Florida Senate Bill S0768 Analysis / Analysis

                    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 Health Policy  
 
BILL: PCS/SB 768 (709032) 
INTRODUCER: Health Policy Committee 
SUBJECT:  Department of Health 
DATE: January 25, 2022 
 
 ANALYST STAFF DIRECTOR  REFERENCE  	ACTION 
1. Rossitto-Vanwinkle 
and Looke 
 
Brown 
 
HP 
 
Pre-meeting 
2.     AHS   
3.     AP  
 
I. Summary: 
PCS/SB 768 addresses numerous health care-related issues regulated by the Department of 
Health (DOH). The PCS: 
 Updates the “Targeted Outreach for Pregnant Women Act of 1998;” 
 Amends s. 381.0303, F.S., to specify that for pediatric special needs shelters, the DOH is the 
lead agency to coordinate local medical and health care providers for the staffing and 
management of the shelters and is the decision-making authority for determining the medical 
supervision in each special needs shelter; 
 Allows the DOH to collect samples of marijuana and marijuana delivery devices, in general, 
from a medical marijuana treatment center (MMTC) for specified testing, rather than only 
samples of edibles; 
 Expands MMTC recall requirements to all marijuana products and delivery devices, rather 
than only edibles; 
 Provides an exception from criminal laws for DOH employees to acquire, possess, test, 
transport, and lawfully dispose of marijuana and marijuana delivery devices; 
 Amends statutes regulating several types of health care professions, including allopathic and 
osteopathic physicians, nurses, midwives, psychologists, orthotists, prosthetists, clinical lab 
personnel, chiropractors, mental health counselors, clinical social workers, and marriage and 
family therapists; 
 Amends ss. 460.406, 468.803, 483.824, 490.005, F.S., to delete references to the term 
“regional” and replace it with the term “institutional” to conform with the U.S. Department 
of Education accreditation nomenclature for approving health care-related educational 
institutions; and 
 Amends s. 766.314, F.S., authorizing the Florida Birth-Related Neurological Injury 
Compensation Association (NICA) to collect and enforce physician assessments in circuit 
REVISED:   BILL: PCS/SB 768 (709032)   	Page 2 
 
court, if necessary, and requires the NICA to notify the DOH and the appropriate board of 
any unpaid final judgments against a physician within a specific timeframe. 
 
The PCS provides an effective date of July 1, 2022, except as otherwise provided. 
 
II. Present Situation: 
Targeted Outreach for Pregnant Women 
The Targeted Outreach for Pregnant Women Act (TOPWA) was enacted by the Florida 
Legislature in 1998. The TOPWA program is designed to establish targeted outreach to high-risk 
pregnant women who may not be receiving proper prenatal care, who suffer from substance 
abuse problems, or who may be infected with the human immunodeficiency virus (HIV). The 
goal of the program is to provide these high-risk pregnant women with referrals for information 
and services. 
 
In 2019, there were 453 HIV-exposed births in Florida. While there were no known perinatal 
HIV transmissions in 2019, the DOH does not have a definitive status on roughly 25 percent of 
the 453 HIV-exposed births. 
 
Without proper care for both mother and newborn, each of these births risks vertical 
transmission. The TOPWA supports outreach programs aimed at preventing 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
 
 
Many of the women targeted by TOPWA programs may not otherwise receive prenatal care or 
know their HIV status. In 2021, there were eight TOPWA programs in Florida.
2
 The TOPWA 
programs, which are funded through General Revenue (GR) dollars and grant funds from the 
federal Centers for Disease Control and Prevention (CDC), provided services to 7,703 women 
from January 2016 to July 2020. Women living with HIV made up just under 10 percent of 
TOPWA program enrollments.
3
 
 
If a pregnant woman tests positive for HIV, medical interventions and prevention, such as the 
following, can greatly reduce her risk of transmitting the virus to her baby during childbirth: 
 Antiretroviral medication to the mother; 
 Delivery by caesarian section; 
 Avoiding breastfeeding; and 
 Antiretroviral medication to the newborn. 
 
                                                
1
 Section 381.0045(2), F.S. 
2
 Florida Department of Health, Diseases and Conditions, AIDS, Prevention, TOWPA Map, available at 
http://www.floridahealth.gov/diseases-and-conditions/aids/prevention/_documents/topwa/TOPWAProviderMap2021.pdf 
(last visited Nov. 2, 2021). 
3
 Department of Health, Senate Bill 768 2022 Agency Legislative Bill Analysis (July 23, 2021) (on file with the Senate 
Committee on Health Policy).  BILL: PCS/SB 768 (709032)   	Page 3 
 
The DOH has developed a GR-funded program, Baby Rxpress, which provides a six-week 
course of ARV medication to HIV-exposed newborns at no cost to the mother. In 2019, this 
program filled 304 prescriptions to 264 HIV-exposed newborns at a cost of $10,801.96, or 
$40.92 per baby.
4
 
 
Special Needs Shelter Program 
Section 381.0303, F.S., was enacted in 2000 to create the Special Needs Shelter Program to 
provide for the operation and closure of special needs shelters (shelters). The shelters are 
designed for persons with a physical impairment, mental impairment, cognitive impairment, or 
sensory disability who, during periods of evacuation or emergency, require sheltering assistance 
to have a safe and secure place to go during an emergency or disaster. In s. 381.0303(1), F.S., the 
Legislature designates the DOH, through its county health departments, as the lead agency for 
coordinating and recruiting health care practitioners to staff the shelters during emergencies or 
disasters.
5
  
 
In s. 381.0303(2), F.S., the Legislature delineates the responsibilities for the shelters as follows: 
 The DOH has the lead responsibility for coordinating local medical and health care 
providers, the American Red Cross, and other interested parties and in developing a plan for 
the staffing and medical management of the shelters; 
 The DOH’s local Children’s Medical Services (CMS) offices have responsible for the 
coordination of local medical and health care providers, the American Red Cross, and other 
interested parties, and for developing a plan for the staffing and medical management of the 
shelters; 
 The county health departments, in conjunction with the local emergency management 
agencies, have lead responsibility for the coordination and recruitment of the health care 
practitioners to staff local shelters; 
 Local emergency management agencies have responsibility for the designation and operation 
of the shelters during an emergency or disaster and the closure of the facilities following the 
event; and 
 The local county health department, local CMS office, and local emergency management 
agency are jointly responsible for deciding who is responsible for the medical supervision in 
each shelter.
6
 
 
According to the DOH, this shared lead responsibility between the DOH, through its local county 
health departments, and CMS, through its local offices was, in large part, due to the large local 
CMS workforce of health care practitioners with specialized training and experience in the 
provision of services for children with special needs. Through a series of program and 
organizational changes at the DOH, toward a more effective operation and cost savings, the CMS 
workforce has been reduced by more than 70 percent since 2018. Due to this change in CMS 
workforce, the DOH advises that CMS is unable to fulfill its responsibilities under s. 381.3030, 
F.S.
7
 
                                                
4
 Id. 
5
 Section 381.0303(1), F.S. 
6
 Section 381.0303(2), F.S. 
7
 Department of Health, 2022 Senate Bill 768 Fiscal Analysis (July 23, 2021) (on file with the Senate Committee on Health 
Policy).  BILL: PCS/SB 768 (709032)   	Page 4 
 
 
Medical Marijuana 
Amendment 2 
On November 4, 2016, Amendment 2 was approved by the statewide electorate and established 
Article X, section 29 of the Florida Constitution. This section of the constitution became 
effective on January 3, 2017, and created several exemptions from criminal and civil liability for: 
 Qualifying patients who medically use marijuana in compliance with the amendment; 
 Physicians, solely for issuing physician certifications with reasonable care and in compliance 
with the amendment; and 
 MMTCs and their agents and employees for actions or conduct under the amendment and in 
compliance with rules promulgated by the DOH. 
 
