Florida Senate - 2022 SB 1144 By Senator Brodeur 9-01005A-22 20221144__ 1 A bill to be entitled 2 An act relating to certificates of public convenience 3 and necessity; amending s. 401.25, F.S.; exempting 4 certain governmental entities from the requirement to 5 obtain a certificate of public convenience and 6 necessity for a license to provide advanced life 7 support services; providing requirements for, and 8 limitations on, the provision of advanced life support 9 services by such entities; defining the term 10 countywide common medical protocol; providing 11 applicability; prohibiting counties from limiting, 12 prohibiting, or preventing such entities from 13 providing advanced life support services; providing 14 construction; amending s. 401.26, F.S.; conforming a 15 provision to changes made by the act; amending s. 16 401.265, F.S.; providing that a medical director is 17 liable for any act or omission of a paramedic under 18 his or her supervision who administers medical 19 countermeasures in a nonemergency environment; 20 amending s. 401.272, F.S.; defining the terms health 21 promotion and wellness activities and medical 22 countermeasures; authorizing paramedics to administer 23 medical countermeasures in a nonemergency environment 24 under the direction of a medical director; providing 25 that a paramedics medical director may have a certain 26 required written agreement with the Department of 27 Health, rather than only with a county health 28 department; requiring medical directors to verify and 29 document that paramedics under their direction have 30 received sufficient training and experience to 31 administer medical countermeasures; authorizing 32 independent special fire control districts to allow 33 their paramedics and emergency medical technicians to 34 perform certain activities and administer certain 35 services in accordance with specified provisions; 36 creating the Florida Certificate of Public Convenience 37 and Necessity Task Force within the Department of 38 Health for a specified purpose; providing duties and 39 membership of the task force; requiring the task force 40 to hold its first meeting within a specified 41 timeframe; requiring the task force to submit a report 42 of its findings and recommendations to the Governor 43 and the Legislature within a specified timeframe; 44 requiring the department to provide administrative 45 support to the task force; providing for dissolution 46 of the task force; providing an effective date. 47 48 Be It Enacted by the Legislature of the State of Florida: 49 50 Section 1.Subsection (8) is added to section 401.25, 51 Florida Statutes, to read: 52 401.25Licensure as a basic life support or an advanced 53 life support service. 54 (8)(a)Notwithstanding paragraph (2)(d) or any general law, 55 special act, or local ordinance to the contrary, and except as 56 provided in paragraph (b), the department shall issue a 57 governmental entity a license to provide advanced life support 58 services without requiring it to obtain a certificate of public 59 convenience and necessity if the governmental entity maintains a 60 fire rescue infrastructure that dispatches first responders as 61 defined in s. 112.1815(1) and meets all other licensure 62 requirements of this section. A governmental entity issued a 63 license under this subsection is subject to all of the following 64 requirements and limitations: 65 1.The governmental entity must require its medical 66 director to issue standing orders or protocols to implement the 67 minimum medical standards of any countywide common medical 68 protocol applicable to the entity, if such protocol is 69 instituted. An entity must submit an affidavit with its 70 licensure application certifying that its medical director has 71 issued such standing orders or protocols. As used in this 72 subparagraph, countywide common medical protocol means minimum 73 medical standards issued by a countys medical director or a 74 council created by county ordinance which specify protocols for 75 the provision of basic and advanced life support services in 76 that county. Such standards must be based on whether the 77 procedures are being performed by an emergency medical 78 technician or a paramedic and not based on the employer of, or 79 type of response vehicle used by, such emergency medical 80 personnel. 81 2.The governmental entity is eligible only for advanced 82 life support nontransport vehicle permits issued under s. 83 401.26. 84 3.The governmental entity may provide only nontransport 85 advanced life support services and is authorized to provide such 86 services within its jurisdictional boundaries and areas that it 87 serves in accordance with a closest unit response agreement or 88 mutual or automatic aid agreement. 89 (b)The exemption under this subsection does not apply to a 90 governmental entity that: 91 1.Is located within a county in which there is a 92 countywide emergency medical services authority created by 93 special act; 94 2.Is located within a county that has more than 35 95 municipalities; or 96 3.Contracts with a private entity to provide emergency 97 medical services. 