The Florida Senate BILL ANALYSIS AND FISCAL IMPACT STATEMENT (This document is based on the provisions contained in the legislation as of the latest date listed below.) Prepared By: The Professional Staff of the Committee on Appropriations BILL: CS/CS/SB 466 INTRODUCER: Appropriations Committee; Health Policy Committee; and Senator Torres and others SUBJECT: Military Medics and Corpsmen of Florida Program DATE: March 2, 2022 ANALYST STAFF DIRECTOR REFERENCE ACTION 1. Rossitto-Van Winkle Brown HP Fav/CS 2. Brown Caldwell MS Favorable 3. Gerbrandt Sadberry AP Fav/CS Please see Section IX. for Additional Information: COMMITTEE SUBSTITUTE - Substantial Changes I. Summary: CS/CS/SB 466 creates the Military Corpsmen and Medics Program of Florida (MCMF program) within the Department of Health (DOH) to assist military-trained veterans and their spouses in identifying and applying for health care and health care-related employment and licensure, and identifying educational and training opportunities. The bill requires the DOH to establish the MCMF Program Office of Veterans Advocacy (MCMF office) to provide information, guidance, and assistance with the licensure application process or with expedited licensure to military trained health care veterans and their spouses. The MCMF office must refer veterans and their spouses to the Department of Economic Opportunity (DEO) for assistance in resume writing and proofreading, job application completion, and interviewing skills and techniques. The bill requires Florida is for Veterans Inc. (FIFVs), to establish, and maintain a statewide list of health care providers who agree to participate in the program and assist such providers in recruiting and hiring military-trained health care veterans and their spouses. The bill authorizes the Board of Governors (BOG) and the State Board of Education (SBE) to create a process that enables military-trained health care veterans to earn uniform postsecondary educational credit for college-level education and training acquired while in the military. REVISED: BILL: CS/CS/SB 466 Page 2 The bill requires State universities, Florida College System Institutions, career centers, training schools, and training programs to award postsecondary education credit and career education and academic and clinical clock hours for certain courses taken and training received during military service. The bill takes effect on July 1, 2022. II. Present Situation: The Department of Economic Opportunity The Department of Economic Opportunity (DEO) assists the Governor in advancing Florida’s economy by championing the state’s economic development vision and by administering state and federal programs and initiatives to help visitors, citizens, businesses, and communities. Jobs for Veterans' State Grant The DEO administers, the Jobs for Veterans’ State Grant program in coordination with 24 Local Workforce Development Boards to promote and maximize the employment of Florida’s veteran population. The Jobs for Veterans’ State Grant provides federal funding to support the staffing of Disabled Veterans’ Outreach Program Specialists, Local Veterans’ Employment Representatives, and Consolidated Positions throughout the CareerSource Florida Career Center Network. The Jobs for Veterans’ State Grant also supports the State Veterans’ Program Office which is comprised of the State Veterans Program Coordinator, Regional Veterans Program Coordinators, and Intensive Service Coordinators. The State Veterans’ Program Office ensures consistency and excellence in program service delivery through the provision of technical assistance, policy, training, and monitoring. Florida’s Jobs for Veterans’ State Grant program prepares veterans, transitioning service members, and eligible spouses for meaningful careers through the development of a proactive employment plan and through connection to a career center and community resources to obtain and maintain employment. The DEO Veterans’ Employment Services and Programs include, but are not limited to the following services: Intensive case management services to veterans with significant barriers to employment including: o On-the-job training development; o Non-paid work experience; o Selective job placement; o Counseling; o Follow-up services; o Job-seeking skills training; o Job analysis; and o Labor market information. Outreach to employers to increase employment opportunities for veterans; BILL: CS/CS/SB 466 Page 3 Priority enrollment and participation in all USDOL funded employment and training programs, including technology-assisted activities; and The VA Veteran Readiness and Employment (VR&E) Program is an employment and training program to assist disabled veterans who are being trained/retrained and rehabilitated for new careers by the U.S. Department of Veterans Affairs. VR&E services include on-the-job training development, non-paid work experience, selective job placement, case management, counseling, follow-up services, provision of job-seeking skills training, job analysis, labor market information, etc. The Military Family Employment Advocacy Program delivers employment assistance services, including interviewing, assessment, counseling, job search and placement assistance, labor market information, resume assistance, etc., through Military Family Employment Advocates co- located within selected career centers. Spouses and dependents of active-duty military personnel, Florida National Guard members, and military reservists are eligible for assistance through this program. The Employ Florida Vets portal is a function of the Employ Florida system and is tailored specifically to the needs and interests of veterans. One specific function is to translate Military Specialty Codes (represents military employment classification) into equivalent civilian job titles. Florida Is For Veterans, Inc. (FIFV) Section 295.21, F.S., created “Florida Is For Veterans, Inc.,” within the Florida Department of Veteran Affairs as a separate nonprofit corporation to help military veterans transition to civilian life or moving to Florida through career service initiatives. FIFV’s mission is to promote the value of military skill sets to businesses, assist in training veterans to match marketplace needs, and enhance entrepreneurial skills of veterans. All agencies of the state are authorized and directed to provide technical assistance to FIFV and identify agency programs to provide assistance or benefits to veterans who are located in or considering relocation to the state. The FDVA may authorize the FIFV to use of FDVA property, facilities, and personnel services, as prescribed by contract. 