Implementation 
Subsequently, the Legislature passed SB 8-A in Special Session A of 2017.
8
 The bill revised the 
Compassionate Medical Cannabis Act of 2014
9
 in s. 381.986, F.S., to implement Article X, 
section 29 of the State Constitution. 
 
Testing Marijuana and Exemption from Criminal Offenses 
Pursuant to s. 381.986(8)(11)d., F.S., the DOH may select a random sample from edibles 
available for purchase in an MMTC’s DOH-approved dispensing facility for testing. The DOH 
must test the random samples for potency, safety for human consumption, and accuracy of 
Tetrahydrocannabinol (THC) and Cannabidiol (CBD) labeling. 
 
MMTCs are required to recall all edibles, including all edibles made from the same batch of 
marijuana, which fail to meet potency requirements, which are unsafe for human consumption, 
or for which the labeling of the THC and CBD concentration is inaccurate. 
 
Presently, the DOH and its employees are not expressly exempt from criminal prosecution under 
ss. 893.13, 893.135, and 893.147, F.S., when acquiring, possessing, testing, transporting, and 
disposing of marijuana and delivery devices under certain circumstances when acting within the 
scope of their duties.
10
 
 
Additional Disclosure for Physician Licensure and Renewal 
Section 456,039, F.S., requires each physician,
11
 chiropractor, and podiatrist seeking initial 
licensure, or license renewal, in Florida, in addition to normal required licensure information, to 
submit the following to the DOH: 
                                                
8
 Chapter 2017-232, Laws of Fla. 
9
 Chapter 2014-157, Laws of Fla. 
10
 Department of Health, Senate Bill 1568 Fiscal Analysis (Mar. 12, 2021) (on file with the Senate Committee on Health 
Policy). 
11
 See ss. 458.345 and 459 021, F.S., Registered medical and osteopathic, residents are exempt from the requirement of 
456.039, F.S.  BILL: PCS/SB 768 (709032)   	Page 5 
 
 Name of each medical school attended, including dates of attendance, graduation, and a 
description of all graduate medical education completed, except continuing education (CE) 
requirements; 
 Name of each hospital where the applicant has privileges; 
 Primary practice address; 
 Specialty board certifications, if any; 
 Date applicant began practicing medicine; 
 Medical school faculty appointments currently held and whether the applicant has had the 
responsibility for graduate medical education within the past 10 years; 
 Any criminal offenses, felony or misdemeanor, of which the applicant has been found guilty, 
regardless of whether adjudication was withheld, or to which the applicant has pled guilty or 
nolo contendere, including those committed in another jurisdiction which would constitute a 
felony or misdemeanor in Florida; 
 Any final professional disciplinary action within the previous 10 years in Florida or any other 
jurisdiction, or by any specialty board, similar national organization, licensed hospital, health 
maintenance organization, prepaid health clinic, ambulatory surgical center, or nursing home; 
 Any claim or action for damages in Florida, in another jurisdiction or in a foreign country, 
for personal injury alleged to have been caused by error, omission, or negligence in the 
performance of licensee’s professional services; and 
 Fingerprints. 
 
Any change in the above information must be updated within 45 days after the occurrence of an 
event or change in status that is required to be reported. The DOH compiles this information and 
submits it to the practitioner profile of the applicant.
12
 
 
Educational Institution Accreditation 
Each profession includes the requirement of completion of a program from a “regionally 
accredited” institution. The U.S. Department of Education issued a letter of guidance on 
February 26, 2020, specifying that final regulations published that year omit references to 
“regional” and “national” accreditation. The letter specifies, “Because 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, will become effective January 1, 2021.
13
 
 
Nursing 
Licensure by Examination 
Part I of ch. 464, F.S., the Nurse Practice Act, governs the licensure and regulation of nurses in 
Florida. Nurses are licensed by the DOH
14
 and are regulated by the Board of Nursing (BON).
15
 
                                                
12
 Section 456.041, F.S. 
13
 U.S. Department of Education, Office of the Under Secretary, Final Accreditation and State Authorization Regulations, 
February 26, 2020, (on file with the Senate Committee on Health Policy). 
14
 Section 464.008, F.S. 
15
 The BON is composed of 13 members appointed by the Governor and confirmed by the Senate who serve four-year terms. 
All members must be residents of the state. Seven members must be registered nurses who are representative of the diverse  BILL: PCS/SB 768 (709032)   	Page 6 
 
Currently, a person desiring to practice nursing in the state of in Florida must obtain a Florida 
license by examination, endorsement
16
or have a multistate license.
17
 
 
Applicants for licensure by examination as a registered nurse (RN) or licensed practical nurse 
(LPN) must, among other requirements: 
 Graduate from an approved program or its equivalent as determined by the BON.
18
 
 Submit an application to the DOH; 
 Pay a fee; 
 Submit information for a criminal background check;
19
 and 
 Pass the National Council Licensure Examination (NCLEX).
20
 
 
Any applicant who fails the NCLEX three consecutive times, regardless of the jurisdiction where 
the examination is taken, must complete a board-approved remedial course before the applicant 
will be approved to re-take the NCLEX. After taking the remedial course, the applicant may be 
approved to retake the examination up to three additional times before the applicant must retake 
remediation. The applicant must apply for reexamination within 6 months after completion of 
remediation.
21
 
 
If an applicant who graduates from an approved program does not take the licensure examination 
within six months after graduation, he or she must enroll in and successfully complete a BON-
approved licensure examination preparatory course. The applicant is responsible for all costs 
associated with the course and may not use state or federal financial aid for such costs. The BON 
is directed to, by rule, establish guidelines for licensure examination preparatory courses.
22
 
 
Disciplinary Actions 
Once an individual is licensed to practice nursing in Florida, he or she has a professional 
responsibility to practice nursing at a minimum level of competency to ensure the safety of the 
public. The safe practice of nursing also requires that a nurse not commit any of the hundreds of 
acts that would constitute grounds for the denial of a license, disciplinary action, or even 
criminal prosecution, as set out under ss. 456.072(2), 464.0095, and 464.018, F.S. 
 
                                                
areas of practice within the nursing profession. Three members must be licensed practical nurses and three members must be 
laypersons. At least one member of the board must be 60 years of age or older. See Section 464.004, F.S. 
16
 Section 464.009, F.S., provides the requirements for licensure by endorsement, and requires an applicant to submit an 
application and fee, passing a criminal background screening, and 1) Hold a valid license to practice professional or practical 
nursing in another state or territory of the United States which, when issued, met or exceeded those in Florida at that time; 2) 
Meet the requirements for licensure in Florida and having successfully completed an examination in another state which is 
substantially equivalent to the examination in Florida; or 3) Have actively practiced nursing in another state, jurisdiction, or 
territory of the United States for two of the preceding three years without having his or her license acted against by the 
licensing authority of any jurisdiction. 
17
 Section 464.0095, F.S., A “Multistate license” is a license to practice as a registered nurse (RN) or a licensed 
practical/vocational nurse (LPN/VN) issued by another Nurse Licensure Compact state’s licensing board which authorizes 
the licensed nurse to practice in all party states under a multistate licensure privilege. 
18
 Section 464.008(1)(c), F.S. 
19
 Section 464.008(1)(b), F.S. 
20
 Section 464.008(2), F.S. 
21
 Section 464.008(3), F.S. 
22
 Section 464.008 (4), F.S.  BILL: PCS/SB 768 (709032)   	Page 7 
 
Section 464.018(1)(c)-(e), F.S., as currently written, uses the modifying phrase, “regardless of 
adjudication;” but where the phrase is placed in subsections (c) and (d) verses subsection (e) has 
a significant impact on its application in law. 
 
In s. 464.018(1)(e), F.S., the placement of the phrase, “regardless of adjudication,” only applies 
to licensees “having been found guilty of,” offenses listed in s. 435.04, F.S., or an offense of 
domestic violence under s. 741.20, F.S. “Regardless of adjudication” does not apply to those 
“entering a plea of guilty or nolo contendere to” listed offenses. This interpretation could result 
in those licensees entering a plea of nolo contendere or guilty and not being found guilty (i.e. 
adjudication is withheld), therefore not being subject to professional disciplinary action. 
 
