This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0117a.HRS
DATE: 2/23/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 117 Genetic Counselors Using Telehealth
SPONSOR(S): Silvers
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 18 Y, 0 N Osborne McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
Telehealth is the remote provision of health care services through the use of technology. Telehealth is not a
type of health care service, but rather is a mechanism for delivery of health care services. Section 456.74, F.S.,
enacted in 2019, regulates the use of telehealth by Florida and out-of-state healthcare providers. The law
specifically lists the health care practitioner types and out-of-state health care providers authorized to provide
health care services through telehealth. The list includes all health care practitioner types regulated by the
Department of Health (DOH) in 2019.
Genetic counselors collect personal and family history and use such information to determine how likely it is
that an individual or their family member has a genetic condition. Based on such information, a genetic
counselor assists an individual in determining if a genetic test is suitable. Genetic test results can help
diagnose, confirm, or indicate increased risk for developing a particular condition which genetic counseling can
help explain the results and available treatment options.
In 2021, genetic counseling became a licensed health care profession regulated by the Department of Health
with the enactment of part III of chapter 483, F.S. However, genetic counselors were not added to s. 456.74,
F.S. list of health care practitioner authorized to provide services through telehealth. Genetic counselors are
currently the only health care practitioner type that cannot provide services through telehealth.
HB 117 authorizes genetic counselors licensed or registered in Florida to provide services to patients through
telehealth.
The bill has an indeterminate, insignificant negative fiscal impact on DOH which can be absorbed within
current resources
The bill provides an effective date of July 1, 2023. STORAGE NAME: h0117a.HRS PAGE: 2
DATE: 2/23/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Telehealth
Telehealth is not a type of health care service, but rather is a mechanism for delivery of health care
services. Health care professionals use telehealth as a platform to provide traditional health care
services in a non-traditional manner. These services include, among others, preventative medicine and
the treatment of chronic conditions.
1
Section 456.74, F.S., enacted in 2019, regulates the use of
telehealth by Florida and out-of-state healthcare providers.
Current law broadly defines telehealth as the use of synchronous or asynchronous telecommunications
technology by a telehealth provider to provide health care services, including, but not limited to:
2
Assessment, diagnosis, consultation, treatment, and monitoring of a patient;
Transfer of medical data;
Patient and professional health-related education;
Public health services; and
Health administration.
Current law sets the standard of care for telehealth providers at the same level as the standard of care
for health care practitioners or health care providers providing in-person health care services to patients
in this state. This ensures that a patient receives the same standard of care irrespective of the modality
used by the health care professional to deliver the services. A patient receiving telehealth services may
be in any location at the time services are rendered and a telehealth provider may be in any location
when providing telehealth services to a patient.
3
Health care services may be provided via telehealth by a Florida-licensed health care practitioner, a
practitioner licensed under a multistate health care licensure compact of which Florida is a member,
4
or
a registered out-of-state-health care provider.
5
Out-of-state health care providers may provide services
to patients in Florida using telehealth upon registering with DOH as an out-of-state telehealth provider.
6
Out-of-state providers must provide services within their applicable scope of practice as established by
Florida law or rule.
7
The out of-state telehealth provider registration does not expire; however,
registered providers must comply with all registration requirements until they request to nullify their
registration.
8
In order to register as an out-of-state telehealth provider, one must:
9
Submit a completed application in the format prescribed by DOH;
Maintain an active and unencumbered license, which is substantially similar to a license issued
to a Florida practitioner in the same profession, in a U.S. state or jurisdiction;
1
U.S. Department of Health and Human Services, Report to Congress: E-Health and Telemedicine (August 12, 2016), available at
https://aspe.hhs.gov/system/files/pdf/206751/TelemedicineE-HealthReport.pdf (last visited January 23, 2023).
2
S. 456.47(1)(a), F.S.
3
S. 456.47(2), F.S.
4
Florida is a member of the Nurse Licensure Compact. See s. 464.0095, F.S.
5
S. 456.47(4), F.S.
6
Id.
7
Id.
8
Florida Department of Health. Division of Medical Quality Assurance. Florida Telehealth: Frequently Asked Questions. Available at
https://flhealthsource.gov/telehealth/faqs/ (last visited February 7, 2023).
9
S. 456.47(4), F.S. STORAGE NAME: h0117a.HRS PAGE: 3
DATE: 2/23/2023
Not have been the subject of disciplinary action relating to his or her license during the five-year
period preceding the submission of the application;
10
Designate a duly appointed registered agent for the service of process in Florida; and
Maintain professional liability coverage or financial responsibility for telehealth services provided
to patients in Florida in an amount equal to or greater than that required for Florida-licensed
practitioners.
