This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0583c.HHS
DATE: 4/18/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 583 Health Care Practitioner Titles and Abbreviations
SPONSOR(S): Healthcare Regulation Subcommittee, Massullo
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 17 Y, 0 N, As CS Osborne McElroy
2) Health & Human Services Committee 15 Y, 3 N Osborne Calamas
SUMMARY ANALYSIS
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners. The MQA works in conjunction with 22 boards and four
councils to license and regulate seven types of health care facilities and more than 40 health care professions.
An unlicensed individual may be subject to administrative action or criminal penalties if the individual states or
otherwise implies that he or she is a licensed medical professional. This may include the use of certain terms
or titles that the public generally associates with a specific medical profession. DOH does not license
specialties or sub-specialties based upon board certification, but current law does limit who can hold
themselves out as board-certified specialists.
Current law authorizes regulatory boards (or DOH) to discipline health care practitioners for violations related
to how they represent their professional identities, including:
Making misleading, deceptive, or fraudulent representations in or related to the practice of the
licensee’s profession; or
Failing to identify to a patient the type of license under which the practitioner is practicing.
CS/HB 583 further regulates the way in which health care practitioners represent their professions. The bill
specifies the titles and abbreviations that health care practitioners may use in advertisements,
communications, and personal identification. Any unauthorized use of a title, abbreviation, or educational
degree constitutes a misleading, deceptive, or fraudulent representation by the health care practitioner.
CS/HB 583 requires any advertisement for health care services naming a practitioner to identify the profession
under which the practitioner is practicing and the practitioner’s educational degree. The bill also requires health
care practitioners to wear name badges, establishes requirements for name badges, and provides exemptions.
The bill directs each board, or DOH if there is no regulatory board, to establish rules determining how
practitioners must comply with this requirement.
The bill authorizes DOH or the boards, as applicable, to discipline any health care practitioner who violates the
provisions of the bill.
The bill has an insignificant, negative fiscal impact on DOH, and no fiscal impact on local governments.
The bill provides an effective date of July 1, 2023.
FULL ANALYSIS STORAGE NAME: h0583c.HHS PAGE: 2
DATE: 4/18/2023
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Health Care Practitioners Licensure and Regulation
The Division of Medical Quality Assurance (MQA), within the Department of Health (DOH), has general
regulatory authority over health care practitioners.
1
The MQA works in conjunction with 22 boards and
four councils to license and regulate seven types of health care facilities and more than 40 health care
professions.
2
Each profession is regulated by an individual practice act and by ch. 456, F.S., which
provides general regulatory and licensure authority for the MQA. MQA is statutorily responsible for the
following boards and professions established within the division:
3
The Board of Acupuncture, created under ch. 457, F.S.;
The Board of Medicine, created under ch. 458, F.S.;
The Board of Osteopathic Medicine, created under ch. 459, F.S.;
The Board of Chiropractic Medicine, created under ch. 460, F.S.;
The Board of Podiatric Medicine, created under ch. 461, F.S.;
Naturopathy, as authorized under ch. 462, F.S.;
The Board of Optometry, created under ch. 463, F.S.;
The Board of Nursing, created under part I of ch. 464, F.S.;
Nursing assistants, as authorized under part II of ch. 464, F.S.;
The Board of Pharmacy, created under ch. 465, F.S.;
The Board of Dentistry, created under ch. 466, F.S.;
Midwifery, as authorized under ch. 467, F.S.;
The Board of Speech-Language Pathology and Audiology, created under part I of ch. 468, F.S.;
The Board of Nursing Home Administrators, created under part II of ch. 468, F.S.;
The Board of Occupational Therapy, created under part III of ch. 468, F.S.;
Respiratory therapy, as authorized under part V of ch. 468, F.S.;
Dietetics and nutrition practice, as authorized under part X of ch. 468, F.S.;
The Board of Athletic Training, created under part XIII of ch. 468, F.S.;
The Board of Orthotists and Prosthetists, created under part XIV of ch. 468, F.S.;
Electrolysis, as authorized under ch. 478, F.S.;
The Board of Massage Therapy, created under ch. 480, F.S.;
The Board of Clinical Laboratory Personnel, created under part III of ch. 483, F.S.;
Medical physicists, as authorized under part IV of ch. 483, F.S.;
The Board of Opticianry, created under part I of ch. 484, F.S.;
The Board of Hearing Aid Specialists, created under part II of ch. 484, F.S.;
The Board of Physical Therapy Practice, created under ch. 486, F.S.;
The Board of Psychology, created under ch. 490, F.S.;
School psychologists, as authorized under ch. 490, F.S.;
The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling, created under ch. 491, F.S.; and
Emergency medical technicians and paramedics, as authorized under part III of ch. 401, F.S.
