 15
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
15 Id. See sections 456.072 and 456.073, F.S.
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 861 2022
1 A bill to be entitled
2 An act relating to medical specialty designations;
3 amending s. 456.072, F.S.; providing that using a term
4 designating a certain medical specialty is grounds for
5 disciplinary action; providing enforcement authority;
6 authorizing the Department of Health to adopt rules;
7 providing an effective date.
8
9 Be It Enacted by the Legislature of the State of Florida:
10
11 Section 1. Paragraph (tt) is added to subsection (1) of
12 section 456.072, Florida Statutes, and subsection (2) of that
13 section is republished, to read:
14 456.072 Grounds for discipline; penalties; enforcement. —
15 (1) The following acts shall constitute grounds for which
16 the disciplinary actions specified in subsection (2) may be
17 taken:
18 (tt) Using a term designating a medical specialty for
19 which the Accreditation Council for Graduate Medical Education
20 accredits or recognizes as a residency or fellowship program
21 unless the licensee has completed such residency or fellowship
22 program or unless otherwise expressly authorized by law. The
23 department shall enforce this paragraph and has the same
24 enforcement authority as an applicable board. The department may
25 adopt rules to implement this paragraph.
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 861 2022
26 (2) When the board, or the department when there is no
27 board, finds any person guilty of the grounds set forth in
28 subsection (1) or of any grounds set forth in the applicable
29 practice act, including conduct constituting a substantial
30 violation of subsection (1) or a violation of the applicable
31 practice act which occurred prior to obtaining a license, it may
32 enter an order imposing one or more of the following penalties:
33 (a) Refusal to certify, or to certify with restrictions,
34 an application for a license.
35 (b) Suspension or permanent revocation of a license.
36 (c) Restriction of practice or license, including, but not
37 limited to, restricting the licensee from practicing in certain
38 settings, restricting the licensee to work only under designated
39 conditions or in certain settings, restricting the licensee from
40 performing or providing designated clinical and administrative
41 services, restricting the licensee from practicing more than a
42 designated number of hours, or any other restriction found to be
43 necessary for the protection of the public health, safety, and
44 welfare.
45 (d) Imposition of an administrative fine not to exceed
46 $10,000 for each count or separate offense. If the violation is
47 for fraud or making a false or fraudulent representation, the
48 board, or the department if there is no board, must impose a
49 fine of $10,000 per count or offense.
50 (e) Issuance of a reprimand or letter of concern.
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 861 2022
51 (f) Placement of the licensee on probation for a period of
52 time and subject to such conditions as the board, or the
53 department when there is no board, may specify. Those conditions
54 may include, but are not limited to, requiring the licensee to
55 undergo treatment, attend continuing education courses, submit
56 to be reexamined, work under the supervision of another
57 licensee, or satisfy any terms which are reasonably tailored to
58 the violations found.
59 (g) Corrective action.
60 (h) Imposition of an administrative fine in accordance
61 with s. 381.0261 for violations regarding patient rights.
62 (i) Refund of fees billed and collected from the patient
63 or a third party on behalf of the patient.
64 (j) Requirement that the practitioner undergo remedial
65 education.
66
67 In determining what action is appropriate, the board, or
68 department when there is no board, must first consider what
69 sanctions are necessary to protect the public or to compensate
70 the patient. Only after those sanctions have been imposed may
71 the disciplining authority consider and include in the order
72 requirements designed to rehabilitate the practitioner. All
73 costs associated with compliance with orders issued under this
74 subsection are the obligation of the practitioner.
75 Section 2. This act shall take effect July 1, 2022.
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hb0861-00
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 861 (2022)
Amendment No.1
COMMITTEE/SUBCOMMITTEE ACTION
ADOPTED (Y/N)
ADOPTED AS AMENDED (Y/N)
ADOPTED W/O OBJECTION (Y/N)
FAILED TO ADOPT (Y/N)
WITHDRAWN (Y/N)
OTHER
1 Committee/Subcommittee hearing bill: Professions & Public
2 Health Subcommittee
3 Representative Massullo offered the following:
4
5 Amendment
6 Remove line 20 and insert:
7 or the American Osteopathic Association accredits or recognizes
8 as a residency or fellowship program
428633 - h0861-line20.docx
Published On: 1/24/2022 5:42:59 PM
Page 1 of 1
HB 931
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 931 Alternate-site Testing
SPONSOR(S): McClure
TIED BILLS: IDEN./SIM. BILLS: SB 1374
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Morris McElroy
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
A clinical laboratory is the physical location in which services are performed to provide information or materials
for use in the diagnosis, prevention, or treatment of a disease or the identification or assessment of a medical
or physical condition. The Board of Clinical Laboratory Personnel within the Department of Health (DOH)
oversees the licensure and regulation of clinical laboratory personnel, including supervisors, technologists,
technicians, directors, and public health laboratory personnel. Licensure requirements for clinical laboratory
personnel include passage of an exam designated by the Board, completion of a medical technology training
program, and completion of applicable education requirements. With limited exceptions, including certain
laboratories and health care practitioners, only licensed clinical laboratory personnel may perform clinical
laboratory testing.
Generally, a hospital’s main or central laboratory, or satellite laboratories that are certified by federal law
established on the same or adjoining grounds of a licensed hospital, may perform clinical laboratory testing.
Current law allows for alternate-site testing, which is any laboratory testing done under the administrative
control of a hospital and the supervision of the laboratory director, but performed out of the physical or
administrative confines of the hospital’s central laboratory. This allows tests to be performed bedside, at a
nurse station, in an operating room or the emergency room, or anywhere else under the administrative control
of a hospital. Current Agency for Health Care Administration rule authorizes advanced practice registered
nurses, registered nurses, licensed practical nurses, and licensed clinical laboratory personnel to perform
testing at alternate-sites.
A freestanding emergency department (FED) is a facility that receives individuals for emergency care and is
structurally separate from a hospital. Only licensed clinical laboratory personnel may perform clinical laboratory
testing in a FED.
HB 931 exempts individuals who perform alternate-site testing outside of a central laboratory of a hospital or at
a hospital-based, off campus emergency department from clinical laboratory personnel licensure requirements.
This allows all individuals, not just licensed clinical laboratory personnel, to perform alternate-site testing within
a hospital or in a FED.
The bill has an insignificant, indeterminate fiscal impact on DOH and no 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: h0931.PPH
DATE: 1/24/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Clinical Laboratories
A clinical laboratory is the physical location in which services are performed to provide information or
materials for use in the diagnosis, prevention, or treatment of a disease or the identification or
assessment of a medical or physical condition. 1 Services performed in clinical labs include: 2
• The examination of fluids or other materials taken from the human body;
• The examination of tissue taken from the human body; and
• The examination of cells from individual tissues or fluid taken from the human body.
Clinical laboratories that provide testing services in this state must be certified by the Clinical
Laboratory Improvement Amendments of 1988 (CLIA) program under federal law. 3
Clinical Laboratory Personnel
The Board of Clinical Laboratory Personnel (Board) oversees the licensure and regulation of clinical
laboratory personnel, including supervisors, technologists, technicians, directors, and public health
laboratory personnel. Generally, licensure requirements for clinical laboratory personnel include
passage of an exam designated by the Board, completion of a medical technology training program,
and completion of applicable education requirements. 4
Current law provides exemptions from the application of part I of ch. 483, F.S., which regulates clinical
laboratory personnel. Exemptions include: 5
• Clinical laboratories operated by the United States Government;
• Laboratories operated and maintained exclusively for research and teaching purposes, involving
no patient or public health service whatsoever;
• Persons engaged in testing performed by laboratories that are wholly owned and operated by
one or more licensed allopathic physicians, osteopathic physicians, chiropractic physicians,
podiatric physicians, naturopaths, optometrists, or dentists, who practice in the same group
practice, and in which no clinical laboratory work is performed for patients referred by any health
care provider who is not a member of that group practice;
• Respiratory therapists and respiratory care practitioners certified or registered under part V of
chapter 468;
• Advanced practice registered nurses licensed under part I of chapter 464 who perform provider-
performed microscopy procedures in a laboratory setting; and
• Persons performing laboratory testing within a physician office practice for patients referred by a
health care provider who is a member of the same physician office practice, if the laboratory or
entity operating the laboratory within a physician office practice is under common ownership,
directly or indirectly, with an entity licensed pursuant to chapter 395.
1 S. 483.803, F.S.
2 Ss. 483.803(2)(a)-(c), F.S.
3 S. 395.009(1), F.S.
4 Section 483.809, F.S. and ch. 64B3-5, F.A.C.
5 S. 483.801, F.S.
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Currently, nurses licensed under ch. 464, F.S., and laboratory technicians licensed under part I of ch.
483, F.S., are not exempt from clinical laboratory personnel regulation.
Alternate-Site Laboratory Testing
Generally, a hospital’s main or central laboratory or satellite laboratories that are certified by CLIA
established on the same or adjoining grounds of a hospital licensed under ch. 395, F.S., may perform
clinical laboratory testing. 6 Testing at satellite labs must be done by licensed clinical laboratory
personnel. Section 395.0091, F.S., allows for alternate-site testing, which is any laboratory testing done
under the administrative control of a hospital and the supervision of the laboratory director, but
performed outside of the physical or administrative confines of the hospital’s central laboratory. This
allows tests to be performed bedside, at a nurse station, in an operating room or the emergency room,
or anywhere else under the administrative control of a hospital.
Current Agency for Health Care Administration rule authorizes advanced practice registered nurses,
registered nurses, licensed practical nurses, and licensed clinical laboratory personnel to perform
testing at alternate-sites. 7 However, current law does not authorize registered nurses or laboratory
technicians to perform alternate-site testing within a freestanding emergency department.
Freestanding Emergency Departments
A freestanding emergency department (FED) is a facility that receives individuals for emergency care
and is structurally separate from a hospital. 8 The federal Centers for Medicare and Medicaid Services
(CMS) refers to these facilities as Provider-based Off-campus Emergency Departments and requires
them to operate under the license of the main provider, for purposes of Medicare reimbursement. 9
In Florida, any licensed hospital which has a dedicated emergency department may provide emergency
services in a location separate from the hospital’s main premises. 10 There are no additional rules or
standards specific for FEDs; in fact, the term FED is not currently defined in statute or rule. The Agency
for Health Care Administration (AHCA) interprets existing law to allow a licensed hospital to establish
and operate a FED as part of facility operations, similar to other hospital outpatient departments,
without a separate license. However, a hospital that wishes to establish a FED is required to get
approval from AHCA’s Office of Plans and Construction. 11
Since 2016, the number of FEDs in Florida increased 45 percent, while the number of visits to FEDs
increased by 83 percent. 12 Currently, 96 FEDs operate under the licenses of 61 hospitals. 13
6 Rule 59A-3.242, F.A.C.
7 Rule 59A-3.242(1)(g)(6), F.A.C.
8 There is no single definition of FED, and there are different requirements as well as different names for FEDs depending on which state
they are located in.
9 42 C.F.R. § 413.65(a)(2) and (d)(1) (2017). See also CMS, Requirements for Provider-based Off-campus Emergency Departments (Jan.
11, 2008), available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-
Memos-to-States-and-Regions-Items/CMS1207239 (last visited Jan. 21, 2022).
10 S. 395.002(22), F.S. Premises means those buildings, beds, and equipment located at the address of the licensed facility and all other
buildings, beds, and equipment for the provision of hospital or ambulatory surgical care located in such reasonable proximity to the
address of the licensed facility as to appear to the public to be under the dominion and control of the licensee.
11 Rule 59A-3.066(2)(e), F.A.C.
12 Florida Agency for Health Care Administration, FloridaHealthFinder.gov, Data Summaries and Reports, Emergency Department Visits
and Admissions by Facility 2016-219, available at https://www.floridahealthfinder.gov/researchers/QuickStat/quickstat.aspx (last visited
Jan. 21, 2022).
13 Florida Agency for Health Care Administration, Hospital and Outpatient Services Unit, List of Florida Licensed Hospitals with Off-site
Emergency Departments as of Jan. 3, 2022, available at
https://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Hospital_Outpatient/Reports.shtml (last visited Jan. 21, 2022).
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Effect of the Bill
Clinical Laboratory Personnel
The bill exempts individuals who perform alternate-site testing outside of a central laboratory of a
hospital or at a hospital-based, off campus emergency department from clinical laboratory personnel
regulation under part I of ch. 483, F.S. This allows all individuals, not just licensed clinical laboratory
personnel, to perform alternate-site testing within a hospital or in a FED.
The bill provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Amends s. 483.801, F.S., relating to exemptions.
Section 2: 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:
None.
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DATE: 1/24/2022
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:
Current law provides sufficient rulemaking authority to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
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DATE: 1/24/2022
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 931 2022
1 A bill to be entitled
2 An act relating to alternate-site testing; amending s.
3 483.801, F.S.; providing an exemption from regulation
4 for persons performing alternate-site testing at
5 certain locations; providing an effective date.
6
7 Be It Enacted by the Legislature of the State of Florida:
8
9 Section 1. Subsection (7) is added to section 483.801,
10 Florida Statutes, to read:
11 483.801 Exemptions.—This part applies to all clinical
12 laboratories and clinical laboratory personnel within this
13 state, except:
14 (7) Persons performing alternate-site testing out of the
15 physical or administrative confines of the central laboratory or
16 at a hospital-based, off-campus emergency department licensed
17 under chapter 395.
18 Section 2. This act shall take effect July 1, 2022.
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hb0931-00
COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 931 (2022)
Amendment No.1
COMMITTEE/SUBCOMMITTEE ACTION
ADOPTED (Y/N)
ADOPTED AS AMENDED (Y/N)
ADOPTED W/O OBJECTION (Y/N)
FAILED TO ADOPT (Y/N)
WITHDRAWN (Y/N)
OTHER
1 Committee/Subcommittee hearing bill: Professions & Public
2 Health Subcommittee
3 Representative McClure offered the following:
4
5 Amendment (with title amendment)
6 Remove everything after the enacting clause and insert:
7 (7) A registered nurse licensed under chapter 464
8 performing alternate-site testing within a hospital or a
9 hospital-based off-campus emergency department licensed under
10 chapter 395.
11
12 -----------------------------------------------------
13 T I T L E A M E N D M E N T
14 Remove line 4 and insert:
15 for registered nurses performing alternate-site testing at
230999 - h0931-strike.docx
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Page 1 of 1
HB 953
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 953 Psychology Interjurisdictional Compact
SPONSOR(S): Hunschofsky
TIED BILLS: HB 955 IDEN./SIM. BILLS: SB 1370
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Morris McElroy
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
Current law allows a Florida-licensed health care practitioner, a practitioner licensed under a multistate health
care licensure compact of which Florida is a member, or a registered out-of-state-health care provider to
provide health care services to Florida patients via telehealth. It does not allow health care practitioners,
including Florida licensed psychologists, to use telehealth to provide services to out-of-state patients.
The Psychology Interjurisdictional Compact (PSYPACT or compact) is an interstate compact, which is an
agreement between states to enact legislation and enter into a contract for a specific, limited purpose. In 2015,
the Association of State and Provincial Psychology Boards (ASPPB) adopted model legislation for the compact
which facilitates the practice of psychology using telepsychology and in-person, face-to-face psychological
practice to patients in other states. The compact establishes the Psychology Interjurisdictional Compact
Commission (commission), made up of each party state’s representative of the state licensing board. The
commission is responsible for administering the compact. PSYPACT became effective in April, 2019, and
currently has 27 member states. The bill enacts PSYPACT and authorizes Florida to enter into the compact.
Psychologists licensed in PSYPACT states may apply for authorization to practice telepsychology (APIT) and
temporary authorization to practice (TAP), which are required under the compact to practice telepsychology
and temporary in-person, face-to-face practice in other PSYPACT states. To practice telepsychology in
PSYPACT states, psychologists licensed in compact states may apply to the Commission for authorization and
obtain an E.Passport from the ASPPB. To conduct temporary in-person, face-to-face practice, a psychologist
licensed in a compact state may apply to the Commission for temporary authority and obtain an
interjurisdictional practice certificate from the ASPPB. Thus, under the compact a Florida licensed psychologist
is eligible to provide services to out-of-state patients through either telehealth or a temporary authorization to
practice.