11
Current law authorizes the following licensed health care practitioners to provide services through
telehealth:
12
Behavioral analyst Nurse
Acupuncturist Pharmacist
Allopathic physician Dentist
Osteopathic physician Dental hygienist
Chiropractor Midwife
Podiatrist Speech therapist
Occupational therapist Medical physicist
Radiology technician Emergency Medical Technician
Electrologist Paramedic
Orthotist Massage therapist
Pedorthist Optician
Prosthetist Hearing aid specialist
Clinical laboratory personnel Dietician/Nutritionist
Respiratory therapist Athletic trainer
Psychologist Clinical social worker
Psychotherapist Marriage and family therapist
Optometrist Mental health counselor
This list includes all health care practitioner types regulated by DOH in 2019.
Genetic Counseling
Genetic counseling provides individuals with information about how genetic conditions may affect them
or their families. Genetic counselors collect personal and family history and use such information to
determine how likely it is that an individual or their family member has a genetic condition. Based on
such information, a genetic counselor assists an individual in determining if a genetic test is suitable.
Genetic test results can help diagnose, confirm, or indicate increased risk for developing a particular
condition which genetic counseling can help explain the results and available treatment options.
13
Individuals may seek genetic counseling for multiple reasons, including:
14
10
Current law requires DOH to consult the National Practitioner Data Bank to verify whether adverse information is available for the
registrant.
11
Florida law requires physicians, acupuncturists, chiropractic physicians, dentists, anesthesiologist assistants, advanced practice
registered nurses, and licensed midwives to demonstrate $100,000 per claim and an annual aggregate of $300,000 of professional
responsibility (see ss. 458.320 and 459.0085, F.S.; r. 64B1-12.001. F.A.C; r. 64B2-17.009, F.A.C.; 64B5-17.0105, F.A.C.; rr. 64B8-
31.006 and 64B15-7.006, F.A.C.; r. 64B9-4.002, F.A.C.; and r. 64B24-7.013, F.A.C.; respectively). Podiatric physicians must
demonstrate professional responsibility in the amount of $100,000 (see r. 64B18-14.0072, F.A.C.).
12
These are professionals licensed under s. 393.17; part III, ch. 401; ch. 457; ch. 458; ch. 459; ch. 460; ch. 461; ch. 463; ch. 464; ch.
465; ch. 466; ch. 467; part I, part III, part IV, part V, part X, part XIII, and part XIV, ch. 468; ch. 478; ch. 480; part II and part III, ch. 483;
ch. 484; ch. 486; ch. 490; or ch. 491.
13
Centers for Disease Control and Prevention, Genetic Counseling, https://www.cdc.gov/genomics/gtesting/genetic_counseling.htm
(last visited January 13, 2023).
14
Id.
STORAGE NAME: h0117a.HRS PAGE: 4
DATE: 2/23/2023
Addressing prenatal concerns about factors that might affect a baby during infancy, including
genetic conditions and birth defects;
Addressing concerns if a child is showing signs and symptoms of a genetic disorder, including
abnormal newborn screening results, intellectual or developmental disabilities, or birth defects;
Determining if an individual is at risk of being affected by a health condition, including hereditary
breast and ovarian cancer, muscular dystrophy, Huntington’s disease, and sickle cell disease.
Genetic counselors have advanced training in medical genetics and counseling to guide and support
patients seeking more information about how inherited diseases and conditions might affect them or
their families, and to interpret genetic test results based on personal and family history. Genetic
counselors may specialize in prenatal, pediatric, oncology, neurology, ophthalmology, psychiatry,
among many other areas.
15
Genetic counselors typically are not physicians; however, they work in
conjunction with medical geneticists to provide genetic services.
16
Medical geneticists will order genetic
testing and interpret the results and a genetic counselor will provide further education on the results
and how they may affect an individual or their family.
17
The profession of genetic counseling is relatively new compared to other medical specialties. Scientific
advancements over the last two decades have enabled genetic testing to become relatively accessible
resulting in a rapid increase in the demand for professionals with specialized training in genetic
counseling.
18
Nationally, the genetic counselor workforce grew by 88% between 2006 and 2016.
19
There are currently fewer than 5,500 certified genetic counselors practicing in the United States; this
has led to frequent utilization of telehealth in order to provide services to address increasing demand,
lack of access to providers, and health disparities.