1 United States Armed Forces The U.S. Armed Forces (U.S.A.F.) is made up of six military branches: Air Force, Army, Coast Guard, Marine Corps, Navy and, most recently, Space Force. The secretary of the U.S. Department of Defense (DoD) has control over the military and each branch, except the Coast Guard, which is under the Department of Homeland Security (DHS). With more than two million civilian and military employees, the U.S. DoD is the world's largest employer. 2 1 Section 295.21(1), F.S. 2 Military.com, What Are the Branches of the US Military? available at https://www.military.com/join-armed-forces/us- military-branches-overview.html (last visited Feb. 3, 2022). BILL: CS/CS/SB 466 Page 4 Enlisted Members vs. Officers Joining the U.S. Armed Forces as an enlisted member or an officer has a significant impact on the type of experience and training a new recruit receives. All enlisted jobs require a high school diploma, although, with certain exceptions, a passing General Education Development (GED) test score is acceptable. While enlisted careers do include infantry roles, most jobs involve hands-on training for mechanical, transportation, human service, or office fields that transfer to the civilian world. Almost all officer positions require a four-year college degree or equivalent. Officers are the managers of the military, acting in leadership roles that require planning, directing operations, and making critical decisions. Officer positions also include careers that require advanced degrees, such as law and medicine. 3 Florida’s Department of Health (DOH) The Legislature created the DOH to protect and promote the health, safety, and welfare of all residents and visitors in the state. 4 The DOH is charged with the regulation of health practitioners for the preservation of the health, safety, and welfare of the public. The Division of Medical Quality Assurance (MQA) is responsible for the boards 5 and professions within the DOH. 6 Health Care Practitioner Regulation The DOH, Division of MQA, provides health care practitioner regulation and support to health care licensure boards and councils. Boards are responsible for approving or denying an applicant’s license based upon: Reviewing applicant qualifications specified in statute; Reviewing continuing education courses and practitioners; Promulgating administrative rules authorized by statute; Determining probable cause in cases resulting from complaints; and Disciplining practitioners found to be in violation of applicable laws. The Division of MQA licenses and regulates seven types of health care facilities and more than 200 license types in over 40 professions, while partnering with 22 boards and four councils. 7 Health Care Practitioner Scope of Practice The scope of practice for a regulated health care profession includes activities and procedures that a person with a specified level of education, training, and competency is authorized to perform under laws and rules of the state in which the person practices. Scope of practice can 3 Today’s Military, Enlisted and Officer Paths, available at https://www.todaysmilitary.com/ways-to-serve/enlisted-officer- paths (last visited Feb. 3, 2022). 4 Sections 20.43(1) and 456.003, F.S. 5 Under s. 456.001(1), F.S., “board” is defined as any board, commission, or other statutorily created entity, to the extent such entity is authorized to exercise regulatory or rulemaking functions within the DOH or, in some cases, within the MQA. 6 Section 20.43(3), F.S. 7 Department of Health, 2022 Agency Legislative Bill Analysis of CS/SB 466, pg. 2 (Feb. 3, 2022) (on file with the Senate Committee on Military and Veterans Affairs, Space, and Domestic Security). BILL: CS/CS/SB 466 Page 5 also incorporate conditions that may limit the exercise of authorized activities and procedures. 8 Licensed health care practitioners 9 in Florida may only perform that which is authorized by the scope of practice for their profession. Individuals who perform functions outside of their scope of practice are subject to discipline. Individuals who perform tasks that are specific to a scope of practice identified in statute without required licensure may be considered to be performing unlicensed activities in violation of law. 10 The Board of Medicine The Florida Board of Medicine (BOM) functions within the DOH/MQA, and is composed of 15 members appointed by the Governor and confirmed by the Senate. Twelve members of the BOM must be licensed physicians in good standing who are state residents and have been actively engaged in the practice or teaching of medicine for at least four years immediately preceding their appointment. Of the members, one must be a full-time faculty member of a Florida medical school; one must be in private practice; one must be a full-time staff member of a statutory teaching hospital; and at least one must be a graduate of a foreign medical school. The remaining three members are consumer members who are residents of the state and have never been licensed health care practitioners. One member must be a health care risk manager and at least one member must be 60 years of age or older. Practice of Medicine A physician is a person who is licensed to practice medicine in Florida. Practice of medicine includes the diagnosis, treatment, operation, or prescription for disease, pain, injury, deformity, or other physical or mental condition. 