The compact requires all participating states to report certain licensure information to a coordinated licensure
information system (CLIS), including identifying information, licensure data, and adverse actions taken against
a psychologist’s license or practice privileges in a compact state. Such information is public under the compact
unless a compact state designates the information it contributes to the CLIS as confidential, prohibiting
disclosure to the public without express permission of the reporting state.
The bill has an insignificant, negative fiscal impact on DOH and no 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: h0953.PPH
DATE: 1/24/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Health Care Professional Shortage
There is currently a health care provider shortage in the U.S. 1 This shortage is predicted to continue
into the foreseeable future and will likely worsen with the aging and growth of the U.S. population 2 and
the passage of the Patient Protection and Affordable Care Act. 3 Aging populations create a
disproportionately higher health care demand. 4 Additionally, as more individuals qualify for health care
benefits, there will necessarily be a greater demand for more health care professionals to provide these
services.
According to the U.S. Health Resources and Services Administration (HRSA), the U.S. will experience
a 7% increase in demand for psychologists by 2030, producing a shortage of approximately 14,300
psychologists nationwide. 5 In Florida, HRSA estimates a shortage of 1,420 clinical, counseling, and
school psychologists by 2030. 6 Exacerbated by the COVID-19 pandemic, the American Academy of
Pediatrics declared a national state of emergency in children’s mental health, creating a need for more
mental health professionals and increased access to such. 7
Psychologist Licensure in Florida
The Board of Psychology oversees the licensure and regulation of psychologists in this state. 8 To
receive a license to practice psychology, an individual must: 9
1 For example, as of December 31, 2021, the U.S. Department of Health and Human Services has designated 7,613 Primary Care
Health Professional Shortage Area (HPSA) (requiring 15,184 additional primary care physicians to eliminate the shortage), 6,803
Dental HPSAs (requiring 11,181 additional dentists to eliminate the shortage), and 6,078 Mental Health HPSAs (requiring 6,851
additional mental health providers to eliminate the shortage). U.S. Department of Health and Human Services, Designated Health
Professional Shortage Areas Statistics (Jan. 1, 2022), https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport (last visited Jan. 22,
2022).
2 According to the U.S. Census Bureau, the U.S population is expected to increase by almost 100 million between 2014 and 2060, and
by 2030, one in five Americans is projected to be 65 and over. Sandra L. Colby & Jennifer M. Ortman, U.S. Census Bureau, Projections
of the Size and Composition of the U.S.Population: 2014 to 2060 (March 2015),
https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf (last visited Jan. 22, 2022).
3 U.S. Dep’t of Health and Human Services, Department of Health and Human Services Strategic Plan: Goal 1: Strengthen Health
Care, available at http://www.hhs.gov/secretary/about/goal5.html (last visited on Jan. 22, 2022).
4 One analysis measured current primary care utilization (office visits) and projected the impact of population increases, aging, and
insured status changes. The study found that the total number of office visits to primary care physicians will increase from 462 million in
2008 to 565 million in 2025, and (because of aging) the average number of visits will increase from 1.60 to 1.66. The study concluded
that the U.S. will require 51,880 additional primary care physicians by 2025. (Petterson, Stephen M., et al., “Projecting U.S. Primary
Care Physician Workforce Needs: 2010-2025,” Annals of Family Medicine, vol. 10, No. 6 (November/December 2012), available at
http://www.annfammed.org/content/10/6/503.full.pdf+html (last visited on Jan. 22, 2022).
5 Health Resources Services Administration, Behavioral Health Workforce Projections, 2016-2030: Clinical, Counseling and School
Psychologists, https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/psychologists-2018.pdf (last visited Jan.
22, 2022).
6 Health Resources Services Administration, State-Level Projections of Supply and Demand for Behavioral Health Occupations: 2016-
2030 (September 2018), https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/state-level-estimates-report-
2018.pdf (last visited Jan. 22, 2022).
7 American Academy of Pediatrics, AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health,
https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-
emergency-in-child-and-adolescent-mental-health/ (last visited Jan. 22, 2022).
8 Section 490.004, F.S.
9 Section 490.005(1), F.S.
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• Meet one of the following educational requirements:
o Received a doctoral-level psychological education from an institution that had
institutional accreditation from an agency recognized by the United States Department of
Education or was recognized as a member in good standing with the Association of
Universities and Colleges of Canada, and had programmatic accreditation from the
American Psychological Association; 10 or
o Received the equivalent of a doctoral-level education from a program at a school or
university located outside of the United States, which is officially recognized by the
government of the country in which it is located as a program or institution to train
students to practice professional psychology.
• Complete 2 years or 4,000 hours of supervised experience;
• Pass the Examination for Professional Practice in Psychology; 11 and
• Pass an examination on Florida laws and rules.
The American Psychological Association (APA) is recognized by the U.S. Department of Education and
the Council for Higher Education Accreditation as the national accrediting authority for professional
education and training in psychology. 12
Applicants for licensure by endorsement must: 13
• Be a diplomate in good standing with the American Board of Professional Psychology;
• Hold a doctoral degree in psychology with at least 10 years of experience as a licensed
psychologist in any jurisdiction or territory of the U.S. within the 25 years preceding the date of
application.
Telehealth
A Florida-licensed health care practitioner, a practitioner licensed under a multistate health care
licensure compact of which Florida is a member, 14 or a registered out-of-state-health care provider to
provide health care services to Florida patients via telehealth. 15 Current law sets the standard of care
for telehealth providers at the same level as the standard of care for health care practitioners or health
care providers providing in-person health care services to patients in this state. This ensures that a
patient receives the same standard of care irrespective of the modality used by the health care
professional to deliver the services. A patient receiving telehealth services may be in any location at the
time services are rendered and a telehealth provider may be in any location when providing telehealth
services to a patient. 16
Under current law, in-state and out-of-state licensed or registered health care practitioners may use
telehealth to provide health care services to patients physically located in Florida. The law does not
allow health care practitioners, including Florida licensed psychologists, to use telehealth to provide
services to out-of-state patients.
Sovereign Immunity
Sovereign immunity generally bars lawsuits against the state or its political subdivisions for torts
committed by an officer, employee, or agent of such governments unless the immunity is expressly
10 Section 490.003(3), F.S., defines doctoral-level education as a Psy.D, an Ed.D., or a Ph.D in psychology.
11 Rule 64B19-11.001, F.A.C.
12 American Psychological Association, Understanding APA Accreditation, http://www.apa.org/ed/accreditation/about/index.aspx (last
visited Jan. 20, 2022).
13 Section 490.006, F.S.
14 Florida is a member of the Nurse Licensure Compact. See s. 464.0095, F.S.
15 S. 456.47(4), F.S.
16 S. 456.47(2), F.S.
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waived. The Florida Constitution recognizes that the concept of sovereign immunity applies to the state,
although the state may waive its immunity through an enactment of general law. 17
In 1973, the Legislature enacted s. 768.28, F.S., a partial waiver of sovereign immunity, allowing
individuals to sue state government and its subdivisions. 18 According to subsection (1), individuals may
sue the government under circumstances where a private person "would be liable to the claimant, in
accordance with the general laws of [the] state . . . . " Section 768.28(5), F.S., imposes a $200,000 limit
on the government's liability to a single person, and a $300,000 total limit on liability for claims arising
out of a single incident.
Impaired Practitioner Program
The impaired practitioner treatment program was created to provide resources to assist health care
practitioners who are impaired as a result of the misuse or abuse of alcohol or drugs, or both, or a
mental or physical condition which could affect the practitioners’ ability to practice with skill and
safety. 19 For a profession that does not have a program established within its individual practice act,
the DOH is required to designate an approved program by rule. 20 By rule, DOH designates the
approved program by contract with a consultant to initiate intervention, recommend evaluation, refer
impaired practitioners to treatment providers, and monitor the progress of impaired practitioners. The
impaired practitioner program may not provide medical services. 21
Interstate Compacts
An interstate compact is an agreement between two or more states to address common problems or
issues, create an independent, multistate governmental authority, or establish uniform guidelines,
standards or procedures for the compact’s member states. 22 Article 1, Section 10, Clause 3 (Compact
Clause) of the U.S. Constitution authorizes states to enter into agreements with each other, without the
consent of Congress. However, the case law has provided that not all interstate agreements are subject
to congressional approval, but only those that may encroach on the federal government’s power. 23
Florida is a party to multiple interstate compacts, including the Nurse Licensure Compact, 24 Driver’s
License Compact, 25 Compact on Adoption and Medical Assistance, 26 and the Interstate Compact on
Educational Opportunity for Military Children. 27
Psychology Interjurisdictional Compact
The Psychology Interjurisdictional Compact (PSYPACT or compact) was created by the Association of
State and Provincial Psychology Boards (ASPPB) and is an interstate compact that facilitates the
practice of telepsychology and temporary in-person, face-to-face practice of psychology across state
boundaries. 28 The compact establishes the Psychology Interjurisdictional Compact Commission
(Commission) which is responsible for creating and finalizing bylaws, rules, and regulation. The
Commission also grants psychologists authority to practice telepsychology and temporary in-person,
17 Fla. Const. art. X, s. 13.
18 Chapter 73-313, L.O.F., codified at s. 768.28, F.S.
19 Section 456.076, F.S. The provisions of s. 456.076, also apply to veterinarians under s. 474.221, F.S. and radiological personnel
under s. 486.315, F.S.
20 Section 456.076(1), F.S.
21 Rule 64B31-10.001(1)(a), F.A.C.
22 National Center for Interstate Compacts, What Are Interstate Compacts?, https://compacts.csg.org/compacts/ (last visited Jan. 20,
2022).
23 For example, see Virginia v. Tennessee, 148 U.S. 503 (1893), New Hampshire v. Maine, 426 U.S. 363 (1976)
24 Section 464.0095, F.S.
25 Section 322.44, F.S.
26 Section 409.406, F.S.
27 Section 1000.36, F.S.
28 PSYPACT, About Us, https://psypact.site-ym.com/page/About (last visited Jan. 22, 2022).
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face-to-face psychology across state lines. 29 Nothing in the compact is to be construed as a waiver of
sovereign immunity.
Psychologists licensed in PSYPACT states may apply to the Commission for authority to practice
telepsychology in PSYPACT states. Authorized psychologists must obtain an E.Passport 30 Certificate
from ASPPB to practice telepsychology. To conduct temporary in-person practice in PSYPACT states,
psychologists licensed in PSYPACT states can apply to the Commission for an interjurisdictional
practice certificate for temporary authority to practice in a distant state. 31 PSYPACT currently has 27
member states.
The compact is arranged in 14 articles and addresses the following issues: 32
Purpose (Article I)
The primary purposes of PSYPACT are:
• Allowing for telepsychological communications from providers to patients in separate states;
• Allowing for up to 30 days of in-person, face-to-face practice;
• Recognizing that states have vested interest protecting public health and safety and the best
available protection is afforded through the compact and legislation;
• Only applying to individuals not holding licenses in both home and receiving jurisdictions; and
29 Id.
30 Under the compact, an E.Passport is a certificate issued by the Association for State and Provincial Psychology Boards that
promotes the standardization in the criteria of interjurisdictional telepsychology practice and facilitates the process for licensed
psychologists to provide telepsychological services across state lines.
31 Supra, note 28. A distant state is a compact state where a psychologist is physically present to provide temporary in-person, face-to-
face psychological services.
32 Psychology Interjurisdictional Compact (PSYPACT), https://cdn.ymaws.com/psypact.site-
ym.com/resource/resmgr/psychology_interjurisdiction.pdf (last visited Jan. 22, 2022).
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• Not applying to permanent in-person, face-to-face practice.
Definitions (Article II)
The compact provides definitions for terms used in the model legislation.
Home State Licensure (Article III)
Under the compact, a psychologist must be licensed by his or her home state, which must be a
compact state, to provide services permitted by the compact. PSYPACT authorizes psychologists with
a home state license to practice telepsychology in receiving states only if the receiving state requires:
• The psychologist to hold an active E.Passport;
• A mechanism for receiving and investigating complaints about licensees;
• Notification to the Commission of any adverse action of significant investigatory information
regarding a licensee;
• An identity history summary (background screening) of all applicants at initial licensure; and
• Compliance with the bylaws and rules of the Commission.
PSYPACT authorizes the practice of temporary, face-to-face practice in a distant state only if the
compact state:
• Currently holds an active interjurisdictional practice certificate;
• Has a mechanism for receiving and investigating complaints about licensees;
• Notifies the Commission of any adverse action of significant investigatory information regarding
a licensee;
• Requires an identity history summary (background screening) of all applicants at initial
licensure; and
• Complies with the bylaws and rules of the Commission.
Compact Privilege to Practice Telepsychology (Article IV)
PSYPACT authorizes the practice of telepsychology in a receiving state in which a psychologist is not
licensed, only if the psychologist:
• Holds a graduate degree in psychology from an institute of higher education which, at the time
the degree was awarded was:
o Regionally accredited by an accrediting body recognized by the U.S. Department of
Education to grant graduate degrees or authorize by provincial statute or royal charter to
grant doctoral degrees; or
o A foreign college or university deemed to be equivalent by a foreign credential
evaluation service that is a member of the National Association of Credential Evaluation
Services or by a recognizes foreign credential evaluation.
• Holds a graduate degree in psychology that meets designated criteria;
• Possess current, full and unrestricted license to practice psychology in a home state which is a
compact state;
• Has no history of adverse action which violate the rules of the Commission;
• Has no criminal record history which violates the rules of the Commission;
• Possess a current and active E. Passport;
• Provides attestations regarding areas of intended practice, conformity with standards of
practice, competence in telepsychology technology, criminal background and knowledge and
adherence to legal requirements in the home and receiving states, and provides a release of
information to allow for primary source verification in a manner specified by the Commission;
and
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• Meets other criteria as defined by the rules of the Commission.
PSYPACT also requires psychologists practicing under the compact to practice within his or her areas
of competency and within the scope of practice of the receiving state. Receiving states are authorized
to limit or revoke a psychologist’s authority to practice interjurisdictional telepsychology and to take any
necessary actions under applicable law to protect the health and safety of the receiving state’s citizens.
States taking such action must immediately notify the psychologist’s home state and the Commission.
E. Passports must be revoked if a psychologist’s home state license or other state license is restricted,
suspended, or otherwise limited.
Compact Temporary Authorization to Practice (Article V)
The compact requires compact states to recognize the right of a psychologist licensed in a compact
state to temporarily practice in other compact states where the psychologist is not licensed. To practice
temporarily in another compact state, a licensed psychologist must:
• Hold a graduate degree in psychology from an institute of higher education which, at the time
the degree was awarded was:
o Regionally accredited by an accrediting body recognized by the U.S. Department of
Education to grant graduate degrees or authorize by provincial statute or royal charter to
grant doctoral degrees; or
o A foreign college or university deemed to be equivalent by a foreign credential
evaluation service that is a member of the National Association of Credential Evaluation
Services or by a recognizes foreign credential evaluation.
• Hold a graduate degree in psychology from an educational program that:
o Is identified and labeled as a psychology program and specify in institutional catalogues
and brochures its intent to educate and train professional psychologists;
o Stands as a recognizable, coherent, organizational entity within the institution;
o Has clear authority and primary responsibility for the core and specialty areas whether or
not the program cuts across administrative lines;
o Consists of an integrated, organized sequence of study;
o Has an identifiable psychology faculty sufficient in size and breadth to carry out its
responsibilities;
o Has a director who must be a psychologist and a member of the core faculty;
o Has an identifiable student body who are matriculated in that program for a degree;
o The program must include supervised practicum, internship, or filed training appropriate
to the practice of psychology;
o Has a curriculum must encompass a minimum of three academic years of full-time
graduate study for doctoral degrees and a minimum of one academic year of full-time
graduate study for a master’s degree; and
o Includes an acceptable residency as defined by Commission rules.
• Possess a current, full and unrestricted license to practice psychology in a home state which is
a compact state;
• Have no history of adverse action or criminal record history that violate Commission rules;
• Possess a current, active interjurisdictional practice certificate;
• Provide attestations regarding areas of intended practice and work experience and allow for
primary source verification in a manner specified by the Commission; and
• Meet other criteria as defined by the Commission rules.