Midwifery 
“Midwifery” is the practice of supervising the conduct of a normal labor and childbirth, with the 
informed consent of the parent; the practice of advising the parents as to the progress of the 
childbirth; and the practice of rendering prenatal and postpartal care.
23
 
 
Chapter 467, F.S., is the Midwifery Practice Act. Any person who seeks to practice midwifery in 
Florida must be at least 21 years of age and be: 
 Licensed under s. 464.012, F.S., as an Advanced Practice Registered Nurse (APRN) nurse 
midwife; or 
 Licensed as a midwife under ch. 467, F.S. 
 
Section 467.009, F.S., governs midwifery programs and education and training requirements 
which are a minimum of three years in an approved program. An applicant must have: 
 A high school diploma or the equivalent. 
 Taken at least three college-level credits such as math and English. 
 
It is unclear under current law whether both a high school diploma and three college level credits 
are required for admission, or whether one or the other will satisfy the admission requirement. 
 
Section 467.009, F.S., also requires a student midwife, during training, to undertake the care of 
50 women in each of the prenatal, intrapartal, and postpartal periods, and observe an additional 
25 women in the intrapartal period under the supervision of a preceptor, but the same women 
need not be seen through all periods. Prenatal, intrapartal, and postpartal periods are not defined, 
and the statute is unclear as to whether this requires 150 patients prenatal, intrapartal, and 
postpartal periods, or just 50 patients in any one of the three phases of pregnancy and delivery. 
The statute is also unclear as to whether the two references to intrapartal care and observation 
may be the same patient or require different patient contacts. 
 
Section 467.009, F.S., uses the terms, “applicant” and “student midwife” interchangeably, which 
is inaccurate. These sections frame standards for admission, education, and clinical training in 
the context of student requirements. Preceptors direct, teach, supervise, and evaluate the learning 
experiences of the student midwife and may be physicians, licensed midwives, or a certified 
                                                
23
 Section 467.003(8), F.S.  BILL: PCS/SB 768 (709032)   	Page 8 
 
nurse midwife, who have a minimum of three years professional experience.
24
 Persons with 
previous midwifery education, RNs, and LPNs may have a reduced training period, but in no 
case less than two years. 
 
Chapter 467.009, F.S., does not include any provisions explicitly allowing a new midwifery 
program to be provisionally approved nor does it provide guidance to schools regarding the 
circumstances under which the DOH may rescind the approval of program. 
 
Section 467.011, F.S., licensure by examination, requires the DOH to: 
 Administer the licensure examination to test the proficiency of applicants in the core 
competencies required to practice midwifery as specified in s. 467.009, F.S.; 
 Develop, publish, and make available to interested parties at a reasonable cost a bibliography 
and guide for the examination; and 
 Issue a license to practice midwifery to an applicant who has graduated from an approved 
midwifery program, successfully completed the examination, and paid a licensure fee. 
 
The DOH no longer administers midwifery examinations, and, pursuant to s. 456.017(c), F.S., 
the DOH has approved the use of a national examination for midwives seeking to become 
licensed.
25
 
 
In lieu of examination, an applicant may apply for a license by endorsement based on 
verification that the applicant holds a current valid license to practice midwifery in another 
jurisdiction that has equivalent or more stringent licensure requirements than those in Florida.
26
 
 
A midwife may accept and provide care only for those women who are expected to have a 
normal pregnancy, labor, and delivery and must ensure that: 
 The patient has signed an informed consent form; and 
 If the patient is delivering at home, the home is safe and hygienic. 
 
The statute does not define “normal delivery,” “low risk pregnancy,” or “high risk pregnancy.” 
 
A midwife licensed under ch. 467, F.S., may administer the following: 
 Prophylactic ophthalmic medication; 
 Oxygen; 
 Postpartum oxytocin; 
 Vitamin K; 
 Rho immune globulin (human); and 
 Local anesthetic and other medications prescribed by a practitioner.
27
 
 
A midwife’s care of mothers and infants throughout the prenatal, intrapartal, and postpartal 
periods must be in conformity with DOH rules and the health laws of Florida. The midwife must: 
                                                
24
 Section 467.003(12), F.S. 
25
 Department of Health, Senate Bill 678 2022 Agency Legislative Bill Analysis -Midwifery (July 23, 2021) (on file with the 
Senate Committee on Health Policy). 
26
 Section 467.0125, F.S. 
27
 Section 467.015, F.S.  BILL: PCS/SB 768 (709032)   	Page 9 
 
 Prepare a written plan of action with the family to ensure continuity of medical care 
throughout labor and delivery and to provide for immediate medical care if an emergency 
arises; 
 Instruct the patient and family regarding the preparation of the environment and ensure 
availability of equipment and supplies needed for delivery and infant care; 
 Instruct the patient in the hygiene of pregnancy and nutrition as it relates to prenatal care; 
 Maintain equipment and supplies; 
 Determine the progress of labor and, when birth is imminent, be immediately available until 
delivery is accomplished, and must: 
o Maintain a safe and hygienic environment; 
o Monitor the progress of labor and the status of the fetus; 
o Recognize early signs of distress or complications; and 
o Enact the written emergency plan when indicated; 
 Remain with the postpartal mother until the conditions of the mother and the neonate are 
stabilized; and 
 Instill into each eye of the newborn infant a prophylactic in accordance with s. 383.04, F.S. 
 
Section 467.0125, F.S., also includes provisions for licensure by endorsement and temporary 
certification of a midwife who is qualifying for endorsement to practice in an area of critical 
need. This statute defines the term “area of critical need” differently from every other profession 
which has temporary certification that allows practice in an area of critical need. In addition, the 
current provisions for temporary certification of midwives require revocation if the area in which 
they practice loses its designation as an area of critical need. 
 
Section 467.205, F.S., provides that any accredited or state-licensed institution of higher 
learning, public or private, may provide midwifery education and training. The statute sets out 
the DOH approval requirements for programs desiring to conduct an approved midwifery 
education program. Under the application and recertification process: 
 The applicant must submit evidence of the program’s compliance with the requirements in 
s. 467.009, F.S. 
 The DOH must survey the organization applying for approval. If the DOH is satisfied that the 
program meets the requirements of s. 467.009, F.S., it must approve the program. 
 The DOH must certify whether each approved midwifery program complies with the 
standards developed under s. 467.009, F.S., at least every three years. 
o If the DOH finds that an approved program no longer meets the required standards, it 
may place the program on probation until such time as the standards are restored. 
o If a program fails to correct these conditions within a specified period of time, the DOH 
may rescind the approval. 
o Any program having its approval rescinded has the right to reapply. 
 Provisional approval of a new program may be granted pending the licensure results of the 
first graduating class.
28
 
 
                                                
28
 Section 467.205, F.S.  BILL: PCS/SB 768 (709032)   	Page 10 
 
Practice of Orthotics, Prosthetics, and Pedorthics 
The practice of orthotics, prosthetics, and pedorthics is governed by part XIV of ch. 468, F.S., 
and all three professions evaluate, measure, design, fabricate, assemble, fit, adjust, service, or 
provide the initial training necessary to accomplish the fitting of an orthosis or pedorthic 
device.
29
 
 
Section 468.803, F.S., provides minimum qualifications for licensure to practice orthotics, 
prosthetics, and pedorthics. An applicant must be 18 years of age or older and must: 
 Submit an application and fee; 
 Submit fingerprint forms and the cost of the state and national criminal background checks;  
 Be of good moral character; 
 Have completed a one year residency or internship in orthotics or prosthetics approved by the 
Board of Orthotists and Prosthetists (BOAP); and 
 Meet the following degree requirements to take the appropriate BOAP-approved 
examination: 
o Orthoptist: A bachelor of science or higher-level postgraduate degree in orthotics and 
prosthetics from a regionally accredited college or university, or a bachelor’s degree with 
a certificate in orthotics from a program recognized by the Commission on Accreditation 
of Allied Health Education Programs, or its equivalent, as determined by the BOAP. 
o Prosthetist: A bachelor of science or higher-level postgraduate degree in orthotics and 
prosthetics from a regionally accredited college or university, or a bachelor’s degree with 
a certificate in prosthetics from a program recognized by the Commission on 
Accreditation of Allied Health Education Programs, or its equivalent, as determined by 
the BOAP; and 
 Pass the BOAP-approved examination. 
 