98 (c)A county may not limit, prohibit, or prevent a 99 governmental entity that has been issued a license under this 100 subsection from providing nontransport advanced life support 101 services, including, but not limited to, requiring the 102 governmental entity to obtain a license, certificate, or vehicle 103 permit or to pay a fee to provide such services in that county. 104 (d)This subsection may not be construed to exempt an 105 applicant from any other requirement for licensure or to exempt 106 a licensee from otherwise complying with this part or department 107 rules. 108 Section 2.Subsection (1) of section 401.26, Florida 109 Statutes, is amended to read: 110 401.26Vehicle permits for basic life support and advanced 111 life support services. 112 (1)Every licensee shall possess a valid permit for each 113 transport vehicle, advanced life support nontransport vehicle, 114 and aircraft in use. Applications for such permits must shall be 115 made upon forms prescribed by the department. The licensee shall 116 provide documentation that each vehicle for which a permit is 117 sought meets the appropriate requirements for a basic life 118 support or advanced life support service vehicle, whichever is 119 applicable, as specified by rule of the department. A permit is 120 not required for an advanced life support nontransport vehicle 121 that is intended to be used for scene supervision, incident 122 command, or the augmentation of supplies. A governmental entity 123 issued a license under s. 401.25(8) is eligible only for an 124 advanced life support nontransport vehicle permit. 125 Section 3.Subsection (4) of section 401.265, Florida 126 Statutes, is amended to read: 127 401.265Medical directors. 128 (4)Each medical director who uses a paramedic or emergency 129 medical technician to perform blood pressure screenings or 130 screening, health promotion, and wellness activities, or to 131 administer immunizations or medical countermeasures in a 132 nonemergency environment immunization on any patient under a 133 protocol as specified in s. 401.272, which is not in the 134 provision of emergency care, is liable for any act or omission 135 of any paramedic or emergency medical technician acting under 136 his or her supervision and control when performing such 137 activities and services. 138 Section 4.Section 401.272, Florida Statutes, is amended to 139 read: 140 401.272Emergency medical services community health care. 141 (1)As used in this section, the term: 142 (a)Health promotion and wellness activities means the 143 provision of public health programs relating to the prevention 144 or reduction of illness or injury. 145 (b)Medical countermeasures means lifesaving medication 146 or medical supplies regulated by the United States Food and Drug 147 Administration which can be used to diagnose, prevent, protect 148 from, or treat conditions associated with chemical, biological, 149 radiological, or nuclear threats, emerging infectious diseases, 150 or natural disasters. 151 (2)The purpose of this section is to encourage more 152 effective utilization of the skills of emergency medical 153 technicians and paramedics by enabling them to perform, in 154 partnership with local county health departments, specific 155 additional health care tasks that are consistent with the public 156 health and welfare. 157 (3)(2)Notwithstanding any other provision of law to the 158 contrary: 159 (a)Paramedics or emergency medical technicians may perform 160 health promotion and wellness activities and blood pressure 161 screenings in a nonemergency environment, within the scope of 162 their training, and under the direction of a medical director. 163 As used in this paragraph, the term health promotion and 164 wellness means the provision of public health programs 165 pertaining to the prevention of illness and injury. 166 (b)Paramedics may administer immunizations or medical 167 countermeasures in a nonemergency environment, within the scope 168 of their training, and under the direction of a medical 169 director. There must be a written agreement between the 170 paramedics medical director and the department or the county 171 health department located in each county in which the paramedic 172 administers immunizations or medical countermeasures. This 173 agreement must establish the protocols, policies, and procedures 174 under which the paramedic must operate. 175 (4)(3)Each medical director under whose direction a 176 paramedic administers immunizations or medical countermeasures 177 must verify and document that the paramedic has received 178 sufficient training and experience to administer immunizations 179 or medical countermeasures, as applicable. The verification must 180 be documented on forms developed by the department, and the 181 completed forms must be maintained at the service location of 182 the licensee and made available to the department upon request. 183 (5)An independent special fire control district as defined 184 in s. 191.003 may allow its paramedics and emergency medical 185 technicians to perform blood pressure screenings or health 186 promotion and wellness activities or administer immunizations or 187 medical countermeasures in accordance with this section. 