A psychologist practicing in a distant state under a temporary authorization to practice must practice
within the scope of practice within such state and is subject to its authority and laws. A distant state
may limit or revoke a psychologist’s temporary authorization in accordance with state law and take any
necessary action under the state’s law to protect the health and safety of its citizens. Any action taken
by a distant state must be reported to the home state and the Commission and the psychologist’s
interjurisdictional practice certificate must be revoked.
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Compact of Telepsychological Practice in a Receiving State (Article VI)
A psychologist must practice interjurisdictional telepsychology in accordance with the scope of practice
of the receiving jurisdiction and within the rules of the commission, as well as:
• The psychologist initiates a client/patient contact in home state via telecommunications
technologies with a client/patient in a receiving state; or
• Other condition regarding telepsychology as determined by rule promulgated by the
commission.
Adverse Actions (Article VII)
This section covers how the compact, home and receiving states will conduct and report adverse
actions. As well as the consequences for a psychologist who receives adverse actions.
The home state may take adverse actions against a psychologist license. A receiving state may take
adverse action on a psychologist authority to practice interjurisdictional telepsychology and temporary
authorization to practice within that receiving state.
If a home state takes adverse action against a psychologist’s license, a psychologist’s authority to
practice interjurisdictional telepsychology is terminated and the E.Passport is revoked. In addition, that
psychologist’s temporary practice is terminated, and the IPC is revoked. All adverse actions taken
should be reported to the Commission.
A home state’s psychology regulatory authority is required to investigate and take appropriate action
with respect to reported inappropriate conduct engaged in by a licensee which occurred in a receiving
state as it would if such conduct had occurred by a licensee within the home state. In such cases, the
home state’s law shall control in determining any adverse action against a psychologist’s license.
Nothing in the compact will override a compact state’s decision that a psychologist’s participation in an
alternative program may be used in lieu of adverse action and that such participation shall remain non-
public if required by the compact state’s law. The psychologist must cease providing services while in
an alternative program.
Additional Authorities Invested in a Compact State’s Psychology Regulatory Authority (Article
VIII)
PSYPACT authorizes compact states to maintain their psychologist regulatory authority, including:
• Issuing subpoenas, for both hearings and investigations; and
• Issuing orders to cease and desist and injunctive relief orders to revoke a psychologist’s
authority to practice interjurisdictional telepsychology or through temporary authorization.
The compact also prohibits a psychologist from changing their home state status if an investigation is
taking place. The compact encourages conclusions of all investigations to be reported to the
Commission. All information provided to the Commission or distributed by compact states pursuant to
the psychologist shall remain confidential, filed under seal and used for investigatory or disciplinary
matters. The Commission may create additional rules for mandated discretionary sharing of information
by compact states.
Coordinated Licensure Information System (Article IX)
The compact requires all compact states to share licensee information. Compact states must submit a
uniform dataset to a coordinated database on all psychologists to whom the compact is applicable, as
required by the rules of the commission. The database allows for expedited sharing of adverse action
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against compact psychologists. The coordinated database information must be expunged according to
laws of the reporting compact state.
Establishment of the Psychology Interjurisdictional Compact Commission (Article X)
The compact establishes the Psychology Interjurisdictional Compact Commission as the ruling
commission. The Commission must consist of one voting representative appointed by each compact
state who serves as that state’s Commissioner. The applicable state regulatory board must also appoint
a delegate to represent the Board of Psychology. Vacancies of Commissioners must be filled in
accordance of the laws of the compact state. Each commissioner is granted one vote in regard to
creation of rules and bylaws and must have the opportunity to participate in the business and affairs of
the Commission.
Rulemaking (Article XI)
PSYPACT provides rule-making authority to the Commission. Rules and amendments to the rules
passed by the Commission are binding on the party states as of the effective date specified in each rule
or amendment.
Prior to the promulgation and adoption of a rule, and at least 60 days in advance, the Commission must
provide notice of the meeting at which the rule is to be considered and voted upon. The notice must be
posted on the Commission’s website and the website of the licensing board of each member state, or
the publication in which each state would otherwise publish proposed rules, and include:
• The time, date, and location of the meeting;
• The text of the proposed rule or amendment,
• The reason for the proposed rule or amendment;
• A request for comment from interested persons; and
• The manner in which interested persons may submit comments.
The public may submit written comments, which must be made publicly available, prior to the adoption
of the proposed rule. The Commission must hold a public hearing before it adopts a rule if requested
by:
• At least 25 people submit comments independently of each other;
• A governmental entity; or
• A duly appointed person in an association having at least 25 members.
If a hearing is held, the Commission must publish the place, time, and date of he scheduled public
hearing. Anyone wishing to speak at the hearing must notify the Executive Director of the Commission,
or another designated member, within five business days before the hearing. Hearings must be
conducted in a manner that provides fair and reasonable opportunity for the public to comment orally or
in writing. Transcripts of hearings are not required unless a written request is made. Recordings may be
made in lieu of transcripts. The Commission may make transcripts of hearings if it so chooses. Rules
may be grouped together in the same hearing for convenience of the Commission.
Following the hearing, the Commission must consider all comments received from the public. A majority
vote of the Commission is required for adoption of rules and the Commission may decide the effective
date of the rule.
The commission has the authority to consider and adopt emergency rules, without prior notice, if there
is an imminent threat to public health, safety, or welfare; to prevent a loss of funds of the commission or
a party state; or to meet a deadline for the promulgation of an administrative rule that is required by
federal law. The standard rule-making procedure is to be applied retroactively as soon as possible but
no later than 90 days after the effective date of the emergency rule.
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Oversight, Dispute Resolution and Enforcement (Article XII)
The executive, legislative, and judicial branches of state government in each compact state is charged
with enforcing the compact and must take any necessary action to effectuate its purpose and intent.
The Commission is entitled to receive service of process relating to its powers, responsibilities, or
actions, and may intervene in any proceeding affecting such.
If a party state defaults in the performance of its duties or responsibilities under the compact, the
Commission must notify the defaulting state, as well as other party states, in writing of the nature of the
default and proposed cure of the default. The Commission will also provide remedial training and
technical assistance related to the default. If the defaulting state fails to cure the default, the
Commission may terminate its membership in PSYPACT, upon majority affirmative vote of the majority
of the administrators. The Commission must notify the governor and the majority and minority leaders
of the defaulting state’s legislature, as well as all compact states, of its intent to suspend or terminate
the state’s membership in the compact. However, termination of membership is to only be imposed
after all other means of compliance have been exhausted.
A termination of membership in the compact may be appealed by petitioning the U.S. District Court for
the state of Georgia or the federal district in which the compact’s principal office is located. The
compact’s principal office is located in Tyrone, Georgia. The Commission may also bring an action in
federal court against a defaulting state to enforce compliance with the provisions of the compact. The
Commission may seek injunctive relief, damages, or any other remedies available under state or
federal law. A prevailing party in either action is entitled to court costs and reasonable attorneys’ fees.
In the event that a dispute arises between party states, the Commission will attempt to resolve such
disputes. The compact directs the Commission to promulgate a rule that provides for mediation and
binding dispute resolution.
Date of Implementation of Psychology Interjurisdictional Compact Commission and Associated
Rules, Withdrawal and Amendment (Article XIII)
The compact became effective on the date of enactment in the seventh compact state, which occurred
on April 9, 2019. 33 States that join after the adoption of the rules shall be subject to the rules as they
exist on the date which the compact becomes law in that state.
To withdraw from PSYPACT, a state must enact a statute repealing the compact. Such withdrawal
does not take effect until six months after the enactment of the repealing legislation. Any adverse
actions or investigations that occur prior to the effective date of a withdrawal must be reported as
required under the compact.
The compact may be amended by the party states; however, an amendment will not be effective until it
is enacted into the laws of all compact states.
Construction and Severability (XIV)
This compact is to be liberally construed to effectuate its purposes. PSYPACT contains a severability
clause that provides that if the entire compact is found to be held contrary to the constitution of any
state member thereto, the compact shall remain in full force and effect as to the remaining compact
states.
33 PSYPACT, History, https://psypact.site-ym.com/page/History (last visited Jan. 22, 2022).
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Effect of the Bill
Psychologist Licensure Compact
The bill enacts the Psychology Interjurisdictional Compact (see description of compact provisions in the
Background section) and authorizes Florida to enter into the compact with all other jurisdictions that
have legally joined the compact. This allows an eligible Florida licensed psychologist to provide
services to out-of-state patients through either telehealth or a temporary authorization to practice.
The bill amends current law to allow PSYPACT implementation. It requires DOH to report any
significant investigation information relating to a psychologist practicing under the compact to the
coordinated database. It requires psychologists practicing under the compact to withdraw from all
practice under the compact if the psychologist in an impaired practitioner program. It requires the Board
of Psychology (Board) to appoint an individual to serve on the Commission and exempts out-of-state
licensed psychologists who practice under the compact from psychologist licensure requirements in this
state. The bill authorizes the Board to take adverse action against a psychologist’s authority to practice
under the compact and impose disciplinary actions for violation of prohibited acts.
The bill makes conforming changes to statute to reference the compact and the requirements under the
compact. The bill does not require changes to Florida’s licensure and license renewal requirements.
Sovereign Immunity
The bill provides that an individual of the Board, when serving as the state administrator of the
compact, and any administrator, officer, executive director, employee, or representative of the
commission, when acting within the scope of their employment, duties, or responsibilities in this state,
are considered agents of the state. The bill also provides that the Commission will pay any claims or
judgments pursuant to s. 768.28, F.S., and may maintain insurance coverage to pay any such claims or
judgements.
The bill provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Creates s. 490.0075, F.S., relating to Psychology Interjurisdictional Compact.
Section 2: Amends s. 456.073, F.S., relating to disciplinary proceedings.
Section 3: Amends s. 456.076, F.S., relating to impaired practitioner program.
Section 4: Amends s. 490.004, F.S., relating to Board of Psychology.
Section 5: Amends s. 490.005, F.S., relating to licensure by examination.
Section 6: Amends s. 490.006, F.S., relating to licensure by endorsement.
Section 7: Amends s. 490.009, F.S., relating to discipline.
Section 8: Amends s. 768.28, F.S., relating to waiver of sovereign immunity in tort actions; recovery
limits; civil liberty for damages caused during a riot; limitation on attorney fees; statute of
limitation; exclusions; indemnification; risk management programs.
Section 9: Provides an effective date of July 1, 2022.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
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2. Expenditures:
DOH estimates 1 full-time equivalent (FTE) position will be needed to implement the provisions of
the bill at a total cost of $56,892 ($44,314/Salary $12,272/Expense $306/Human Resources). 34
DOH may also experience an increase in cost related to annual membership with PSYPACT,
additional complaints and investigations, and updating licensure systems and can be absorbed
within current resources. 35
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Fees associated with applying for a license in a compact state would be eliminated for a psychologist
whose home state is Florida and wants to practice in a compact state, as well as a psychologist whose
home state is in a compact state and wishes to practice in Florida.
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:
As discussed below in the section entitled, “RULE-MAKING AUTHORITY,” the bill delegates
authority to the commission to adopt rules that facilitate and coordinate the implementation and
administration of the Psychology Interjurisdictional Compact.
If enacted into law, the state will effectively bind itself to rules not yet adopted by the commission.
The Florida Supreme Court has held that while it is within the province of the Legislature to adopt
federal statutes enacted by Congress and rules promulgated by federal administrative bodies that
are in existence at the time the Legislature acts, it is an unconstitutional delegation of legislative
power to prospectively adopt federal statutes not yet enacted by Congress and rules not yet
promulgated by federal administrative bodies. 3637 Under this holding, the constitutionality of the bill’s
34 Department of Health Agency Analysis of 2022 House Bill 953 (Jan. 21, 2022).
35 Id.
36 Freimuth v. State, 272 So.2d 473, 476 (Fla. 1972) (quoting Fla. Ind. Comm’n v. State ex rel. Orange State Oil Co., 155 Fla. 772
(1945).
37 This prohibition is based on the separation of powers doctrine, set forth in Article II, Section 3 of the Florida Constitution, which has
been construed in Florida to require the Legislature, when delegating the administration of legislative programs, to establish the
minimum standards and guidelines ascertainable by reference to the enactment creating the program. See Avatar Development Corp.
v. State, 723 So.2d 199 (Fla. 1998).
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adoption of prospective rules might be questioned, and there does not appear to be binding Florida
case law that squarely address this issue in the context of interstate compacts.
The most recent opportunity Florida courts have had to address this issue appears to be in
Department of Children and Family Services v. L.G., involving the Interstate Compact for the
Placement of Children (ICPC). 38 The First District Court of Appeal considered an argument that the
regulations adopted by the Association of Administrators of the Interstate Compact were binding and
that the lower court’s order permitting a mother and child to relocate to another state was in violation
of the ICPC. The court denied the appeal and held that the Association’s regulations did not apply as
they conflicted with the ICPC and the regulations did not apply to the facts of the case.
The court also references language in the ICPC that confers to its compact administrators the “power
to promulgate rules and regulations to carry out more effectively the terms and provisions of this
compact.” 39 The court states that “the precise legal effect of the ICPC compact administrators’
regulations in Florida is unclear,” but noted that it did not need to address the question to decide the
case. 40 However, in a footnote, the court provided:
Any regulations promulgated before Florida adopted the ICPC did not, of course, reflect
the vote of a Florida compact administrator, and no such regulations were ever
themselves enacted into law in Florida. When the Legislature did adopt the ICPC, it did
not (and could not) enact as the law of Florida or adopt prospectively regulations then
yet to be promulgated by an entity not even covered by the Florida Administrative
Procedure Act. See Freimuth v. State, 272 So.2d 473, 476 (Fla.1972); Fla. Indus.
Comm'n v. State ex rel. Orange State Oil Co., 155 Fla. 772, 21 So.2d 599, 603 (1945)
(“[I]t is within the province of the legislature to approve and adopt the provisions of
federal statutes, and all of the administrative rules made by a federal administrative
body, that are in existence and in effect at the time the legislature acts, but it would be
an unconstitutional delegation of legislative power for the legislature to adopt in advance
any federal act or the ruling of any federal administrative body that Congress or such
administrative body might see fit to adopt in the future.”); Brazil v. Div. of Admin., 347
So.2d 755, 757–58 (Fla. 1st DCA 1977), disapproved on other grounds by LaPointe
Outdoor Adver. v. Fla. Dep't of Transp., 398 So.2d 1370, 1370 (Fla.1981). The ICPC
compact administrators stand on the same footing as federal government administrators
in this regard. 41
In accordance with the discussion provided by the court in this above-cited footnote, it may be
argued that the bill’s delegation of rule-making authority to the commission is similar to the
delegation to the ICPC compact administrators, and thus, could constitute an unlawful delegation of
legislative authority. This case, however, does not appear to be binding as precedent as the court’s
footnote discussion is dicta. 42
B. RULE-MAKING AUTHORITY:
The bill authorizes the Commission to adopt rules to facilitate and coordinate the implementation and
administration of the compact. The compact specifies that the rules have the force and effect of law and
are binding in all compact states. If a compact state fails to meet its obligations under the compact or
the promulgated rules, the state may be subject to remedial training, alternative dispute resolution,
suspension, termination, or legal action.
38 801 So.2d 1047 (Fla. 1st DCA 2001).
39 Id at 1052.
40 Id.
41 Id.
42 Dicta are statements of a court that are not essential to the determination of the case before it and are not a part of the law of the
case. Dicta has no biding legal effect and is without force as judicial precedent. 12A FLA JUR. 2D Courts and Judges s. 191 (2015).