11 Allopathic standards of practice and standards of care for particular practice settings include, but are not limited to, education and training, equipment and supplies, medications including anesthetics, assistance of and delegation to other personnel, transfer agreements, sterilization, 8 Federation of State Medical Boards, Assessing Scope of Practice in Health Care Delivery: Critical Questions in Assuring Public Access and Safety (April 2005) available at https://www.fsmb.org/siteassets/advocacy/policies/assessing-scope-of- practice-in-health-care-delivery.pdf The Federation of State Medical Boards is an association whose members include all medical licensing and disciplinary boards in the U.S. and U.S. territories. The Federation acts as a collective voice for 70 member medical boards in promoting high standards for medical licensure and practice. The Guidelines recommend that State regulators and legislators review various factors when considering scope of practice initiatives in the interest of public health and patient safety. 9 Section 456.001, F.S., defines a “health care practitioner” to mean any person licensed under chapter 457 (acupuncture); chapter 458 (medical practice); chapter 459 (osteopathic medicine); chapter 460 (chiropractic medicine); chapter 461 (podiatric medicine); chapter 462 (naturopathy); chapter 463 (optometry); chapter 464 (nursing); chapter 465 (pharmacy); chapter 466 (dentistry, dental hygiene, and dental laboratories); chapter 467 (midwifery); part I, part II, part III, part V, part X, part XIII, or part XIV of chapter 468 (speech-language pathology, nursing home administration, occupational therapy, respiratory therapy, dietetics and nutrition practice, athletic trainers, orthotics, prosthetics, and pedorthics); chapter 478 (electrolysis); chapter 480 (massage therapy); part I, part II, or part III of chapter 483 (clinical laboratory personnel, medical physicists, genetic counseling); chapter 484 (dispensing of optical devices and hearing aids); chapter 486 (physical therapy practice); chapter 490 (psychological services); or chapter 491 (clinical, counseling, and psychotherapy). 10 Section 456.072, F.S. 11 Section 458.305(3), F.S. BILL: CS/CS/SB 466 Page 6 records, performance of complex or multiple procedures, informed consent, and policy and procedure manuals. 12 The Practice of Nursing The scope of practice of nursing varies based on the type of education, training, and nursing licensure held by the health care practitioner. Licensed Practical Nurse (LPN) An LPN may perform selected acts, including: The administration of treatments and medications; The promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist; and The teaching of general principles of health and wellness to the public and students other than nursing students. 13 Qualifications and training for licensure for an LPN, in accordance with s. 464.003, F.S., includes the following minimum education qualifications and exam requirements, with noted alternative methods to meet requirements: Graduation from a Florida approved, or accredited LPN nursing education program as defined in s. 464.003, F.S.; Graduation from an Accreditation Commission for Education in Nursing (ACEN) or Commission on Collegiate Nursing Education (CCNE) accredited LPN nursing program that has been issued a National Council Licensure Examination (NCLEX) code by the National Council of State Boards of Nursing (NCSBN); Graduation from an LPN nursing education program that is approved or recognized by the jurisdiction in which it is based and that has been issued an NCLEX code by the NCBSN; Graduation from a military nursing education program that has been issued an NCLEX code by NCSBN; Graduation from a non-NCSBN jurisdiction (e.g. Puerto Rico), or international nursing education program that the Board of Nursing (BON) determines to be equivalent to an approved program; or Successful completion of courses in a registered nursing education program that are equivalent to a practical nursing education program – Practical Nurse Examination based on practical nursing Equivalency (PNEQ). An LPN may also qualify for licensure in Florida by meeting endorsement qualifications (holding a valid license in another state and meeting other minimum qualifications) or by Nurse Licensure Compact. All nursing programs requesting Board of Nursing approval must conform to the state Department of Education curriculum framework. Required content of a practical nursing 12 Section 458.331(1)(v), F.S. 13 Section 464.003(18), F.S. BILL: CS/CS/SB 466 Page 7 program must cover medical, surgical, obstetrical, pediatric, geriatric, acute care in long term care and community settings; personal, family, and community health concepts; nutrition; human growth and development; body structure and function; interpersonal relationship skills; mental health concepts; pharmacology and medication administration; and legal aspects of nursing. Additionally, the curriculum must include at least 50% clinical training. 14 Certified Nursing Assistant (CNA) A CNA may provide care and assistance to persons with tasks related to activities of daily living. These tasks include personal care, maintaining mobility, nutrition and hydration, toileting and elimination, assistive devices, safety and cleanliness, data gathering, reporting abnormal signs and symptoms, postmortem care, patient socialization and reality orientation, end-of-life care, cardiopulmonary resuscitation and emergency care, residents’ or patients’ rights, and documentation of nursing-assistant services. Other tasks may be performed upon completion of training beyond the minimum qualifications for initial certification and upon validation of competence in that skill by an RN. 15 Qualifications and training for licensure for a CNA, in accordance with s. 464.203, F.S., include the following education qualifications and exam requirements, with noted alternative methods to meet requirements. Successfully complete an approved training program and a minimum score on the nursing assistant competency examination; Achieve a minimum score, established by rule of the board, on the nursing assistant competency examination, and have a high school diploma, or its equivalent; or is at least 18 years of age; Complete curriculum developed under the Enterprise Florida Jobs and Education Partnership Grant and a minimum score on the nursing assistant competency examination; or Qualify for licensure by endorsement if currently certified in another state or territory of the U.S. or District of Columbia and successfully complete criminal history and discipline history requirements. The CNA Examination must consist of a written exam and a clinical skills test. Both must be passed within a two-year period in order to achieve certification. General areas of competency of the written exam include: the role of the nursing assistant; promotion of safety; promotion of function and health of patients; and basic and specific nursing care for patients with changes in health. For the written exam, the BON accepts a minimum passing score of 76 percent. 