Clinical Lab Personnel 
Part I of ch. 483, F.S., regulates clinical laboratory personnel. “Clinical laboratory personnel” 
includes a clinical laboratory director, supervisor, technologist, blood gas analyst, or technician 
who performs or is responsible for laboratory test procedures, but the term does not include 
trainees, persons who perform screening for blood banks or plasmapheresis centers, 
phlebotomists, or persons employed by a clinical laboratory to perform manual pretesting duties 
or clerical, personnel, or other administrative responsibilities.
30
 
 
Section 483.824(2), F.S., requires that the doctoral degree held by a clinical laboratory director 
must be from a regionally-accredited institution in a chemical, physical, or biological science. 
 
Psychologists 
Chapter 490, F.S., regulates the practice of psychology by psychologists. A psychologist is a 
person licensed by examination under s. 490.005(1), F.S., or endorsement under s. 490.006, F.S. 
 
                                                
29
 Section 468.80, F.S. 
30
 Section 483.803(4), F.S.  BILL: PCS/SB 768 (709032)   	Page 11 
 
Section 490.003. F.S., defines a “doctoral-level psychological education” and “doctoral degree in 
psychology” as of July 1, 1999, to include a Psy.D., an Ed.D. in psychology, or a Ph.D. in 
psychology from a psychology program at an educational institution that, at the time the 
applicant was enrolled and graduated: 
 Had institutional accreditation from an agency recognized and approved by the U.S. 
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). 
 
Section 490.005, F.S., provides that any person desiring to be licensed by examination as a 
psychologist must apply to the DOH to take the licensure examination. The DOH will license 
each applicant who the Board of Psychology (BOP) certifies has: 
 Completed an application and submitted a fee; 
 Submitted proof satisfactory to the BOP that the applicant has received: 
o Doctoral-level psychological education; or 
o The equivalent of a doctoral-level psychological education from a program at a school or 
university located outside the U.S.; 
 Had at least two years or 4,000 hours of experience in the field of psychology; and 
 Passed the licensing examination. 
 
Section 490.0051, F.S., also requires the DOH to issue a provisional psychology license to each 
applicant who the BOP certifies has: 
 Completed the application form and paid the fee; 
 Earned a doctoral degree in psychology as defined in s. 490.003(3); and 
 Met any additional requirements established by BOP rule. 
 
Provisional licensees must practice under the supervision of a licensed psychologist until the 
provisional licensee receives a license or a letter from the DOH stating that he or she is licensed 
as a psychologist. A provisional license expires 24 months after the date it is issued and may not 
be renewed or reissued. 
 
Mental Health Professionals 
Section 491.005, F.S., sets out the educational and examination requirements for a clinical social 
worker, marriage and family therapist, and mental health counselor to obtain a license by 
examination in Florida. An individual applying for licensure by examination who has satisfied 
the clinical experience requirements of s. 491.005, F.S., or an individual applying for licensure 
by endorsement pursuant to s. 491.006, F.S., intending to provide clinical social work, marriage 
and family therapy, or mental health counseling services in Florida, while satisfying coursework 
or examination requirements for licensure, must obtain a provisional license in the profession for 
which he or she is seeking licensure prior to beginning practice.
31
 
 
An individual who has not satisfied the postgraduate or post-master’s level of experience 
requirements under s. 491.005, F.S., must register as an intern in the profession for which he or 
she is seeking licensure before commencing the post-master’s experience requirement. An 
                                                
31
 Section 491.0046, F.S.  BILL: PCS/SB 768 (709032)   	Page 12 
 
individual who intends to satisfy part of the required graduate-level practicum, internship, or 
field experience outside the academic arena, must register as an intern in the profession for 
which he or she is seeking licensure before commencing the practicum, internship, or field 
experience.
32
 
 
Clinical Social Workers 
Section 491.005(1), F.S., relates to licensure by examination for clinical social workers. The 
DOH must issue a license to an applicant as a clinical social worker if the Board of Clinical 
Social Work, Marriage and Family Therapy, and Mental Health Counseling (Board) certifies that 
the applicant: 
 Has submitted an application and appropriate fees; 
 Has earned a doctoral degree in social work from a graduate school of social work accredited 
by an accrediting agency recognized by the U.S. Department of Education, or a master’s 
degree in social work from a graduate school of social work which:  
o Was accredited by the Council on Social Work Education (CSWE); 
o Was accredited by the Canadian Association of Schools of Social Work (CASSW); or 
o Has been determined to be an equivalent program to programs approved by the CSWE by 
the Foreign Equivalency Determination Service of the CSWE;  
o Completed all of the following coursework: 
 A supervised field placement during which the applicant provided clinical services 
directly to clients; and 
 Twenty-four semester hours or 32 quarter hours in theory of human behavior and 
practice methods as courses in clinically oriented services, with a minimum of one 
course in psychopathology and no more than one course in research; 
 Has completed at least two post graduate years of clinical social work experience under the 
supervision of a licensed clinical social worker or the equivalent supervisor as determined by 
the Board;
33
 
 Has passed a theory and practice examination; and  
 Demonstrates, in a manner designated by Board rule, knowledge of the laws and rules 
governing the practice of clinical social work, marriage and family therapy, and mental 
health counseling. 
 
Marriage and Family Therapists 
Section 491.005(3), F.S., relates to licensure by examination for marriage and family therapists. 
The DOH must issue a license to an applicant as a marriage and family therapist if the Board 
certifies that the applicant has: 
 Submitted an application and appropriate fee; 
 A minimum of a master’s degree with major emphasis in marriage and family therapy or a 
closely related field from a: 
o Program accredited by the Commission on Accreditation for Marriage and Family 
Therapy Education (CAMFTE); or  
                                                
32
 Section 491.0045, F.S. 
33
 Section 491.005(1)(c), F.S. An individual who intends to practice in Florida to satisfy clinical experience requirements 
must register with the DOH pursuant to s. 491.0045, F.S., before commencing practice.  BILL: PCS/SB 768 (709032)   	Page 13 
 
o Florida university program accredited by the Council for Accreditation of Counseling and 
Related Educational Programs (CACREP); 
 Documentation of the completion of graduate courses approved by the Board;
34
  
 Completed at least two years of clinical experience during which 50 percent of the 
applicant’s clients were receiving marriage and family therapy services: 
o At the post-master’s level; and 
o Under the supervision of a licensed marriage and family therapist with at least five years 
of experience, or the equivalent, and whom the Board determines is a qualified 
supervisor; 
 Passed a theory and practice examination provided by the DOH;
35
 
 Demonstrated, in a manner designated by Board rule, knowledge of the laws and rules 
governing the practice of clinical social work, marriage and family therapy, and mental 
health counseling.
36
 
 
The required master’s degree must have been earned at an institution of higher education that, at 
the time the applicant graduated, was fully accredited by a regional accrediting body recognized 
by: 
 The Commission on Recognition of Postsecondary Accreditation (CORPA); 
 A member in good standing with the Association of Universities and Colleges of Canada; or  
 An institution of higher education located outside the United States and Canada which, at the 
time the applicant attended and graduated, maintained a standard of training substantially 
equivalent to the standards of training of those institutions in the United States which are 
accredited by a regional accrediting body recognized by the CORPA.
37
 
 
The applicant has the burden of establishing that all above requirements for licensure are met. 
 