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The compact details the rule-making process that must be followed including, notice, an opportunity for
public participation, and hearings. The compact also provides a procedure for emergency rule-making
in cases of imminent danger to public health, safety, or welfare, to prevent financial loss to the state’s
or commission, or to comply with federal laws or regulations. All rules and amendments are binding on
party state as of the effective date specified.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 953 2022
1 A bill to be entitled
2 An act relating to the Psychology Interjurisdictional
3 Compact; creating s. 490.0075, F.S.; creating the
4 Psychology Interjurisdictional Compact; providing
5 purposes and objectives; defining terms; providing for
6 recognition of psychologist licenses in compact
7 states; authorizing a compact state to require
8 licensure under certain circumstances; requiring
9 compact states to meet certain criteria to participate
10 in the compact; providing criteria that a psychologist
11 must satisfy to practice under the compact;
12 maintaining that authority over a psychologist's
13 license remains with the home state but authorizing
14 receiving states to define the scope of and act on a
15 psychologist's authority to practice in the compact
16 state under the compact; prohibiting a psychologist
17 from practicing under the compact if his or her
18 authority to do so has been acted on by any compact
19 state; requiring compact states to report adverse
20 actions they take against psychologists to the
21 Psychology Interjurisdictional Compact Commission;
22 requiring compact states to participate in a
23 coordinated licensure information system; providing
24 for the development of the system, reporting
25 procedures, and the exchange of certain information
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26 between compact states; establishing the Psychology
27 Interjurisdictional Compact Commission; providing for
28 the jurisdiction and venue for court proceedings;
29 providing membership, duties, and powers; authorizing
30 the commission to adopt rules; providing rulemaking
31 procedures; providing for state enforcement of the
32 compact; providing for the termination of compact
33 membership; providing procedures for the resolution of
34 certain disputes; providing compact amendment
35 procedures; authorizing nonparty states to participate
36 in commission activities before adoption of the
37 compact; providing construction and severability;
38 amending s. 456.073, F.S.; requiring the Department of
39 Health to report certain investigative information to
40 the coordinated licensure information system; amending
41 s. 456.076, F.S.; requiring monitoring contracts for
42 impaired practitioners participating in treatment
43 programs to contain certain terms; amending s.
44 490.004, F.S.; requiring the Board of Psychology to
45 appoint an individual to serve as the state's
46 commissioner on the Psychology Interjurisdictional
47 Compact Commission; amending s. 490.005, F.S.;
48 exempting certain persons from licensure requirements;
49 amending s. 490.006, F.S.; exempting certain persons
50 from requirements for licensure by endorsement;
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51 amending s. 490.009, F.S.; authorizing certain
52 disciplinary action under the compact for certain
53 prohibited acts; amending s. 768.28, F.S.; designating
54 the state commissioner and other members or employees
55 of the commission as state agents for the purpose of
56 applying sovereign immunity and waivers of sovereign
57 immunity; requiring the commission to pay certain
58 judgments or claims; authorizing the commission to
59 maintain insurance coverage to pay such judgments or
60 claims; providing an effective date.
61
62 WHEREAS, states license psychologists to protect the public
63 through verification of education, training, and experience and
64 to ensure accountability for professional practice, and
65 WHEREAS, this compact is intended to regulate the day -to-
66 day practice of telepsychology, or the provision of
67 psychological services using telecommunication technologie s, by
68 psychologists across state boundaries in the performance of
69 their psychological practice as defined by an appropriate state
70 psychology regulatory authority, and
71 WHEREAS, this compact is intended to regulate the temporary
72 in-person, face-to-face practice of psychology by psychologists
73 across state boundaries for up to 30 days within a calendar year
74 in the performance of their psychological practice as defined by
75 an appropriate state psychology regulatory authority, and
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76 WHEREAS, this compact is intended to authorize state
77 psychology regulatory authorities to afford legal recognition,
78 in a manner consistent with the terms of the compact, to
79 psychologists licensed in another state, and
80 WHEREAS, this compact recognizes that states have a vested
81 interest in protecting the public's health and safety through
82 their licensing and regulation of psychologists and that such
83 state regulation will best protect public health and safety, and
84 WHEREAS, this compact does not apply when a psychologist is
85 licensed in both the home and receiving states, and
86 WHEREAS, while this compact does not apply to permanent in -
87 person, face-to-face practice, it does allow for authorization
88 of temporary psychological practice, NOW, THEREFORE,
89
90 Be It Enacted by the Legislature of the State of Florida:
91
92 Section 1. Section 490.0075, Florida Statutes, is created
93 to read:
94 490.0075 Psychology Interjurisdictional Compact.—The
95 Psychology Interjurisdictional Compact is hereby enacted and
96 entered into by this state with all other jurisdictions legally
97 joining therein in the form substantially as follows:
98
99 PSYCHOLOGY INTERJURISDICTIONAL COMPACT
100 ARTICLE I
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101 PURPOSE
102 This compact is designed to achieve the following purposes
103 and objectives:
104 (1) Increase public access to professional psychological
105 services by allowing for telepsychological practice across state
106 lines as well as temporary in-person, face-to-face services in a
107 state where the psychologist is not licensed to practice
108 psychology;
109 (2) Enhance the states' ability to protect the public's
110 health and safety, especially client or patient safety;
111 (3) Encourage the cooperation of compact states in the
112 areas of psychologist licensure and regulation;
113 (4) Facilitate the exchange of information between compact
114 states regarding psychologist licensure, adverse actions, and
115 disciplinary history;
116 (5) Promote compliance with the laws governing the
117 practice of psychology in each compact state; and
118 (6) Invest all compact states with the authority to hold
119 licensed psychologists accountable through the mutual
120 recognition of compact state licenses.
121
122 ARTICLE II
123 DEFINITIONS
124 As used in this compact, the term:
125 (1) "Adverse action" means any disciplinary action that is
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126 a matter of public record which is taken by a state's psychology
127 regulatory authority against an individual's license to practice
128 psychology in that state.
129 (2) "Association of State and Provincial Psychology
130 Boards" means the membership organization composed of state and
131 provincial psychology regulatory authorities that are
132 responsible for the licensure and registration of psychologists
133 throughout the United States and Canada.
134 (3) "Authority to practice interjurisdictional
135 telepsychology" means a licensed psychologist's authority to
136 practice telepsychology, within the limits authorized under this
137 compact, in a compact state other than the one in which he or
138 she is licensed.
139 (4) "Bylaws" means those rules established by the
140 Psychology Interjurisdictional Compact Commission pursuant to
141 Article X for its governance, or for directing and controlling
142 its actions and conduct.
143 (5) "Client or patient" means the recipient of
144 psychological services, whether psychological services are
145 delivered in the context of health care, corporate, supervision,
146 or consulting services.
147 (6) "Commissioner" means the voting representative
148 appointed by each state psychology regulatory authority pursuant
149 to article X.
150 (7) "Compact state" means a state, the District of
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151 Columbia, or a United States territory that has enacted this
152 compact legislation and that has not withdrawn pursuant to
153 subsection (3) of article XIII or been terminated pursuant to
154 subsection (2) of article XII.
155 (8) "Confidentiality" means the principle that data or
156 information is not made available or disclosed to unauthorized
157 persons or processes.
158 (9) "Coordinated licensure information system," also
159 referred to as "coordinated database," means an integrated
160 process that is administered by the Association of State and
161 Provincial Psychology Boards for collecting, storing, and
162 sharing information on psychologists' licensure and enforcement
163 activities related to psychology licensure laws and the
164 Psychology Interjurisdictional Compact.
165 (10) "Day" means any part of a day in which the
166 psychologist practices psychology.
167 (11) "Distant state" means the compact state where a
168 psychologist is physically present, not through the use of
169 telecommunication technologies, to provide temporary in -person,
170 face-to-face psychological services.
171 (12) "E-passport" means a certificate issued by the
172 Association of State and Provincial Psychology Boards which
173 allows a licensed psychologist to provide telepsychological
174 services across state lines.
175 (13) "Executive board" means a group of directors elected
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176 or appointed to act on behalf of, and within the powers granted
177 to them by, the commission.
178 (14) "Home state" means a compact state where a
179 psychologist is licensed to practice psychology, as provided in
180 article III.
181 (15) "Identity history summary" means a summary of
182 information retained by the Federal Bureau of Investigation, or
183 other designee with similar authority, in connection with
184 arrests and, in some instances, federal employment or military
185 service.
186 (16) "In-person, face-to-face" means interactions in which
187 the psychologist and the client or patient are in the same
188 physical space and does not include interactions that may occur
189 through the use of telecommunication technologies.
190 (17) "Interjurisdictional Practice Certificate (IPC)"
191 means the certificate issued by the Association of State and
192 Provincial Psychology Boards which grants temporary authority to
193 practice based on notification to the state psychology
194 regulatory authority of one's intention to practice temporarily,
195 and verification of one's qualifications for such practice.
196 (18) "License" means authorization by a state psychology
197 regulatory authority to engage in the independent practice of
198 psychology, which would be unlawful without the authorization.
199 (19) "Noncompact state" means a state that is not a
200 compact state.
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201 (20) "Psychologist" means an individual who is licensed by
202 a state psychology regulatory authority to independently
203 practice psychology in that state.
204 (21) "Psychology Interjurisdictional Compact Commission,"
205 also referred to as "commission," means the national
206 administration of which all compact states are members.
207 (22) "Receiving state" means a compact state where the
208 client or patient is physically located when the
209 telepsychological services are delivered.
210 (23) "Rule" means a written statement by the Psychology
211 Interjurisdictional Compact Commission promulgated pursuant to
212 article XI of the compact which is of general applicability;
213 implements, interprets, or prescribes a policy or provision of
214 the compact; or is an organizational, procedural, or practice
215 requirement of the commission; and has the force and effect of
216 statutory law in a compact state, and includes the amendment,
217 repeal, or suspension of an existing rule.
218 (24) "Significant investigatory information" means:
219 (a) Investigative information that a state psychology
220 regulatory authority, after a preliminary inquiry that includes
221 notification and an opportunity to respond if required by state
222 law, has reason to believe, if proven true, would indicate a
223 violation of state statute or rule that would be considered more
224 substantial than a minor infraction; or
225 (b) Investigative information that indicates that the
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226 psychologist represents an immediate threat to public health and
227 safety regardless of whether the psychologist has been notified
228 or had an opportunity to respond.
229 (25) "State" means a state, commonwealth, territory, or
230 possession of the United States, or the District of Columbia.
231 (26) "State psychology regulatory authority" means the
232 board, office, or other agency with the legislative mandate to
233 license and regulate the practice of psychology in that state.
234 (27) "Telepsychology" means the provision of psychological
235 services using telecommunication technologies.
236 (28) "Temporary authorization to practice" means a
237 licensed psychologist's authority to conduct temporary in-
238 person, face-to-face practice, within the limits authorized
239 under this compact, in another compact state.
240 (29) "Temporary in-person, face-to-face practice" means
241 when a psychologist is physically present, not through the use
242 of telecommunication technologies, in the distant state to
243 provide psychological services for up to 30 days within a
244 calendar year and based on notification to the distant state.
245
246 ARTICLE III
247 HOME STATE LICENSURE
248 (1) The home state is a compact state where a psychologist
249 is licensed to practice psychology.
250 (2) A psychologist may hold one or more compact state
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251 licenses at a time. If the psychologist is licensed in more than
252 one compact state, the home state is the compact state where the
253 psychologist is physically present when the services are
254 delivered as authorized by the authority to practice
255 interjurisdictional telepsychology under the terms of this
256 compact.
257 (3) A compact state may require a psychologist who is not
258 previously licensed in a compact state to obtain and retain a
259 license to be authorized to practice in the compact state under
260 circumstances that are not authorized by the authority to
261 practice interjurisdictional telepsychology under the terms of
262 this compact.
263 (4) A compact state may require a psychologist to obtain
264 and retain a license to be authorized to practice in a compact
265 state under circumstances that are not authorized by a temporary
266 authorization to practice under the terms of this compact.
267 (5) A home state's license authorizes a psychologist to
268 practice in a receiving state under the authority to practice
269 interjurisdictional telepsychology only if the compact state:
270 (a) Currently requires the psychologist to hold an active
271 e-passport;
272 (b) Has a mechanism in place for receiving and
273 investigating complaints about licensed individuals;
274 (c) Notifies the commission, in compliance with the terms
275 herein, of any adverse action or significant investigatory
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276 information regarding a licensed individual;
277 (d) Requires an identity history summary of all applicants
278 at initial licensure, including the use of the results of
279 fingerprints or other biometric data checks compliant with the
280 requirements of the Federal Bureau of Investigation, or other
281 designee with similar authority, no later than 10 years after
282 activation of the compact; and
283 (e) Complies with the bylaws and rules of the commission.
284 (6) A home state's license grants a psychologist temporary
285 authorization to practice in a distant state only if the compact
286 state:
287 (a) Currently requires the psychologist to hold an active
288 IPC;
289 (b) Has a mechanism in place for receiving and
290 investigating complaints about licensed individuals;
291 (c) Notifies the commission, in compliance with the terms
292 herein, of any adverse action or significant investigatory
293 information regarding a licensed individual;
294 (d) Requires an identity history summary of all applicants
295 at initial licensure, including the use of the results of
296 fingerprints or other biometric data checks compliant with the
297 requirements of the Federal Bureau of Investigation, or other
298 designee with similar authority, no later than 10 years after
299 activation of the compact; and
300 (e) Complies with the bylaws and rules of the commission.
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301
302 ARTICLE IV
303 COMPACT PRIVILEGE TO PRACTICE TELEPSYCHOLOGY
304 (1) Compact states shall recognize the right of a
305 psychologist, licensed in a compact state in conformance with
306 article III, to practice telepsychology in other compact states,
307 or receiving states, in which the psychologist is not licensed,
308 under the authority to practice interjurisdictional
309 telepsychology as provided in the compact.
310 (2) To exercise the authority to practice
311 interjurisdictional telepsychology in a receiving state under
312 the terms and provisions of this compact, a psychologist
313 licensed to practice in a compact state must:
314 (a) Hold a graduate degree in psychology from an
315 institution of higher education that was, at the time the degree
316 was awarded:
317 1. Regionally accredited by an accrediting body recognized
318 by the United States Department of Education to grant graduate
319 degrees, or authorized by Provincial Statute or Royal Charter to
320 grant doctoral degrees; or
321 2. A foreign college or university deemed to be equivalent
322 to subparagraph 1. by a foreign credential evaluation service
323 that is a member of the National Association of Credential
324 Evaluation Services or by a recognized foreign credential
325 evaluation service;
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326 (b) Hold a graduate degree in psychology which meets the
327 following criteria:
328 1. The program, wherever it may be administratively
329 housed, is clearly identified and labeled as a psychology
330 program. Such program must specify in pertinent institutional
331 catalogs and brochures its intent to educate and train
332 professional psychologists;
333 2. The psychology program stands as a recognizable and
334 coherent organizational entity within the institution;
335 3. There is a clear authority and primary responsibility
336 for the core and specialty areas regardless of whether the
337 program overlaps across administrative lines;
338 4. The program consists of an integrated, organized
339 sequence of study;
340 5. There is an identifiable psychology faculty sufficient
341 in size and breadth to carry out its responsibilities;
342 6. The designated director of the program is a
343 psychologist and a member of the core faculty;
344 7. The program has an identifiable body of students who
345 are matriculated in that program for a degree;
346 8. The program includes supervised practicum, internship,
347 or field training appropriate to the practice of psychology;
348 9. The curriculum encompasses a minimum of 3 academic
349 years of full-time graduate study for doctoral degrees and a
350 minimum of 1 academic year of full-time graduate study for
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351 master's degrees; and
352 10. The program includes an acceptable residency as
353 defined by the rules of the commission;
354 (c) Possess a current, full, and unrestricted license to
355 practice psychology in a home state that is a compact state;
356 (d) Have no history of adverse actions that violate the
357 rules of the commission;
358 (e) Have no criminal history reported on an identity
359 history summary which violates the rules of the commission;
360 (f) Possess a current, active e-passport;
361 (g) Provide attestations in regard to areas of intended
362 practice, conformity with standards of practice, competence in
363 telepsychology technology, criminal background, and knowledge
364 and adherence to legal requirements in the home and receiving
365 states, and provide a release of information to allow for
366 primary source verification in a manner specified by the
367 commission; and
368 (h) Meet other criteria as defined by the rules of the
369 commission.
370 (3) The home state maintains authority over the license of
371 any psychologist practicing in a receiving state under the
372 authority to practice interjurisdictional telepsychology.
373 (4) A psychologist practicing in a receiving state under
374 the authority to practice interjurisdictional telepsychology
375 will be subject to the receiving state's scope of practice. A
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376 receiving state may, in accordance with that state's due process
377 law, limit or revoke a psychologist's authority to practice
378 interjurisdictional telepsychology in the receiving state and
379 may take any other necessary actions under the receiving state's
380 applicable law to protect the health and safety of the receiving
381 state's citizens. If a receiving state takes action, the state
382 shall promptly notify the home state and the commission.
