House of Representatives Staff Analysis — PCS for HB 693 Department of Health (1/24/2022)
- Issuer
- Congressional materials
- Document type
- 2022 3093 Professions Public Health Subcommittee Proposed Committee Bill Analyses Fn Pcs06
Summary
A Florida House of Representatives staff analysis of the PCS for HB 693, Department of Health, prepared for the Professions & Public Health Subcommittee and dated 1/24/2022. It describes a bill updating the Targeted Outreach for Pregnant Women Act program, requiring medical marijuana treatment centers to recall marijuana that fails safety and potency requirements, and authorizing DOH to test samples. For health care professions, the analysis lists changes to accreditation references, nursing license denial and discipline, midwifery requirements and licensing of marriage and family therapy graduates until July 1, 2026. It also covers proof of NICA assessment payments as a condition of physician licensure and DOH's role in staffing pediatric special needs shelters. The analysis reports an insignificant, negative fiscal impact on DOH and an effective date of July 1, 2022.
Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used
Cite this document
“House of Representatives Staff Analysis — PCS for HB 693 Department of Health (1/24/2022).”
Original at www.flhouse.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2022-3093-professions-public-health-subcommittee-proposed-committee-bill-analyses-fn-pcs0693-pph/
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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 (TOPW A) 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 docum ent 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, Datab ase of Accredited Postsecondary Institutions and Programs,
https://ope.ed.gov/dapip/#/home (last visited March 20, 2021).
7 U.S. Department of Education, Datab ase 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 (Feb ruary 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 s tate 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 trea tment, 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 li nks 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, Ab out 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, clinica l 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 thera pist 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, Ab out 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 – 202183
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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