An applicant who has a master’s degree from a program that did not emphasize marriage and 
family therapy may complete the coursework requirement in an institution fully accredited by the 
CAMFTE, and recognized by the U.S. Department of Education. 
 
To satisfy the clinical experience requirements, an individual who intends to practice in Florida 
must register with the DOH before he or she may commence practice. 
 
A licensed mental health professional must be on the premises when clinical services are 
provided by a registered intern in a private practice setting. 
 
                                                
34
 Section 491.005(3)(b), F.S. If the course title that appears on the applicant’s transcript does not clearly identify the content 
of the coursework, the applicant must provide additional documentation, including, but not limited to, a syllabus or catalog 
description published for the course. 
35
 See s. 491.004(5), F.S., and Fla. Admin. Code R. 64B4-3.003(2)(c) and 3, (2021). The DOH no longer provides the theory 
and practice examination for Marriage and Family Therapists. The examination used is the one developed by the 
Examination Advisory Committee of the Association of Marital and Family Therapy Regulatory Board (AMFTRB). The 
minimum passing score is established by that provider as well. 
36
 See Fla. Admin. Code R. 64B4-3.0035, (2021). 
37
 Id. Such foreign education and training must have been received in an institution or program of higher education officially 
recognized by the government of the country in which it is located as an institution or program to train students to practice as 
professional marriage and family therapists or psychotherapists.  BILL: PCS/SB 768 (709032)   	Page 14 
 
The DOH must issue a dual license to persons licensed as psychologists, clinical social workers, 
mental health counselors, and psychiatric advanced practice registered nurses, if the candidate 
has: 
 A valid, active license for at least three years; and 
 Passed the examination provided by the DOH for marriage and family therapy. 
 
Mental Health Counselors 
Section 491.005(4), F.S., relates to licensure by examination for mental health counselors. 
Education and training in mental health counseling must have been received in an institution of 
higher education that, at the time the applicant graduated, was fully accredited by: 
 A regional accrediting body recognized by the Council for Higher Education Accreditation 
(CHEA) or its successor; 
 A publicly recognized member in good standing with the Association of Universities and 
Colleges of Canada; or 
 An institution of higher education located outside the United States and Canada which, at the 
time the applicant was enrolled and at the time the applicant graduated, was officially 
recognized by the government of the country in which it is located as an institution or 
program, to train students to practice as mental health counselors that maintained a standard 
of training substantially equivalent to the standards of training of those institutions in the 
United States which are accredited by a regional accrediting body recognized by the CHEA 
or its successor. 
 
The DOH must issue a license to an applicant as a mental health counselor if the Board certifies 
that the applicant has: 
 Submitted an application and appropriate fees; 
 Earned a minimum of a master’s degree from: 
o A mental health counseling program accredited by the CACREP
38
 which includes clinical 
and didactic instruction, including courses in human sexuality and substance abuse; or 
o A non-CACREP accredited program related to the practice of mental health counseling, 
but with coursework and practicum, internship, or fieldwork that meet all of the 
following: 
 Thirty-three semester hours, or 44 quarter hours, which must include a minimum of 
three semester hours, or four quarter hours, of graduate-level coursework in 11 
specified content areas;
39
or 
 A minimum of one graduate level course emphasizing the diagnostic processes, 
including differential diagnosis and the use of the current diagnostic tools, such as the 
current edition of the American Psychiatric Association’s Diagnostic and Statistical 
Manual of Mental Disorders. the common core curricular experience; or 
                                                
38
 Council for Accreditation of Counseling & Related Educational Programs, 2016 CACREP Standards, available at 
http://www.cacrep.org/wp-content/uploads/2018/05/2016-Standards-with-Glossary-5.3.2018.pdf (last visited Nov. 20, 2021). 
39
 See s. 491.005(4)(b)1.a., F.S. The graduate course work must include the following 11 content areas: counseling theories 
and practice; human growth and development; diagnosis and treatment of psychopathology; human sexuality; group theories 
and practice; individual evaluation and assessment; career and lifestyle assessment; research and program evaluation; social 
and cultural foundations; substance abuse; and legal, ethical, and professional standards issues in the practice of mental 
health counseling. Courses in research, thesis or dissertation work, practicums, internships, or fieldwork may not be applied 
toward this requirement.  BILL: PCS/SB 768 (709032)   	Page 15 
 
 An equivalent program to the two previously described options, as determined by the 
Board, including at least 700 hours of university-sponsored supervised clinical 
practicum, internship, or field work, that includes at least 280 hours of direct client 
services, as required by CACREP accrediting standards for mental health counseling 
programs. This experience may not be used to satisfy the post-master’s clinical 
experience requirement; 
 Had at least two years of clinical experience in mental health counseling, which must be at 
the post-master’s level under the supervision of a licensed mental health counselor or the 
equivalent who is a Board qualified supervisor;
40
 
 Passed a theory and practice examination provided by the DOH;
41
 and  
 Demonstrated, in a manner designated by Board rule, knowledge of the laws and rules 
governing the practice of clinical social work, marriage and family therapy, and mental 
health counseling.
42
 
 
Beginning July 1, 2025, an applicant for mental health counseling licensure must have a master’s 
degree from a program that is accredited by the CACREP which consists of at least 60 semester 
hours or 80 quarter hours. 
 
A licensed mental health professional is required to be on the premises when clinical services are 
provided by a registered intern in a private practice setting. Section 491.005, F. S., contains the 
same provision for registered clinical social worker interns. 
 
Recent Legislative History of Section 491.005, F.S. 
The current program accreditation and licensure requirements in s. 491.005, F.S., for social 
workers, marriage and family therapists and mental health counselors were enacted during the 
2020 legislative session. 
 
As of July 1, 2020 an applicant seeking licensure under current s. 491.005(4), F.S., as a mental 
health counselor was required to have a master’s degree from an a program accredited by the 
CACREP beginning July 1, 2025. Until July 1, 2025, mental health counseling students in 
programs related to the practice of mental health counseling that were not accredited by the 
CACREP could still obtain a license as a mental health counselor by satisfying the additional 
statutory requirements in s. 491.005(4), F.S., which required coursework and practicum, 
                                                
40
 Section 491.005(4), F.S., An individual who intends to practice in Florida to satisfy the clinical experience requirements 
must register pursuant to s. 491.0045, F.S., before commencing practice. If a graduate has a master’s degree with a major 
related to the practice of mental health counseling which did not include all the coursework required under sub-subparagraphs 
(b)1.a. and b., credit for the post-master’s level clinical experience may not commence until the applicant has completed a 
minimum of seven of the courses required under sub-subparagraphs (b)1.a. and b., as determined by the Board, one of which 
must be a course in psychopathology or abnormal psychology. A doctoral internship may be applied toward the clinical 
experience requirement. 
41
 See s. 491.004(5), F.S., and Fla. Admin Code R. 64B4-3.003(2)(b) and 3, (2021). The DOH no longer provides the theory 
and practice examination for mental health counselors. The examination used is the National Clinical Mental Health 
Counseling Examination (NCMHCE), clinical simulation examination developed by the National Board for Certified 
Counselors (NBCC). Applicants for licensure by endorsement may use the National Counselor Examination for Licensure 
and Certification (NCE) if the exam was taken prior to the year 2000. The minimum passing score is established by the test 
provider. 
42
 Fla. Admin. Code R. 64B4-3.0035, (2021).  BILL: PCS/SB 768 (709032)   	Page 16 
 
internship, or fieldwork consisting of at least 60 semester hours or 80 quarter hours and meeting 
other specific requirements. This window of time also gave those non-CACREP accredited 
programs time to apply for and obtain CACREP accreditation. 
 