383 (5) If a psychologist's license in any home state or
384 another compact state or any authority to practice
385 interjurisdictional telepsychology in any receiving state is
386 restricted, suspended, or otherwise limited, the e-passport must
387 be revoked and the psychologist is not eligible to practice
388 telepsychology in a compact state under the authority to
389 practice interjurisdictional telepsychology.
390
391 ARTICLE V
392 COMPACT TEMPORARY AUTHORIZATION TO PRACTICE
393 (1) Compact states shall recognize the right of a
394 psychologist licensed in a compact state in conformance with
395 article III to practice temporarily in other compact states, or
396 distant states, in which the psychologist is not licensed, as
397 provided in the compact.
398 (2) To exercise the temporary authorization to practice in
399 distant states under the terms and provisions of this compact, a
400 psychologist licensed to practice in a compact state must:
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401 (a) Hold a graduate degree in psychology from an
402 institution of higher education that was, at the time the degree
403 was awarded:
404 1. Regionally accredited by an accrediting body recognized
405 by the U.S. Department of Education to grant graduate degrees,
406 or authorized by Provincial Statute or Royal Charter to grant
407 doctoral degrees; or
408 2. A foreign college or university deemed to be equivalent
409 to subparagraph 1. above by a foreign credential evaluation
410 service that is a member of the National Association of
411 Credential Evaluation Services or by a recognized foreign
412 credential evaluation service;
413 (b) Hold a graduate degree in psychology that meets the
414 following criteria:
415 1. The program, wherever it may be administratively
416 housed, is clearly identified and labeled as a psychology
417 program. Such program must specify in pertinent institutional
418 catalogs and brochures its intent to educate and train
419 professional psychologists;
420 2. The psychology program stands as a recognizable and
421 coherent organizational entity within the institution;
422 3. There is a clear authority and primary responsibility
423 for the core and specialty areas regardless of whether the
424 program overlaps across administrative lines;
425 4. The program consists of an integrated, organized
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426 sequence of study;
427 5. There is an identifiable psychology faculty sufficient
428 in size and breadth to carry out its responsibilities;
429 6. The designated director of the program is a
430 psychologist and a member of the core faculty;
431 7. The program has an identifiable body of students who
432 are matriculated in that program for a degree;
433 8. The program includes supervised practicum, internship,
434 or field training appropriate to the practice of psychology;
435 9. The curriculum encompasses a minimum of 3 academic
436 years of full-time graduate study for doctoral degrees and a
437 minimum of 1 academic year of full-time graduate study for
438 master's degrees; and
439 10. The program includes an acceptable residency as
440 defined by the rules of the commission;
441 (c) Possess a current, full, and unrestricted license to
442 practice psychology in a home state that is a compact state;
443 (d) Have no history of adverse actions that violate the
444 rules of the commission;
445 (e) Have no criminal history that violates the rules of
446 the commission;
447 (f) Possess a current, active IPC;
448 (g) Provide attestations in regard to areas of intended
449 practice and work experience, and provide a release of
450 information to allow for primary source verification in a manner
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451 specified by the commission; and
452 (h) Meet other criteria as defined by the rules of the
453 commission.
454 (3) A psychologist practicing in a distant state under a
455 temporary authorization to practice shall practice within the
456 scope of practice authorized by the distant state.
457 (4) A psychologist practicing in a distant state under a
458 temporary authorization to practice will be subject to the
459 distant state's authority and law. A distant state may, in
460 accordance with that state's due process law, limit or revoke a
461 psychologist's temporary authorization to practice in the
462 distant state and may take any other necessary actions under the
463 distant state's applicable law to protect the health and safety
464 of the distant state's citizens. If a distant state takes
465 action, the state shall promptly notify the home state and the
466 commission.
467 (5) If a psychologist's license in any home state or
468 another compact state or temporary authorization to practice in
469 any distant state is restricted, suspended, or otherwise
470 limited, the IPC shall be revoked and the psychologist is not
471 eligible to practice in a compact state under the temporary
472 authorization to practice.
473
474 ARTICLE VI
475 CONDITIONS OF TELEPSYCHOLOGY PRACTICE IN A RECEIVING STATE
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476 A psychologist may practice in a receiving state under the
477 authority to practice interjurisdictional telepsychology only in
478 the performance of the scope of practice for psychology as
479 defined by an appropriate state psychology regulatory authority,
480 as defined in the rules of the commission, and under the
481 following circumstances:
482 (1) The psychologist initiates a client or patient contact
483 in a home state via telecommunication technologies with a client
484 or patient in a receiving state; and
485 (2) Other conditions regarding telepsychology as
486 determined by rules promulgated by the commission.
487
488 ARTICLE VII
489 ADVERSE ACTIONS
490 (1) A home state may take adverse action against a
491 psychologist's license issued by the home state. A distant state
492 shall have the power to take adverse action on a psychologist's
493 temporary authorization to practice within that distant state.
494 (2) A receiving state may take adverse action on a
495 psychologist's authority to practice interjurisdictional
496 telepsychology within that receiving state. A home state may
497 take adverse action against a psychologist based on an adverse
498 action taken by a distant state regarding temporary in-person,
499 face-to-face practice.
500 (3) If a home state takes adverse action against a
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501 psychologist's license, that psychologist's authority to
502 practice interjurisdictional telepsychology is terminated and
503 the e-passport is revoked. Furthermore, that psychologist's
504 temporary authorization to practice is terminated and the IPC is
505 revoked.
506 (a) All home state disciplinary orders that take adverse
507 action shall be reported to the commission in accordance with
508 the rules promulgated by the commission. A compact stat e shall
509 report adverse actions in accordance with the rules of the
510 commission.
511 (b) In the event that discipline is reported on a
512 psychologist, the psychologist will not be eligible for
513 telepsychology or temporary in-person, face-to-face practice in
514 accordance with the rules of the commission.
515 (c) Other actions may be imposed as determined by the
516 rules promulgated by the commission.
517 (4) A home state's psychology regulatory authority shall
518 investigate and take appropriate action with respect to reported
519 inappropriate conduct engaged in by a licensee which occurred in
520 a receiving state in the same manner as it would if such conduct
521 had occurred by a licensee within the home state. In such cases,
522 the home state's law shall control in determining any advers e
523 action against a psychologist's license.
524 (5) A distant state's psychology regulatory authority
525 shall investigate and take appropriate action with respect to
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526 reported inappropriate conduct engaged in by a psychologist
527 practicing under temporary authorization to practice which
528 occurred in that distant state in the same manner as it would if
529 such conduct had occurred by a licensee within the home state.
530 In such cases, the distant state's law shall control in
531 determining any adverse action against a psychologist's
532 temporary authorization to practice.
533 (6) Nothing in this compact shall override a compact
534 state's decision that a psychologist's participation in an
535 alternative program may be used in lieu of adverse action and
536 that such participation shall remain nonpublic if required by
537 the compact state's law. Compact states must require
538 psychologists who enter any alternative programs to not provide
539 telepsychology services under the authority to practice
540 interjurisdictional telepsychology or temporary psycholo gical
541 services under the temporary authorization to practice in any
542 other compact state during the term of the alternative program.
543 (7) Other judicial or administrative remedies will not be
544 available to a psychologist in the event a compact state takes
545 adverse action pursuant to subsection (3).
546
547 ARTICLE VIII
548 ADDITIONAL AUTHORITIES INVESTED IN A COMPACT STATE'S PSYCHOLOGY
549 REGULATORY AUTHORITY
550 (1) In addition to any other powers granted under state
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551 law, a compact state's psychology regulatory authority s hall
552 have the authority under this compact to:
553 (a) Issue subpoenas, for both hearings and investigations,
554 which require the attendance and testimony of witnesses and the
555 production of evidence. Subpoenas issued by a compact state's
556 psychology regulatory authority for the attendance and testimony
557 of witnesses, or the production of evidence from another compact
558 state, shall be enforced in the latter state by any court of
559 competent jurisdiction, according to that court's practice and
560 procedure in considering subpoenas issued in its own
561 proceedings. The issuing state psychology regulatory authority
562 shall pay any witness fees, travel expenses, mileage, and other
563 fees required by the service statutes of the state where the
564 witnesses or evidence are located; and
565 (b) Issue cease and desist or injunctive relief orders to
566 revoke a psychologist's authority to practice
567 interjurisdictional telepsychology or temporary authorization to
568 practice.
569 (2) During the course of any investigation, a psychologist
570 may not change his or her home state licensure. A home state
571 psychology regulatory authority is authorized to complete any
572 pending investigations of a psychologist and to take any actions
573 appropriate under its law. The home state psychology regulatory
574 authority shall promptly report the conclusions of such
575 investigations to the commission. Once an investigation has been
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576 completed, and pending the outcome of such investigation, the
577 psychologist may change his or her home state licensure. The
578 commission shall promptly notify the new home state of any such
579 decisions as provided in the rules of the commission. All
580 information provided to the commission or distributed by compact
581 states related to the psychologist shall be confidential, filed
582 under seal, and used for investigatory or disciplinary matters.
583 The commission may create additional rules for mandated or
584 discretionary sharing of information by compact states.
585
586 ARTICLE IX
587 COORDINATED LICENSURE INFORMATION SYSTEM
588 (1) The commission shall provide for the development and
589 maintenance of a Coordinated Licensure Information System and a
590 reporting system containing licensure and disciplinary action
591 information on all psychologists to whom this compact is
592 applicable in all compact states as defined by the rules of the
593 commission.
594 (2) Notwithstanding any other provision of state law to
595 the contrary, a compact state shall submit a uniform data set to
596 the coordinated database on all licensees as required by the
597 rules of the commission, including:
598 (a) Identifying information;
599 (b) Licensure data;
600 (c) Significant investigatory information;
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601 (d) Adverse actions against a psychologist's license;
602 (e) An indicator that a psychologist's authority to
603 practice interjurisdictional telepsychology or temporary
604 authorization to practice is revoked;
605 (f) Nonconfidential information related to alternative
606 program participation information;
607 (g) Any denial of application for licensure, and the
608 reasons for such denial; and
609 (h) Other information that may facilitate the
610 administration of this compact, as determined by the rules of
611 the commission.
612 (3) The coordinated database administrator shall promptly
613 notify all compact states of any adverse action taken against,
614 or significant investigatory information on, any licensee in a
615 compact state.
616 (4) Compact states reporting information to the
617 coordinated database may designate information that may not be
618 shared with the public without the express permission of the
619 compact state reporting the information.
620 (5) Any information submitted to the coordinated database
621 which is subsequently required to be expunged by the law of the
622 compact state reporting the information shall be removed from
623 the coordinated database.
624
625 ARTICLE X
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626 ESTABLISHMENT OF THE PSYCHOLOGY INTERJURISDICTIONAL COMPACT
627 COMMISSION
628 (1) COMMISSION CREATED.—The compact states hereby create
629 and establish a joint public agency known as the Psychology
630 Interjurisdictional Compact Commission.
631 (a) The commission is a body politic and an
632 instrumentality of the compact states.
633 (b) Venue is proper and judicial proceedings by or against
634 the commission shall be brought solely and exclusively in a
635 court of competent jurisdiction where the principal office of
636 the commission is located. The commission may waive venue and
637 jurisdictional defenses to the extent that it adopts or consents
638 to participate in alternative dispute resolution proceedings.
639 (c) Nothing in this compact shall be construed to be a
640 waiver of sovereign immunity.
641 (2) MEMBERSHIP, VOTING, AND MEETINGS.—
642 (a) The commission shall consist of one voting
643 representative appointed by each compact state who shall serve
644 as that state's commissioner. The state psychology regulatory
645 authority shall appoint its delegate. This delegate shall be
646 empowered to act on behalf of the compact state. This delegate
647 shall be limited to:
648 1. The executive director, the executive secretary, or a
649 similar executive of the compact state's psychology regulatory
650 authority;
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651 2. A current member of the state psychology regulatory
652 authority of a compact state; or
653 3. A designee empowered with the appropriate delegate
654 authority to act on behalf of the compact state.
655 (b) A commissioner may be removed or suspended from office
656 as provided by the law of the state from which the commissioner
657 is appointed. Any vacancy occurring in the commission shall be
658 filled in accordance with the laws of the compact state in which
659 the vacancy exists.
660 (c) Each commissioner shall be entitled to one vote with
661 regard to the promulgation of rules and creation of bylaws and
662 shall otherwise have an opportunity to participate in the
663 business and affairs of the commission. A commissioner shall
664 vote in person or by such other means as provided in the bylaws.
665 The bylaws may provide for commissioners' participation in
666 meetings by telephone or other means of communication.
667 (d) The commission shall meet at least once during each
668 calendar year. Additional meetings shall be held as set forth in
669 the bylaws.
670 (e) All meetings shall be open to the public, and public
671 notice of meetings shall be given in the same manner as required
672 under the rulemaking provisions in article XI.
673 (f) The commission may convene in a closed, nonpublic
674 meeting if the commission must discuss:
675 1. Noncompliance of a compact state with its obligations
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676 under the compact;
677 2. Employment, compensation, or discipline of or other
678 personnel matters, practices, or procedures related to specific
679 employees, or other matters related to the commission's internal
680 personnel practices and procedures;
681 3. Current, threatened, or reasonably anticipated
682 litigation against the commission;
683 4. Negotiation of contracts for the purchase or sale of
684 goods, services, or real estate;
685 5. An accusation of any person of a crime or a formal
686 censure of any person;
687 6. Information disclosing trade secrets or commercial or
688 financial information which is privileged or confidential;
689 7. Information of a personal nature where disclosure would
690 constitute a clearly unwarranted invasion of personal privacy;
691 8. Investigatory records compiled for law enforcement
692 purposes;
693 9. Information related to any investigatory reports
694 prepared by or on behalf of or for use of the commission or
695 other committee charged with responsibility for investigation or
696 determination of compliance issues pursuant to the compact; or
697 10. Matters specifically exempted from disclosure by
698 federal or state statute.
699 (g) If a meeting, or portion of a meeting, is closed
700 pursuant to this subsection, the commission's legal counsel or
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701 designee shall certify that the meeting may be closed and shall
702 reference each relevant exempting provision. The commission
703 shall keep minutes that fully and clearly describe all matters
704 discussed in a meeting and shall provide a full and accurate
705 summary of actions taken, of any person participating in the
706 meeting, and the reasons therefor, including a description of
707 the views expressed. All documents considered in connection with
708 an action shall be identified in such minutes. All minutes and
709 documents of a closed meeting shall remain under seal, subject
710 to release only by a majority vote of the commission or order of
711 a court of competent jurisdiction.
712 (3) BYLAWS.—
713 (a) The commission shall, by a majority vote of the
714 commissioners, prescribe bylaws or rules to govern its conduct
715 as may be necessary or appropriate to carry out the purposes and
716 exercise the powers of the compact, including, but not limited
717 to:
718 1. Establishing the fiscal year of the commission;
719 2. Providing reasonable standards and procedures:
720 a. For the establishment and meetings of other committees;
721 and
722 b. Governing any general or specific delegation of any
723 authority or function of the commission;
724 3. Providing reasonable procedures for calling and
725 conducting meetings of the commission, ensuring reasonable
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726 advance notice of all meetings, and providing an opportunity for
727 attendance of such meetings by interested parties, with
728 enumerated exceptions designed to protect the public's interest,
729 the privacy of individuals involved in such proceedings, and
730 proprietary information, including trade secrets. The commission
731 may meet in closed session only after a majority of the
732 commissioners vote to close a meeting to the public in whole or
733 in part. As soon as practicable, the commission must make public
734 a copy of the vote to close the meeting which reveals the vote
735 of each commissioner with no proxy votes allowed;
736 4. Establishing the titles, duties and authority, and
737 reasonable procedures for the election of the officers of the
738 commission;
739 5. Providing reasonable standards and procedures for the
740 establishment of the personnel policies and programs of the
741 commission. Notwithstanding any civil service or other similar
742 law of any compact state, the bylaws shall exclusively govern
743 the personnel policies and programs of the commission;
744 6. Promulgating a code of ethics to address permissible
745 and prohibited activities of commission members and employees;
746 and
747 7. Providing a mechanism for concluding the operations of
748 the commission and the equitable disposition of any surplus
749 funds that may exist after the termination of the compact after
750 the payment or reserving of all of its debts and obligations.
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751 (b) The commission shall publish its bylaws in a
752 convenient form and file a copy thereof, and a copy of any
753 amendment thereto, with the appropriate agency or officer in
754 each of the compact states.