1
Pursuant to s. 456.001(4), F.S., health care practitioners are defined to include acupuncturists, physicians, physician assistants,
chiropractors, podiatrists, naturopaths, dentists, dental hygienists, optometrists, nurses, nursing assistants, pharmacists, midwives,
speech language pathologists, nursing home administrators, occupational therapists, respiratory therapists, dieticians, athletic trainers,
orthotists, prosthetists, electrologists, massage therapists, clinical laboratory personnel, medical physicists, dispensers of optical
devices or hearing aids, physical therapists, psychologists, social workers, counselors, and psychotherapists, among others.
2
Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year 2021-2022, p.
5. Available at https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/annual-report-2122.pdf (last
visited March 28, 2023).
3
S. 456.001(4), F.S; Id. STORAGE NAME: h0583c.HHS PAGE: 3
DATE: 4/18/2023
DOH and the practitioner boards have different roles in the regulatory system. Boards act as the
governing body of a specified profession; they establish practice standards by rule, pursuant to
statutory authority and directives, and determine disciplinary action against practitioners who have
violated the practice standards. DOH receives and investigates complaints against practitioners and
facilitates the legal response when necessary.
DOH, on behalf of the professional boards, investigates legally sufficient complaints against
practitioners.
4
Once an investigation is complete, DOH presents the investigatory findings to the
boards. DOH recommends a course of action to the appropriate board’s probable cause panel
5
which
may include:
6
Having the file reviewed by an expert;
Issuing a closing order; or
Filing an administrative complaint.
The boards determine the course of action and any disciplinary action to take against a practitioner.
7
For professions in which there is no board, DOH determines the action and discipline to take against a
practitioner and issues the final orders.
8
DOH is responsible for ensuring that licensees comply with the
terms and penalties imposed by the boards.
9
If a case is appealed, DOH attorneys defend the final
actions of the boards before the appropriate appellate court.
10
Board Certification and Florida Licensure
DOH licenses health care practitioners by profession according to the requirements established in
statute and rule. DOH does not, however, license health care practitioners by specialty or subspecialty;
rather, private national specialty boards grant board certification to practitioners.
11
Examples of such
boards include the American Board of Medical Specialties (ABMS), the Accreditation Board for
Specialty Nursing Certification, and the American Board of Dental Specialties.
12
Current law limits which health care practitioners may hold themselves out as board-certified
specialists. An allopathic physician may not hold himself or herself out as a board-certified specialist
unless he or she has received formal recognition as a specialist from a specialty board of the ABMS or
other recognizing agency
13
approved by the allopathic board.
14
Similarly, an osteopathic physician may
not hold himself or herself out as a board-certified specialist unless he or she has successfully
completed the requirements for certification by the American Osteopathic Association (AOA) or the
Accreditation Council on Graduate Medical Education (ACGME) and is certified as a specialist by a
certifying agency
15
approved by the board.
16
4
Department of Health, Investigative Services. Available at http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-
complaint-process/isu.html (last visited March 28, 2023).
5
See also, Department of Health, A Quick Guide to the MQA Disciplinary Process: Probable Cause Panels. Available at
https://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-complaint-process/_documents/a-quick-guide-to-the-mqa-
disciplinary-process.pdf
6
Department of Health, Prosecution Services. Available at http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-
complaint-process/psu.html (last visited March 28, 2023).
7
S. 456.072(2), F.S.
8
Id. Professions which do not have a board include naturopathy, nursing assistants, midwifery, respiratory therapy, dietetics and
nutrition, electrolysis, medical physicists, and school psychologists.
9
Supra, note 6.
10
Id.
11
Examples of specialties include dermatology, emergency medicine, ophthalmology, pediatric medicine, certified registered nurse
anesthetist, clinical nurse specialist, cardiac nurse, nurse practitioner, endodontics, orthodontics, and pediatric dentistry.
12
See also, The American Board of Medical Specialties website available at https://www.abms.org/ (last visited April 15, 2023). The
Accreditation Board for Specialty Nursing Certification website available at https://absnc.org/ (last visited April 15, 2023). The American
Board of Dental Specialties website available at https://dentalspecialties.org/ (last visited April 15, 2023).