16 The CNA clinical skills exam includes four test areas: personal care, promotion of function, health and safety; reporting and recording; and hand washing. If an applicant fails to pass the CNA competency examination three times, the applicant is not eligible for reexamination unless the applicant completes an approved training program. 17 14 Fla. Admin. Code. R. 64B9-2.021 (2021). 15 Section 464.201(5), F.S. 16 Fla. Admin. Code R. 64B9-15.008 (2021). 17 Id. BILL: CS/CS/SB 466 Page 8 Emergency Medical Services (EMS) The Legislature created ch. 401, F.S., in 1973 to establish a statewide organized and regulated system of regional EMS providers with two major objectives: To develop a statewide system of emergency medical telecommunications to maximize the use of existing radio channels to provide faster and more effective EMS to the general population; 18 and To protect and enhance public health, safety, and welfare with the establishment of a statewide EMS plan to: o Monitor the quality of patient care delivered by each licensed service; o Certify EMS personnel; o Create an EMS advisory council; o Develop a comprehensive statewide injury-prevention program; and o Develop minimum standards for EMS providers, personnel, vehicles, services, medical direction, and inspections. 19 The Legislature further created the Florida Emergency Medical Services Grant Act. 20 This law authorizes the DOH to make grants to local agencies, EMS organizations, and youth athletic organizations to provide EMS, including emergency medical dispatch, and work with local EMS organizations to expand the use of automated external defibrillator (AED) devices. 21 Emergency Medical Service Providers Entities that provide prehospital or interfacility advanced life support (ALS) services or basic life support (BLS) transportation services must be licensed as a BLS service or an ALS service, or both. 22 Emergency Medical Technician (EMT) An EMT is certified by the DOH to perform BLS techniques. 23 BLS techniques include treatment of medical emergencies by a certified EMT qualified in the use of techniques of patient assessment, CPR, splinting, obstetrical assistance, bandaging, administration of oxygen, application of medical anti-shock trousers, administration of a subcutaneous injection using an auto-injector of epinephrine for an anaphylactic reaction, and other techniques described in the U.S. DOT, EMT Basic Training Course Curriculum (EMT-BTCC). 24 Qualifications and training for an EMT, in accordance with s. 401.27, F.S., include the following minimum requirements: Out of state or military applicants trained in accordance with either the 1994 U.S. DOT EMT-Basic National Standard Curriculum or the January 2009 U.S. DOT National EMS 18 Section 401.013, F.S. 19 Section 401.211, F.S. 20 See ss. 401.101 and 401.104, F.S. 21 Section 401.111, F.S. 22 Section 401.25(1), F.S. 23 Section 401.23(11), F.S. 24 Section 401.23(7), F.S. BILL: CS/CS/SB 466 Page 9 Education Standards and who currently hold a valid EMT certification from the National Registry of Emergency Medical Technicians (NR-EMT); Completion of an emergency medical technician training course equivalent to the most recent emergency medical technician basic training course of the U.S. DOT, within one year after course completion have passed an examination for an emergency medical technician, and hold either a current American Heart Association cardiopulmonary resuscitation course card or an American Red Cross cardiopulmonary resuscitation course card or its equivalent. To be eligible for an EMT certification in Florida, an applicant must: Submit a completed application; Submit proof to the Certification Unit of meeting required professional education in one of the following ways: o Florida Trained – Successful completion of EMT course from a DOH approved program within two years of passing the examination; o Out-of-State Trained – Submit proof of current NR-EMT certification; o Florida Paramedic Certification. A Florida certified paramedic may use his or her paramedic certificate, provided it is current and in good standing, to satisfy professional education requirements for certification as an EMT; or o If the applicant was initially trained in Florida, received a Florida EMT certification, but did not maintain certification, the applicant may apply by Out of State Certification and submit a copy of either: An American Red Cross CPR for Professional Rescuer card; or An American Heart Association BLS for the Healthcare Provider. Paramedic A certified paramedic may perform both BLS and ALS. 25 ALS includes the assessment or treatment by a certified paramedic qualified in the use of techniques such as endotracheal intubation, the administration of drugs or intravenous fluids, telemetry, cardiac monitoring, cardiac defibrillation, and other techniques described in the EMT-Paramedic National Standard Curriculum or the National EMS Education Standards, pursuant to DOH administrative rules. 