755 (c) The commission shall maintain its financial records in
756 accordance with the bylaws.
757 (d) The commission shall meet and take such actions as are
758 consistent with the provisions of this compact and the bylaws.
759 (4) POWERS.—The commission has the power to:
760 (a) Promulgate uniform rules to facilitate and coordinate
761 implementation and administration of this compact. The rules
762 shall have the force and effect of law and shall be binding in
763 all compact states;
764 (b) Bring and prosecute legal proceedings or actions in
765 the name of the commission, provided that the standing of any
766 state psychology regulatory authority or other regulatory body
767 responsible for psychology licensure to sue or be sued under
768 applicable law is not affected;
769 (c) Purchase and maintain insurance and bonds;
770 (d) Borrow, accept, or contract for services of personnel,
771 including, but not limited to, employees of a compact state;
772 (e) Hire employees, elect or appoint officers, fix
773 compensation, define duties, grant such individuals appropriate
774 authority to carry out the purposes of the compact, and
775 establish the commission's personnel policies and programs
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776 relating to conflicts of interest, qualifications of personnel,
777 and other related personnel matters;
778 (f) Accept any and all appropriate donations and grants of
779 money, equipment, supplies, materials and services, and to
780 receive, utilize and dispose of the same; provided that at all
781 times the commission shall strive to avoid any appe arance of
782 impropriety or conflict of interest;
783 (g) Lease, purchase, accept appropriate gifts or donations
784 of, or otherwise to own, hold, improve, or use, any property,
785 real, personal, or mixed; provided that at all times the
786 commission shall strive to avoid any appearance of impropriety
787 or conflict of interest;
788 (h) Sell, convey, mortgage, pledge, lease, exchange,
789 abandon, or otherwise dispose of any property, real, personal,
790 or mixed;
791 (i) Establish a budget and make expenditures;
792 (j) Borrow money;
793 (k) Appoint committees, including advisory committees
794 consisting of commission members, state regulators, state
795 legislators or their representatives, and consumer
796 representatives, and such other interested persons as may be
797 designated in this compact and the bylaws;
798 (l) Provide and receive information from, and to cooperate
799 with, law enforcement agencies;
800 (m) Adopt and use an official seal; and
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801 (n) Perform such other functions as may be necessary or
802 appropriate to achieve the purposes of this compact consistent
803 with the state regulation of psychology licensure, temporary in -
804 person, face-to-face practice, and telepsychology practice.
805 (5) EXECUTIVE BOARD.—
806 (a) The executive board shall have the power to act on
807 behalf of the commission according to the terms of this compact,
808 and shall consist of the following six members:
809 1. Five voting members who are elected from the current
810 membership of the commission by the commission; and
811 2. One ex-officio, nonvoting member from the Association
812 of State and Provincial Psychology Boards.
813 (b) The ex-officio member must have served as staff for or
814 a member of a state psychology regulatory authority and shall be
815 selected by its respective organization.
816 (c) The commission may remove any member of the executive
817 board as provided in its bylaws.
818 (d) The executive board shall meet at least annually.
819 (e) The executive board shall have the following duties
820 and responsibilities:
821 1. Recommend to the entire commission changes to the rules
822 or bylaws, this compact legislation, or fees paid by compact
823 states, such as annual dues, and other applicable fees;
824 2. Ensure compact administration services are
825 appropriately provided, contractual or otherwise;
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826 3. Prepare and recommend the budget;
827 4. Maintain financial records on behalf of the commission;
828 5. Monitor compact compliance of member states and provide
829 compliance reports to the commission;
830 6. Establish additional committees as necessary; and
831 7. Other duties as provided in rules or bylaws.
832 (6) FINANCING.—
833 (a) The commission shall pay, or provide for the payment
834 of, the reasonable expenses of its establishment, organization,
835 and ongoing activities.
836 (b) The commission may accept any and all appropriate
837 revenue sources, donations, and grants of money, equipment,
838 supplies, materials, and services.
839 (c) The commission may levy and collect an annual
840 assessment from each compact state or impose fees on other
841 parties to cover the cost of the operations and activities of
842 the commission and its staff which must be in a total amount
843 sufficient to cover its annual budget as approved each year for
844 which revenue is not provided by other sources. The aggregate
845 annual assessment amount shall be allocated based upon a formula
846 to be determined by the commission, which shall promulgate a
847 rule binding upon all compact states.
848 (d) The commission may not incur obligations of any kind
849 before securing the funds adequate to meet the same; nor shall
850 the commission pledge the credit of any of the compact states,
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851 except by and with the authority of the compact state.
852 (e) The commission shall keep accurate accounts of all
853 receipts and disbursements. The receipts and disbursements of
854 the commission shall be subject to the audit and accounting
855 procedures established under its bylaws. However, all receipts
856 and disbursements of funds handled by the commission shall be
857 audited yearly by a certified or licensed public accountant and
858 the report of the audit shall be included in and become part of
859 the annual report of the commission.
860 (7) QUALIFIED IMMUNITY, DEFENSE, AND INDEMNIFICATION.—
861 (a) The members, officers, executive director, employees,
862 and representatives of the commission shall be immune from suit
863 and liability, either personally or in their official capacity,
864 for any claim for damage to or loss of property or personal
865 injury or other civil liability caused by or arising out of any
866 actual or alleged act, error, or omission that occurred, or that
867 the person against whom the claim is made had a reasonable basis
868 for believing occurred, within the scope of commission
869 employment, duties, or responsibilities; provided that nothing
870 in this paragraph shall be construed to protect any such person
871 from suit or liability for any damage, loss, injury, or
872 liability caused by the intentional or willful or wanton
873 misconduct of that person.
874 (b) The commission shall defend any member, officer,
875 executive director, employee, or representative of the
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876 commission in any civil action seeking to impose liability
877 arising out of any actual or alleged act, error, or omission
878 that occurred within the scope of commission employment, duties,
879 or responsibilities, or that the person against whom the claim
880 is made had a reasonable basis for believing occurred within the
881 scope of commission employment, duties, or responsibilities;
882 provided that nothing herein may be construed to prohibit that
883 person from retaining his or her own counsel; and provided
884 further, that the actual or alleged act, error, or omission did
885 not result from that person's intentional or willful or wanton
886 misconduct.
887 (c) The commission shall indemnify and hold harmless any
888 member, officer, executive director, employee, or representative
889 of the commission for the amount of any settlement or judgment
890 obtained against that person arising out of any actual or
891 alleged act, error, or omission that occurred within the scope
892 of commission employment, duties, or responsibilities, or that
893 such person had a reasonable basis for believing occurred within
894 the scope of commission employment, duties, or responsibilities;
895 provided that the actual or alleged act, error, or omission did
896 not result from the intentional or willful or wanton misconduct
897 of that person.
898
899 ARTICLE XI
900 RULEMAKING
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901 (1) The commission shall exercise its rulemaking powers
902 pursuant to the criteria set forth in this article and the rules
903 adopted thereunder. Rules and amendments become binding as of
904 the date specified in each rule or amendment.
905 (2) If a majority of the legislatures of the compact
906 states reject a rule by enactment of a statute or resolution in
907 the same manner used to adopt the compact, such rule shall have
908 no further force and effect in any compact state.
909 (3) Rules or amendments to the rules shall be adopted at a
910 regular or special meeting of the commission.
911 (4) Before promulgation and adoption of a final rule or
912 rules by the commission, and at least 60 days in advance of the
913 meeting at which the rule will be considered and voted upon, the
914 commission shall file a notice of proposed rulemaking:
915 (a) On the website of the commission; and
916 (b) On the website of each compact state's psychology
917 regulatory authority or the publication in which each state
918 would otherwise publish proposed rules.
919 (5) The notice of proposed rulemaking shall include:
920 (a) The proposed time, date, and location of the meeting
921 in which the rule will be considered and voted upon;
922 (b) The text of the proposed rule or amendment and the
923 reason for the proposed rule;
924 (c) A request for comments on the proposed rule from any
925 interested person; and
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926 (d) The manner in which interested persons may submit
927 notice to the commission of their intention to attend the public
928 hearing and any written comments.
929 (6) Before adoption of a proposed rule, the commission
930 shall allow persons to submit written data, facts, opinions, and
931 arguments, which shall be made available to the public.
932 (7) The commission shall grant an opportunity for a public
933 hearing before it adopts a rule or amendment if a hearing is
934 requested by:
935 (a) At least 25 individuals who submit comments
936 independently of each other;
937 (b) A governmental subdivision or agency; or
938 (c) A duly appointed person in an association that has at
939 least 25 members.
940 (8) If a hearing is held on the proposed rule or
941 amendment, the commission shall publish the place, time, and
942 date of the scheduled public hearing.
943 (a) All individuals wishing to be heard at the hearing
944 shall notify the executive director of the commission or other
945 designated member in writing of their desire to appear and
946 testify at the hearing at least 5 business days before the
947 scheduled date of the hearing.
948 (b) Hearings shall be conducted in a manner providing each
949 person who wishes to comment a fair and reasonable opportunity
950 to comment orally or in writing.
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951 (c) A transcript of the hearing is not required, unless a
952 written request for a transcript is made, in which case the
953 person requesting the transcript shall bear the cost of
954 producing the transcript. A recording may be made in lieu of a
955 transcript under the same terms and conditions as a t ranscript.
956 This subsection does not preclude the commission from making a
957 transcript or recording of the hearing if it so chooses.
958 (d) Nothing in this section shall be construed as
959 requiring a separate hearing on each rule. Rules may be grouped
960 for the convenience of the commission at hearings required by
961 this section.
962 (9) If a written notice of intent to attend the public
963 hearing by interested parties is not received, the commission
964 may proceed with promulgation of the proposed rule without a
965 public hearing.
966 (10) Following the scheduled hearing date, or by the close
967 of business on the scheduled hearing date if the hearing was not
968 held, the commission shall consider all written and oral
969 comments received.
970 (11) The commission shall, by majority vote of all
971 members, take final action on the proposed rule and shall
972 determine the effective date of the rule based on the rulemaking
973 record and the full text of the rule.
974 (12) Upon determination that an emergency exists, the
975 commission may consider and adopt an emergency rule without
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976 prior notice, opportunity for comment, or hearing, provided that
977 the usual rulemaking procedures provided in the compact and in
978 this section shall be retroactively applied to the rule as soon
979 as reasonably possible, but no later than 90 days after the
980 effective date of the rule. For the purposes of this subsection,
981 an emergency rule is one that must be adopted immediately in
982 order to:
983 (a) Meet an imminent threat to public health, safety, or
984 welfare;
985 (b) Prevent a loss of commission or compact state funds;
986 (c) Meet a deadline for the promulgation of an
987 administrative rule that is established by federal law or rule;
988 or
989 (d) Protect public health and safety.
990 (13) The commission or an authorized committee of the
991 commission may direct revisions to a previously adopted rule or
992 amendment for purposes of correcting typographical errors,
993 errors in format, errors in consistency, or grammatical errors.
994 Public notice of any revisions shall be posted on the website of
995 the commission. The revision shall be subject to challenge by
996 any person for a period of 30 days after posting. The revision
997 may be challenged only on grounds that the revision results in a
998 material change to a rule. A challenge shall be made in writing
999 and delivered to the chair of the commission before the end of
1000 the notice period. If a challenge is not made, the revision will
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1001 take effect without further action. If the revision is
1002 challenged, the revision may not take effect without the
1003 approval of the commission.
1004
1005 ARTICLE XII
1006 OVERSIGHT; DEFAULT, TECHNICAL ASSISTANCE, AND TERMINATION;
1007 DISPUTE RESOLUTION; AND ENFORCEMENT
1008 (1) OVERSIGHT.—
1009 (a) The executive, legislative, and judicial branches of
1010 state government in each compact state shall enforce this
1011 compact and take all actions necessary and appropriate to
1012 effectuate the compact's purposes and intent. The provisions of
1013 this compact and the rules promulgated hereunder shall have
1014 standing as statutory law.
1015 (b) All courts shall take judicial notice of the compact
1016 and the rules in any judicial or administrative proceeding in a
1017 compact state pertaining to the subject matter of this compact
1018 which may affect the powers, responsibilities, or actions of the
1019 commission.
1020 (c) The commission shall be entitled to receive service of
1021 process in any such proceeding, and shall have standing to
1022 intervene in such a proceeding for all purposes. Failure to
1023 provide service of process to the commission shall render a
1024 judgment or order void as to the commission, this compact, or
1025 promulgated rules.
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1026 (2) DEFAULT, TECHNICAL ASSISTANCE, AND TERMINATION.—
1027 (a) If the commission determines that a compact state has
1028 defaulted in the performance of its obligations or
1029 responsibilities under this compact or the promulgated rules,
1030 the commission shall:
1031 1. Provide written notice to the defaulting state and
1032 other compact states of the nature of the default, the proposed
1033 means of remedying the default, and any other action to be taken
1034 by the commission; and
1035 2. Provide remedial training and specific technical
1036 assistance regarding the default.
1037 (b) If a state in default fails to remedy the default, the
1038 defaulting state may be terminated from the compact upon an
1039 affirmative vote of a majority of the compact states, and all
1040 rights, privileges, and benefits conferred by this compact shall
1041 be terminated on the effective date of termination. A remedy of
1042 the default does not relieve the offending state of obligations
1043 or liabilities incurred during the period of default.
1044 (c) Termination of membership in the compact shall be
1045 imposed only after all other means of securing compliance have
1046 been exhausted. The commission shall submit a notice of intent
1047 to suspend or terminate a defaulting compact state to the
1048 state's governor, the majority and minority leaders of the
1049 state's legislature, and each of the compact states.
1050 (d) A compact state that has been terminated is
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1051 responsible for all assessments, obligations, and liabilities
1052 incurred through the effective date of termination, including
1053 obligations that extend beyond the effective date of
1054 termination.
1055 (e) The commission may not bear any costs incurred by the
1056 state that is found to be in default or has been terminated from
1057 the compact, unless agreed upon in writing between the
1058 commission and the defaulting state.
1059 (f) The defaulting state may appeal the action of the
1060 commission by petitioning the United States District Court for
1061 the state of Georgia or the federal district where the compact
1062 has its principal offices. The prevailing party shall be awarded
1063 all costs of such litigation, including reasonable attorney
1064 fees.
1065 (3) DISPUTE RESOLUTION.—
1066 (a) Upon request by a compact state, the commission shall
1067 attempt to resolve disputes related to the compact which arise
1068 among compact states and between compact and noncompact states.
1069 (b) The commission shall promulgate a rule providing for
1070 both mediation and binding dispute resolution for disputes that
1071 arise before the commission.
1072 (4) ENFORCEMENT.—
1073 (a) The commission, in the reasonable exercise of its
1074 discretion, shall enforce the provisions and rules of this
1075 compact.
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1076 (b) By majority vote, the commission may initiate legal
1077 action in the United States District Court for the state of
1078 Georgia or the federal district where the compact has its
1079 principal offices against a compact state in default to enforce
1080 compliance with the provisions of the compact and its
1081 promulgated rules and bylaws. The relief sought may include both
1082 injunctive relief and damages. In the event judicial enforcement
1083 is necessary, the prevailing party shall be awarded all costs of
1084 such litigation, including reasonable attorney fees.
1085 (c) The remedies herein are not the exclusive remedies of
1086 the commission. The commission may pursue any other remedies
1087 available under federal or state law.
1088
1089 ARTICLE XIII
1090 DATE OF IMPLEMENTATION OF THE PSYCHOLOGY INTERJURISDICTIONAL
1091 COMPACT COMMISSION AND ASSOCIATED RULES; WITHDRAWAL, AND
1092 AMENDMENTS
1093 (1) The compact shall become effective on the date o n
1094 which the compact is enacted into law in the seventh compact
1095 state. The provisions that become effective at that time shall
1096 be limited to the powers granted to the commission relating to
1097 assembly and the promulgation of rules. Thereafter, the
1098 commission shall meet and exercise rulemaking powers necessary
1099 to the implementation and administration of the compact.
1100 (2) Any state that joins the compact subsequent to the
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1101 commission's initial adoption of the rules shall be subject to
1102 the rules as they exist on the date on which the compact becomes
1103 law in that state. Any rule that has been previously adopted by
1104 the commission shall have the full force and effect of law on
1105 the day the compact becomes law in that state.