20
Genetic counseling is unique in that evaluating a
patient’s health and family history with genetic test results could be done almost entirely through
telehealth services. Telehealth genetic counseling has been shown to be comparable in quality and
outcomes to genetic counseling services rendered in-person.
21
Florida Genetic Counselors
In 2021, the Legislature passed legislation creating part III of Chapter 483 related to the regulation of
genetic counselors.
22
Current law authorizes genetic counselors to advise an individual or a family
affected by or at risk of genetic disorders, including:
23
Evaluating individual and family medical histories to determine risk for genetic or medical
conditions and diseases;
Discussing health factors and risk management for genetic or medical conditions and diseases
with patients;
Ordering genetic laboratory tests and diagnostic studies;
Evaluating laboratory test results and diagnostic studies against individual and family medical
history to assess risk factors for genetic or medical conditions and diseases;
Explaining clinical implications of genetic laboratory tests and diagnostic studies results to
patients;
Evaluating the individual or family and providing client centered counseling and guidance;
15
Id.
16
Medical geneticists are physicians who specialize in medical genetics and conduct genetic testing and provide diagnoses.
17
Supra, note 13.
18
Green, S., et al. (2022). An Evidence-based Practice Guideline of the National Society of Genetic Counselors for Telehealth Genetic
Counseling. Journal of Genetic Counseling. 00, 1-14. https://doi.org/10.1002/jgc4.1627
19
American Board of Genetic Counseling, Inc. Workforce Study Executive Summary. Available at
https://www.abgc.net/abgc/media/documents/Workforce_Study_Executive-Summary_FINAL.pdf (last visited February 7, 2023).
20
Id.
21
Danylchuk, N.R., et al. (2021). Telehealth for genetic counseling: A systematic evidence review. Journal of genetic counseling, 30(5),
1361–1378. https://doi.org/10.1002/jgc4.1481
22
S. 483.911, F.S.
23
S. 483.913(3), F.S.
STORAGE NAME: h0117a.HRS PAGE: 5
DATE: 2/23/2023
Using community resources that provide medical, educational, financial, and psychosocial
support and advocacy;
Providing written documentation of medical, genetic, and counseling information for individuals,
families, and health care professionals; and
Referring individuals to a physician for diagnosis and treatment.
To be licensed as a genetic counselor, an individual must meet the following requirements:
24
Has submitted an application on a form approved by DOH;
Is of good moral character;
Has earned a:
o Master’s degree from a genetic counseling program or an equivalent program as
determined by the Accreditation Council for Genetic Counseling or its successor or
equivalent; or
o Doctoral degree from a medical genetics program accredited by the American Board of
Genetics and Genomics or the Canadian College of Medical Geneticists.
Has passed the examination for certification as:
o A genetic counselor by the American Board of Genetic Counseling, the American Board
of Genetics and Genomics, or the Canadian Association of Genetic Counselors; or
o A medical or clinical geneticist by the American Board of Medical Genetics and
Genomics or the Canadian College of Medical Geneticists.
There are currently 532 Florida-licensed genetic counselors, of which 107 (20%) live in-state and 425
(80%) live out-of-state.
25
Genetic counselors were not added to s. 456.74, F.S. list of health care
practitioner authorized to provide services through telehealth. Genetic counselors are currently the only
health care practitioner type that cannot provide services through telehealth. There are 31 states
regulating licensure for genetic counselors and all, except for Florida, authorize genetic counselors to
provide services through telehealth.
26
Effect of the Bill
The bill authorizes Florida licensed and out-of-state registered genetic counselors to provide services
through telehealth.
The bill provides an effective date of July 1, 2023.
B. SECTION DIRECTORY:
Section 1: Amends s. 456.47, F.S., relating to the use of telehealth to provide services.
Section 2: Provides an effective date of July 1, 2023.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
24
S. 483.914, F.S.
25
Florida Department of Health. Division of Medical Quality Assurance. Annual Report and Long-Range Plan. Fiscal Year 2021-2022.
Available at https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/annual-report-2122.pdf (last
visited February 6, 2023).
26
Florida Department of Health, Agency Analysis of 2023 House Bill 117, p. 2. On file with the Healthcare Regulation Subcommittee.
STORAGE NAME: h0117a.HRS PAGE: 6
DATE: 2/23/2023
1. Revenues:
None.
2. Expenditures:
The bill has an indeterminate, insignificant negative fiscal impact on DOH which can be absorbed
within current resources.
27
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
DOH has sufficient rulemaking authority to implement the bill’s provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
27
Supra note 26, at 5.