However, for marriage and family therapy licensure candidates, the current s. 491.005(3), F.S., 
contains no similar window of time for students to obtain licensure, or programs to obtain 
CAMFTE or CACREP accreditation. On July 1, 2020, students who had satisfied the previous 
requirements of s. 491.005(3), F.S., for licensure in programs not accredited by the CAMFTE, or 
who were in a Florida program not accredited by the CACREP, became immediately unable to 
obtain a license to practice marriage and family therapy without seeking a variance from the 
Board. 
 
Currently, there are six universities in Florida with a marriage and family program that are not 
accredited by either COAMFTE or CACREP. They are: Carlos Albizu, Jacksonville University, 
Palm Beach Atlantic University, St. Thomas University, University of Miami, and University of 
Phoenix. As a result, students who are presently enrolled in a marriage and family program at 
one of the specified universities will not meet minimum requirements for Florida licensure upon 
graduation, although the programs did meet the requirements at the time of the student’s 
enrollment.
43
  
 
 
Regional Accreditation 
The minimum qualifications for licensure specified in s. 491.005(3), F.S., includes the 
requirement of completion of a graduate program from a “regionally accredited body recognized 
by the Commission on Recognition of Postsecondary Accreditation.” The U.S. Department of 
Education issued a letter of guidance on February 26, 2020, specifying that final regulations 
published that year omit references to “regional” and “national” accreditation. The letter 
specifies, “Because 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. s. 602.32(d), relating to the recognition of accrediting agencies, will 
become effective January 1, 2021.
44
 
 
Department Examination 
The DOH has discontinued the practice of conducting examinations or purchasing examinations 
for licensure. Applicants are presently responsible for coordinating the completion of an 
examination with an approved vendor and submitting passing scores to the applicable board to 
meet minimum qualifications. Current statutory references to the DOH collecting fees for 
examinations or conducting examinations is not consistent with current practice.
45
 
 
Florida Birth-Related Neurological Injury Compensation Association (NICA) 
In 1988 the Florida Legislature created the Florida Birth-Related Neurological Injury 
Compensation Association (NICA), to provide compensation, long-term medical care, and other 
                                                
43
 Department of Health, Senate Bill 768 2022 Agency Legislative Bill Analysis - Mental Health Professionals (July 23, 2021) 
(on file with the Senate Committee on Health Policy.) 
44
 Id. 
45
 Id.  BILL: PCS/SB 768 (709032)   	Page 17 
 
services to persons with birth-related neurological injuries.
46
 If an infant suffers such an injury, 
and the physician participates in NICA and delivers obstetrical services in connection with the 
birth, then an administrative award for a compensable injury is the infant’s sole and exclusive 
remedy for the injury, with exceptions.
47
 Although the benefits paid under the Florida Birth-
Related Neurological Injury Compensation Plan (the Plan) are limited, the Plan does not require 
the claimant to prove malpractice and provides a streamlined administrative hearing process to 
resolve the claim.
48
 
 
A “birth-related neurological injury” is an injury to the brain or spinal cord of a live infant who 
weighs at least 2,500 grams for a single gestation or, in the case of a multiple gestation, a live 
infant who weighs at least 2,000 grams at birth caused by oxygen deprivation or by mechanical 
injury occurring in the course of labor, delivery, or resuscitation in the immediate post-delivery 
period in a hospital.
49
 Such an injury addressed by this statute renders the infant permanently and 
substantially mentally and physically impaired.
50
 
 
The NICA is an independent association, and was created by the Legislature to manage the Plan. 
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 the 
NICA’s board are appointed by the Chief Financial Officer for staggered terms of three years or 
until their successor is appointed, but there is no limit on the number of terms a director may 
serve.
51
 The five-member board of directors of NICA administers the Plan.
52
 The board of 
directors is composed of: 
 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.
53
 
 
The duties of the NICA board of directors include: 
 Administering the Plan; 
 Administering the funds collected on behalf of the Plan; 
 Reviewing and paying claims; 
 Directing the investment and reinvestment of any surplus funds over losses and expenses, 
provided that any investment income generated thereby remains credited to the Plan; 
 Reinsuring the risks of the Plan in whole or in part; 
 Suing and being sued, appearing and defending, in all actions and proceedings in its name; 
                                                
46
 Chapter 88-1, ss. 60-75, Laws of Fla., was enacted by the Legislature to stabilize and reduce malpractice insurance 
premiums for physicians practicing obstetrics. The intent of the Legislature is to provide compensation, on a no-fault basis, 
for a limited class of high costs catastrophic injuries, specifically birth-related neurological injuries, that result in unusually 
high costs for custodial care and rehabilitation. Section 766.301, F.S. 
47
 Section 766.31(1), F.S.  
48
 See Florida Birth-Related Neurological Injury Compensation Ass’n v. McKaughan, 668 So.2d 974, 977 (Fla. 1996). 
49
 Section 766.302(2), F.S. 
50
 Id. 
51
 Section 766.315, F.S., and ch. 88-1, s. 74, Laws of Fla. 
52
 Sections 766.315(1) and (2), F.S. 
53
 Section 766.315, F.S., and ch. 88-1, s. 74, Laws of Fla.  BILL: PCS/SB 768 (709032)   	Page 18 
 
 Exercising all powers necessary or convenient to effect any or all of the purposes for which 
the Plan was created; 
 Entering into such contracts as are necessary or proper to administer the Plan; 
 Employing or retaining such persons as are necessary to perform the administrative and 
financial transactions and responsibilities of the Plan; 
 Taking such legal action as may be necessary to avoid payment of improper claims; and 
 Indemnifying any person acting on behalf of the Plan in an official capacity, provided that 
such person acted in good faith.
54
 
 
Annually, the NICA must furnish audited financial reports to: 
 Any Plan participant upon request; 
 The OIR; and 
 The Joint Legislative Auditing Committee.
55
 
 
The reports must be prepared in accordance with accepted accounting procedures. The OIR or 
the Joint Legislative Auditing Committee may conduct an audit of the Plan at any time.
56
 
 
NICA Funding 
The initial funding for the Plan is derived from an appropriation of $20 million by the 
Legislature at the time the Plan was created
57
 and annual assessments paid by physicians and 
hospitals.
58
 A participating physician is required to pay a $5,000 fee each year for coverage 
which runs January 1 through December 31.
59
 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 facilities.
60
 In 2019, NICA collected $26,989,960 
in hospital and physician assessments. In 2020, NICA collected $27,000,000.
61
  
 
Section 766.314, F.S., requires the OIR to maintain a $20 million reserve in the Insurance 
Regulatory Trust Fund. If the assessments collected and the appropriation of funds provided by 
ch. 88-277, s. 41, Laws of Florida, to the Plan from the trust fund are insufficient to maintain the 
Plan on an actuarially sound basis, the OIR is authorized to transfer an additional amount up to 
$20 million to the NICA from the Insurance Regulatory Trust Fund reserve.
62
 
 
Obsolete Statutory References and Provisions 
Currently, s. 766.314, F.S., contains numerous references to the Department of Business and 
Professional Regulation (DBPR) as the agency housing the Florida Board of Medicine and the 
                                                
54
 Section 766.315(4), F.S. 
55
 Section 766.315(5)(e), F.S. 
56
 Id. 
57
 Section 766.314(5)(b), F.S. 
58
 Section 766.314, F.S. 
59
 Id. 
60
 Id. 
61
 Turner Consulting, Inc., Proposed Increase in Parental Award – Section 766.31 (1) (b) (1), Florida Statutes (Jan. 14, 
2020). 
62
 Section 766.314(5)(b), F.S.  BILL: PCS/SB 768 (709032)   	Page 19 
 
Florida Board of Osteopathic Medicine. All medical boards were moved to the DOH in the early 
2000s. DOH accepted all of the responsibilities in this statute when the boards moved; however, 
the statute still indicates that these functions should be performed by the DBPR. In addition, the 
statute contains obsolete language related to how the initial NICA assessment was collected in 
1988. This language is no longer needed. 
 