1106 (3) Any compact state may withdraw from this compact by
1107 enacting a statute repealing the same.
1108 (a) A compact state's withdrawal does not take effect
1109 until 6 months after enactment of the repealing statute.
1110 (b) Withdrawal does not affect the continuing requirement
1111 of the withdrawing state's psychology regulatory authority to
1112 comply with the investigative and adverse action reporting
1113 requirements of this act before the effective date of
1114 withdrawal.
1115 (4) Nothing contained in this compact shall be construed
1116 to invalidate or prevent any psychology licensure agreement or
1117 other cooperative arrangement between a compact state and a
1118 noncompact state which does not conflict with the provisions of
1119 this compact.
1120 (5) This compact may be amended by the compact states. An
1121 amendment to this compact will not become effective and binding
1122 upon any compact state until it is enacted into the law of all
1123 compact states.
1124
1125 ARTICLE XIV
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1126 CONSTRUCTION AND SEVERABILITY
1127 This compact shall be liberally construed so as to
1128 effectuate the purposes thereof. If this compact shal l be held
1129 contrary to the constitution of any state member thereto, the
1130 compact shall remain in full force and effect as to the
1131 remaining compact states.
1132 Section 2. Subsection (10) of section 456.073, Florida
1133 Statutes, is amended to read:
1134 456.073 Disciplinary proceedings.—Disciplinary proceedings
1135 for each board shall be within the jurisdiction of the
1136 department.
1137 (10) The complaint and all information obtained pursuant
1138 to the investigation by the department are confidential and
1139 exempt from s. 119.07(1) until 10 days after probable cause has
1140 been found to exist by the probable cause panel or by the
1141 department, or until the regulated professional or subject of
1142 the investigation waives his or her privilege of
1143 confidentiality, whichever occurs first. The department shall
1144 report any significant investigation information relating to a
1145 nurse holding a multistate license to the coordinated licensure
1146 information system pursuant to s. 464.0095, and any significant
1147 investigatory information relating to a psychologist practicing
1148 under the Psychology Interjurisdictional Compact to the
1149 coordinated licensure information system pursuant to s.
1150 490.0075. Upon completion of the investigation and a
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1151 recommendation by the department to find probable cause, and
1152 pursuant to a written request by the subject or the subject's
1153 attorney, the department shall provide the subject an
1154 opportunity to inspect the investigative file or, at the
1155 subject's expense, forward to the subject a copy of the
1156 investigative file. Notwithstanding s. 456.057, the subject may
1157 inspect or receive a copy of any expert witness report or
1158 patient record connected with the investigation if the subject
1159 agrees in writing to maintain the confidentiality of any
1160 information received under this subsection until 10 day s after
1161 probable cause is found and to maintain the confidentiality of
1162 patient records pursuant to s. 456.057. The subject may file a
1163 written response to the information contained in the
1164 investigative file. Such response must be filed within 20 days
1165 of mailing by the department, unless an extension of time has
1166 been granted by the department. This subsection does not
1167 prohibit the department from providing such information to any
1168 law enforcement agency or to any other regulatory agency.
1169 Section 3. Subsection (5) of section 456.076, Florida
1170 Statutes, is amended to read:
1171 456.076 Impaired practitioner programs.—
1172 (5) A consultant shall enter into a participant contract
1173 with an impaired practitioner and shall establish the terms of
1174 monitoring and shall include the terms in a participant
1175 contract. In establishing the terms of monitoring, the
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1176 consultant may consider the recommendations of one or more
1177 approved evaluators, treatment programs, or treatment providers.
1178 A consultant may modify the terms of monitoring if the
1179 consultant concludes, through the course of monitoring, that
1180 extended, additional, or amended terms of monitoring are
1181 required for the protection of the health, safety, and welfare
1182 of the public. If the impaired practitioner is a psychologist
1183 practicing under the Psychology Interjurisdictional Compact
1184 pursuant to s. 490.0075, the terms of the monitoring contract
1185 must include the impaired practitioner's withdrawal from all
1186 practice under the compact.
1187 Section 4. Subsection (7) is added to section 490.004,
1188 Florida Statutes, to read:
1189 490.004 Board of Psychology.—
1190 (7) The board shall appoint an individual to serve as the
1191 state's commissioner on the Psychology Interjurisdictional
1192 Compact Commission, as required under s. 490.0075.
1193 Section 5. Subsection (4) is added to section 490.005,
1194 Florida Statutes, to read:
1195 490.005 Licensure by examination.—
1196 (4) A person licensed as a psychologist in another state
1197 who is practicing pursuant to the Psychology Interjurisdictional
1198 Compact under s. 490.0075, and only within the scope provided
1199 therein, is exempt from the licensure requirements of this
1200 section.
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1201 Section 6. Subsection (4) is added to section 490.006,
1202 Florida Statutes, to read:
1203 490.006 Licensure by endorsement.—
1204 (4) A person licensed as a psychologist in another state
1205 who is practicing pursuant to the Psychology Interjurisdictional
1206 Compact under s. 490.0075, and only within the scope provided
1207 therein, is exempt from the licensure requirements of this
1208 section.
1209 Section 7. Section 490.009, Florida Statutes, is amended
1210 to read:
1211 490.009 Discipline.—
1212 (1) The following acts constitute grounds for denial of a
1213 license or disciplinary action, as specified in s. 456.072(2) or
1214 s. 490.0075:
1215 (a) Attempting to obtain, obtaining, or renewing a lic ense
1216 under this chapter by bribery or fraudulent misrepresentation or
1217 through an error of the board or department.
1218 (b) Having a license to practice a comparable profession
1219 revoked, suspended, or otherwise acted against, including the
1220 denial of certification or licensure by another state,
1221 territory, or country.
1222 (c) Being convicted or found guilty, regardless of
1223 adjudication, of a crime in any jurisdiction which directly
1224 relates to the practice of his or her profession or the ability
1225 to practice his or her profession. A plea of nolo contendere
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1226 creates a rebuttable presumption of guilt of the underlying
1227 criminal charges. However, the board shall allow the person who
1228 is the subject of the disciplinary proceeding to present any
1229 evidence relevant to the underlying charges and circumstances
1230 surrounding the plea.
1231 (d) False, deceptive, or misleading advertising or
1232 obtaining a fee or other thing of value on the representation
1233 that beneficial results from any treatment will be guaranteed.
1234 (e) Advertising, practicing, or attempting to practice
1235 under a name other than one's own.
1236 (f) Maintaining a professional association with any person
1237 who the applicant or licensee knows, or has reason to believe,
1238 is in violation of this chapter or of a rule of the department
1239 or, in the case of psychologists, of the department or the
1240 board.
1241 (g) Knowingly aiding, assisting, procuring, or advising
1242 any nonlicensed person to hold himself or herself out as
1243 licensed under this chapter.
1244 (h) Failing to perform any statutory or legal obligation
1245 placed upon a person licensed under this chapter.
1246 (i) Willfully making or filing a false report or record;
1247 failing to file a report or record required by state or federal
1248 law; willfully impeding or obstructing the filing of a report or
1249 record; or inducing another person to make or file a false
1250 report or record or to impede or obstruct the filing of a report
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1251 or record. Such report or record includes only a report or
1252 record which requires the signature of a person licensed under
1253 this chapter.
1254 (j) Paying a kickback, rebate, bonus, or other
1255 remuneration for receiving a patient or client, or receiving a
1256 kickback, rebate, bonus, or other remuneration for referring a
1257 patient or client to another provider of mental health care
1258 services or to a provider of health care services or goods;
1259 referring a patient or client to oneself for services on a fee-
1260 paid basis when those services are already being paid for by
1261 some other public or private entity; or entering into a
1262 reciprocal referral agreement.
1263 (k) Committing any act upon a patient or client which
1264 would constitute sexual battery or which would constitute sexual
1265 misconduct as defined in s. 490.0111.
1266 (l) Making misleading, deceptive, untrue, or fraudulent
1267 representations in the practice of any profession licensed under
1268 this chapter.
1269 (m) Soliciting patients or clients personally, or through
1270 an agent, through the use of fraud, intimidation, undue
1271 influence, or a form of overreaching or vexatious conduct.
1272 (n) Failing to make available to a patient or client, upon
1273 written request, copies of test results, reports, or documents
1274 in the possession or under the control of the licensee which
1275 have been prepared for and paid for by the patient or client.
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1276 (o) Failing to respond within 30 days to a written
1277 communication from the department concerning any investigation
1278 by the department or to make available any relevant records with
1279 respect to any investigation about the licensee's conduct or
1280 background.
1281 (p) Being unable to practice the profession for which he
1282 or she is licensed under this chapter with reasonable skill or
1283 competence as a result of any mental or physical condition or by
1284 reason of illness; drunkenness; or excessive use of drugs,
1285 narcotics, chemicals, or any other substance. In enforcing this
1286 paragraph, upon a finding by the State Surgeon General, the
1287 State Surgeon General's designee, or the board that probable
1288 cause exists to believe that the licensee is unable to practice
1289 the profession because of the reasons stated in this paragraph,
1290 the department shall have the authority to compel a licensee to
1291 submit to a mental or physical examination by psychologists or
1292 physicians designated by the department or board. If the
1293 licensee refuses to comply with the department's order, the
1294 department may file a petition for enforcement in the circuit
1295 court of the circuit in which the licensee resides or does
1296 business. The licensee may shall not be named or identified by
1297 initials in the petition or in any other public court records or
1298 documents, and the enforcement proceedings shall be closed to
1299 the public. The department shall be entitled to the summary
1300 procedure provided in s. 51.011. A licensee affected under this
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1301 paragraph shall be afforded an opportunity at reasonable
1302 intervals to demonstrate that he or she can resume the competent
1303 practice for which he or she is licensed with reasonable skill
1304 and safety to patients.
1305 (q) Performing any treatment or prescribing any therapy
1306 which, by the prevailing standards of the mental health
1307 professions in the community, would constitute experimentation
1308 on human subjects, without first obtaining full, informed, and
1309 written consent.
1310 (r) Failing to meet the minimum standards of performance
1311 in professional activities when measured against generally
1312 prevailing peer performance, including the undertaking of
1313 activities for which the licensee is not qualified by training
1314 or experience.
1315 (s) Delegating professional responsibilities to a person
1316 whom the licensee knows or has reason to know is not qualified
1317 by training or experience to perform such responsibilities.
1318 (t) Violating a rule relating to the regulation of the
1319 profession or a lawful order of the department previously
1320 entered in a disciplinary hearing.
1321 (u) Failing to maintain in confidence a communication made
1322 by a patient or client in the context of such services, except
1323 as provided in s. 490.0147.
1324 (v) Making public statements which are derived from test
1325 data, client contacts, or behavioral research and which identify
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1326 or damage research subjects or clients.
1327 (w) Violating any provision of this chapter or chapter
1328 456, or any rules adopted pursuant thereto.
1329 (2)(a) The department, or in the case of psychologists,
1330 the board, may enter an order denying licensure or imposing any
1331 of the penalties in s. 456.072(2) against any applicant for
1332 licensure or licensee who is found guilty of violating any
1333 provision of subsection (1) of this section or who is fo und
1334 guilty of violating any provision of s. 456.072(1).
1335 (b) The board may take adverse action against a
1336 psychologist's authority to practice interjurisdictional
1337 telepsychology or his or her temporary authorization to practice
1338 under the Psychology Interjurisdictional Compact pursuant to s.
1339 490.0075, and may impose any of the penalties in s. 456.072(2)
1340 if a psychologist commits an act specified in subsection (1) or
1341 s. 456.072(1).
1342 Section 8. Paragraph (h) is added to subsection (10) of
1343 section 768.28, Florida Statutes, to read:
1344 768.28 Waiver of sovereign immunity in tort actions;
1345 recovery limits; civil liability for damages caused during a
1346 riot; limitation on attorney fees; statute of limitations;
1347 exclusions; indemnification; risk management programs.—
1348 (10)
1349 (h) For purposes of this section, the individual appointed
1350 under s. 490.004(7) as the state's commissioner on the
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1351 Psychology Interjurisdictional Compact Commission, when serving
1352 in that capacity pursuant to s. 490.0075, and any administrator,
1353 officer, executive director, employee, or representative of the
1354 Psychology Interjurisdictional Compact Commission, when acting
1355 within the scope of his or her employment, duties, or
1356 responsibilities in this state, is considered an agent of the
1357 state. The commission shall pay any claims or judgments pursuant
1358 to this section and may maintain insurance coverage to pay any
1359 such claims or judgments.
1360 Section 9. This act shall take effect July 1, 2022.
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HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 955 Pub. Rec. and Meetings/Psychology Interjurisdictional Compact
SPONSOR(S): Hunschofsky
TIED BILLS: HB 953 IDEN./SIM. BILLS: SB 1372
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Morris McElroy
2) Government Operations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
HB 953 authorizes Florida to enter into the Psychology Interjurisdictional Compact (PSYPACT or compact) enacting its
provisions into the laws of the state. PSYPACT is an interstate compact that facilitates the practice of psychology using
telepsychology and in-person, face-to-face psychological practice to patients in other states. The compact requires states
to submit psychologist licensure and regulation records, including any actions taken against the ability to practice, to a
coordinated licensure information system (coordinated database). The compact also requires a commission to be formed
to oversee the implementation and administration of the compact and the coordinated database.
This bill, which is linked to the passage of HB 953, creates public records and public meetings exemptions for certain
records and meetings relating to PSYPACT.
The bill also creates a public meeting exemption for commission meetings, if the commission must discuss:
• Noncompliance of a party state with its obligations under the compact;
• The employment, compensation, discipline, or other personnel matters, practices, or procedures related
to specific employees or other matters related to the commission’s internal personnel practices and
procedure;
• Current, threatened, or reasonably anticipated litigation;
• Contract negotiations for the purchase or sale of goods, services, or real estate;
• Accusing a person of a crime or formally censuring a person;
• Disclosure of trade secrets or commercial or financial information that is privileged or confidential;
• Disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted
invasion of personal privacy if disclosed to the public;
• Disclosure of active investigatory records compiled for law enforcement purposes;
• Disclosure of information related to any reports prepared by or on behalf of the commission for the
purpose of investigation for compliance with the compact;
• Matters specifically exempted from disclosure by federal law or the laws of any party state; and
• Information made exempt pursuant to the rules or the bylaws of the commission, which would protect the
public’s interest, the privacy of individuals, and proprietary information.
The bill provides that the public record exemption is subject to the Open Government Sunset Review Act and will repeal
on October 2, 2027, unless reviewed and saved from repeal by the Legislature. It also provides a statement of public
necessity as required by the Florida Constitution.
The bill has an insignificant, negative fiscal impact on the Department of Health and no fiscal impact on local
governments.
The bill will become effective on the same date that HB 953 or similar legislation takes effect, if such legislation is adopted
in the same legislative session or an extension thereof and becomes law.
Article I, s. 24(c) of the Florida Constitution requires a two-thirds vote of the members present and voting for final
passage of a newly created or expanded public record or public meeting exemption. The bill creates a public
record exemption; thus, it requires a two-thirds vote for final passage.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0955.PPH
DATE: 1/24/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Public Records
Article I, s. 24(a) of the Florida Constitution sets forth the state’s public policy regarding access to
government records. This section guarantees every person a right to inspect or copy any public record
of the legislative, executive, and judicial branches of government. The Legislature, however, may
provide by general law for the exemption of records from the requirements of art. I, s. 24(a) of the
Florida Constitution. 1 The general law must state with specificity the public necessity justifying the
exemption 2 and must be no broader than necessary to accomplish its purpose. 3
Public policy regarding access to government records is addressed further in s. 119.07(1), F.S., which
guarantees every person a right to inspect and copy any state, county, or municipal record, unless the
record is exempt. Furthermore, the Open Government Sunset Review Act 4 provides that a public
record or public meeting exemption may be created or maintained only if it serves an identifiable public
purpose. In addition, it may be no broader than necessary to meet one of the following purposes: 5
• Allow the state or its political subdivisions to effectively and efficiently administer a
governmental program, which administration would be significantly impaired without the
exemption.
• Protect sensitive personal information that, if released, would be defamatory or would
jeopardize an individual’s safety; however, only the identity of an individual may be exempted
under this provision.
• Protect trade or business secrets.
