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/SB 768
INTRODUCER: Health Policy Committee and Senator Rodriguez
SUBJECT: Department of Health
DATE: February 25, 2022
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Van
Winkle and Looke
Brown
HP
Fav/CS
2. Howard Money AHS Recommend: Favorable
3. Howard Sadberry AP Pre-meeting
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 768 addresses numerous health care-related issues regulated by the Department of Health
(DOH). The bill:
Updates the “Targeted Outreach for Pregnant Women Act of 1998”;
Amends section 381.0303, Florida Statutes., 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 the 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 sections 460.406, 468.803, 483.824, and 490.005, Florida Statutes, to delete
references to the term “regional” and replace it with the term “institutional” to conform with
REVISED: BILL: CS/SB 768 Page 2
the U.S. Department of Education accreditation nomenclature for approving health care-
related educational institutions; and
Amends section 766.314, Florida Statutes, authorizing the Florida Birth-Related
Neurological Injury Compensation Association (NICA) to collect and enforce physician
assessments in circuit 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 bill is projected to have an insignificant negative fiscal impact on the DOH, however, the
agency can absorb this impact within existing resources.
The bill 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 Department of Health (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
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: CS/SB 768 Page 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.
The DOH has developed a GR-funded program, Baby Rxpress, which provides a six-week
course of antiretroviral (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 responsibility for the
coordination of 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 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
4
Id.
5
Section 381.0303(1), F.S.
6
Section 381.0303(2), F.S. BILL: CS/SB 768 Page 4
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 the CMS
workforce, the DOH advises that the CMS is unable to fulfill its responsibilities under s.
381.3030, F.S.
7
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
7
Department of Health, 2022 Senate Bill 768 Fiscal Analysis (July 23, 2021) (on file with the Senate Committee on Health
Policy).
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). BILL: CS/SB 768 Page 5
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:
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
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.
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). BILL: CS/SB 768 Page 6
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
Currently, a person desiring to practice nursing in the state of 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 six 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
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
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: CS/SB 768 Page 7
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.
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.
23
Section 467.003(8), F.S. BILL: CS/SB 768 Page 8
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
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;
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. BILL: CS/SB 768 Page 9
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 the DOH rules and the health laws of Florida. The midwife
must:
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 a 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.
27
Section 467.015, F.S. BILL: CS/SB 768 Page 10
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
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
28
Section 467.205, F.S.
29
Section 468.80, F.S.
30
Section 483.803(4), F.S. BILL: CS/SB 768 Page 11
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.
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 BILL: CS/SB 768 Page 12
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
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.
31
Section 491.0046, F.S.
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: CS/SB 768 Page 13
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
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.
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: CS/SB 768 Page 14
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.
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
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 BILL: CS/SB 768 Page 15
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 graduate program must have emphasized the
common core curricular experience; or
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 the 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.
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.
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: CS/SB 768 Page 16
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 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,
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 the 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
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. BILL: CS/SB 768 Page 17
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
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;
45
Id.
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. BILL: CS/SB 768 Page 18
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;
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,
53
Section 766.315, F.S., and ch. 88-1, s. 74, Laws of Fla.
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. BILL: CS/SB 768 Page 19
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
Florida Board of Osteopathic Medicine. All medical boards were moved to the DOH in the early
2000s. The 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 the 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.
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: CS/SB 768 Page 20
III. Effect of Proposed Changes:
Targeted Outreach for Pregnant Women
The bill 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 human immunodeficiency virus (HIV), per the Department of Health (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.
Special Needs Shelters
The bill amends s. 381.0303, F.S., and removes Children’s Medical Services (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 bill 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 bill 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
medical marijuana treatment center (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 the 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 bill amends s. 456.039, F.S., requiring 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 Neurological Injury Compensation Association (NICA) assessment required under s.
766.314, F.S., if applicable.
BILL: CS/SB 768 Page 21
Chiropractic Licensure
The bill amends s. 460.406, F.S., to delete 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 bill 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 bill 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.
Midwifery
The bill amends s. 467.003(12) to clearly define “preceptor” in the midwifery education process.
Specifically, the bill 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 bill 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 bill clarifies language to
promote consistency in terminology and that midwifery programs must incorporate all required
standards, guidelines, and education objectives.
The bill 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 bill 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 or alternate birth settings or both; and
Assessment and differentiation between a high-risk and low-risk pregnancy.
The bill 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; BILL: CS/SB 768 Page 22
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 bill 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 bill 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;
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 Advanced Practice Registered Nurse
(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 bill 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 bill
adds to the Council for Higher Education Accreditation (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 met 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.
The bill 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.
BILL: CS/SB 768 Page 23
Practice of Orthotics, Prosthetics, and Pedorthics
The bill 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.
63
The bill also amends the educational requirements for orthotists and prosthetists. The orthoptist
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 bill 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.
64
Clinical Lab Personnel
The bill 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 bill 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 bill 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
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).
The bill 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
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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).
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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: CS/SB 768 Page 24
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 bill requires psychologists applying for licensure to have obtained a doctoral degree from:
An APA accredited program; or
The equivalent of a degree from an 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.
Lack of a degree from an APA-accredited program would be grounds for denial of licensure
under the bill.
Mental Health Professionals
The bill 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 Commission on Accreditation for Marriage and Family Therapy
Education (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 Council on Accreditation of Counseling and
Related Educational Programs (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 before September 1, 2027, from an
institutionally accredited college or university.
The bill updates the education requirements for marriage and family therapists, including current
law’s obsolete reference to accreditation by Commission on Recognition of Postsecondary
Accreditation (CORPA), which was dissolved in 1997. The bill replaces the CORPA with the
CHEA or its successors.
The bill deletes references to the term “regional” in s. 491.005(3), F.S., and replaces it with the
term “institutional” to conform to 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 bill amends s. 766.314, F.S., deleting references to the Department of Business and
Professional Regulation (DBPR) and revising the frequency and content of certain reports which
the DOH must submit to the NICA. The bill eliminates unnecessary and obsolete language
regarding the initial fees collected in 1988.
BILL: CS/SB 768 Page 25
The bill deletes obsolete language and updates provisions to conform to current law. The bill
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 bill updates the provisions regarding data sharing with the NICA to reflect current DOH
practice and requires the 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 bill provides an effective date of July 1, 2022, except as otherwise provided.
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 Department of Health (DOH) indicates it will experience a non-recurring workload
increase associated with updating online applications and websites; limited costs BILL: CS/SB 768 Page 26
associated with rule making; limited costs associated with updating licensure databases
and the License and Enforcement System; and minimal costs associated with testing from
medical marijuana treatment centers (MMTCs). According to the DOH, current resources
are adequate to absorb these costs.
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VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill 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 Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Health Policy on January 26, 2022:
The CS:
Removes the underlying bill's provisions relating to emergency medical services;
Requires allopathic and osteopathic physicians who apply to the DOH for Florida
licensure to provide proof of payment of any NICA assessments, as applicable;
Requires NICA to inform the DOH and the applicable regulatory board of an unpaid
final judgment against a physician within seven days of the final judgment;
Removes authority granted by the underlying bill for counseling interns to provide
services via telehealth under certain conditions; and
Makes technical corrections to the underlying bill's provisions relating to practitioner
education requirements for numerous practitioner types.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.
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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)