13
The allopathic board has approved the specialty boards of the ABMS as recognizing agencies. See, Rule 64B8-11.001(1)(f), F.A.C.
14
S. 458.3312, F.S.
15
The osteopathic board has approved the specialty boards of the ABMS and AOA as recognizing agencies. See, Rule 64B15-
14.001(h), F.A.C.
16
S. 459.0152, F.S. STORAGE NAME: h0583c.HHS PAGE: 4
DATE: 4/18/2023
A dentist may not hold himself or herself out as a specialist, or advertise membership in or specialty
recognition by an accrediting organization, unless the dentist has completed a specialty education
program approved by the American Dental Association and the Commission on Dental Accreditation
and the dentist is:
17
Eligible for examination by a national specialty board recognized by the American Dental
Association; or
A diplomate of a national specialty board recognized by the American Dental Association.
If a dentist announces or advertises a specialty practice for which there is not an approved accrediting
organization, the dentist must clearly state that the specialty is not recognized or that the accrediting
organization has not been approved by the American Dental Association or the Florida Board of
Dentistry.
18
Additionally, an advanced practice registered nurse may not advertise or hold himself or herself out as
a specialist for which he or she has not received certification.
19
By rule, the Board of Chiropractic Medicine (BCM) prohibits chiropractors from using deceptive,
fraudulent, and misleading advertising. The BCM permits chiropractors to advertise that they have
attained Diplomate status in a chiropractic specialty area recognized by the BCM. BCM-recognized
specialties include those which are recognized by the Councils of the American Chiropractic
Association, the International Chiropractic Association, the International Academy of Clinical Neurology,
or the International Chiropractic Pediatric Association.
20
Professional Specialty Designations
Section 456.072, F.S., authorizes a regulatory board or DOH, if there is no board, to discipline a health
care practitioner’s licensure for a number of offenses, including but not limited to:
Making misleading, deceptive, or fraudulent representations in or related to the practice of the
licensee’s profession; or
Failing to identify to a patient the type of license under which the practitioner is practicing.
Using a term designating a medical specialty for which a non-physician practitioner has not completed
a residency or fellowship program accredited or recognized by the ACGME or the AOA in such
specialty is not expressly grounds for discipline under current law.
21
If the board or DOH finds that a licensee committed a violation, the board or DOH may:
22
Refuse to certify, or to certify with restrictions, an application for a license;
Suspend or permanently revoke a license;
Place a restriction on the licensee’s practice or license;
Impose an administrative fine not to exceed $10,000 for each count or separate offense; if the
violation is for fraud or making a false representation, a fine of $10,000 must be imposed for
each count or separate offense;
Issue a reprimand or letter of concern;
Place the licensee on probation;
Require a corrective action plan;
17
S. 466.0282, F.S. A dentist may also hold himself or herself out as a specialist if the dentist has continuously held himself or herself
out as a specialist since December 31, 1964, in a specialty recognized by the American Dental Association.
18
S. 466.0282(3), F.S.
19
S. 464.018(1)(s), F.S.
20
Rule 64B-15.001(2)(e), F.A.C. Examples of chiropractic specialties include chiropractic acupuncture, chiropractic internist,
chiropractic and clinical nutrition, radiology chiropractic, and pediatric chiropractors.
21
See also, ss. 458.331(1)(ll) and 459.015(1)(nn), F.S., wherein allopathic and osteopathic physicians may be subject to discipline for
advertising a board-certified specialty for which they are not qualified.
22
S. 456.073(1), F.S. STORAGE NAME: h0583c.HHS PAGE: 5
DATE: 4/18/2023
Refund fees billed and collected from the patient or third party on behalf of the patient; or
Require the licensee to undergo remedial education.
Effect of the Bill
CS/HB 583 further regulates the way in which health care practitioners represent their professions.
Professional Designations
CS/HB 583 specifies the specific titles and abbreviations that may be used by allopathic and
osteopathic physicians, chiropractic physicians, podiatric physicians, dentists, anesthesiologist
assistants, and optometrists. The bill specifies that health care practitioners, regardless of whether they
are specified in the bill, may also use the titles and abbreviations used in their respective practice acts.
Advertisements
Current law authorizes licensure discipline for “deceptive or misleading terms or false representation.”
The bill further specifies what constitutes misleading, deceptive, or fraudulent representation and
incorporates a misrepresentation of a practitioner’s educational degree into qualifying offenses.