The Open Government Sunset Review Act requires the automatic repeal of a newly created public
record exemption on October 2nd of the fifth year after creation or substantial amendment, unless the
Legislature reenacts the exemption. 6
Psychology Interjurisdictional Compact
HB 953 authorizes Florida to enter into the Psychological Interjurisdictional Compact (PSYPACT or
compact) by enacting its provisions into Florida law. PSYPACT was created by the Association of State
and Provincial Psychology Boards (ASPPB) and is an interstate compact that facilitates the practice of
telepsychology and temporary in-person, face-to-face practice of psychology across state boundaries. 7
The compact establishes the Psychology Interjurisdictional Compact Commission (Commission) which
is responsible for creating and finalizing bylaws, rules, and regulation. The Commission also grants
psychologists authority to practice telepsychology and temporary in-person, face-to-face psychology
across state lines. 8
1 Article I, s. 24(c), Fla. Const.
2 This portion of a public record exemption is commonly referred to as a “public necessity statement.”
3 Article I, s. 24(c), FLA. CONST.
4 Section 119.15, F.S.
5 Section 119.15(6)(b), F.S.
6 Section 119.15(3), F.S.
7 PSYPACT, About Us, https://psypact.site-ym.com/page/About (last visited Jan. 22, 2022).
8 Id.
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To practice telepsychology, in PSYPACT states, only psychologists licensed in PSYPACT states may
apply to the Commission for authority. Authorized psychologists must obtain an E.Passport 9 Certificate
from ASPPB to practice telepsychology. To conduct temporary in-person practice in PSYPACT states,
only psychologists licensed in PSYPACT states can apply to the Commission for an interjurisdictional
practice certificate for temporary authority to practice in a distant state. 10
Coordinated Licensure Information System
The compact requires all compact states to share licensee information. 11 Compact states must submit
a uniform dataset to a coordinated database on all psychologists to whom the compact is applicable.
The database allows for expedited sharing of information, which is not currently exempt from disclosure
requirements under s. 119.07(1), F.S. and s. 24(a), Art. 1 of the Florida Constitution, including: 12
• Identifying information;
• Licensure data;
• Significant investigatory information;
• Adverse actions against a psychologist’s license;
• Indicators that a psychologist’s authority to practice under the compact is revoked;
• Nonconfidential information related to participation in alternative programs;
• Any licensure application denials and reasons for such denial; and
• Other information, determined by Commission rule, which may facilitate the administration of
the compact.
The coordinated database information must be expunged according to laws of the reporting compact
state.13
Effect of the Bill
The bill creates public record and public meeting exemptions related to PSYPACT.
The bill creates a public records exemption for a psychologist’s personal identifying information, other
than his or her name, licensure status, or licensure number, obtained from the coordinated database
required under PSYPACT and held by DOH or the Board. The bill allows such information to be publicly
disclosed if the state which originally reported the information to the coordinated database authorizes
such disclosure by law. If disclosure is authorized, information may only be disclosed to the extent
authorized by law of the reporting state.
The bill also creates a public meeting exemption for commission meetings, if the commission must
discuss:
• Noncompliance of a party state with its obligations under the compact;
• The employment, compensation, discipline, or other personnel matters, practices, or procedures
related to specific employees or other matters related to the commission’s internal personnel
practices and procedure;
• Current, threatened, or reasonably anticipated litigation;
• Contract negotiations for the purchase or sale of goods, services, or real estate;
• Accusing a person of a crime or formally censuring a person;
9 Under the compact, an E.Passport is a certificate issued by the Association for State and Provincial Psychology Boards that promotes
the standardization in the criteria of interjurisdictional telepsychology practice and facilitates the process for licensed psychologists to
provide telepsychological services across state lines.
10 Supra, note 7. A distant state is a compact state where a psychologist is physically present to provide temporary in-person, face-to-
face psychological services.
11 Psychology Interjurisdictional Compact (PSYPACT), https://cdn.ymaws.com/psypact.site-
ym.com/resource/resmgr/psychology_interjurisdiction.pdf (last visited Jan. 22, 2022).
12 Id.
13 Id.
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• Disclosure of trade secrets or commercial or financial information that is privileged or
confidential;
• Disclosure of information of a personal nature where disclosure would constitute a clearly
unwarranted invasion of personal privacy if disclosed to the public;
• Disclosure of active investigatory records compiled for law enforcement purposes;
• Disclosure of information related to any reports prepared by or on behalf of the commission for
the purpose of investigation for compliance with the compact; and
• Matters specifically exempted from disclosure by federal law or the laws of any party state.
Recordings, minutes, and records generated during an exempt portion of a Commission meeting are
also exempt from public disclosure.
The bill provides a public necessity statement for the public records exemption, as required by the State
Constitution, and states that the protection of such information is required under the compact, which the
state must adopt in order to become a party state to the compact. Without the public records
exemption, the state would be unable to effectively and efficiently implement and administer the
compact.
Additionally, the bill provides a statement of public necessity for the public meeting exemption, as
required by the State Constitution, and states that PSYPACT requires any meeting in which certain
matters are discussed and matters that are exempt from disclosure by federal or state statute are
discussed to be closed to the public. Without the public meeting exemption, the state will be prohibited
from becoming a party to the compact and would be unable to effectively and efficiently administer the
compact. The bill further provides that without the public records exemption for the recordings, minutes,
and records generated during an exempt meeting, the release of such information would negate the
public meeting exemption.
The bill provides for repeal of the public record exemption on October 2, 2027, unless reviewed and
saved from repeal through reenactment by the Legislature.
The effective date of this bill is the same date that HB 953 or similar legislation takes effect, if such
legislation is adopted in the same legislative session or an extension thereof becomes law.
B. SECTION DIRECTORY:
Section 1: Creates s. 490.0076, F.S., relating to Psychology Interjurisdictional Compact; public
records and meeting exemptions.
Section 2: Provides a public necessity statement.
Section 3: Provides that the bill is effective on the same date that HB 953 (2022) or similar
legislation takes effect.
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.
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2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to affect county or municipal governments.
2. Other:
Vote Requirement
Article I, s. 24(c) of the Florida Constitution requires a two-thirds vote of the members present and
voting for final passage of a newly created or expanded public record or public meeting exemption.
The bill creates a public record exemption; thus, it requires a two-thirds vote for final passage.
Public Necessity Statement
Article I, s. 24(c) of the Florida Constitution requires a public necessity statement for a newly created
or expanded public record or public meeting exemption. The bill creates a public record exemption;
thus, it includes a public necessity statement.
Breadth of Exemption
Article I, s. 24(c) of the State Constitution provides that an exemption must be created by general law
and the law must contain only exemptions from public record or public meeting requirements. The
exemption does not appear to be in conflict with the constitutional requirement.
B. RULE-MAKING AUTHORITY:
The bill does not appear to create a need for rule-making or rule-making authority.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 955 2022
1 A bill to be entitled
2 An act relating to public records and meetings;
3 creating s. 490.0076, F.S.; providing an exemption
4 from public records requirements for certain
5 information held by the Department of Health or the
6 Board of Psychology pursuant to the Psychology
7 Interjurisdictional Compact; authorizing disclosure of
8 the information under certain circumstances; providing
9 an exemption from public meeting requirements for
10 certain meetings of the Psychology Interjurisdictional
11 Compact Commission; providing an exemption from public
12 records requirements for recordings, minutes, and
13 records generated during the closed portion of such
14 meetings; providing for future legislative review and
15 repeal of the exemptions; providing a statement of
16 public necessity; providing a contingent effective
17 date.
18
19 Be It Enacted by the Legislature of the State of Florida:
20
21 Section 1. Section 490.0076, Florida Statutes, is created
22 to read:
23 490.0076 Psychology Interjurisdictional Compact; public
24 records and meetings exemptions.—
25 (1) A psychologist's personal identifying information,
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HB 955 2022
26 other than the psychologist's name, licensure status, or
27 licensure number, obtained from the coordinated licensure
28 information system, as described in article IX of s. 490.0075,
29 and held by the department or the Board of Psychology is exempt
30 from s. 119.07(1) and s. 24(a), Art. I of the State Constitution
31 unless the state that originally reported the information to the
32 coordinated information system authorizes the disclosure of such
33 information by law. If disclosure is so authorized, information
34 may be disclosed only to the extent authorized by law by the
35 reporting state.
36 (2)(a) A meeting or a portion of a meeting of the
37 Psychology Interjurisdictional Compact Commission, established
38 in article X of s. 490.0075, is exempt from s. 286.011 and s.
39 24(b), Art. I of the State Constitution if the commission must
40 discuss:
41 1. Noncompliance of a compact state with its obligations
42 under the compact;
43 2. Employment, compensation, or discipline of, or other
44 personnel matters, practices, or procedures related to, specific
45 employees, or other matters related to the commission's internal
46 personnel practices and procedures;
47 3. Current, threatened, or reasonably anticipated
48 litigation against the commission;
49 4. Negotiation of contracts for the purchase or sale of
50 goods, services, or real estate;
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HB 955 2022
51 5. An accusation of any person of a crime or a formal
52 censure of any person;
53 6. Information disclosing trade secrets or commercial or
54 financial information that is privileged or confidential;
55 7. Information of a personal nature where disclosure would
56 constitute a clearly unwarranted invasion of personal privacy;
57 8. Investigatory records compiled for law enforcement
58 purposes;
59 9. Information related to any investigatory reports
60 prepared by or on behalf of or for the use of the commission or
61 other committee charged with responsibility for investigation or
62 determination of compliance issues pursuant to the compact; or
63 10. Matters specifically exempted from disclosure by
64 federal or state statute.
65 (b) In keeping with the intent of the Psychology
66 Interjurisdictional Compact, recordings, minutes, and records
67 generated during an exempt meeting or portion of such a meeting
68 are exempt from s. 119.07(1) and s. 24(a), Art. I of the State
69 Constitution.
70 (3) This section is subject to the Open Government Sunset
71 Review Act in accordance with s. 119.15 and shall stand repealed
72 on October 2, 2027, unless reviewed and saved from repeal
73 through reenactment by the Legislature.
74 Section 2. (1) The Legislature finds that it is a public
75 necessity that a psychologist's personal identifying
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HB 955 2022
76 information, other than the psychologist's name, licensure
77 status, or licensure number, obtained from the coordinated
78 licensure information system, as described in article IX of s.
79 490.0075, Florida Statutes, and held by the Department of Health
80 or the Board of Psychology, be made exempt from s. 119.07(1),
81 Florida Statutes, and s. 24(a), Article I of the State
82 Constitution. Protection of such information is required under
83 the Psychology Interjurisdictional Compact, which the state must
84 adopt in order to become a member state of the compact. Without
85 the public records exemption, this state will be unable to
86 effectively and efficiently implement and administer the
87 compact.
88 (2)(a) The Legislature finds that it is a public necessity
89 that any meeting of the Psychology Interjurisdictional Compact
90 Commission held as provided in s. 490.0075, Florida Statutes, in
91 which matters specifically exempted from disclosure by federal
92 or state law are discussed be made exempt from s. 286.011,
93 Florida Statutes, and s. 24(b), Article I of the State
94 Constitution.
95 (b) The Psychology Interjurisdictional Compact requires
96 the closure of any meeting, or any portion of a meeting, of the
97 Psychology Interjurisdictional Compact Commission if it is
98 discussing certain sensitive and confidential subject matters or
99 if a majority of the commission members vote to close a meeting
100 to the public in whole or in part. In the absence of a public
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101 meeting exemption, this state would be prohibited from becoming
102 a member state of the compact.
103 (3) The Legislature also finds that it is a public
104 necessity that the recordings, minutes, and records generated
105 during a meeting that is exempt pursuant to s. 490.0076(2),
106 Florida Statutes, be made exempt from s. 119.07(1), Florida
107 Statutes, and s. 24(a), Article I of the State Constitution.
108 Release of such information would negate the public meeting
109 exemption. As such, the Legislature finds that the public
110 records exemption is a public necessity.
111 Section 3. This act shall take effect on the same date
112 that HB 953 or similar legislation takes effect, if such
113 legislation is adopted in the same legislative session or an
114 extension thereof and becomes a law.
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 955 (2022)
Amendment No.1
COMMITTEE/SUBCOMMITTEE ACTION
ADOPTED (Y/N)
ADOPTED AS AMENDED (Y/N)
ADOPTED W/O OBJECTION (Y/N)
FAILED TO ADOPT (Y/N)
WITHDRAWN (Y/N)
OTHER
1 Committee/Subcommittee hearing bill: Professions & Public
2 Health Subcommittee
3 Representative Hunschofsky offered the following:
4
5 Amendment
6 Remove everything after the enacting clause and insert:
7 Section 1. Section 490.0076, Florida Statutes, is created
8 to read:
9 490.0076 Psychology Interjurisdictional Compact; public
10 records and meeting exemptions.—
11 (1) A psychologist's personal identifying information,
12 other than the psychologist's name, licensure status, or
13 licensure number, obtained from the coordinated licensure
14 information system, as described in article IX of s. 490.0075,
15 and held by the department or the Board of Psychology is exempt
16 from s. 119.07(1) and s. 24(a), Art. I of the State Constitution
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 955 (2022)
Amendment No.1
17 unless the state that originally reported the information to the
18 coordinated information system authorizes the disclosure of such
19 information by law. If disclosure is so authorized, information
20 may be disclosed only to the extent authorized by law by the
21 reporting state.
22 (2)(a) A meeting or a portion of a meeting of the
23 Psychology Interjurisdictional Compact Commission, established
24 in article X of s. 490.0075 at which matters specifically
25 exempted from disclosure by federal or state statute are
26 discussed is exempt from s. 286.011 and s. 24(b), Art. I of the
27 State Constitution.
28 (b) Recordings, minutes, and records generated during an
29 exempt meeting or portion of such a meeting are exempt from s.
30 119.07(1) and s. 24(a), Art. I of the State Constitution.
31 (3) This section is subject to the Open Government Sunset
32 Review Act in accordance with s. 119.15 and shall stand repealed
33 on October 2, 2027, unless reviewed and saved from repeal
34 through reenactment by the Legislature.
35 Section 2. (1) The Legislature finds that it is a public
36 necessity that a psychologist's personal identifying
37 information, other than the psychologist's name, licensure
38 status, or licensure number, obtained from the coordinated
39 licensure information system, as described in article IX of s.
40 490.0075, Florida Statutes, and held by the Department of Health
41 or the Board of Psychology, be made exempt from s. 119.07(1),
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 955 (2022)
Amendment No.1
42 Florida Statutes, and s. 24(a), Article I of the State
43 Constitution. Protection of such information is required under
44 the Psychology Interjurisdictional Compact, which the state must
45 adopt in order to become a member state of the compact. Without
46 the public records exemption, this state will be unable to
47 effectively and efficiently implement and administer the
48 compact.
49 (2)(a) The Legislature finds that it is a public necessity
50 that any meeting of the Psychology Interjurisdictional Compact
51 Commission held as provided in s. 490.0075, Florida Statutes, in
52 which matters specifically exempted from disclosure by federal
53 or state law are discussed be made exempt from s. 286.011,
54 Florida Statutes, and s. 24(b), Article I of the State
55 Constitution.
56 (b) The Psychology Interjurisdictional Compact requires
57 the closure of any meeting, or any portion of a meeting, of the
58 Psychology Interjurisdictional Compact Commission in which the
59 substance of paragraph (a) is discussed to be closed to the
60 public. In the absence of a public meeting exemption, this state
61 would be prohibited from becoming a member state of the compact.
62 Thus, this state will be unable to effectively and efficiently
63 administer the compact.
64 (3) The Legislature also finds that it is a public
65 necessity that the recordings, minutes, and records generated
66 during a meeting that is exempt pursuant to s. 490.0076(2),
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COMMITTEE/SUBCOMMITTEE AMENDMENT
Bill No. HB 955 (2022)
Amendment No.1
67 Florida Statutes, be made exempt from s. 119.07(1), Florida
68 Statutes, and s. 24(a), Article I of the State Constitution.
69 Release of such information would negate the public meeting
70 exemption. As such, the Legislature finds that the public
71 records exemption is a public necessity.
72 Section 3. This act shall take effect on the same date
73 that HB 953 or similar legislation takes effect if such
74 legislation is adopted in the same legislative session or an
75 extension thereof and becomes a law.
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