26 A member of the U.S. Armed Forces, on active duty, who at the time he or she became a member, was in good standing with the DOH, and certified to practice as an EMT or paramedic in Florida remains in good standing without registering, paying dues or fees, or performing any other act, as long as he or she is an active duty member of the U.S. Armed Forces, and for a period of six months after discharge from active duty. 27 Protection of the public is incumbent upon the accurate determination that a health care professional is qualified to practice the health care profession for which they are seeking licensure. Florida statutes delineate minimum qualifications for each license based on the profession and the associated scope of practice. However, all professions have the same general categories of requirements for licensure, including: 25 Section 401.23(17), F.S. 26 Section 401.23(1), F.S. 27 Section 401.271, F.S. BILL: CS/CS/SB 466 Page 10 Minimum educational requirements, which may also encompass an internship program or residency training. Successful examination completion. Most health care professions require successful completion of a national examination to demonstrate competency. Criminal history evaluation. All applicants are required to disclose prior criminal history, and professions identified in s. 456.0135, F.S., require electronic fingerprint submission. Certain criminal activity reflected in the history may preclude licensure. Disciplinary history evaluation. Disciplinary history evaluation includes all prior licensure in any profession in any jurisdiction. Certain types of discipline may preclude licensure. Health history evaluation. Applicants are required to disclose health history, including evidence of impairment. Boards evaluate the disclosure to determine if the applicant is safe to practice prior to making a final licensure determination. To be eligible for a paramedic certification in Florida, an applicant must: Submit a completed application; Possess a high school diploma or GED; Submit proof to the Certification Unit of meeting the required professional education in one of the following ways: o Florida Trained - Successful completion of a paramedic course from an approved program within two years of passing the examination; o Out of State Certification – Proof of current NR-EMT certification; or o Health Professional Licensure – A Florida licensed physician, physician assistant, dentist, or registered nurse may apply for certification as a paramedic and subsequently challenge the paramedic exam, provided he or she holds a Florida EMT certificate which is current, in good standing, and has successfully completed an advance cardiac life support course. 28 The Florida Department of Education The Department of Education (DOE) serves as the single repository of education data from school districts, state and community colleges, universities, and independent postsecondary institutions, allowing the DOE to track student performance over time and across varying education sectors. The DOE administers a statewide reading initiative for Florida's public schools, and among community groups and volunteer organizations that support them, with a goal of having every child able to read at or above grade level; and serves approximately 2.8 million students, 4,400 public schools, 28 colleges, 202,500 instructional staff, 46,000 college professors and administrators, and 340,000 full-time staff throughout the state, the DOE enhances the economic self-sufficiency of Floridians through programs and services geared toward college, workforce education, apprenticeships, job-specific skills, and career development. 28 Section 401.25, F.S.; Fla. Admin. C. Rule 64J-1.009, (2021); Florida Department of Health, Licensing and Regulation, EMT and Paramedics, Licensing, Paramedic, available at https://www.floridahealth.gov/licensing-and-regulation/emt- paramedics/licensing/index.html (last visited Feb. 3, 2022). BILL: CS/CS/SB 466 Page 11 The Articulation Coordination Committee In 1996, the Articulation Coordinating Committee (ACC) directed an effort to establish a list of common prerequisite courses for every university degree program. Specifically, s. 1007.25(5), F.S., directs the DOE to “identify common prerequisite courses and course substitutions for degree programs across all institutions.” These common degree program prerequisites must be offered and accepted by all state universities and community colleges, except in cases approved by the State Board of Education (SBE) and the Board of Governors (BOG). The statute also directs the department to develop a centralized database containing the list of approved courses and courses substitutions that meet the prerequisite requirements for each baccalaureate degree program. Required completion of common prerequisites is further addressed in SBE Rule 6A- 10.024 and BOG Articulation Regulation. The mission of the Office of Articulation is to facilitate the effective and efficient progression and transfer of students through Florida’s K-20 education system. Through the work of the ACC, a K-20 advisory body appointed by the Commissioner of Education, the office coordinates ways to help students move easily from institution to institution and from one level of education to the next. The ACC serves as an advisory board to the SBE and the BOG on postsecondary transition issues. The committee provides a unique K-20 forum for cross-sector collaboration that informs the policy decisions of the SBE and the BOG regarding the implementation of the statewide articulation agreement. The ACC reports to the commissioner and comprises of the following members: two members each representing the State University System (SUS), the Florida College System (FCS), public career and technical education, public K-12 education, and non- public education, and one member representing students. The ACC is responsible for reviewing and monitoring the different components of Florida’s articulation system and making policy recommendations to facilitate seamless articulation between and among public schools, career and technical education centers, FCS institutions, state universities, and nonpublic postsecondary institutions. For instance, the ACC annually reviews statewide articulation agreements as well as the statewide course numbering system, the levels of courses, and the application of transfer credit requirements among public and non- public institutions participating in the statewide course numbering system. Section 1007.096, F.S., requires the BOG, in consultation with the Florida Department of Veterans’ Affairs, to adopt regulations, and the SBE to adopt rules that create a process that enables eligible servicemembers or veterans of the United States Armed Forces to earn uniform postsecondary credit across all Florida public postsecondary educational institutions for college- level training and education acquired in