"Following Year" Assessments 
The statute requires the DBPR to collect the initial NICA assessment (fee) from all applicants. 
The statute also requires that if a license is being issued between October 1 and December 31, 
the DBPR is to collect the fee for the following year. 
 
Currently, the DOH is not collecting the “following year” fees from individuals licensed during 
the specified period. Every licensee pays the initial NICA assessment (ranging from $0 to 
$5,000) at the time of application. The “following year” fees have been collected directly by 
NICA since the boards were moved to the DOH. NICA requires fees to be paid by January 31 of 
the calendar year. 
 
Data Sharing with NICA  
The statute requires the DBPR to provide a listing in a computer-readable format of the names 
and addresses of physicians licensed under chs. 458 and 459, F.S., as often “as determined to be 
necessary.” 
 
Currently, the DOH provides NICA with a list of newly licensed physicians each month, 
including their license numbers, the date they were licensed, and the fees collected. Any 
additional information that NICA may need can be downloaded from DOH’s website. This 
coincides with the transfer of those fees collected by the DOH to NICA, allowing NICA to 
reconcile the amount received with the fees listed in the monthly report. 
 
III. Effect of Proposed Changes: 
Targeted Outreach for Pregnant Women 
 
The PCS amends s. 381.0045, F.S., to: 
 Add pregnant women who are suffering from mental health problems to the list of outreach 
targets; 
 Encourage high risk pregnant women to get tested for other sexually transmissible diseases, 
as well as HIV, per DOH rule; 
 Provide pregnant women with information on: 
o The need for antiretroviral medications, deleting reference to a single type of 
antiretroviral (AZT), for themselves and their newborn; and 
o How to access antiretroviral medications after discharge from the hospital; 
 Link women to mental health services; and 
 Require additional follow up for HIV-exposed newborns to determine final HIV status and 
ensure continued linkages to care, if needed. 
  BILL: PCS/SB 768 (709032)   	Page 20 
 
Special Needs Shelters 
The PCS amends s. 381.0303, F.S., and removes CMS from responsibility for coordinating local 
medical and health care providers, the American Red Cross, and other interested parties in 
developing a plan for the staffing and medical management of pediatric special needs shelters. 
The PCS instead specifies that the DOH has the sole lead-agency responsibility in the 
coordination of local medical and health care providers for the staffing and management of 
pediatric special needs shelters and is the decision-making authority for determining the medical 
supervision in each special needs shelter. Under the bill, the DOH will no longer share that duty 
with CMS. 
 
Medical Marijuana Sampling and Testing 
The PCS amends s. 381.986, F.S., related to the medical use of marijuana to: 
 Allow the DOH to collect samples of marijuana and marijuana delivery devices from a 
MMTC for specified testing. Currently, the DOH may only collect samples of edibles;  
 Expand MMTC recall requirements to all marijuana products and delivery devices, rather 
than only edibles; and 
 Provide an exception from criminal laws for DOH employees to acquire, possess, test, 
transport, and lawfully dispose of marijuana and marijuana delivery devices. 
 
Additional Disclosure Requirement for Physician Licensure and Renewal 
The PCS amends s. 456.039, F.S., requiring require each physician seeking licensure, or license 
renewal, under chs, 458 or 459, F.S., to provide, in addition to the other requirements, proof of 
payment of the NICA assessment required under s. 766.314, F.S., if applicable. 
 
Chiropractic Licensure 
The PCS amends s. 460.406, F.S., to deletes references to the term “regional” and replaces it 
with the term “institutional” to conform with the U.S. Department of Education accreditation 
nomenclature for approving educational institutions. 
 
Nursing Licensure and Disciplinary Actions 
The PCS amend s. 464.008, F.S., and deletes the requirement that graduates from an approved 
nursing program who do not take the licensure examination within six months after graduation, 
must successfully complete and pay for a board-approved licensure examination preparatory 
course.  
 
The PCS also amends s. 464.018(1)(e), F.S., and moves the placement of the phrase, “regardless 
of adjudication,” after the phrase “[h]aving been found guilty of, or entered a plea of nolo 
contendere or guilty to”, to clarify that “regardless of adjudication” does not apply only to guilty 
pleas but to any plea to offenses listed in ss. 435.04, F.S., or 741.28, F.S. 
  BILL: PCS/SB 768 (709032)   	Page 21 
 
Midwifery 
The PCS amends s. 467.003(12) to clearly define “preceptor” in the midwifery education 
process. Specifically, the PCS provides that a preceptor may not supervise an individual as a 
midwifery student unless the student has been enrolled in an approved midwifery program. 
 
The PCS defines “prelicensure course” to mean a course of study, offered by an accredited 
midwifery program and approved by the DOH, which an applicant for licensure must complete 
before a license may be issued, and which provides instruction in the laws and rules of Florida 
and demonstrates the student’s competency to practice midwifery. The PCS clarifies language to 
promote consistency in terminology and that midwifery programs must incorporate all required 
standards, guidelines, and education objectives. 
 
The PCS also clarifies that both a high school diploma or the equivalent and three college-level 
credits in math and English or demonstration of competency in communication and computation 
may be required for admission to a midwifery program. The PCS amends s. 467.009, F.S., and 
requires, for the accreditation and approval of midwifery programs, that a program’s clinical 
training must include all of the following: 
 Care for 50 women in each of the prenatal, intrapartal, and postpartal periods under the 
supervision of a preceptor; 
 Observation of an additional 25 women in the intrapartal period before qualifying for a 
license; 
 Training in a hospital and alternate birth settings or both; and 
 Assessment and differentiation between a high-risk and low-risk pregnancy. 
 
The PCS amends s. 467.011, F.S., to require the following for the issuance of a midwifery 
license: 
 Application and fee; 
 Graduation from: 
o An accredited and approved midwifery program; 
o A medical or midwifery program offered in another jurisdiction whose graduation 
requirements were equivalent to or exceeded those required in Florida; 
o Completion of a prelicensure course offered by an accredited and approved midwifery 
program; and 
o A passing score on the examination specified by the DOH. 
 
The PCS amends s. 467.0125, F.S, to repeal the abbreviated oral examination to determine the 
applicant’s competency without a written examination for temporary certificates and clarifies the 
criteria for obtaining a license by endorsement and temporary certificate to practice in areas of 
critical need. The PCS does not specifically define “areas of critical need” for temporary 
certificates but requires the applicant to: 
 Specify that he or she will only practice in one or more of the following areas: 
o A county health department; 
o A correctional facility; 
o A U.S. Department of Veterans’ Affairs clinic; 
o A community health center funded by s. 329, s. 330, or s. 340 of the United States Public 
Health Service Act;  BILL: PCS/SB 768 (709032)   	Page 22 
 
o Any other agency or institution that is approved by the state Surgeon General that 
provides health care to meet the needs of an underserved populations in this state; or  
o Areas of critical need determined by the state Surgeon General, which areas include, but 
are not be limited to, health professional shortage areas designated by the U.S. 
Department of Health and Human Services. 
 Practice only under the supervision of a physician, an APRN certified nurse midwife or a 
midwife licensed under ch. 467, F.S., who has a minimum of three years professional 
experience; and 
 Voluntarily relinquish the temporary certificate, or report a new practice area of critical need 
to the DOH, if his or her current practice area ceases to be an area of critical need. 
 
The PCS amends s. 467.205, F.S., to update the DOH’s approval process of midwifery programs 
to allow such programs to be provisionally approved for five years. This conforms to the five-
year period provisional licensure period the Florida Department of Education’s Commission for 
Independent Education uses when seeking accreditation status. For private institutions, the PCS 
adds to the CHEA, an accrediting agency approved by the U.S. Department of Education, as an 
institutional accrediting agency for direct-entry midwifery education programs and its licensing 
or provisional licensing by the Commission for Independent Education. The DOH will be able to 
give provisional approval to a new program that has meet all requirements except for showing its 
students have an 80-percent passage rate on the national exam. Programs provisionally approved 
will have five years to demonstrate the required exam approval rate after they are preliminary 
approved. This time period should allow completion the three-year education program for at least 
one cohort of students and for those students to take the exam before the DOH tries to determine 
the passing rate.
63
 
 
The PCS requires the DOH to certify every three years whether each approved midwifery 
program is compliant and has maintained compliance with the requirements of s. 467.009, F.S., 
or has lost its accreditation status. The DOH must provide its finding to the program in writing 
and may place the program on probationary status for a specified period of time, not to exceed 
three years. If a program on probationary status does not come into compliance or regain its 
accreditation status within the specified time, the DOH may rescind the program’s approval. 
 