188 (6)(4)The department may adopt and enforce all rules 189 necessary to enforce the provisions relating to a paramedics 190 administration of immunizations and medical countermeasures and 191 the performance of health promotion and wellness activities and 192 blood pressure screenings by a paramedic or emergency medical 193 technician in a nonemergency environment. 194 Section 5.The Florida Certificate of Public Convenience 195 and Necessity Task Force, a task force as defined in s. 196 20.03(8), Florida Statutes, is created within the Department of 197 Health to evaluate the need to continue the certificate of 198 public convenience and necessity (COPCN) requirement imposed 199 under s. 401.25(2)(d), Florida Statutes. 200 (1)The task force shall undertake a review and analysis of 201 the states licensure of emergency medical services providers 202 under chapter 401, Florida Statutes, including the county-level 203 COPCN process, and programs and determine if changes are 204 necessary to ensure quality of care and access to emergency 205 medical services for all state residents. In its review and 206 analysis, the task force shall, at a minimum, do all of the 207 following: 208 (a)Perform a comprehensive review of the states licensure 209 of emergency medical services providers, including an analysis 210 of the scope, existing authority, and structure of the 211 department and counties, to determine if any changes are 212 necessary to improve efficiency, effectiveness, and alignment 213 with the evolving provision of emergency medical services in 214 this state since chapter 401, Florida Statutes, was adopted in 215 1973. 216 (b)Perform an analysis of how the COPCN process and 217 provision of emergency medical services operate within each 218 county of this state. 219 (c)Identify any challenges to the states licensure of 220 emergency medical services providers at the state and county 221 levels. 222 (d)Identify how the COPCN process benefits and restricts 223 the provision of emergency medical services within a county, 224 including the impacts to rural areas. 225 (e)Identify challenges of the COPCN process to alternative 226 methods of providing emergency medical services, such as fire 227 rescue-based emergency medical services, treatment in place, 228 transport to nonemergency locations, and community paramedicine. 229 (f)Analyze the positive and negative impacts of the 230 suspension of the COPCN requirement in this state during the 231 COVID-19 pandemic. 232 (g)Identify how the COPCN process ensures the delivery of 233 quality emergency medical services. 234 (h)Develop recommendations on how to improve the existing 235 licensure of emergency medical services providers, including the 236 COPCN process, and address any identified challenges or gaps in 237 the states regulation of these services. 238 (i)Review or analyze any other information deemed relevant 239 by the task force. 240 (2)The task force shall consist of the following members: 241 (a)The State Surgeon General, or his or her designee, who 242 shall serve as chair. 243 (b)The State Emergency Medical Services Medical Director. 244 (c)One member appointed by the Florida College of 245 Emergency Physicians. 246 (d)One member of the Florida Ambulance Association. 247 (e)One member appointed by the Florida Association of 248 Counties. 249 (f)One member appointed by the Florida Fire Chiefs 250 Association. 251 (g)One member appointed by the Florida League of Cities. 252 (h)One member appointed by the Florida Medical 253 Association. 254 (i)One member appointed by the Florida Professional 255 Firefighters Association. 256 (j)One member appointed by the Florida Association of 257 Special Districts. 258 (k)One member who is a citizen representative, appointed 259 by the Governor. 260 (3)The Governor shall appoint any members who have not 261 been appointed to the task force pursuant to subsection (2) 262 within 60 days after the effective date of this act. Members 263 shall serve for the duration of the task forces operation. Any 264 vacancy that occurs must be filled in the same manner as the 265 original appointment. Task force members serve without 266 compensation and are not entitled to reimbursement for per diem 267 or travel expenses. 268 (4)The task force shall hold its first meeting within 60 269 days after the effective date of this act. Meetings must be held 270 in accordance with s. 286.011, Florida Statutes, and notice of 271 such meetings must be published at least 7 days before the 272 meeting. 273 (5)The task force shall submit a report of its findings 274 and recommendations to the Governor, the President of the 275 Senate, the Speaker of the House of Representatives, and the 276 chairs of the legislative committees having jurisdiction within 277 180 days after the first meeting of the task force. 278 (6)The Department of Health shall provide administrative 279 support to the task force. 280 (7)The task force dissolves 30 days after submission of 281 its report. 282 Section 6.This act shall take effect upon becoming a law.