the military. The regulations and rules must include procedures for credential evaluation and the uniform award of postsecondary credit or career education clock hours, including, but not limited to, equivalency and alignment of military coursework with appropriate postsecondary courses and course descriptions. The ACC is responsible for developing a process for determining postsecondary course equivalencies and the minimum postsecondary credit or career education clock hours that must BILL: CS/CS/SB 466 Page 12 be awarded for courses taken and occupations held by individuals during their service in the military. The ACC workgroup is composed of the following 13 members who establish a process for prioritizing and determining postsecondary course equivalencies and the minimum postsecondary credit or career education clock hours that must be awarded for courses taken and occupations held by individuals during their service in the military. The workgroup then provides recommendations to the BOG and the SBE for approval at the next meeting of each board to allow for adequate public notice. Upon approval of the workgroup’s recommendations by the BOG and the SBE, the ACC facilitates the review of courses taken and occupations held by individuals during their service in the military for postsecondary course equivalencies and the minimum postsecondary credit or career education clock hours that must be awarded in accordance with the approved process. Within one year after approval of the workgroup’s recommendations by the BOG and the SBE, the ACC must approve a prioritized list of postsecondary course equivalencies and the minimum postsecondary credit or career education clock hours that must be awarded for courses taken and occupations held by individuals during their service in the military. The list must be updated annually. The BOG and the SBE must timely adopt the list approved by the ACC at the next meeting of each board to allow for adequate public notice. The postsecondary course equivalencies and the minimum postsecondary credit or career education clock hours must be awarded for courses taken and occupations held by individuals during their service in the military as delineated by the SBE and the BOG in the statewide articulation agreement State universities, Florida College System institutions, and career centers must award postsecondary credit or career education clock hours for courses taken and occupations held by individuals during their service in the military based on the list adopted by the BOG and the SBE if the credit or career education clock hours are applicable toward the student’s degree or certificate. Institutions may award additional postsecondary credit or career education clock hours if appropriate. Credit or career education clock hours awarded in accordance with minimum postsecondary credit and clock hour require. III. Effect of Proposed Changes: Military Corpsmen and Medics Program of Florida Program Purpose The bill creates the Military Corpsmen and Medics Program of Florida (MCMF program) within the Department of Health (DOH) to assist military-trained veterans and their spouses in identifying and applying for health care and health care-related employment and licensure, and identifying educational and training opportunities. Definitions A military-trained veteran is a person who: BILL: CS/CS/SB 466 Page 13 Has served within the preceding consecutive 12 months as an Army Combat Medic Specialist, Air Force or Space Force Aerospace Medical Service Technician, Navy or Fleet Marine Force Hospital Corpsman, or Coast Guard Health Services Technician; Was discharged or separated from military service under conditions other than dishonorable or upgraded to an honorable discharge; A participating health care provider is: A physician licensed under chs. 458, or 459, F.S.; A professional corporation or partnership of a licensed physicians licensed under ch. 458 or ch. 459, F.S.; A hospital or ambulatory surgical center licensed under ch. 395, F.S.; An office registered under s. 458.328 or s. 459.0138, F.S; A company with a medical facility for its employees which is supervised by at least one licensed physician; or A facility licensed under ch. 395, F.S., which offers medical services to the public and is supervised by at least one licensed physician. A veteran as referenced in the bill means a former member of the Florida National Guard who was discharged or separated from service under conditions other than dishonorable or upgraded to an honorable discharge, or as the term “veteran” is defined in s. 1.01(14), F.S., which means a person who served in the active military, naval, or air service and who was honorably discharged or released or who later received an upgraded discharge. Program Components The bill requires the DOH to establish the MCMF Program Office of Veterans Advocacy (MCMF office) to provide information, guidance, and assistance with the licensure application process or with expedited licensure to military trained health care veterans and their spouses. The MCMF office must be headed by a MCMF Program Veterans’ Advocate (MCMF advocate) who has an understanding of the practice requirements of the DOH recognized licensed occupations and professions, and certain military training and educational opportunities. The MCMF advocate must collaborate with the United States Department of Defense, The Department of Veterans ‘ Affairs, the DEO, Florida is for Veterans, Inc., the Department of Education, and other stakeholders to further the mission of the program. The MCMF advocate duties include, but are not limited to the following, as they relate to military trained health care veterans and their spouses: Provide information, guidance, direction, and assistance, as appropriate, with health care or health care related licensure applications or with expedited licensing requirements; Provide information on statewide educational and training opportunities and resources; Provide information on education and training required to obtain a license in a health care or health care-related field; and Provide information on the expedited state licensure qualifications for certain health care fields. BILL: CS/CS/SB 