Practice of Orthotics, Prosthetics, and Pedorthics 
The PCS amends part XIV of ch. 468, F.S., to reflect current procedures for applicants to obtain 
a criminal history check and the method of transmission to the DOH for review. The DOH no 
longer collects fingerprint forms or fees from applicants to process the initial criminal history 
check for licensure. Applicants are required to complete fingerprinting electronically through 
independent vendors and provide an originating agency identifier number specific to the 
profession for the results to be submitted to the DOH. If a criminal history is indicated, the 
BOAP will review the application for consideration of licensure.
64
 
 
The PCS also amends the educational requirements for orthotists and prosthetists. The orthoptist  
                                                
63
 Department of Health, Senate Bill 768 2022 Agency Legislative Bill Analysis - Midwifery (July 23, 2021) (on file with the 
Senate Committee on Health Policy). 
64
 Department of Health, Senate Bill 768 Fiscal Analysis - Practice of Orthotics, Prosthetics, and Pedorthics (July 23, 2021) 
(on file with the Senate Committee on Health Policy).  BILL: PCS/SB 768 (709032)   	Page 23 
 
and prosthetists acceptable bachelor of science or higher-level postgraduate degree in orthotics 
and prosthetics from an accredited college or university must now also specifically be recognized 
by the Commission on Accreditation of Allied Health Education Programs. 
 
The PCS deletes references to the term “regionally accredited” and replaces it with the term 
“institutionally accredited” or simply references the programmatic accrediting body to conform 
with the U.S. Department of Education accreditation nomenclature for approving educational 
institutions.
65
 
 
Clinical Lab Personnel 
The PCS amends s. 483.824(2), F.S., to delete the reference to the term “regionally” and replace 
it with “institutionally” in regard to the accredited institution at which a clinical laboratory 
director is required to have earned a doctoral degree in a chemical, physical, or biological 
science. 
 
Psychologists 
The PCS amends ss. 490.003, 490.005, and 490.0051, F.S., to clarify definitions and the 
educational requirements for psychologists applying for licensure by examination or provisional 
licensure. 
 
The PCS defines a “doctoral degree from an APA accredited program” as a Psy.D., an Ed.D. in 
psychology, or a Ph.D. in psychology from a psychology program at an educational institution 
that, at the time the applicant was enrolled and graduated had both an institutional accreditation 
from an agency recognized and approved by the U.S. Department of Education or was as 
recognized as a member in good standing with the Association of Universities and Colleges of 
Canada, and had programmatic accreditation from the APA. 
 
The PCS further defines “doctoral degree in psychology” as a Psy.D., an Ed.D. in psychology, or 
a Ph.D. in psychology from a psychology program at an educational institution that, at the time 
the applicant was enrolled and graduated, had institutional accreditation from an agency 
recognized and approved by the U.S. Department of Education or was recognized as a member 
in good standing with the Association of Universities and Colleges of Canada. 
 
The PCS requires psychologists applying for licensure to have obtained a doctoral degree from: 
 An APA accredited program; or 
 The equivalent of a degree from APA-accredited program from a school or university located 
outside the United States which was officially recognized by the government of the country 
in which it is located as an institution or program to train students to practice professional 
psychology. 
 
Provisional licensure applicants must have earned a degree from an APA accredited program. 
                                                
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 Department of Health, Senate Bill 768 2022 Agency Legislative Bill Analysis - Practice of Orthotics, Prosthetics, and 
Pedorthics (July 23, 2021) (on file with the Senate Committee on Health Policy).  BILL: PCS/SB 768 (709032)   	Page 24 
 
Lack of a degree from an APA-accredited program would be grounds for denial of licensure 
under the PCS. 
 
Mental Health Professionals 
The PCS amends s. 491.005, F.S., effective upon the bill becoming law, to create three pathways 
to licensure for applicants for a marriage and family therapy license to meet the minimum 
educational requirements by one of the following methods: 
 A minimum of a master’s degree in marriage and family therapy from a college or university 
that is accredited by the CAMFTE; 
 A minimum of a master’s degree with an emphasis in marriage and family therapy from a 
college or university that is accredited by the CACREP and graduate courses approved by the 
board; or 
 A minimum of a master’s degree with an emphasis in marriage and family therapy or a 
closely related field, with a degree conferred date before September 1, 2027, from an 
institutionally accredited college or university. 
 
The PCS updates the education requirements for marriage and family therapists, including 
current law’s obsolete reference to accreditation by CORPA, which was dissolved in 1997. The 
PCS replaces the CORPA with the CHEA or its successors. 
 
The PCS deletes references to the term “regional” in s. 491.005(3), F.S., and replaces it with the 
term “institutional” to conform with the U.S. Department of Education accreditation 
nomenclature for approving educational institutions and deletes obsolete statutory references to 
the DOH collecting fees for examinations or conducting examinations. 
 
Florida Birth-Related Neurological Injury Compensation Association (NICA) 
The PCS amends s. 766.314, F.S., deleting references to the DBPR and revising the frequency 
and content of certain reports which the DOH must submit to the NICA. The PCS eliminates 
unnecessary and obsolete language regarding the initial fees collected in 1988.  
 
The PCS deletes obsolete language and updates provisions to conform to current law. The PCS 
authorizes the NICA to enforce the collection of physician assessments in circuit court under 
certain circumstances and requires the NICA to notify the DOH and the appropriate regulatory 
board of any unpaid final judgments against a physician within seven days of the issuance of a 
final judgment. 
 
The PCS updates the provisions regarding data sharing with the NICA to reflect current DOH 
practice and requires DOH to continue providing NICA with an electronic monthly report of 
physicians licensed in the previous month, including their license numbers, the date they were 
licensed, and the fees collected. 
 
The PCS provides an effective date of July 1, 2022, except as otherwise provided. 
  BILL: PCS/SB 768 (709032)   	Page 25 
 
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. 
E. Other Constitutional Issues: 
None. 
V. Fiscal Impact Statement: 
A. Tax/Fee Issues: 
None. 
B. Private Sector Impact: 
None. 
C. Government Sector Impact: 
The DOH indicates it will experience a non-recurring workload increase associated with 
updating online applications and websites; limited costs associated with rule making; 
limited costs associated with updating licensure databases and the License and 
Enforcement System; and minimal costs associated with testing from MMTCs. 
According to the DOH, current resources are adequate to absorb these costs.
66
 
VI. Technical Deficiencies: 
None. 
VII. Related Issues: 
None. 
                                                
66
 Department of Health, Senate Bill 768 2022 Agency Legislative Bill Analysis- Practice of Orthotics, Prosthetics, and 
Pedorthics (July 23, 2021) (on file with the Senate Committee on Health Policy)  BILL: PCS/SB 768 (709032)   	Page 26 
 
VIII. Statutes Affected: 
This PCS substantially amends the following sections of the Florida Statutes: 381.0045, 
381.0303, 381.986, 456.039, 460.406, 464.008, 464.018, 467.003, 467.009, 467.011, 
467.0125, 467.205, 468.803, 483.824, 490.003, 490.005, 490.0051, 491.005, and 
766.314. 
IX. Additional Information: 
A. Committee Substitute – Statement of Changes: 
(Summarizing differences between the Committee Substitute and the prior version of the bill.) 
None. 
B. Amendments: 
None. 
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.