CS/HB 583 requires any advertisement for health care services naming a practitioner to identify the
profession and educational degree as related to the services featured in the advertisement.
For the purposes of the bill, an advertisement means any printed, electronic, or oral statement that:
Is communicated or disseminated to the general public.
Is intended to encourage a person to use a practitioner’s services or to promote those services
or the practitioner in general.
For commercial purposes, names a practitioner in connection with the practice, profession, or
institution in which the practitioner is employed, volunteers, or provides health care services.
Is prepared, communicated, or disseminated by the practitioner or with their consent.
CS/HB 583 requires any advertisement for a health care practitioner include the specific license under
which the practitioner is authorized to provide services and restricts practitioners to advertising with
only the specific titles and abbreviations they are authorized to use under the bill. The bill permits only
allopathic or osteopathic physicians to use the titles, abbreviations, or medical specialties specified in
the bill, such as “dermatologist,” “oncologist,” and “urologist,” in advertisements. Non-physician
practitioners may identify themselves according to specialties expressly named in their respective
practice acts, but only in conjunction with the title of the profession which they are licensed to practice.
License Display
The bill requires health care practitioners to wear a name tag displaying their name and profession
when treating or consulting a patient. The practitioner’s profession must be identified on the name
badge consistent with the naming conventions specified in the bill.
The bill requires name badges to include the practitioner’s name and profession, consistent with the
naming conventions specified in the bill. This requirement does not apply to a practitioner providing
services in his or her own office if the practitioner prominently displays a copy of his or her license in a
conspicuous area of the practice so that it is easily visible to patients.
Discipline
Failure to adhere to the provisions of the bill constitute grounds for discipline. The bill authorizes DOH
or the boards, as applicable, to discipline any health care practitioner who violates the preceding
requirements. The bill directs each board, or DOH if there is no board, to develop rules determining
how practitioners must comply with the requirements of the bill.
STORAGE NAME: h0583c.HHS PAGE: 6
DATE: 4/18/2023
The bill provides an effective date of July 1, 2023.
B. SECTION DIRECTORY:
Section 1: Creates s. 456.0651, F.S., relating to health care practitioner titles and designations.
Section 2: Amends s. 456.072, F.S., relating to grounds for discipline; penalties; enforcement.
Section 3: Provides an effective date of July 1, 2023.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
DOH may experience a non-recurring increase in workload associated with rulemaking, which can
be absorbed within current resources.
23
DOH may also experience an increase in workload and
costs associated with the enforcement of the provisions of this bill, which can be absorbed within
current resources.
24
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Health care practitioners in violation of the restrictions in this bill may be subject to disciplinary actions
and fines.
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:
23
Department of Health, Agency Analysis of House Bill 583 (2023), p. 6 (February 7, 2023).
24
Id. STORAGE NAME: h0583c.HHS PAGE: 7
DATE: 4/18/2023
The bill provides sufficient rulemaking authority to DOH and the relevant regulatory boards to
implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
By specifying titles and abbreviations applicable to a specialty or certification, it is unclear if other
recognized credentials authorized under a practitioner’s respective practice act, but not expressly listed,
may be used. For example, it is unclear if a dentist who has completed the appropriate advanced
training and been permitted by the Board of Dentistry to administer anesthesia could refer to
themselves as a dental anesthesiologist.
25
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
On April 3, 2023, the Healthcare Regulation Subcommittee adopted a strike-all amendment and
reported the bill favorably as a committee substitute. The amendment:
Revised the definition of “advertisement,” and defined “educational degree,” practitioner,” and
“profession.”
Revised the list of titles which constitute misleading, deceptive, or fraudulent representation if
used by a practitioner without the necessary education and training.
Specified that a health care practitioner may use names, titles, designations, and abbreviations
as provided in their respective practice act.
Revised the list of titles, designations, and abbreviations that may be used by chiropractors,
podiatrists, dentists, anesthesiologist assistants, optometrists.
Outlined offenses which constitute grounds for disciplinary actions and provides exemptions.
Deleted provisions relating to practitioners licensed or certified under Ch. 464, F.S., the Nurse
Practice Act, and physician assistants licensed under Chs. 458 or 459, F.S.
The analysis is drafted to the committee substitute as passed by the Healthcare Regulation
Subcommittee.
25
See also, Rule 64B5-14, F.A.C., for more information on the permitting of dentists to administer anesthesia.