466 Page 14 The MCMF office must refer veterans and their spouses to the Department of Economic Opportunity (DEO) for assistance in resume writing and proofreading, job application completion, and interviewing skills and techniques. Additional Assistance for Veterans and their Spouses Veterans who do not meet definition of the term “military-trained health care veteran” but who served in a health care related field may receive assistance from the MCMF program through the DEO in resume writing, mentorship, and obtaining employment with participating health care providers. The MCMF Program through the Department of Economic Opportunity shall assist veterans and their spouses who have gained management experience or have completed an advanced degree in finding civilian health care leadership and management employment opportunities in a variety of health care and health care-related disciplines. The bill grants rulemaking authority to the DOH to implement the provisions of the bill. Florida is for Veterans, Inc. The bill amends s. 295.22, F.S., to require Florida is for Veterans, Inc. (FIFVs), to collaborate with the DOH to implement the MCMF program, in coordination with the DEO and MCMF office. Specifically, FIFVs is required to: Recruit, establish, and maintain a statewide list of participating health care providers who agree to employ qualified veterans. Assist participating health care providers in recruiting and hiring military-trained health care veterans and their spouses. Provide assistance and mentorship in resume writing and proof reading, interview training, and application assistance to military-trained veterans and their spouses. FIFV is authorized to coordinate with the Department of Economic Opportunity (DEO) to make referrals for such assistance. Assist certified military-trained veterans and their spouses in identifying participating health care providers for potential employment. Assist military-trained veterans and their spouses, who have gained management experience or have an advanced degree, in finding civilian healthcare leadership and management employment. Department of Education The bill creates s. 1004.0963, F.S., authorizing the Board of Governors (BOG) and the State Board of Education (SBE) to create a process that enables military-trained health care veterans to earn uniform postsecondary educational credit for college-level education and training acquired while in the military. The bill requires the Articulation Coordinating Committee to convene a workgroup by July 15, 2023, to develop a process for determining postsecondary educational course equivalencies and minimum educational credit or career education and academic and clinical clock hours that may BILL: CS/CS/SB 466 Page 15 be awarded for courses taken and occupations held during military service. The Articulation Coordinating Committee must approve a prioritized list of such equivalencies, based on the recommendations made by the workgroup, and the list must be updated on an annual basis. The bill authorizes the Articulation Coordinating Committee to form a subcommittee for carry out the duties as they relate to the bill. The office of K-20 Articulation must provide administrative support to the workgroup. The workgroup must be composed of the following 10 members: The chair of the Articulation Coordinating Committee; One member, appointed by the BOG, representing academic affairs administrators and faculty with expertise in health care. One member, appointed by the SBE, representing academic affairs administrators and faculty with expertise in health care. One member, appointed by the SBE, representing faculty from career centers with expertise in health care. Two members, appointed the Executive Director of the Florida Department of Veteran Affairs, representing veterans familiar with military educational training. Four faculty members, appointed by the DOH, representing health care professions. The list of approved educational course equivalencies and educational credit for courses taken and occupations held during military service must be delineated in the statewide articulation agreement. State universities, Florida College System Institutions, career centers, training schools, and training programs must award postsecondary education credit and career education and academic and clinical clock hours for certain courses taken and training received during military service. The bill takes effect July 1, 2022. IV. Constitutional Issues: A. Municipality/County Mandates Restrictions: None. B. Public Records/Open Meetings Issues: None. C. Trust Funds Restrictions: None. D. State Tax or Fee Increases: None. BILL: CS/CS/SB 466 Page 16 E. Other Constitutional Issues: None identified. V. Fiscal Impact Statement: A. Tax/Fee Issues: None. B. Private Sector Impact: CS/CS/SB 466, in part, is designed to address the shortage of health care professionals in this state, but impact is indeterminate at this time. C. Government Sector Impact: None. VI. Technical Deficiencies: None. VII. Related Issues: The bill does not address adverse incident reporting or professional liability insurance. VIII. Statutes Affected: This bill creates the following sections of the Florida Statutes: 295.126, and 1004.0963. The bill substantially amends section 295.22 of the Florida Statutes. IX. Additional Information: A. Committee Substitute – Statement of Substantial Changes: (Summarizing differences between the Committee Substitute and the prior version of the bill.) CS/CS by Appropriations on February 28, 2022: The committee substitute: Creates the Military Corpsmen and Medics of Florida Program (MCMF program) within the Department of Health (DOH) to assist military-trained veterans and their spouses in finding employment in a health care or health care related field, and to offer educational credit for certain military service that can be applied toward licensure requirements. Deletes all provisions related to the Military Corpsmen and Medics of Florida (MMACOF) Program including the MMACOF Health Care Certification program and rule making authority as it relates to such certification program. BILL: CS/CS/SB 466 Page 17 Deletes provisions related to the Board of Medicine’s responsibility to determine qualified status under the certification program, and the responsibility to determine scope of practice of military trained veterans. Defines “license” to mean any permit, registration, certificate, or license, including a provisional license, issued by the department. Revises the definition of “military-trained veteran” to include one of the following: o Army Combat Medic Specialist. o Nay Fleet Marine Force Hospital Corpsmen. o Air Force or Space Force Aerospace Medical Service Technician. o Coast Guard Health Services Technician. o Any other military position similar to civilian X-ray technicians, dental assistants, or phlebotomists. Revises the definition of “veteran” to include a former member of the Florida National Guard who was discharged or separated from services under conditions other that dishonorable or upgrade to an honorable discharge. Revises the purpose of the program to include assisting military-trained veterans and their spouses with the following: o Identifying and applying for health care and health care related employment and licensure, for which they may or may not immediately qualify. o Connect veterans who have military health care experience with health care organizations. o Facilitate access to training and education in health care and health care related fields to promote the health care licensing programs provided in Florida. o Identify health care or health care related organizations and training programs that will recognize a veterans and their spouse’s medical skills and allow such veteran to gain employment and work toward obtaining the appropriate health care license. o Assist veterans and their spouses with certain licenses. Requires the DOH to establish the MCMF Program Office of Veterans Advocacy (Office) to provide veterans and their spouses with the following: o Information, guidance, and assistance with the licensure application process or with expedited licensure o Training opportunities and resources. o Assistance with certain licensure requirements. o Referrals to the Department of Economic Opportunity for assistance with resume writing and proofreading, job application completion, and interviewing skills. Requires the Office to be headed by a qualified individual. Requires the MCMF office to refer veterans and their spouses to the Department of Economic Opportunity (DEO) for assistance in resume writing and proofreading, job application completion, interviewing skills and techniques, and finding employment. Requires the DOH to waiver all application fees, certificate fees, and unlicensed activity fees for military trained health care veterans and they’re spouses. Authorizes rule making authority for DOH to implement the MCMF program. Revises the duties of the FIFV under the program to include: o Recruiting, establishing, and maintaining a statewide list of health care providers who agree to participate in the MCMF program. BILL: CS/CS/SB 466 Page 18 o Assisting health care providers in recruiting and hiring military trained health care veterans and their spouses. o Making referrals to the DEO for assistance in resume writing and proofreading, job application completion, and interviewing skills. Authorizes the Board of Governors (BOG) and the State Board of Education (SBE) to create a process that enables military-trained health care veterans to earn uniform postsecondary educational credit for college-level education and training acquired while in the military. Requires the Articulation Coordinating Committee to convene a workgroup by July 15, 2023 and develop a process for determining postsecondary educational course equivalencies and minimum educational credit or career education and academic and clinical clock hours that must be awarded for courses taken and occupations held during military service. Requires the workgroup to provide recommendations to the BOG and SBE by December 1, 2024. Requires the workgroup to be composed 10 members and be administratively supported by the Office of K-20 Articulation. Requires that the list of approved educational course equivalencies and educational credit for courses taken and occupations held during military service must be delineated in the statewide articulation agreement. State universities, Florida College System Institutions, career centers, training schools, and training programs must award postsecondary education credit and career education and academic and clinical clock hours for certain courses taken and training received during military service. CS by Health Policy on January 13, 2022: The CS: Authorizes the DOH to establish and administer the program, in collaboration with the FIFV, instead of the FDVA establishing and administering the program; Applies to military veterans and their spouses, not just military veterans; Requires the DOH to waive certain fees for program applicants; Provides application requirements; Requires disclosure of specific information by an applicant; Requires the participating health care providers to agree to specified terms; Requires a specific application process; Requires the board, and any other boards it deems appropriate, to determine areas of practice and specify what skills the veterans may perform under direct supervision; Requires the certificate holder, DOH, FIFV, participating health care providers, and certain education and training programs to provide specific information to each other within specified time periods regarding employment status and the status of the veteran’s enrollment on at least a half-time basis in an approved program; Authorizes grounds for denial of a certificate or disciplinary action against a certificateholder; Authorizes both the DOH or the board to issue disciplinary orders; Authorizes the DOH to make rules for certificate renewal; the board to make rules to establish guidelines for the disposition of disciplinary cases; and the DOH and the board to make rules to implement s. 295.126, F.S.; and BILL: CS/CS/SB 466 Page 19 Amends s. 295.21, F.S. to authorize the creation of a subprogram dedicated to health care services employment for veterans in Florida. B. Amendments: None. This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.